HIGH FLYERS THINK TANK

Emerging diseases – Ready and waiting?

The Shine Dome, Canberra, 19 October 2004

Emerging diseases: Coordination and implications

Dr Graeme Garner
Manager, Epidemiology and Modelling Section, Office of the Chief Veterinary Officer, Commonwealth Department of Agriculture, Fisheries and Forestry

My first task is to apologise on behalf of Dr Gardner Murray, the Australian Chief Veterinary Officer, who fully intended to be here today for this meeting. Unfortunately, following the recent election and changes in planning within the Department, he has found that he could not really get away at this time: he is caught up with some fairly significant and major planning issues within the Department of Agriculture. So he has asked me to fill in for him.

I guess I should begin by apologising, in the sense that Gardner has a far broader policy perspective on these issues than I do. My background is predominantly technical. However, I did discuss with him the sorts of messages he would like to get through, and hopefully in my presentation today we can learn a little bit about how the response to diseases is managed and coordinated within Australia.

In the time I have available, I want to briefly give you a national perspective on emerging diseases, from the Department of Agriculture point of view. I will be concentrating on animal diseases, although our portfolio certainly covers other diseases – in the plant area, fish, even marine pests.

I am going to talk briefly about the coordination which goes on in response, and Australia's involvement, firstly at the international level, following up from what Martyn [Jeggo] was talking about with foot and mouth disease, to give you a case study of an international program which is managing foot and mouth disease in South East Asia. Also, I want to very briefly explain the national coordination of response to emergency animal diseases, and I will refer to a recent whole-of-government exercise that was carried out in Australia.

Finally, I would like to draw to your attention some of the issues which we believe are important in responding to emergency diseases, and I will identify a few conclusions.

Emerging zoonoses
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Emerging diseases, as we have heard from the previous speakers, pose an ongoing and increasing threat to animal health, plant health, human health, trade and biodiversity. The link between animal and human disease is one which Martyn raised and I will reinforce. Published work recently identifies that something like 75 per cent of the emerging pathogens in humans have been passed on from animals or have an animal component.

We can look at a whole range of predisposing factors which contribute and lead to the emergence of some of these new diseases, and I think what we are seeing is a shift and a broadening of the traditional epidemiological paradigm, where we had host, agent and environment, to a far more sophisticated model.

Convergence Model
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One example of this is given by the so?called convergence model, which identifies emergence as being a product of the interaction of a whole range of disparate factors, involving physical/environmental factors, genetic/biological factors, microbe/ecological factors, and then a whole range of social, political and economic factors, all contributing to the conditions which ultimately lead to the selection or emergence of a new agent which has pathogenic consequences.

Emerging/re-emerging diseases in Australia
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From an Australian perspective, recently there was an analysis done within our Department, within the Office of the Chief Veterinary Officer, to look at some of the issues which had been identified and caused at least some form of national response over the last 15 years. This (Slide 3) is just looking at the animal and fish side – we are not talking about plant diseases here, and I am sure you will hear later on that in fact we have faced, in numerical terms, far more plant incursions than we have on the animal side.

I just draw these figures to your attention. There have been 56 – this is not complete; as I said, it is really related to those which have resulted in some sort of response at a national level. Of those 56, only 12 were actually truly exotic to Australia. A number of them were discovered for the first time; a number of them had been here for some time. More than 21 per cent of these conditions were zoonoses (ie, a disease of animals transmissible to humans), and of the 27 previously unreported, 85 per cent involved wildlife or fish.

Moving on to coordination at an international level: how does Australia get involved and work, at least on the animal side of things?

Australia is actually heavily involved with a number of international agencies, and we will see those in a minute. We also have bilateral arrangements with a number of countries. For example, Australia's northern quarantine strategy has MOUs with countries like PNG, Indonesia and East Timor, where we do joint and collaborative surveillance activities. We also have a whole range of regional activities which Australia gets involved in, particularly in the South East Asian region, and I will talk in a moment about the OIE Regional Commission. Also, as I said, I will give you an example of an emerging disease response in action: the coordination and follow-up, and Australia's role in it.

Some international linkages
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First of all, some international linkages. Martyn has mentioned OIE, the World Organization for Animal Health. Australia is also involved in Codex Alimentarius, which is concerned with food standards; FAO itself and obviously AI (avian influenza) at the moment – we have a lot of involvement with the AI at the poultry level; the World Health Organization; the International Plant Protection Convention; the OECD; the National Aquaculture Group of Asia; UNEP – just some examples of agencies Australia is actively working with.

OIE regional commission
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I mentioned the OIE Regional Commission. I think it is important to point out that Australia currently has the presidency of the Regional Commission for Asia, the Far East and Oceania. This covers something like 40 countries in South Asia, South East Asia, East Asia and Oceania. I think it is a very significant point that this includes most of the high-risk areas for recently emerging diseases. Through its membership of this commission, Australia is actually in a good position to know about and contribute to some of the programs which the Regional Commission is working on, and I have listed some of those programs there (Slide 5) for you.

FMD control in South-East Asia
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I want to talk about FMD (foot and mouth disease) control in South East Asia. Martyn has given you a good overview of the disease and how it has spread. It is not a new disease; it has been around for a very long time. But it certainly has re-emerged as a major problem, and it has re-emerged in countries which have been free of the disease for many years, in some cases up to 50, 60, 70 years.

OIE SEAFMD campaign
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The OIE South East Asian Foot and Mouth Disease Campaign was set up as an initiative to try and address the threat in our region to our immediate north. It has a series of identified goals, a purpose and an objective.

South-East Asia FMD status
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Slide 8 is to give you a feel for the region we are talking about, and the endemic and the free countries within that region.

OIE SEAFMD campaign
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Here we have a brief history of what has happened with this program. It has now been going for almost 10 years, beginning with an initial meeting to set up and agree that a program was warranted to try and control the threat that this disease posed, both to the countries in the region that were infected and also to those countries outside of the region who are at risk because of the continuing presence of the disease.

Australia has played an active role, both in funding and in coordinating this program. The regional coordinator was actually an Australian appointee, appointed to the OIE to work under that program. As the program has evolved and progressed, it is now increasingly being run by people within the region, and it is planned that it will be taken over by ASEAN (Association of South East Asian Nations) in the future.

Approach of SEAFMD
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We wanted to draw this particular disease to your attention because this represents the classic complex situation of a disease – FMD is recognised as one of the most contagious diseases of animals known; there were multiple countries involved, from countries with good infrastructure to very poor infrastructure; and it represented a major challenge to get all these countries to work together to the common good. The important steps in this process were identifying what were agreed objectives, but we have to recognise that individual countries have different approaches and different priorities in terms of where they want to get to.

It is necessary to set up a good regional infrastructure and coordination, and to develop agreed plans, and a phased implementation is very important. As I said, the campaign is coordinated through a regional coordinator.

I guess what we are seeing here is a potential model for other diseases, at least in this region, which could be used to try and achieve some of the outcomes that we have identified as important.

Avian influenza
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With this sort of approach, is this the sort of thing we should be looking at with avian influenza?

Domestic coordination
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I would now like to move on and talk briefly about how we coordinate response to diseases within Australia. I think it is important to make the point that, compared with other sectors, things are reasonably well developed in the animal health world in Australia. I think this has been largely due to the fact that we have had a number of successful national eradication programs for endemic diseases, like bovine tuberculosis, bovine brucellosis and contagious bovine pleuropneumonia, which have meant that State agencies, national agencies and industry have had to work together and learn to work together.

In terms of how we coordinate these activities, for non-emergencies we have a government infrastructure where all the Chief Veterinary Officers of the States and Commonwealth meet on a regular basis and discuss issues at the technical level. This is Australia's Animal Health Committee. That committee reports up through the Primary Industry Standing Committee directly into the policy making fora of this country. That system has served us reasonably well. It can be quite cumbersome to get things to happen, but it means we start off with an agreed technical approach to solving a problem.

In terms of emergencies, the system works on a graded response. Depending on the nature of the threat, we can go right through to a very high-level response quickly, to a lower-level surveillance/investigation type response. That activity is coordinated through the Consultative Committee on Exotic Animal Diseases, and I will talk to you about Exercise Minotaur, which represents the most complete and up-to-date incarnation of this coordination system.

Organisation of animal health in Australia
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Just to remind you: in terms of animal health management in Australia, nationally the federal government is only responsible for quarantine and international matters. It is the State and Territory governments which are responsible for implementing actual disease control/eradication procedures.

Recently, from 1993, a new structure called Animal Health Australia was formed, which involved Commonwealth government, State governments and peak industry groups, providing a coherent forum for industry to be directly involved in the decision making and implementation process for disease programs.

Organisation of animal health in Australia
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This diagram shows you the organisation of animal health services in Australia, starting at the state industry/departmental level and moving right up to the national government level and the Primary Industries Ministerial Council, which is the peak decision-making process within Australia.

Exercise minotaur — FMD simulation exercise
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If we now look at an emergency disease response: for new or emerging diseases, how would we go about doing it? I will briefly take you through Exercise Minotaur. This exercise was designed to test the coordination arrangements that are in place in Australia, and is the largest disease control exercise ever held. There were over 1000 people formally involved, and probably that many people again informally involved, with over 80 exercise facilitators and evaluators.

The areas that were tested were particularly the national consultative arrangements, the communication policies, the trade management arrangements, and relief and recovery.

Emergency diseases
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This diagram shows the decision-making process in an emergency. On the right-hand side we have the technical side of making decisions about appropriate responses and implementation of strategies. That is passed up the chain of command to the Primary Industries Ministerial Council to get engagement right up to Cabinet level. In fact, in Exercise Minotaur we even had the Prime Minister directly involved in this exercise.

That then feeds through the Council of Australian Governments (COAG), through Cabinet, as I said, and leads to the formation of a range of groups which takes responsibility not just for the technical aspects but for some of the social, recovery and adjustment processes as well.

Emerging diseases: some issues
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I want to very briefly identify some of the issues when it comes to emerging diseases. How do we manage threats? Conceptually, in the animal world we are looking at it at three levels. We are looking at pre-border, through some of our activities offshore and our involvement in international agencies and organisations, our involvement in regional projects. At the border we have things like quarantine inspection; at one end of technology we have sniffer dogs to find people who might inadvertently bring in material that could be dangerous, and it goes right through to high-tech X-ray facilities which X-ray baggage, containers coming in and so on.

In terms of scope, we have to think not just about the immediate disease response. We have to think about preparedness and we have to think about the post-response relief and recovery.

In terms of how we do it, clearly this is beyond the scope of any single agency, and a whole-of-government approach is required if these sorts of emergencies are to be managed successfully.

Finally, we have to appreciate that there is no single skill set here which is going to deliver it all to us. We need a multidisciplinary approach and we have to look beyond some of the technical and emergency areas through to some of the economic, social, political and communication areas as well, for some assistance and guidance.

Conclusions
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In conclusion, I will finish with a couple of points. Australia is working on an integrated national biosecurity strategy. All issues related to biosecurity – animals, plants, fish, weeds, marine pests – are being considered, and a common-framework approach is being investigated as a way of improving coordination.

Given the nature of the threats, as I have mentioned, a multidisciplinary approach to these diseases is absolutely essential.

And, finally, we have to appreciate that we are dealing with uncertainty. It does not matter how effectively we plan an exercise, our response system and our coordination system need to be flexible enough to deal with the unexpected, because if history teaches us anything, that is what we are going to face.