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Preparedness -- To Stamp Out Foreign By Dr. Richard McCapes, Chairman Why are we concerned about national preparedness in 1996 to stamp out1 foreign animal disease outbreaks in the United States? Essentially it is because our nation's huge populations of animals of all types are susceptible to a number of exotic infectious diseases which, if allowed to gain a foothold in the United States and spread, would be highly destructive. Our preparedness and commitment as a nation to quickly stamp out such an incursion is our only effective defense against such a catastrophe.
Foreign animal diseases have the capability to catastrophically disrupt food animal production as we know it. In 1992, our livestock and poultry population inventory and/or production totaled some 7 billion animals, including 101 million cattle and calves, 60 million swine, 10 million sheep, 357 million egg-type chickens, 289 million turkeys and 6.4 billion broilers. In 1991, these combined industries represented a value of some $79 billion. It is this dollar value that is at risk from foreign animal disease.
It is, however, not only the absolute dollar value of the livestock and poultry industries themselves that is at risk, but also their productivity contribution to American society as a whole. A major outcome of our capitalistic, private enterprise system is the incredibly efficient production of foods of plant and animal origin enabling us, as citizens, to feed ourselves utilizing only about 13% of our personal consumption expenditures. Because of American agriculture's amazing productivity, we have a relatively large amount of time to pursue activities, other than feeding ourselves, which contribute to the wealth of the nation and a rising standard of living. The provision of time to fellow citizens to pursue nonagricultural wealth building is, in my mind, the major contribution of American agriculture to society. It is this wealth building time that is at risk from the capacity of foreign animal disease to catastrophically lower and disrupt livestock and poultry industry productivity.
In discussing the nation's preparedness to protect the value and productivity of our livestock and poultry industries, I would like to review the recommendations of the Secretary's Advisory Committee on Foreign Animal and Poultry Diseases, which I chair, and a recent survey of State Veterinarians on the nation's preparedness to eradicate foreign animal disease outbreaks.
I. Recommendations of the USDA Secretary's Advisory Committee on Foreign Animal and Poultry Diseases - The USDA Secretary's Advisory Committee on Foreign Animal and Poultry Diseases, a panel of nineteen members, has as its purpose to advise the Secretary on means to prevent, suppress, control or eradicate an outbreak of foot-and-mouth disease or other destructive foreign animal diseases in the event such diseases should enter the U.S. The committee met in 1995 in McAllen, Texas and made the following six recommendations to the Secretary of Agriculture, Dan Glickman: _________________________ 1 "Stamp out" means to rapidly and effaciously eradicate a foreign animal disease outbreak.
• Review the nation's preparedness to stamp out foreign animal disease outbreaks.
• Develop a system for establishing national foreign animal disease priorities. • Alert citizens and professionals to the national threat of foreign animal diseases.
The first recommendation, Review the nation's preparedness to stamp out foreign animal disease outbreaks, consisted of two subparts as follows:
1. Audit of emergency disease preparedness - The committee recommended that the Secretary initiate an independent audit of the effectiveness of the nation's planned response to a foreign animal disease outbreak including evaluation of federal/state/industry cooperative efforts and the effectiveness of emergency disease training and test exercises. The committee believes that an audit by an independent agency or firm would provide an accurate assessment of the nation's preparedness.
2. Indemnification - The committee recommended that the Secretary initiate an evaluation of each foreign animal disease to determine if and when immediate depopulation and indemnification are appropriate. When appropriate, the Secretary should ensure that indemnification funding is available for immediate and sustained response. The committee felt that depopulation is the most effective means of eradication in response to foreign animal diseases, however, it was unsure whether the Secretary or Congress will make the necessary funds available for indemnification in every situation. For that reason, the committee asked for clarification of this question. If funding is unavailable, then alternative plans of action need to be pursued.
The committee advised the Secretary that it undertook its discussions and recommendations with the understanding that our nation is experiencing a period of substantial change in the public sector, including downsizing, devolution and reinvention of the federal government system, a relative increase in state government responsibility, and an urgency to harmonize our state and federal SPS standards with newly developing international SPS standards to facilitate international trade agreements. Reduction in federal and state budgets due to completion of programs, such as brucellosis eradication and screw worm control, represent additional significant change.
A primary consideration of the committee was the knowledge that this change impacts USDA resources and programs developed over many years to protect our nation's livestock and poultry populations from foreign animal disease outbreaks and the need to maintain the prerequisite ability to respond immediately to prevent or lessen the suffering and economic disruption associated with such outbreaks.
II. Survey of State Veterinarians on foreign animal disease preparedness -
Background of the survey - To prepare for the presentation to the LCI meeting in Colorado Springs, the author undertook a survey of the nation's 50 State Veterinarians on the subject of the nation's preparedness to rapidly and effectively eradicate a foreign animal disease outbreak in 1996. It was felt their combined views would give a broad national view of preparedness based on familiarity with actual farm conditions at the state level and close relationships with their state's livestock and poultry industries, practitioners and resources (state and federal) available for animal health.
I would like to thank Drs. Richard Breitmeyer, DVM and Ken Thomazin, DVM and others for their suggestions for and editing of the wording and content of the survey questionnaire. Special thanks also to Mr. Jack Brickey, MS, for his recommendation to divide respondents' written comments into 'management' versus 'resource' categories and other ideas.
Survey methods - Forty eight (96%) of 50 State Veterinarians responded, by March 26, 1996, to the survey questionnaire sent to them on March 5, 1996. The questionnaire was composed of twelve questions pertaining to the nation's preparedness to rapidly and effectively eradicate a foreign animal disease outbreak in 1996. Respondents were asked to: 1) assign a letter grade (A=excellent, B=above average, C=average, D=below average or F=fail) to 11 questions pertaining to preparedness and: 2) to give a reason(s) for their grade. The final question provided the respondents space for other comments, as they desired.
The number of each letter grade for each question was charted graphically on a national and regional basis. The regional areas utilized were the four United States Animal Health Association (USAHA) geographic districts: Northeast; North Central; Southern and; Western. Letter grades were converted to numerical values (A=4; B=3; C=2; D=1; F=0) and a numerical grade point average (GPA) was calculated for each question on a national and regional basis. The numerical GPA was used to assign an overall average letter grade, utilizing a plus/minus system, for national and regional summary results.
Respondents' written comments associated with each survey question were gathered together according to letter grade. In addition, the 150 written comments associated with the first four questions were categorized as: a) statements primarily of 'satisfaction' versus 'concern' and; b) statements primarily directed towards 'management' versus 'resource' issues. This was done to get a clearer understanding of: 1) whether respondents' comment was one of satisfaction or concern with a letter grade (A, B, C, D or F) and; 2) whether the respondent was directing a particular comment primarily at a management issue, such as concern about lack of leadership and planning, or concern about a resource issue, such as reduction in budget or lack of personnel.
Synopsis of the complete survey report - A complete 51 page report of the survey, including both national and regional results, discussion and all written comments, was prepared and sent to each State Veterinarian. Persons interested in obtaining a complete report can contact their State Veterinarian for a photocopy or the author (at cost of reproduction and mailing).
The following is a synopsis of the report which discusses only overall national results. It does not show regional differences, the written comments or any of the charts shown in the address, all of which are included in the 51 page complete report.
Table #1 State Veterinarian survey questions: By category, overall average letter grade, point average (GPA) and level of satisfaction* with average letter grade __________________________________________________________________
Category and question Grade GPA Satisfaction A. Overall agency, industry & national preparedness State animal health agency preparedness? B- 2.5 53% State livestock & poultry industry preparedness? C+ 2.3 39% APHIS-Veterinary Services preparedness? C 2.1 33% Combined state & local resources? C 2.1 30% Overall national preparedness? C 2.1 26% B. Specific outbreak response task preparedness Laboratory support preparedness? B 3.0 76% Diagnostic investigation preparedness? B 2.9 72% Rapid industry & practitioner reporting preparedness? B- 2.7 65% Epidemiologic & economic assessment preparedness? C+ 2.3 36% Containment & eradication program preparedness? C 2.1 28% Timely availability of indemnity fund preparedness? D 0.9 0%
* Level of satisfaction with letter grade=percent of the sum of all letter grades for each question represented by the sum of letter grades A plus B.
Grading the nation's overall preparedness - Combining all states, the overall preparedness of the nation to rapidly and effectively eradicate a foreign animal disease outbreak in 1996 received a C average (see Table #1 above). In ranking overall animal health agency and industry preparedness, the respondents gave a B- to state animal health agency preparedness, a C+ to livestock and poultry industry preparedness and a C to APHIS Veterinary Services preparedness. The adequacy of combined state and local resources was graded as C.
Grading preparedness for six specific outbreak response tasks - When asked to grade the nation's preparedness to carry out six specific outbreak response tasks to a foreign animal disease outbreak, the respondents gave B grade averages to the preparedness of: laboratory support; diagnostic investigation and rapid industry and practitioner reporting (See Table #1 above). C grades were given to the preparedness for: epidemiologic and economic assessment and containment and eradication programs. Grade D was given to preparedness of timely availability of indemnity funds.
Preparedness for laboratory support received the highest numerical GPA (3.0) in the survey and timely availability of indemnity funds received the lowest (0.9).
Respondents' level of satisfaction with grades - Categorization of written reasons for assigning a particular letter grade as primarily a statement of 'satisfaction' versus a statement of 'concern' demonstrated a high level of 'satisfaction' (91%) in the comments associated with the letter grades A and B and a high level of 'concern' (100%) in the comments associated with the letter grades D and F. Of great interest was the observation that the respondents comments associated with the letter grade C also demonstrated a high level of 'concern' (95%). This observation has led the author to conclude that the letter grade C, defined as average in the questionnaire, is clearly considered to be an unsatisfactory grade for preparedness and is a manifestation of a high level of concern.
Another way, then, to view the survey grading is to consider letter grades A and B as satisfactory in relation to preparedness and the letter grades C, D and F as unsatisfactory. The level of satisfaction with the overall letter grade for each question can be determined by calculating the percent of the sum of all the respondents' letter grades for each question represented by the sum of letter grades A plus B (#A+B/#A+B+C+D+F).
Utilizing the level of satisfaction measurement, one sees, in the author's opinion, a clearer view of the nation's strengths and weakness in preparedness as viewed by the respondents. For example, in terms of the question category, overall agency, industry and national preparedness, state animal health agency preparedness received the highest level of satisfaction (53%), meaning that slightly over half of the comments associated with this question were categorized as primarily statements of satisfaction (See Table #1 above). The level of satisfaction for state livestock and poultry industry preparedness was 39%; APHIS-Veterinary Services 33% and combined state and local resources 30%. Overall national preparedness received a level of satisfaction of only 26%, meaning that 74% of the written comments were primarily statements of concern, reflecting, in the author's opinion, broad dissatisfaction with the current state of the nation's overall preparedness in 1996.
Upon examination of the level of satisfaction for the six questions under the category, Specific outbreak response task preparedness, one sees the beginning of a strategy to strengthen overall national preparedness. It seems clear to the author, for example, that priority efforts should be directed towards improving preparedness in the three specific outbreak response tasks receiving the lowest level of satisfaction, namely preparedness for: 1) timely availability of indemnity funds (0%); 2) containment and eradication program (28%) and; 3) epidemiologic and economic assessment (36%) (See Table #1 above). Such an effort would involve state and federal agencies and the livestock and poultry industries working together in a well planned, cooperative effort.
The respondents' 0% level of satisfaction for preparedness for timely availability of indemnity funds brightly illuminates, in the author's opinion, the persisting and unresolved uncertainty as to whether or not indemnity funds (public tax dollars, private sector dollars or a combination) will be available to expedite effective and rapid eradication of future foreign animal disease outbreaks by depopulation. The critical importance of timely availability of indemnity funds to eradication program planning and strategy based on depopulation was cited by the Secretary's Advisory Committee on Foreign Animal and Poultry Diseases earlier in this paper. This uncertainty about indemnity funds is, in the author's opinion, the major obstacle to planning containment and eradication programs.
Of interest is the observation that the three outbreak response tasks given the highest level of satisfaction were clinically oriented, veterinary medical procedures similar, in nature, to the type of clinical activities carried out in support of a veterinary medical practice, namely preparedness for: laboratory support (76%); diagnostic investigation (72%); rapid industry and practitioner reporting (65%) (See Table #1 above).
Based on my interpretation of the respondents grades and comments, it would appear that, as a nation, we are at a point in time where we have been able to justify, provide and maintain reasonably satisfactory commitment and support for these clinical oriented activities (outbreak reporting, diagnostic investigation and laboratory support), but are falling behind in the planning, resources and commitment to pursue an aggressive stamping out of future foreign animal disease outbreaks utilizing a clearly defined, cooperative, state/federal/industry program of rapid containment, depopulation and sanitary clean-up.
Improving unsatisfactory grades by improving management - Categorization of the respondents' written reasons for assigning a particular letter grade as primarily a statement directed towards 'management' issues, such as leadership and planning, versus a statement primarily directed towards 'resource' issues, such as budget reductions and lack of personnel, demonstrated that the majority of reasons for assigning any letter grade were primarily related to management issues (67%), rather than resource issues (33%). For letter grades A plus B, 76% of the reasons given for the grade were primarily directed towards management issues; for C, 60% were primarily management issues and for D plus F, 63% were primarily management issues. Management issues, then, are more frequently cited as the primary reason for assigning both satisfactory (A and B) and unsatisfactory (C, D and F) grades.
If one groups all of the written reasons for assigning unsatisfactory grades (C, D and F) in the questions analyzed, 61% of the reasons were primarily management related and 39% were primarily resource related. These findings suggest that, in an era when increases in public sector agency resources (budget, personnel, etc.) is not likely to occur, significant improvement in overall national preparedness at the federal, state and industry level is still possible by concentrating on improving management. It is understood by the author that management and resources are closely associated. The management issue themes identified by the author in the respondents' written reasons for assigning an unsatisfactory grade (C, D or F) include lack of: leadership; commitment; confidence; planning; coordination; communication; authorities; timeliness; reporting; training; state/federal/industry rapport; role definition; system integration; competence; state/federal/industry model; realistic expectations and avoidance of uncertainty.
Targeting efforts to strengthen these management themes as a means to improve the unsatisfactory grades given to the three Outbreak response tasks with the lowest level of satisfaction (timely availability of indemnity funds; containment and eradication plan and epidemiologic and economic assessment) (See Table #1) would, in the author's opinion, produce significant improvement in the nation's overall preparedness with minimal need for additional resources.
III. What else can we do now to improve preparednesss? - The following are some thoughts of the author and others on ways in which individuals, organizations and agencies can contribute today to improving the nation's preparedness to rapidly and effectively stamp out foreign animal disease outbreaks.
1. Get involved with APHIS reinvention and budget transition -
a. Government Performance Act and Results Act of 1994 - This is a law passed by Congress that every citizen should read and participate in. It specifically addresses waste and inefficiencies in federal programs which, it says, undermine the confidence of the American people. And the stated purpose of the law is to improve the confidence of the American people in the capability of the government by holding agencies accountable for results. It calls for development of strategic plans, performance plans and reports and, ultimately, performance budgeting.
Unfortunately, this law is one of the best kept secrets in Washington, DC. The law directs agencies to seek stake holder (citizen) input into strategic planning, definition of performance measurements, etc. This process is underway at this time, and all interested parties should be demanding involvement in the ongoing APHIS strategic planning process and the definition of the outcome results by which the agency's performance will be judged in future years. This is a great opportunity for citizen involvement on a formal, meaningful basis.
b. Industry and state input into the 1998 APHIS transition budget - The target date for achieving brucellosis eradication is 1998, meaning that the APHIS budget will no longer carry a line item for brucellosis, a major budget item for decades. Similarly, other budgeted programs, such as screw worm control, will be winding down. The 1998 budget begins a transition for APHIS from a budget heavily oriented to programs, such as brucellosis, to a budget emphasizing emergency programs, trade and quality assurance.
It is imperative that industries and states study this transition budget and work with APHIS to reach agreement on its thrust. The reason this is important is that the APHIS transition budget will require active support by industries and states in order for it to prevail at the Congressional level.
A strong APHIS organization is, in the author's opinion, essential for the nation's overall preparedness for foreign animal disease outbreaks and this strength is dependent on reasonable funding as well as strong leadership and a commitment in its administration.
2. Get involved today with audit of APHIS preparedness - APHIS Emergency Programs has stated it plans to engage in two audits of its emergency preparedness. An Internal Audit has been discussed and, if conducted, will survey agency and some stake holders on preparedness. The External Audit will consist of a review of emergency preparedness by animal health officials from Australia, Canada and New Zealand. Industry organizations and state agencies should be involved in the Internal Audit. The Animal Agriculture Coalition has made a special effort to work with APHIS and the Secretary's Advisory Committee on preparedness. Finally, if the audits are completed, the agency has discussed the idea of reviewing them at the United States Animal Health Association (USAHA) meeting this fall.
3. Get involved with harmonization and regionalization policy today -
a. OIE organizational deficiencies limit innovation and commerce - The World Trade Organization (WTO) and the North American Free Trade Agreement (NAFTA) require that participating countries base their animal health requirements on relevant international animal health standards and both WTO and NAFTA have recognized the Office International des Epizooties (OIE) as the official forum to develop and promote these standards. Codex Alimentarious (Codex) will serve a similar role for food safety standards.
OIE was established in 1924 (part of the League of Nations) as an international veterinary organization to facilitate intergovernmental cooperation to prevent the spread of contagious diseases of animals and other cooperative animal health goals. In 1968, OIE started the International Animal Health Code (Code) to be utilized by member countries to resolve animal health issues and has long maintained the List A and List B disease categorization for infectious diseases of particular importance. OIE will play a key role in promoting the development of risk assessment standards and guidelines necessary for the implementation of regionalization throughout the world.
OIE operates under an International Committee formed by delegates of its member countries (127+ member countries) which meets in a general session once a year in Paris. This committee rules, by resolution, on all questions pertaining to the mission and operations of the organization.
I am not affiliated with OIE, nor am I knowledgeable about the ins and outs of its operations. However, in my opinion, the organizational structure of OIE, which restricts voting membership to one government representative per member country and does not allow, as voting members, livestock producers, veterinary practitioners, state veterinarians, allied organizations and researchers will severely limit OIE innovations and its adaptability to commerce. Its structure, in my opinion, weeds out and forbids voting membership to the very people with the knowledge necessary for solving animal health problems in a noneconomically disruptive, industry compatible manner. No doubt there are other world trade agencies with similar characteristics.
b. Global USAHA needed to counteract OIE deficiencies - In 1897, the USAHA was formed to deal with interstate and international animal health issues. Over the past 100 years, the organization has developed characteristics that paved the way for the U.S. to be highly effective in solving animal health problems through federal/state/industry cooperative programs. The characteristics most important to its success and which assure the right people are involved in discussing and resolving a problem are as follows: • It is a science-based, national, problem-solving forum for all interested parties.
• Each member has one vote.
In my opinion, there is a need in 1996 to initiate development of a global USAHA-like forum to counteract the organizational deficiencies of OIE discussed above. Just as USAHA has served as an effective and independent forum to guide U.S. regulatory agencies towards effective solutions, a global USAHA is needed to guide OIE and other world regulatory agencies, such as Codex.
Abdicating responsibility for animal health issues related to national or international trade to a purely governmental regulatory fiefdom will, in the author's opinion, inevitably lead to reduced trade and unacceptable disease risk.
c. APHIS regionalization proposal needs your review and comment - APHIS proposed rule on regionalization (published in the Federal Register on April 18, 1996) represents a major change in our nation's strategic defense against foreign animal disease incursions into the U.S. All are urged to read this proposed rule and to provide comment to APHIS on its content.
In the author's opinion, a regionalization plan must be intuitively and easily understandable and readily recognized as scientifically and practically valid.
4. Assure preparedness of state animal health agencies - As the federal government downsizes and devolution of responsibility for federal programs is transferred to state agencies, it is imperative to make certain the states have the capability to carry out these increased activities.
Nowhere is this more important than in maintaining a high level of preparedness for animal health programs. As APHIS downsizing continues and as WTO and NAFTA take effect, state animal health agencies will play a much larger and key role in national and international animal health, including preparedness to stamp out foreign animal disease outbreaks. The central role of State Veterinarians in the recent Russian/U.S. poultry trade dispute is an example of these responsibilities. It is critical that we support the efforts of State Veterinarians to maintain a high level of preparedness for these increased responsibilities.
a. USAHA accreditation program for state animal health agencies - The author recommends the development of an accreditation program for state animal health agencies, based on uniform standards for resources and programs, which would provide State Veterinarians with a periodic comparative review of their agency's strengths and weaknesses and specific recommendations for improvement necessary to attain or retain accreditation. Such an accreditation review and recommendations would provide State Veterinarians with a valuable management tool for use in planning and budgeting within their agency, administration and legislature.
The proposed accreditation would be similar in nature and purpose to the accreditation program for U.S. veterinary schools, administered by the American Veterinary Medical Association, and the accreditation of diagnostic laboratories, administered by the American Association of Veterinary Laboratory Diagnosticians. The organization most capable of administering this proposed accreditation program for state animal health agencies, in my opinion, is the USAHA.
State veterinarians and industry are encouraged to discuss the pros and cons of such an accreditation. The National Assembly of Chief Livestock Health Officials and regional meetings of the USAHA would provide a good forum for discussion as well as the USAHA annual meeting and within allied organizations. Should the idea have merit, the National Association of State Departments of Agriculture could play a significant role in calling for such accreditation and designating a recognized accreditation body.
b. Practitioner cadre with APHIS FAD accreditation - State Veterinarians Larry Williams (Nebraska), Clarence Siroky (Montana) and others have called for the development of a cadre of private veterinary practitioners with foreign animal disease (FAD) accreditation by APHIS to buttress state and federal agency and industry preparedness to stamp out foreign animal disease outbreaks. c. Defined roles for agencies, industry and practitioners - State Veterinarian Terry Beals (Texas) and others have called for the development of new national model for emergency preparedness in which specific emergency preparedness roles and responsibilities are spelled out for state and federal agencies, industry, veterinary practitioners and researchers. Rather than all levels trying to cover the same roles, a defined division of labor is seen as essential in this environment of a general downsizing of the public sector.
d. Block grants to state animal health agencies - National debate on the devolution of responsibility for certain federal programs to states, such as welfare, has resulted in the idea of transferring federal block grants to the states to provide the resources to carry them out. In the author's opinion, block grants should also be considered when responsibility for animal health programs is transferred to the states.
IV. LCI and USAHA proactive leadership essential - As we continue in this environment of government downsizing, devolution, reinvention and budget transition and international regionalization and harmonization of animal health standards, we face continuing uncertainties about our nation's preparedness to stamp our foreign animal disease outbreaks. This is, indeed, a time to gather together all those with the ideas and the knowledge necessary to counter these uncertainties.
We are fortunate in this country to have had the foresight to develop the LCI and the USAHA, both of which are science based, national forums for industry, state and federal agencies, practitioners and researchers. Between them, there is 180 years of experience, commitment and success in: a) problem solving, planning and coordination; b) information dissemination and communication; c) development of uniform methods and; d) developing national consensus (LCI: 80 years; USAHA: 100 years).
Through the proactive leadership of LCI and USAHA and other organizations, these and other concerns can be addressed and our regulatory agencies guided towards effective, industry compatible, noneconomically disruptive means to assure a continued high level of preparedness to stamp out foreign animal and poultry disease outbreaks.
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