The Food and Agriculture Organization of the United Nations (FAO) has been in the forefront of the global effort to fight highly pathogenic avian influenza (HPAI) over the last eight years since its emergence in Southeast Asia. FAO's collaborative HPAI global programme has significantly contributed to limiting the impact of the disease, establishing stronger national systems and strengthening regional coordination for disease preparedness, prevention and control, the organisation says. With the continuous support of the international donor community, national governments, regional and international organisations, development agencies and international development banks, sustained coordinated action has progressively reduced the number of countries affected by H5N1 HPAI and the disease has now been eliminated from most of the countries in the world. This result was achieved by assisting national veterinary services to develop preparedness and contingency plans, by improving surveillance systems that interface between animal and public health authorities, by acquiring laboratory resources and disease diagnostic capacity, by developing response capabilities, communication and awareness and by promoting biosecurity along the value chain.

Since the emergence of zoonotic H5N1 HPAI, the disease situation has evolved considerably. Currently, H5N1 HPAI is endemic in Bangladesh, China, Egypt, Indonesia, Viet Nam and large parts of eastern India. A number of countries in Asia, including the Lao People’s Democratic Republic, Cambodia, Myanmar and Nepal, also experience regular but sporadic, outbreaks.

According to FAO, a number of elements that inhibit progress towards disease control, prevention and elimination from the poultry sector are common to endemically infected countries/regions.

The major identified challenges in endemic countries fall into three groups:

• the structure of the poultry sector (i.e. production and marketing or trading methods)
• weaknesses in veterinary services and animal production services; and
• insufficient commitment from the public and private sectors to elimination of the virus.

Measures have been introduced in these countries to address the major identified challenges, but all require further long-term commitments and investment if the virus is to cease being a threat to human health and safe and efficient poultry production, reports FAO. To move forward, each of the endemically infected countries should implement activities that take them closer to virus elimination and reduce the prevalence of disease in poultry and humans, progressively building upon the gains made since they first reported cases of the disease.

In the past few years, a newer variant of the H5N1 virus, referred to as clade 2.3.2.1, has emerged and expanded its geographic range from Southeast Asia to East Asia, South Asia and Eastern Europe. Some variants of clade 2.3.2.1 are different enough from other H5N1 avian influenza clades so that poultry vaccinations are becoming ineffective in some countries. This clade appears to have evolved in domestic poultry in China with altered characteristics and a higher virulence in wild birds. The virus clade 2.3.2, in its various forms, exists in China and may continue to expand its geographic range from Southeast Asia to other regions.

The report continues that the information generated from isolation, and genetic and antigenic characterisation of a large number of viruses in Asia and other parts of the world, coupled with the information on disease outbreaks, has improved our understanding of the virus's evolution and its implications with regard to its spread, infectivity and suitability for use in development of vaccines. The current trends in evolution present a number of concerns and work will need to continue on surveillance and virus isolation and characterisation.

Changes in the virus and technical challenges with current vaccines, especially to prohibit or protect infection ducks, as well as the need for vaccine options and flexibility per production settings, necessitate improved vaccine tools. Vaccination discussions and guidance at the global level would benefit endemic countries’ further development of comprehensive, sound vaccination policies with clearly defined exit strategies.

Successful animal health programmes involve engagement and partnership from all levels. Also, countries require sufficient and sustained investment in animal health services. Essential aspects include capacity to prevent, prepare, detect and respond (e.g. adequate numbers of trained personnel, surveillance and laboratory capacity, appropriate biosecurity, and vaccination tools), coordination, communication and socio-economic analysis to understand the causes or drivers of disease.

Coordination must be at all levels – local, national, regional and global. Global efforts provide frameworks in a systems approach upon which more targeted regional, national and local disease prevention, detection, control, response or eradication plans are efficiently designed, implemented and monitored, including required adjustments made with inputs from the private sector. Regional HPAI and other disease plans have centred on communication, coordination, surveillance, and data gathering and analysis. In 2011, FAO conducted or supported annual regional coordination meetings in all regions where FAO projects exist (North Africa, West/Central Africa, Eastern Africa, Southeast Asia, and South Asia). Pathogens and vectors do not recognise political or geographical boundaries and today's globalised world increases that reality. Animal movement, trade and human movement as well as endemic, emerging and re-emerging pests and diseases around the world will demand a continuing and improved level of global and regionally coordinated infrastructure and discussion.

Additionally, FAO's activities have fostered collaborations at the local and national level. For example, before the pandemic threat, in many countries, the ministries of agriculture, human health, wildlife, environment or food safety did not work together. To deal effectively with HPAI at the national level, many countries put inter-ministerial structures of coordination into place to enable a national systems approach to respond better to the threat. While HPAI and the potential of a pandemic served as the impetus for initial or improved intergovernmental coordination, the experiences of coordination between animal health and human health authorities in dealing with HPAI also bode well for future collaboration. Foundations have been laid for these authorities to better address other animal diseases, zoonotic diseases and for collaboration on possible emerging infectious diseases. Additionally, inter-ministerial and crosssectoral collaborations develop trust among partners and cross-pollinate areas of expertise.

The HPAI systems approach has matured to apply a methodical systems framework approach to foot-and-mouth disease (FMD) which culminated in the development of the FAO/OIE progressive control pathway for FMD (PCP-FMD) in 2011. The approach is currently in process for other high impact diseases such as brucellosis, contagious bovine pleuropneumonia (CBBP), peste des petits ruminants (PPR) and rabies. PCPs help countries ascertain where they are in regards to the particular disease, so that they can then progressively reduce the impact and load of the disease agent through improved risk management based on surveillance studies and targeted interventions. PCPs are a working tool in the design of country, and some regional, control programmes.

Activities in 2011 also included extensive efforts for integrated training of field and laboratory personnel in design and analysis of surveillance data to improve coordination at country and regional levels, including the Field Epidemiology Training Programme for Veterinarians (FETPV) and the laboratory and epidemiology networks. FAO expanded FETPV to develop a human-wildlife-environment interface module, which will be delivered to more than 45 countries by mid-2012.

Surveillance is now a risk-based, targeted and more comprehensive approach that recognises the dynamic and complex nature of today's world, continues the FAO report. Current activities are to integrate environmental and food safety data into the wildlife, livestock, poultry and duck data so that a more integrated comprehensive picture of a particular disease or pathogen can be used to better inform decisions, which, in turn, leads to improved results. Included in this activity are innovative means of data collection (e.g. mobile devices, participatory approaches) that reflect today's global world and provide flexibility for the structures of each country and local community.

FAO has been emphasising the need to shift away from didactic, top-down communication towards processes and tools that are driven by deeper community participation and voluntarism. The communication strategies developed are also tailored for the multiple stakeholder levels, outlets and consumers.

HPAI highlighted the importance of understanding stakeholder behaviour and how it can affect disease spread as well as its management and control. Incentives for stakeholders and the context within which they operate must be understood and taken into account.

Successful disease control interventions or programmes, require stakeholder engagement up front, a detailed value chain assessment, control impact assessments and economic cost/ benefit analysis, including assessment for other livestock sub-sectors. Engaging and including stakeholders from the beginning will enable practical sustainable solutions, balancing disease control needs with human livelihood needs. Socio-economic work is now concentrating on improving the understanding of the livelihoods, demands and decisions made by livestock producers, on the economics and relationships they have across the value chains, and on identifying gaps in technologies within this context. Additionally, these efforts will provide useful information to improve many of the outstanding biosecurity issues in endemic countries.

FAO says that, while much progress has been made, HPAI remains a significant threat to the poultry industry, destabilising agriculture in countries where backyard farming of domestic ducks is common, impacting the food security and livelihood of millions of people and maintaining a very real potential for emergence of a pandemic human influenza. Despite the fact that nearly all H5N1 human infections to date appear to have been the result of transmission of the virus from poultry to people, the continued presence in poultry in numerous countries, its tendency to quickly mutate and change, its ability to infect humans and its continuing high case fatality rate remain a concern. A continued pandemic potential is extra troubling given the mounting evidence of increasingly active bi-directional swine-human virus genetic exchange in the form of reassortments of H3 and H1 viruses. Also, it appears that 2011 marked an increase of avian origin H5N1 and H9N2 virus segments into the swine gene pool.

None of the successes against H5N1 HPAI and other transboundary animal diseases (TADs) could be possible without technical, policy and funding partnerships. At its peak, FAO's HPAI global programme comprised 168 donor-supported projects, of which 64 remain active, with more than half of them in Asia. Coordination and partnerships at the local, national, regional and global level have been essential in the eight-year HPAI effort in all countries. Coordination and a concerted, sustained effort are vital in endemic areas. FAO has played a central role in forging and coordinating partnerships among a number of players and stakeholders involved in the control of HPAI and other high impact emerging and re-emerging infectious diseases.

These have included partnerships with national governments, non-governmental organisations (NGOs), donors, national and international research institutes, regional organizations and other international developmental and technical agencies.

These collaborative efforts to address the problem of H5N1 HPAI have clearly yielded significant results. Yet much work remains to be done to further address ongoing influenza threats as well as other zoonotic and TADs.

Due to the H5N1 HPAI pandemic experience, the FAO report says that the global conversation has begun to move away from emergency response against individual diseases towards including more measured and integrated action for the long-term prevention of endemic, emerging and re-emerging infectious diseases. FAO has taken the lessons learned from the HPAI global programme and is applying this knowledge in approaches to the control of other emerging infectious diseases (EIDs) and high impact TADs, in addition to HPAI. This work is being done in the context of a 'One Health' strategic framework, the FAO Action Plan (AP) (2011–2015) entitled, Sustainable animal health and contained animal-related human health risks – in support of the emerging 'One Health agenda. The goal of this plan is to establish a robust global animal health system that effectively manages major animal health risks, paying particular attention to the animal-human-ecosystem interface, and placing disease dynamics into the broader context of agriculture and socio-economic development and environmental sustainability.

'One Health' addresses threats and reduces risks of emerging and re-emerging infectious disease through a collaborative, international, cross-sectoral, multidisciplinary approach. FAO has taken the lead in advocacy to develop regional and local mechanisms and platforms for intersectoral work and the Action Plan, in part, is designed for local level implementation. A suite of tools, such as simulation exercises, risk assessment along value chains, and livestock field schools are available to bring together different relevant sectors to identify strengths and weaknesses of the coordination, cooperation and communication for emergency preparedness. The actions recommended are risk-based and tailored to the local context engaging the people involved through participatory processes. The Action Plan promotes a proactive approach to disease risk management. All actions of the Action Plan aim at sustainability and ownership by countries and regions and range from immediate to long-term actions with a developmental perspective.

Advocacy initiatives at the country and regional level provide a wider focus on infectious diseases of high impact and facilitate information sharing, improved evidence-based decision- making and a more strategic and effective long-term prevention and response capacity for animal, human and zoonotic pathogens.

To date, the 'One Health' approach has been used to address infectious diseases but it has been recognised that this framework can be used across disciplines to address a wider range of issues across the three health domains. The FAO report concludes that, while the aetiology of 'One Health' stems from infectious diseases, it is clear that the application of this approach can contribute to ensuring global food security.

Further Reading You can view the full report by clicking here.

December 2012