The Royal Society Report: Reading between the lines

(The full summary of the report may be read here)
At the time of the public meeting in Carlisle, the Royal Society gave the impression that, in their view, the policy that had been adopted was the right one and that their recommendations would not include vaccination.

It is to their credit that they were prepared to be open-minded enough to change their minds.

Indeed, conducting the Inquiry must have been an eye-opener for many on the Committee and not always a comfortable one, for these were scientists already basking in high status who had thought they knew a lot about the issues already.

Once they had invited Paul van Aarle from Intervet they must surely have realised at last that the vaccines and tests were far more advanced than they had believed. Indeed, what must have occurred to them (although many people had been trying to say so for months) was that emergency vaccination to live had been the obvious and civilized way to proceed in the 2001 crisis once things has got out of control.

It is to be deeply regretted that they failed to include in their report for all to see, the vaccination planthat NFMG and Vets for Vaccination prepared with the help of the real experts: Keith Sumption, Paul Sutmoller, Simon Barteling and Paul van Aarle.

If one reads between the lines of the Royal Society Report the implicit criticisms of the Government and of DEFRA are plain to see. The medium is civilized and neutral - but the message constitutes an indictment of the way things were handled.

We suggest what sub text may be read between the lines of the Report Summary

Better contingency planning is vital. The Government must be empowered to act decisively during an outbreak. This requires prior debate about the control measures to be adopted. The Government's Contingency Plans should therefore be brought before Parliament for debate and approval.

The Plans should be subject to a practical rehearsal each year and should be formally reviewed triennially to ensure that they take account of: the latest information about the scale of international disease threat; changes in farming practice; scientific and technological developments; regulatory developments at national, EU and global level; and the country's state of preparedness

Routine vaccination against some of the most infectious diseases is possible. While there are no overwhelming scientific or economic reasons against this approach being adopted we believe that, at present, the considerable technical problems and the trade implications argue against changing current arrangements. Nevertheless it is clear that the long-term solution is to develop a vaccine against FMD (and other diseases such as classical swine fever) that confers lifelong sterile immunity against all strains of the virus. An international research effort is required to develop such a vaccine

The first suspected case in an outbreak must be diagnosed in an approved OIE reference laboratory. Thereafter, modern diagnostic methods - including pen-side tests - need to be developed that can shift the burden of diagnosis to veterinarians on the farm. Rapid diagnosis, particularly before clinical signs appear, would limit the size of any epidemic and improve strategic deployment of resources. Such diagnostic methods must be linked by modern telecommunications to central headquarters.

A prerequisite is a central database incorporating improved data on farms, the location of animals, animal movements, and the characteristics of the diseases, together with arrangements to input disease control data in a timely and assured way during an outbreak.

. More work is required to refine the existing models and to strengthen their capacity to inform policy, which in turn requires full access by researchers to this database and to the data on previous outbreaks.

A national strategy for animal disease research should be developed. The overall costs of animal diseases to the UK over the past 15 years may well have exceeded #15 billion: research is the only rational means available of improving animal health and diminishing disease. The strategy should be delivered through a 'virtual national centre for animal disease research and surveillance' involving the Institute for Animal Health, the Veterinary Laboratories Agency and research groups in universities.

At the working level, farmers and veterinarians need to be more aware of the risks and more familiar with the symptoms of rarely encountered exotic diseases. Effective surveillance depends on close collaboration between farmers and their veterinarians, and between them and the State Veterinary Service (SVS). The SVS has become smaller in recent years. Farm animal disease surveillance needs to be strengthened.

New developments in vaccine research and development should be applied to produce a vaccine capable of conferring lifelong sterile immunity against all strains of the FMD virus. With such a vaccine available it would be possible to change policies radically and introduce routine vaccination for all susceptible species.
During an outbreak, the short length of immunity conferred by current vaccines is less of a problem because it would normally still be longer than the outbreak. Moreover, it would be clear which specific FMD strain had to be countered.
So emergency vaccination is a technical option.

Until recently, the main problem over the use of emergency vaccination has been the difficulty in distinguishing animals that have been infected but then recovered from those that have simply been vaccinated.

The possibility of infection from the former is very low, but it led the OIE/WTO to impose a 12 month delay before a country that had used emergency vaccination could regain the status of 'disease free without vaccination'. ..This compared with a 3 month delay if culling alone had been used, and the additional 9 months delay was why emergency vaccination had always been considered a strategy of last resort. That was why the animals vaccinated in the 2001 FMD epidemic in The Netherlands were subsequently destroyed and did not enter the food chain. Important advances have taken place within the last year
- both technical and in the attitudes of the authorities and consumers
- that should allow emergency vaccination to develop into a prime control strategy ..

The following issues have to be solved before emergency vaccination can be introduced. With significant effort by DEFRA, this should be possible by the end of 2003.

The policy should be vaccinate-to-live. This will necessitate clear acceptance by all concerned that meat and meat products from vaccinated animals may enter the food chain normally. Validation of the marker vaccines to be employed and the tests to distinguish between vaccinated and vaccinated-infected animals, and clear rules for defining the post-surveillance strategy for monitoring herds and flocks. Remaining trade implications both within and beyond the EU. The precise vaccination strategy to be employed, including the threshold criteria for its implementation when an outbreak occurs and the relative focus upon geographical regions, high risk farms or species to be vaccinated. Modelling should play a key role here. Practical issues concerned with storing vaccines, manufacturing extra vaccine stocks, delivery of vaccines and the training of vaccination teams. Hence, we believe that the UK should now be planning to use emergency vaccination as an important component of its control strategy for FMD. Culling of infected premises and known dangerous contacts, and any other farms on which evidence of disease is subsequently found, will still be required, but emergency vaccination could be far more appropriate than the alternative of extensive culling.

. In its work on veterinary education and training, the Royal College of Veterinary Surgeons should reflect on the experiences of the recent veterinary graduates pitched into dealing with the 2001 FMD outbreak.

The UK Government should bring before Parliament for debate a framework for the Contingency Plans covering the principles involved in handling outbreaks of infectious exotic diseases and the resources required for their implementation.
The Prime Minister should establish a formal procedure to review at three-yearly intervals: the level of threat from imported diseases of livestock; changes in livestock farming practices that could affect vulnerability to disease; scientific and therapeutic advances that could affect policy options; the UK's, and Europe's, state of preparedness. The UK should continue to strive for 'disease-free' status against highly infectious diseases such as those listed in the OIE's List A.

DEFRA should: undertake a systematic analysis of the information available on the relative threats to the UK from the range of diseases covered here (and other significant disease such as transmissible spongiform encephalopathies and tuberculosis), taking account of the impact of globalisation and climate change, in order to set priorities for the national strategy for animal disease and surveillance; undertake a comprehensive review of the available information on FMD, and develop a consistent and coherent database of the basic information that would be required during an outbreak; carry out urgent research into local transmission of FMD that will improve biosecurity in the field

DEFRA should: establish a review to determine the data required for informing policy both before and during epidemics of infectious diseases. This review should involve all those likely to be involved with disease control, including modelling teams, and cover: - information to be collected on a routine basis, and how this can be kept up to date; - information to be collected during the outbreak; - incorporation of the data into a central database; - use of modern techniques for real-time data capture and verification; commission research to improve the methodology used to identify dangerous contacts; undertake a major research programme into the potential of mathematical modelling for understanding the quantitative aspects of animal disease dynamics. Mathematical models can be used both in preparing for outbreaks (including evaluating alternative strategies) and during the course of controlling an epidemic; ensure that the data from the 2001 epidemic are checked and then made widely available, while ensuring that any data protection issues are resolved.

DEFRA should: ensure that sufficiently specific and sensitive pen-side antigen detection ELISAs are developed for FMD and other major diseases, are validated as quickly as possible, and are available on a large scale for use in the field, and that a similar ELISA is developed especially for detecting antibodies in sheep; explore the potential for portable RT-PCR machines for use in the field or at regional laboratories; develop advanced telecommunications between the field and central control; consider the benefits of bringing responsibility for all List A diseases under a single organisation.

Vaccination The Government should take the lead in developing an international research programme aimed at an improved vaccine that would permit routine and global vaccination of livestock against FMD and other List A diseases. Emergency vaccination should be seen as a major tool of first resort, along with culling of infected premises and known dangerous contacts, for controlling FMD outbreaks. This policy should be vaccinate-to-live, which necessitates acceptance that meat and meat products from vaccinated animals enter the food chain normally. DEFRA should explore with the EU and OIE what improvements to vaccines and surveillance tests are required to allow disease-free status to be based entirely on surveillance results without the requirement for a minimum waiting period.

The main objective in dealing with an outbreak must be to ensure that it does not develop into an epidemic. This requires the following basic measures: on suspicion of an outbreak, immediate imposition of strict local movement restrictions and biosecurity measures including culling the animal with clinical signs; on confirmation by an OIE Reference Laboratory of an outbreak: - mobilization of the full emergency arrangements including all additional logistic resources and the interdepartmental coordination and scientific advisory structure; - imposition of a total country-wide ban on animal movement with unambiguous and widely publicised advice on the fate of any animals in transit; - rapid culling of all infected premises; - identification and rapid culling of all premises where there is a high risk of the disease. Where these measures are insufficient to guarantee that the outbreak will be contained, we recommend in addition the early deployment of emergency vaccination.