THE celebratory day at the Royal Veterinary College for Professor Joe Brownlie, after 41 years of research and now impending retirement, was a glittering affair.
At the all-day conference on Who Owns Disease?, there were more professors and learned folk than you could shake a stick at, and you needed to be at the banquet to understand why the good professor was wearing thick rubber gloves, holding a wire coat-hanger in the left hand and a rubber mobile ’phone with a lighted sparkler attached in the right.
He was also clutching a battery-operated mooing plastic cow. If you haven’t made the connection, the clue is that it was all to do with the detection of disease, so eloquently promoted by many of the speakers.
The agenda introduction to Who Owns Disease? is worth careful consideration. “Infectious diseases can threaten all of us, our communities and, on occasions, our nation. They can re-emerge, evolve or even emerge anew. From a recent Foresight programme (www.foresight.gov.uk), it is clear that the risks are ever present; with one new worldwide infection every eight months. The majority of these appear to ‘jump’ from animal reservoirs.
Confused
“The technology for their diagnosis is impressive although not universally implemented. However, the issue of ‘who’ is responsible for the diagnosis and control of disease is at best confused.
“Without a proper understanding of ownership, there can be no clarity about responsibility. The line between personal responsibility, organisational responsibility and overall government responsibility is too often ill defined; such obfuscation prevents effective management and control of potentially life-threatening events.”
The day was opened by Professor Quinton McKellar, principal of the RVC, who set the tone of, on one hand, complimenting Joe Brownlie for his achievements while at the same time commenting on his claims for travel and hotel arrangements.
This approach was taken up by the majority of the speakers and antics of the class of ’66 at the Bristol veterinary school, that yielded seven professors, was blended in with some very serious observations about disease.
Peter Kendall, president of the National Farmers Union, concluded that food production is a serious business and needs to be valued by all of society. The farmer has ownership of the prevention of disease and a responsibility to be aware of disease risks. He highlighted TB as a disease where the farmer is currently unable to take control. Farming is a risk business and the concept of ownership of disease is new to farmers and new challenges expose weaknesses in the idea of ownership.
Working together
The farming industry would wish to take ownership but cannot do so in its entirety; there has to be a way forward by working together in groups. His observations provided a sound grounding to what was to follow and established the absolute need for cooperation and understanding.
A few days before the conference, the England Implementation Group of the Health and Welfare Strategy had been disbanded by the Minister and Dick Sibley, a former member of the EIG, was unsure what this meant for future control of disease.
He was tasked to speak about the endemic challenge but one couldn’t help feeling that there were other challenges that needed to be addressed. He is unlikely to have been disappointed with the observations of the speakers who followed.
To combat endemic disease, Dick Sibley highlighted the need to be clear whether the aim is freedom from disease, control of disease or tolerance of disease.
Veterinary surgeons and farmers are finding practical ways to manage risk and four pillars of risk – disease entry, surveillance, manipulation of immunity/resistance, and control within a herd – were highlighted.
Struggling to engage
He admitted that his own practice in Devon is “struggling to engage with farmers who are being sapped by TB”.
Current practices of animal movements and trade are increasing the risks of spread of disease. Sharing of workers, direct contact with the animals on neighbouring farms and buying in of replacements are major risks of local biosecurity. Competition between farmers, instead of collaboration, is built into the payment structures.
The way forward is for motivation, not regulation. Risks and risk management need to be properly identified, best practice incentivised, poor practice discouraged and costs should not be transferred to industry for things that are not under their control.
Professor Sir David King of Oxford University,aformer chief scientific adviser to the Government, addressed the global challenge. From this point on in the day, the issues just seemed to get bigger and bigger.
To hear about the on-going work for global governance of disease and the production of “a long-term vision for the detection, monitoring and identification of diseases across plants, animals and humans” was sobering.
It was stated that 80% of human disease was derived from animals and that the key to infection control was early identification. The recognition of the increase in global temperatures, with the highest ever levels of carbon dioxide, enforced the need to feed science into policy decisions.
The function of air travel in the spread of human disease, specifically with swine fever and bird flu, was emphasised.
The first of the class of ’66 to present was Dr George Poste from Arizona State University, with a fastmoving account of global preparedness. The text of his talk, The challenge of global preparedness for outpacing infections and parasitic preparedness is available from george.poste@asu.edu.
Credit was given to the Bill and Melinda Gates foundation for financing work on TB and the issue of the evolution of microbial resistance with TB.
“You cannot have zero risk,” he said, and he highlighted the difficulties of traceability moving down the chain and blaming the farmer for disease. Improved diagnostics saves lives and the need is to “profile, sense and act”.
Global sourcing leads to global vulnerability with the example that China and India now provide 94% of US medicines. Improved knowledge of the host pathogen pathology is essential with people working in the field to be aware of their role in the global picture.
‘One health’
The task is to rebuild the global public health infrastructure for both animals and humans – “one health”.
Later, Nigel Gibbens, the chief veterinary officer at DEFRA, outlined the department’s responsibilities. The thrust was that the Government would intervene where the market on its own could not deliver and that there was a shared responsibility for the response to disease.
He said that the share of Government for health and welfare was not expected to increase but that co-operation was anticipated rather than increased regulation. A closing observation was that DEFRA is expecting to respond to demand from the livestock community.
Exotic threat
The exotic threat was addressed by another member of the class of ’66, Professor Mark Rweyemamu of Sokoine University in Tanzania.
Highlighting the spread of type 0 foot-and-mouth disease from India in 1990 to the UK in 2001, the question was raised, “What would have been saved if the disease had been stopped in India?” Surveillance begins at the source of the epidemic, not at home.
Other questions were raised. Can technology overcome the constraints of human deficiencies? Is veterinary medicine in a position to assume expanding responsibilities?
Disease moves around humans, livestock and wildlife and an understanding of the dynamics of trade is important. The professor concluded that exotic is an inadequate concept and that trans-boundary is more appropriate.
Dr Ian Thompson of Novartis Animal Health explained that ownership for pharma includes technology restraints, research funding and intellectual property. Investors need a degree of ownership but a high level of proof of concept is not required before funding by commercial interests.
He warned, however, that if there are too many stakeholders, there is too little action. It was left to Joe Brownlie to indicate the scientific priorities, relevance and conclusions, which provided a stimulating insight. Using the example of the farmer who sells his cows because he believes they may fail the TB test, the question was raised, “If the farmer doesn’t know about disease in his animals, is he responsible?”
Partnership between the farmer, the vet and the neighbours to the farm, with biosecurity, are important for diseases that move.
An earlier speaker had shown a slide with animals in a fog, concluding that the answer to “Who owns disease?” is foggy. With ownership and responsibility, the roles of the farmer, the vet and government are not fully defined. Some good news is that rinderpest has been eliminated: the world owned this disease and it has been removed. The debate on “Who owns disease?” has only just started – but it is “critically important”
