Appendix 5. The challenge. Virus pools and Regional Roadmaps. The Progressive Control Pathway PCP) for FMD control PCP-FMD

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1 No circulation / containment zones only No circulation / containment zones only Regional Roadmaps and the Progressive Control Pathway (PCP): - lessons learnt in promoting monitoring and risk based FMD management in endemic regions of Eurasia [1] Prepared by: Sumption K (1), BenYoussef, A (1), Potzch, C (1), McLaws, M (1), Ferrari G (2) and Lubroth J (2), (1) European Commission for the Control of Foot-and-Mouth Disease (EuFMD), FAO, Rome, Italy, (2) EMPRES Animal Health, AGAH, FAO, Rome, Italy 1 2 Critical risk points identified, strategy being developed 3 Critical points addressed incidence 4 Approaching freedom Outbreaks < once / year 5 Officially free without vaccination Officially free with vaccination Stages 0-3 = infected countries/zones The challenge To initiate monitoring of FMD in all countries considered endemic To support countries interested to develop (or improve) their FMD risk management To enable countries to compare their FMD risk management progress To create a system that fairly rewards progress in reducing risk PCP-FMD Progressive Control Pathway for FMD 0 Risk not controlled Continuous FMDV circulation Global Control through Regional Roadmaps for each of the seven virus pools Virus pools and Regional Roadmaps SEVEN FMDV virus pools - common strains/ risk a recommendation of the 2008 Open Session of the EuFMD research group 7 virus pools recognised by the OIE/FAO FMD lab network differ in FMDV antigenic types/required vaccines, risk factors and control capacities, requires tailored approach FAO follow-up has been to develop the PCP approach first applied at the Shiraz Regional Workshop in November 08 Regional Roadmaps exist - for South-East Asia (SEAFMD campaign) and South America NEW - West Eurasia Roadmap -since 2008 African Roadmaps (3) developed 2009 Gaps South Asia (Pool 2), implementation (Africa) The Progressive Control Pathway PCP) for FMD control developed by FAO in 2008 pathway leading from endemic towards free status applied in West Eurasia, and for developing Roadmap for Africa ; enables assessment of country progress within a Region between Regions self-assessment at National level provide progress indicators for donors/investment under study by OIE as a major tool in a Global Approach (FAO/OIE) 2010 Session brings PCP practitioners and methods developers together - considers uptake of refinements into PCP practice Sessions to come PCP in Practice 1: Lessons from application, relevance to free regions (5 speakers) PCP in practice 2: Methodologies monitoring, identification of intervention points (6 papers) Lab services needed for each stage: Diagnostics session (E. Brocchi, K van Maanen) Epidemiology Sessions: relevant to control strategy development (PCP Stage 1-2) Vaccine development, control, vaccination campaign monitoring: Relevant to improving PCP Stage 2 (monitoring programmes for control and eradication) FAO Consultative Group (expert) meeting on the PCP: next week (4-6 th October) OIE Scientific Commission - considering the PCP criteria and may set up recognition process for national control strategies that aim at eradication (PCP Stage 3)

2 Conclusions The Progressive Control Pathway (PCP) for FMD is a FMD risk based management approach which has wide applicability at national to regional scale; More technical work is needed : On Stage 1, to improve identification of critical risk control points, and socio-economic aspects of strategy optimisation; On Stage 2, to include both disease control and proeradication as valid management options Monitoring vaccination campaigns what indicators to use? define criteria and assessment processes identify assessment criteria for quality of national FMD risk management (Stage 2) validate the approach in Stage 2 countries resolve issues on sharing (sero-) monitoring data (which has regional-global value) Conclusions/2 Need for more political work With OIE, on recognition of National FMD Pro-Freedom Control Strategy (= recognition of PCP Stage 3) International application in Roadmaps, Processes for evaluation of country progression FAO Progressive control pathway - risk reduction approach Wide variation in effectiveness of national FMD management not a top down prescribed approach: but each MS encouraged to develop national risk reduction strategies that are supportive to the regional effort Officially free without vaccination 5 No circulation / containment zones only Herd immunity High Effectiveness of Quarantine of infected groups Epidemic potential 4 Officially free with vaccination No circulation / containment zones only 3 Approaching freedom Outbreaks < once / year 0 Critical points addressed 2 incidence Critical risk points identified, 1 strategy being developed Risk not controlled Continuous FMDV circulation Stages 0-3 = infected countries/zones NOT an official status the common feature of all stages is the measurement of FMD infection/circulation in the population at risk the difference is the level of control of transmission/risk High The four PCP Principles The PCP approach is based on the following principles: 1. active monitoring for FMDV circulation is the basic requirement of a control program, and therefore common action in all stages - the monitoring of outcomes (indicators of control), within a national FMD management system, is required at the higher stages; 2. activities in each PCP stage should be appropriate to the required reduction in virus circulation and risk of disease to be achieved; 3. activities and their impacts in each stage are measurable, comparable between countries, and generate information and potential benefits at national as well as to international stakeholders; 4. the optimisation of use of scarce resources for FMD control through the targeting of measures to the husbandry systems and critical risk points where the impact on disease control and/or virus circulation will be greatest; Stage 0: risk not controlled Criteria: no systematic FMDV monitoring system in past 12 months Stage 0: characteristics level of virus circulation (prevalence in serological studies) has not been studied in past 12 months; and/or: outbreaks occur every year and: the impact of control measures (vaccination, quarantines) on virus circulation is not studied or measured Risk not controlled Continuous FMDV circulation

3 Stage 0: Lessons learnt West Eurasia in 2009 many countries! whether vaccinating or not countries that [deliberately?] do not report FMD...and do not report results of serological surveys are automatically in Stage 0 Stage 0 Criteria - clear Countries do not wish to remain in Stage O political incentive to undertake Stage 1 Stage 0 in red Stage 1: critical FMD risk points assessed, national strategy under development Main criterion: systematic information gathering on FMD circulation to define possible high risk groups and critical control points Stage 1: characteristics level of virus circulation (prevalence - NSP positives) has been studied in past 12 months, and indicates virus circulation has occurred the critical risk points associated with the major husbandry/marketing chains are being identified ; and: a strategy is under development to address the CRP Stage 1 low cost serological survey to identify incidence and risk groups identify FMDV strains identify Critical Control Points (CCP) identify capacity to control and identify willingness to pay develop strategy provides valuable surveillance data for risk assessment therefore Stage 1 activities of regional value Critical risk points identified, strategy being developed Regional NSP situation four country sero-survey Sampling Mid-2008 in 6-24 month animals (true prev.) Critical control points... adm0 adm2 cauc BZ admin2_baseline08 NSP_prev 0 % > 0-20% > % > % > 60 % not sampled

4 Lessons learnt Keep principles simple, easy to communicate Ensure sufficient depth Analyse production systems at risk/market chains first? Before designing sero-surveys? Application Practiced (FAO Projects): 5 Central Asian Countries Bhutan (2010) Egypt (2010) Successes, great improvement in information base - but strategy development? What about countries not wishing to progress? (to implement control) Can they remain in Stage 1? - a case for requiring minimum monitoring? Stage 2: FMD under control, circulation is progressively reduced Main criterion: FMD control strategy has been implemented and monitored (repeated sero-surveys) Stage 2: characteristics each new outbreak(s) is investigated and potential sources identified level of virus circulation (prevalence in serological studies) has been studied repeatedly for at least 24 months, and evidence of FMDV exposure found in each survey the risk associated with the major husbandry/marketing chains identified, and strategies implemented for each ; and: the impact of control measures (vaccination, quarantines, measures at borders) on virus circulation is being measured Critical points addressed incidence Stage 2: can be high cost usually involves vaccination but does not prescribe national mass vaccination expected that some countries will choose not to effectively implement Stage 2 lack of economic incentives and finance importance of regional political pressure and support potential incentives: FMD controlled compartments/commodity based trade Vaccination is often not enough... very high Ro of virus high vaccination cover rarely enough gaps remain critical control points need to be addressed - stop virus finding gaps Kevenlik, Turkey: June 4 th, 2009 Stage 2: issues Should we differentiate between disease and pro-eradication management options? Or is this only real difference between what is acceptable (incidence /trend in critical groups) Measuring impact of measures - use of indicators and tolerances (e.g acceptable levels of vaccination performance) Can we should we compare key indicators across countries (harmonisation?: post-vaccination, incidence surveys?) Stage 2 Criteria include expectations of national decision making processes? Issues include decentralisation of FMD management Stage 3: Approaching freedom; effective prevention and containment measures main criterion: FMD outbreaks are exogenous (no continual circulation) Stage 3: characteristics each new outbreak(s) is shown to originate outside of the country or zone, not originate within; level of virus circulation (prevalence in serological studies) has been studied repeatedly for at least 24 months, and evidence of FMDV exposure found but being restricted to limited foci or limited time periods; each cluster of infection or outbreaks have a plausible explanation, through outbreak tracing; each outbreak or evidence of infection is followed up by immediate measures and post-outbreak surveillance, and review of the impact of control measures (vaccination, quarantines, measures at borders) Application : targetting control measures : new, difficult for decision makers Need to validate approach -examples include I.R of Iran, Turkey Approaching freedom FMD Events < once / year

5 Stage 3: This is where early warning and response are critical Surveillance, rather than monitoring new events require response Therefore : - contingency planning is critical access to vaccine reserves/banks for emergency Control of incursions requires prevention (border..) rapid response to risk ability to regulate animal movement; example: several North African countries in response to the type A Iran 05 incursion into Libya in 2009 Stage 3: lessons Some countries claim to be in Stage 3 (but cannot supply sero-monitoring evidence - therefore annual assessment resulted in downgrade) Possible recognition of this Stage by OIE as a recognised control strategy (aimed at eradication/freedom) Proving every outbreak/cluster is an incursion emphasis on invetigation and molecular typing Proving short lived circulation; focus on serosurveillance capacity Some countries with continual, short lived incursions (cannot control borders) really should be Stage 2? PCP and Roadmaps application West EurAsia Roadmap for FMD Control: Vision : freedom from clinical disease by 2020 West Eurasia (Virus Pool 3) Roadmap -14 countries -developed st assessment of progress October 2009 progress on track to achieve 2020 Vision Subsaharan Africa (Virus Pools 4-6) Continental Roadmap - developed January 2009 (Nairobi1 meeting) composed of three subregional Roadmaps progress in year 1 mainly to establish FMD Lab networks (part of information base) formidable obstacles! Progress meeting late 2010 Regional cooperation among Eurasian countries... for the progressive control of FMD through public and private partnerships leading towards freedom of clinical disease by 2020 for regional economic development, food security, and poverty alleviation. Progress in of the 14 countries undertook sero-monitoring program in 2009 TUR, GEO,AZB, ARM, IRAN (pilot areas), PAK, AFG, UZB, TAJIK, IRAQ results pending: Syria, Turkenistan breakthrough - first FMD reported serosurveys in several countries high incidence in all (5-10% yearly exposure) except UZB incentives largely project driven but no country wants to be seen as lagging in the Roadmap Annual Progress meeting Negative progress: two countries downgraded - on lack of monitoring evidence submitted

6 West Eurasia East Africa Central Africa Western Africa North Africa South Africa Agreed timetable for Africa Countries Algeria Egypt Libya Mauritania Morocco Tunisia Benin Burkina Faso Cote D'Ivoire Gambia Ghana Guinea Guinea- Bissau Liberia Mali Niger Nigeria Senegal Sierra Leone Togo Cameroon Cape Verde Central African Republic Chad Congo (Dem. Rep. of the) Congo (Rep. of the) Equatorial Guinea Gabon Sao Tome and Principe Djibouti Eritrea Ethiopia Kenya Somalia Sudan Tanzania Burundi Rwanda Uganda Angola?? 4/5 4/5 Botswana 3z/5 3z/5 3z/5 4/5 4/5 4/5 4/5 4/5 4/5 4/5 4/5 4/5 Comoros Lesotho Madagascar Malawi 4/5 Mauritius Mayotte (France) Mozambique 4/5 Namibia 4z/5 4z/5 4z/5 4z/5 4Z/5 4z/5 4z/5 4z/5 4z/5 4z/5 4z/5 4z/5 Reunion (France) Seychelles South Africa 4z/5 4z/5 4z/5 4z/5 4z/5 4z/5 4z/5 4z/5 4z/5 4z/5 4z/5 4z/5 Swaziland 4/5 Zambia 4z/5 4z/5 4z/5 4z/5 Zimbabwe z/5 By 2020, there will be sufficient control of FMD in Africa to enable the livestock sector to participate in local, regional, sub-continental, international trade, and contribute to improved food security and livelihoods. In this regard, obtain by 2010 th Vision statement agreed at the Final Plenary Session, 30th January N Z Vision statement for North Africa agreed at the OIE General Session, 26th May (Paris) Level 0 Level 1 Level 2 Level 3 Level 4 Level 5 West EurAsia Roadmap- country Stage position following the Progress Review of 2009, and expected progression to 2020 by 2020, all at least in Stage 3 FINAL assessment of country Stage position for 2009, together with the expected progression to (Chart2) Kazakh Comment Kyrgyz new FMD seromonitoring system therefore Sta assumed 2, 3 and 5 years to move throug Tajik new progress to stage 1 Turkmen Uzbek new progress to stage 1 AFG new progress to stage 1 IRN PAK new 2009: progress to stage 1. Progress to Sta TURK new progress to stage 2 Thrace (TR) new dossier to OIE in 2010 added zones (TR) Syria Iraq Armenia Azerbaijan Georgia pending new new Syria considered to be in Stage 1 in 2009 reporting of seromonitoring expected in : re-assessed as Stage 1, expect ent Stage 2 in 2011 PCP criteria and processes Africa Roadmap progression to 2020 after Nairobi and Algiers Workshops Subject of the FAO Consultative Group meeting in Pirbright, October 4-6th criteria tested in 4 workshops/surveys surveillance principles developed require refinement, validation technical developments Through application in FAO and other projects in 3 continents Ideas emerging in this Session linkage to OIE Under study; recognition of Stages, link to PVS criteria for progress could include PVS evaluation and follow-up Africa Roadmaps to 2020 Expected PCP progression, North, West/Central, East and Southern Africa (Nairobi Workshop, Jan 09 and Algiers, Feb 09) PCP and global FMD intelligence If enough countries implement PCP Stage 1 or above, countries in a region can act on the risk Global level: improved information for risk assessment based on incidence and virological threat What level of PCP application needed - for sufficient regional and global viral intelligence monitoring? How many countries per Pool would be enough? How often to repeat sero-monitoring? ( if the country does not intend to progress to control?) High potential for PCP take-up to address regional and global information gaps

7 Acknowledgements EUFMD Commission member states EC (DG-SANCO Regional workshops) FAO ( J. Lubroth, G Ferrari, J Pinto) J. Domenech OIE (G. Bruckner) African Union-IBAR (Pan African Workshop) FAO World Reference Laboratory (WRL) Pirbright (D Paton, Jef Hammond) Supporting centres: EUFMD Secretariat staff (Nadia Rumich) RAHCs in Nairobi, Bamako, Beirut, Tunis, Gaborone, Nepal