Rapid tools for assessment of risk. Dr Helen Roberts Veterinary & Science Policy Advice Team
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1 Rapid tools for assessment of risk Dr Helen Roberts Veterinary & Science Policy Advice Team Helsinki 2011
2 Current risks for the UK Exotic disease outbreaks Emerging risks Unknown risks Helsinki 2011
3 Helsinki 2011 How risk changes: Bluetongue
4 Helsinki 2011 Bluetongue at present
5 Helsinki 2011 Perception of risk: Foot and mouth disease
6 Helsinki 2011 FMD in Turkey
7 Helsinki 2011 Other means of identifying risk: NASA data on rainfall patterns
8 Helsinki 2011 Rift Valley Fever
9 Helsinki 2011 Re-emerging disease: Dourine in Italy
10 Can legislation help: African Swine Fever in the Caucasus Helsinki 2011
11 Helsinki 2011 Complacency: Highly Pathogenic Avian Influenza H5N1
12 Helsinki 2011 Too risk averse: Equine Infectious Anaemia
13 Can legislation hinder: Rabies in Europe Map 1a: Distribution of cases of rabies in domestic animals (dogs, cats and livestock) in Europe, 2010 Map 1b: Distribution of cases of rabies in wildlife (foxes, racoon dogs, wolves badgers, mustelids and other carnivores) in Europe, 2010 Helsinki 2011
14 Helsinki 2011 Public Health not AH: West Nile Fever in Europe
15 Why are we looking at risk? Different types of risk Balance between risk averse and disproportionate response Do we miss the obvious? Helsinki 2011
16 Risk Pathways and Countermeasures project Threat of exotic animal disease incursion causing an outbreak High level review of routes and risk management Defra must routinely review risk management priorities and measures and identify vulnerabilities Horizon scanning Helsinki 2011
17 Risk Management Cycle for Animal Related Threats Integration of existing tools and processes D2R2 prioritises diseases, med/long term planning, evidence based IDM, VRAs, horizon scanning ETHiR - individual events, reactive, evidence + expert opinion Processes: G6 portfolios/vrg/4cvos/policy programmes Enables a systematic approach Provides evidence to inform decisions on distribution of resources to different AH policy areas Maximises use of resources Efficient use of remaining resource Informs actions/intervention based on risk & evidence, including what we don t do
18 Helsinki 2011 The risk management cycle (RMC): A suite of tools, structures and processes that guarantee a systematic and integrated approach to the management of Emerging Threats & Vulnerabilities
19 Veterinary Risk Group The identification and escalation of risks and vulnerabilities can be an inconsistent and lengthy process. The Veterinary Risk Group (VRG) provides a coordinated process that ensures risks and vulnerabilities will be assessed and appropriate action taken within a short timescale. The formation of a risk group was recommended in the Anderson Review (the Lessons Learned review following Foot & Mouth Disease outbreak 2007). The Objectives To ensure risks and vulnerabilities are assessed regularly and that appropriate action can be recommended within a short timescale. To escalate risks to the Senior Management of the Veterinary Science Team and the Four Administrations CVOs meeting on a monthly basis. To provide a log of threats and vulnerabilities (T&Vs) which have been mitigated. Helsinki 2011
20 Monthly meeting of 8 managers within the Veterinary Science Team submit technical threats and vulnerabilities in an Emerging Threats and Highlights Report (ETHiR). ETHiRs consist of a description of the threat, potential impacts and mitigating actions. They have not been considered in current business or work plans. VRG members consider threats and mitigating actions for whether actions are sufficient. Portfolio managers review recommendations and feedback. Senior managers provide comment and action on the recommendations and Portfolio manager feedback. Provides senior managers with the foresight to plan strategically and determine where resources are required. Helsinki 2011
21 Veterinary Risk Group and ETHiR (Emerging Threats and Highlights Report) ETHiR a semi-quantitative spreadsheet for risk managers within Veterinary & Science Policy Advice Data from variety of sources. Risk Managers input a description of the threat, semiquantitative scores for impacts (RFI), public perception and capabilities of the threat and a list of mitigating actions.
22 UK VETERINARY SURVEILLANCE STRATEGY A Decision Support Tool for the Prioritisation of Animal Health & Welfare Issues for Government Intervention
23 Prioritisation decision support tool: D2R2 Decision Support: Systematically and objectively compares animal diseases in the context of current policies & animal health situation (i.e. status quo) FMD (Foot and Mouth Disease) in Pigs FMD (Foot and Mouth Disease) in Cattle FMD (Foot and Mouth Disease) in Sheep FMD (Foot and Mouth Disease) in Goats Avian Influenza (Highly Pathogenic) in Chickens African Horse Sickness in Horses African Horse Sickness in Donkeys Newcastle Disease in Chickens Enables simple, rapid modelling of the possible effect of a policy change Swine fever, Classical in Pigs Swine Fever, African in Pigs Aujeszky's disease in Pigs Rabies, classical (genotype 1) in Dogs Bluetongue in Sheep Bluetongue in Cattle Bluetongue in Goats Bluetongue in Deer Brucellosis (Brucella abortus) in Cattle ENDEMIC BSE (Bovine Spongiform Encephalopathy) in Cattle TB (Tuberculosis) in Cattle Scrapie, Classical in Sheep E. coli, VTEC O157 in Cattle E. coli, VTEC O157 in Sheep Ranking: shows at high level which diseases are important and why, according to Campylobacter, jejuni and coli in Chickens Campylobacter, jejuni and coli in Turkeys Anthrax (Bacillus anthracis) in Pigs Anthrax (Bacillus anthracis) in Cattle Coccidiosis in Goats Their impact on each of the 4 Reasons for Intervention (AHW Strategy) Likelihood that an unaffected holding will become affected Provides supporting documentation Disease Briefing and Risk Assessment: an accessible up-todate shared evidence base for briefings and QRAs Leptospirosis in Cattle Leptospirosis in Sheep Coccidosis in Sheep Toxoplasmosis in Sheep Risk & Epi x -1 Public health Welfare Wider society International trade
24 How the DST works Up to 10 criteria defined for each RFI Each has a score Each has a relative weight The greater the weighting, the more likely that a change in that criterion will change the disease s relative ranking Score = sum of contribution from each criterion Example: Wider Society criterion with weight 10 (Detailed guidance defines each category) 08 Total potential unplanned cost to exchequer (6.1) Value Contribution to WS score Negligible 0 0 Low 3 30 Medium 8 80 High Very High
25 Impact/Importance Scores AHWS: To protect the health of the public How bad human disease is/might be 65% Human attributable risk or exposure 23% Uncertainty 4% Costs of human disease 8% AHWS: Protect & promote the welfare of animals Number of individual animals affected 30% Welfare impact: Five Freedoms + Duration 53% Welfare impact of control measures 11% Extent of excess suffering (disease/controls) 6% AHWS: Protect wider economy, environment & society Risk of unexpected government costs 29% Wider community social & economic impact 29% Environmental impact 29% Producer economic impact 14% AHWS: Ensure sustainable opportunities for (commercial) trade Government effort 40% Legal risk 30% (Potential) extent of impact on sector 28%
26 Risk & Mitigation Overall risk in epidemiological & societal terms Likelihood of an unaffected holding becoming affected 28% Exotics informed by International Disease Monitoring tool & assessment (Potential) rate of spread 8% Extent to which the keeper can and does control 40% Extent to which government can and does control 25% 01 Current holding level prevalence / Risk of introduction into animals in GB 5 03 Efficacy and practicality of control applied at the holding level 5 11 Uptake of control measures applied at the holding level by keepers of this 5 species 12 Level of national preparedness or level of implementation for endemics/welfare 5 issues 02 Rate of spread on and between affected premises 1 04 Efficacy of control measures to prevent dissemination in or between animals that are implemented above holding level 06 Potential for risk change in animals in GB 1 08 Potential for silent spread 1 10 Is there a reservoir in GB for this disease/agent in another species or vector 1 1
27 OUTPUTS FROM THE DATABASE Across the profiles: Ranked lists of diseases by RFI Graph to show relative priorities Other reports on request For each disease Summary Prioritisation Report Summary profile Full profile Q&A brief Other reports on request
28 Summary scores for disease prioritization Public Health Impact How bad human disease might be (weighting - 44%) Human attributable risk or exposure + extent GB based (38%) Uncertainty as to public health significance (13%) Costs of human disease (5%) Animal Welfare Impact Number of individual animals affected (30%) Welfare impact: Five Freedoms + duration (53%) Welfare impact of control measures (11%) Extent of excess suffering (disease/controls) (6%) Wider Society Impact Risk of unexpected government costs (29%) Wider community social & economic impact (29%) Environmental impact (29%) Producer economic impact (14%) International Trade Impact Government effort (40%) Legal risk (30%) Helsinki 2011 (Potential) extent of impact on industry sector (28%) Risk and Epidemiology Likelihood of an unaffected holding becoming affected (44%) (Potential) rate of spread (12%) Extent to which the keeper or government can control (44%)
29 Helsinki 2011
30 Import Controls and Responsibilities EU Pre-export checks Exporting Member State Random checks at destination Animal Health & Local Authorities Food Standards Agency, Port Health Authorities & Local Authorities TRACES - Animal Health Non- EU Live animals including pets and checks at ports for animal products Animal Health Food of animal origin and animal products Local Authorities & Port Health Authorities Rapid Alert System for Food & Feed Food Standards Agency, Port Health Authorities & Local Authorities TRACES - Animal Health Helsinki 2011 Illegal Smuggling, includes checks on baggage, freight & post UK Border Agency / HMRC Detection inland, i.e. Retail, catering Local Authorities
31 Tool for assessing the risk of disease introduction to the UK Risk Cycle & VRG Risk Management Helsinki 2011
32 Helsinki 2011
33 Helsinki 2011 Controls for Products Of Animal Origin
34 Helsinki 2011 Tool 1: Products of animal origin
35 Helsinki 2011 Where is disease?
36 Tool 2: risk of incursion. What sort of information do we use? Country disease status Country Trade status Volume of Trade, according to York Stats unit, TRACES Risk Pathways and Vulnerabilities project EU legislation National rules for disease control are not included Helsinki 2011
37 Helsinki 2011 Tool Schematic
38 Where is disease? African horse sickness African swine fever Avian influenza Bluetongue Classical Swine Fever Equine Viral Encephalomyelitis Equine Infectious Anaemia Disease Distribution UK Northern EU Southern EU Eastern EU Southern Europe Eastern Europe Trading Partner - North America Trading Partner - South America Trading Partner - Africa Trading Partner - Middle East Trading Partner - Australasia Trading Partner - Asia Global - Africa Global - Asia Global America Global - Middle East Helsinki 2011
39 How is it transmitted? African horse sickness African swine fever Avian influenza Bluetongue Classical Swine Fever Equine Viral Encephalomyelitis Eqiuine Infectious Anaemia Foot and mouth Disease Imports of Livestock or Pets (excludes horses) X Yes Yes Yes Yes X X Yes Imports of Meat X Yes Yes X Yes X X Yes Imports of Germplasm Yes X X Yes Yes X Yes Yes Imports of laboratory material Yes Yes Yes X Yes X Yes Yes Livestock transport vehicles / fomites from abroad X Yes Yes Yes Yes X X Yes Importation & Movement of Horses Yes X X X X Yes Yes X Waste from Retail / Food Processing X Yes Yes X Yes X X Yes Migration of Wild Birds X X Yes X X Yes X X Contact between livestock & competent insect vectors in GB Yes X X Yes X Yes Yes X Illegal imports X Yes Yes Yes Yes X X Yes Helsinki 2011
40 Importance of Trade Livestock trade is 17% of global agricultural exports and rising. Global production and consumption of meat is 233 million tonnes in 2000, expected to rise to 300 million tonnes in For milk, same figures are 568 million tonnes rising to 700 million tonnes. Small ruminant trade between Horn of Africa and Saudi Arabia during Eid is worth between 0.6 and 0.9 billion USD per year. Helsinki 2011
41 Who trades where? Commodity Country Export Country Import Beef Brazil, USA, Canada, Argentina,, New Zealand, India, Australia USA, Russia, Japan, EU Poultry Meat USA, Brazil Russia, EU, Japan, Saudi Arabia Eggs Netherlands Germany, Netherlands, France Milk Pork EU, New Zealand, Australia, Argentina USA, EU, Canada, Brazil, China Russia, Mexico, Philippines, Canada, China Japan, Russia, Mexico, Hong Kong, USA and S. Korea Helsinki 2011
42 Exports of high value genetic stock Source: Narrod et al. (2011) Current and predicted trends in the production, consumption and trade of live animals and their products Rev. Sci. Tech. Off. Int. Epiz. 30(1) Helsinki 2011
43 How much trade is there? Bluetongue Brucellosis Foot and Mouth Vesicular Stomatitis Volumes of trade where 0=none, 1=low or sporadic, 2=regular but small quantities and 3=high volumes of trade Live Animals Germplasm POAO Live Animals UK Northern EU Southern EU Eastern EU Southern Europe Eastern Europe Trading Partner - North America Trading Partner - South America Trading Partner - Africa Trading Partner - Middle East Trading Partner - Australasia Trading Partner - Asia Global - Africa Global - Asia Global - America Global - Middle East Helsinki 2011 Germplasm POAO Live Animals Germplasm POAO Live Animals Germplasm POAO
44 Mitigation a negative score African horse sickness African swine fever Avian influenza Bluetongue Classical Swine Fever Equine Viral Encephalomyelitis Equine Infectious Anaemia Foot and mouth Disease Control Plan in place N N Y Y Y N Y Y Vaccine applied in EU N N N Y Y Y N Y Movement restrictions imposed Y Y Y Y N Y Y Y Culling/Surveillance in place Y N Y Y N Y Y Y EU trade rules apply Y Y Y Y Y Y Y Y Environmental conditions in the EU Y P Y Y Y Y Y Y Helsinki 2011
45 Helsinki 2011 New Tool addition: Wild Bird migration
46 Helsinki 2011 East Atlantic route connected to UK Black Sea and Mediterranean to E and S EU Central Asia to S and E Europe East Africa and West Asia to E Europe Therefore the risk is divided by the degree of separation to give risk score
47 Adding the migration paths Helsinki 2011 EU and Third Countries Bird Migration Pathway - East Atlantic Flyway Black Sea Mediterranean Central Asia West Asia & East Africa East Asia and Australasia Which countries are within this pathway? UK Northern EU Southern EU Eastern EU Southern Europe Eastern Europe Trading Partner - North America Trading Partner - South America Trading Partner - Africa Trading Partner - Middle East Trading Partner - Australasia Trading Partner - Asia Global - Africa Global - Asia Global - America Global - Middle East
48 East Atlantic Flyway Avian Influenza Newcastle Disease West Nile Virus Black Sea Mediterranean Central Asia West Africa and East Asia East Asia Australasia East Atlantic Flyway Black Sea Mediterranean Central Asia West Africa and East Asia East Asia Australasia East Atlantic Flyway Black Sea Mediterranean Central Asia West Africa and East Asia East Asia Australasia Disease Distribution UK Northern EU Southern EU Eastern EU Southern Europe Eastern Europe Trading Partner - North America Trading Partner - South America Trading Partner - Africa Trading Partner - Middle East Trading Partner - Australasia Trading Partner - Asia Global - Africa Global - Asia Global - America Global - Middle East Total Trade Risk Helsinki 2011
49 Helsinki 2011
50 Our response Regulatory action taken Assessed Risk Risk Category Terminology Check Traces Inform UKBA Enforcement Inform BIP Postimport Increased Surveillance Disease control Investigatio n Disease control Negligibl e G So rare, does not merit consideration Very low G/A Very rare, but cannot be excluded [ ] [ ] Low A Rare, but does occur [ ] [ ] [ ] Medium A/R Occurs regularly [ ] [ ] [ ] [ ] High R Occurs very often [ ] [ ] [ ] [ ] Very high R Events occur almost certainly [ ] [ ] [ ] Helsinki 2011
51 Helsinki 2011 Risk of disease spread - R o
52 Disease Goat Pox Pests des petits ruminants Incursio n Risk Level Negligible Negligible Rift Valley fever Negligible Sheep Pox Vesicular stomatitis Lumpy Skin Disease Epizootic Haemorrhagic Disease Negligible Negligible Negligible Negligible Reason Currently present in Third Country Trading partners; risk pathways in live animals but infection through direct contact; movement restrictions and disease controls are in place. Very little trade. Attenuated vaccines are available Currently present in Europe and Third Country Trading partners; risk pathways in live animals but infection through direct contact; movement restrictions and disease controls are in place and vaccination is available. Currently present in Third Country Trading partners; risk pathways include vectors and live animal movement; mitigation - controls abroad and surveillance; environmental conditions in this country may not totally suitable for vector establishment. Currently present in Third Country Trading partners; risk pathways in live animals but infection through direct contact; movement restrictions and disease controls are in place. Attenuated vaccines are available Currently present in Third Country Trading partners; risk pathways in live animals but infection through direct contact; movement restrictions and disease controls are in place. Currently present in Africa, Middle East, including trading partners; pathways through live animals, germplasm and vectors (midges). Very low trade from risk areas; vaccine available Currently present in North America, Asia and Australasia; pathways through vectors (mosquitoes) and possibly live animals (deer); negligible trade from risk areas; possibly no conditions suitable for vector Spread Risk Level Low Low Very Low Low Very Low Very Low Very Low Helsinki 2011
53 Case studies Why do we still need risk assessments? Threat from delayed disease reporting Threat from vectors Threat from exotic animals Threat from wild birds Threat from transport and illegal products Helsinki 2011
54 How do we use the tools? Hazard identification Entry Assessment Possible routes of entry; likelihood of pathogen being in commodity Exposure Assessment Likelihood of spread once introduced Consequence Assessment 4 reasons to intervene: public health, animal welfare, international trade, wider social impact Risk Estimation If non-negligible, mitigation actions / risk management should be considered Helsinki 2011
55 Scope of the Risk Assessment Always use appropriate scientific names Describe the nature, source, intended use of commodity Describe relevant methods of production, processing, manufacturing Describe any quality assurance programmes Estimate likely volume of trade Is it bilateral, multilateral or generic?
56 1 st step: Identify Hazard 1. Is disease notifiable/reportable? 2. Is the hazard present in importing country? 3. Is the hazard present in your country? 4. If yes, is it under official control or less virulent? 5. Can commodity act as a vehicle for transmission? 6. Is a vector required and if so, is vector present in your country? If Yes to questions 2 (or 6) and 5 = HAZARD
57 2 nd Step: Release Assessment Epidemiological assessment May require entomologists, parasitologists, climatologists Describe the pathway(s) for infection Estimate the likelihood of commodity being infected when imported
58 Scenario pathway for EIA
59 Scenario Tree for Pets and rabies
60 3 rd Step: Exposure Assessment Scientific evidence Each step of pathway likelihood of occurrence, given the scientific evidence Virus incubation period Geographical distribution Current legislation
61 4 th Step: Consequence Assessment Likelihood of introduction to livestock population and consequent spread Four reasons for intervention Animal Welfare Public Health International Trade Wider Social Impact Prioritise the impact Economic impact
62 5 th Step: Risk Estimation Using the EFSA definition of risk: Negligible Very Low Low Medium High Very High Anything non-negligible requires further communication and possible management
63 How do we use them? Policy questions Comms for industry Training Helsinki 2011
64 Helsinki 2011
65 Helsinki 2011 Available to the public:
66 Helsinki 2011 Bluetongue Imports
67 Mean risk map for Culex pipiens molestus (From Rogers, 2010) Mean risk map for Culex pipiens sensu stricto Helsinki 2011
68 Helsinki 2011 Predictive map of WNV suitability according to environmental conditions across Europe (blue dots represent WNV positive sites)
69 Conclusions Horizon Scanning is an important tool in Defra s risk management repertoire. Risk of disease incursion is only one of several sources of information. The tool is a simple, quick method for assessing changing risk levels. Other sources of intelligence are gathered through the Veterinary Risk Group. Thank you for your attention! Helsinki 2011
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