Recent zoonotic disease outbreaks such as the COVID-19 crisis have highlighted the link between human and animal health, making it evident that a greater investment in animal health systems must be prioritised. But what can vets bring to the table when managing pandemics such as the recent COVID-19 crisis?
This question was discussed as part of the British Veterinary Association (BVA) Congress at the first face-to-face event of 2021 for the whole veterinary profession, the London Vet Show. With BVA Junior Vice President Malcom Morley chairing the session, Christine Middlemiss, the UK’s chief veterinary officer (CVO), and Klara Saville, head of animal health, welfare and community development for Brooke, explored “the role of vets in pandemics”.
Why is a One Health approach important?
The spread of infectious diseases is likely to become more prevalent by 2030 due to climate change, population growth and the return of travel. This return of movement, of “more people, more often, more places”, creates risk pathways for the introduction of infectious diseases, many of which will be zoonotic or reverse-zoonotic, explained Christine. “As well as diseases of pandemic potential, there is also a heavy burden of endemic zoonotic disease, and people in poorer countries bear the greatest burden of this,” added Klara.
‘One Health … really matters in pandemic prevention’ but it ‘has to [involve] humans, animals and the environment in an integrated fashion’
“One Health … really matters in pandemic prevention” but it “has to [involve] humans, animals and the environment in an integrated fashion,” observed Christine. “Historical underinvestment in animal health systems globally has led to under-resourced veterinary services and critical shortages in veterinary resources,” explained Klara. And yet, “we know that people are healthier, safer and better off when the livestock and other animals around them are in good health”.
Understanding the role of animals in the emergence of the COVID-19 virus and in other zoonotic diseases is essential in building a universal picture which answers the questions of how the virus works, especially when our knowledge and the disease themselves are constantly changing and evolving. Vets therefore have a crucial set of skills and expertise to share, both in how to prepare for and in how to deal with a pandemic.
What role can vets play in pandemics?
Christine suggested that vets’ past experiences with disease outbreaks in large populations, as well as what has been learnt from them, are key aspects they can bring to the table.
The CVO went on to explain that vets, not only those with a veterinary degree but the entire veterinary team and those who support their work (such as epidemiologists, scientists, data analysts, etc), are constantly coping with the outbreaks that they have experienced while preparing for those that have yet to come. With this comes an understanding of how to bring evidence, intelligence and data together to make it into something that can be acted upon. Vets have experience converting evidence into coherent and collated data, and then converting data into action, both in managing current outbreaks and in preparing for future eventualities.
Vets have experience converting evidence into coherent and collated data, and then converting data into action, both in managing current outbreaks and in preparing for future eventualities
The processes, technologies and knowledge useful in animal health could be adapted and altered for public health, making vets a potential font of knowledge that could be tapped when it comes to disease control and prevention strategies. “Vets have experience in these things,” declared Christine, “yes, [our patients] might be four-legged and not two-legged, but you are controlling a virus in a large population.”
What can be learnt from veterinary experiences with animal disease outbreaks?
Communication is key
In her personal experience, the “biggest” lesson that Christine learnt as a result of the 2001 foot and mouth disease outbreak “wasn’t something really technical and clever, it was the importance of communication”. Christine thanked the organisations such as BVA and the Royal College of Veterinary Surgeons who were key in communicating information to the profession amid the COVID-19 pandemic, utilising multiple platforms to get word out quickly, coherently and accurately.
With all the different people involved in the processes from the UK farm to the international fork, you need to ensure that information is passed across the spectrum and that everyone’s voices, concerns and opinions are heard, said Christine. Cross-government teamwork is “not just about pandemics, [it’s] about every day, all the time,” she remarked. “We all share the risks that the outbreaks bring and we all have responsibility in managing [disease].”
Good biosecurity involves global collaboration
On an international scale, collaboration and communication is even more crucial, especially in terms of biosecurity. “We are only as strong as our weakest health system,” Klara reminds us. In fact, Christine observed that achieving coherence and understanding surrounding pandemics is something we have seen international medical organisations struggle with, especially with different countries making their own policies in regard to COVID-19.
On an international scale, collaboration and communication is even more crucial, especially in terms of biosecurity. “We are only as strong as our weakest health system,” Klara reminds us
The veterinary profession has systems in place that create a “global animal health system”, a term Christine used to describe the “international down to farm-level standards system” that provides trust and assurance in animal and animal products when trading. Trade standards that are internationally recognised and adhered to mean better biosecurity as other countries are assured in a product’s safety by use of competent authority systems, certification providing a trusted professional guarantee that products are safe, and disease regulation and control which can be validated by international systems.
One example of this international collaboration which fuels trade standards and thus biosecurity is the World Organisation for Animal Health (OiE), which involves a collaboration between 183 countries coming together annually to discuss animal health and welfare on a global scale. Though it is a slow process and the group does not provide legislation, the OiE provides a baseline that balances the needs of humans and animals in a way that incorporates the situations of multiple countries and people with differing processes, needs and cultures.
The OiE provides a baseline that balances the needs of humans and animals in a way that incorporates the situations of multiple countries and people with differing processes, needs and cultures
Christine gave the example of recent debates surrounding banning the use of cages in poultry farming. In countries that are better-off economically and where the public perception of welfare ideas is really high, there is a desire to ban cages. But for some countries animal products such as eggs are a vital food source and by setting standards that they cannot afford you risk potentially damaging their population’s access to nutrition.
“Animal health systems include the workforce and the training that they receive, access to essential veterinary medicines, the diagnostics and surveillance systems, and also the financing,” stated Klara. But they must also “empower and integrate the users of that system, enabling them to hold to account those who are making decisions”.
Strengthening international animal health systems
Klara, however, argued that “animal health systems need strengthening in order to contribute to the operationalisation of One Health”. In Ghana there are 63 veterinary officers across the whole country, when actually 683 are needed to meet demand. This “impacts the ability of communities to report diseases and to access animal health services, and therefore potentially increases the number of disease outbreaks,” she explained.
The way to provide long-lasting change, argues Klara, is not to simply fly in support, equipment and expertise, but to build on existing infrastructures
But the solution is not a simple one. The way to provide long-lasting change, argues Klara, is not to simply fly in support, equipment and expertise, but to build on existing infrastructures: “There is a wealth of expertise out there, there are really good training institutions that just need some support to ensure that that change can be sustained by national governments in the absence of external support.” This also supports pandemic prevention in other countries as by managing risks at an international level you are also “managing down [y]our risk”, Christine states.
Brooke’s animal health mentoring framework is an example of this which has already been adopted by the Ethiopian government and by training institutions in Pakistan and Kenya. It is a scheme that is rooted in competency- and outcome-based education, and focuses on building practical skills, clinical competency, animal welfare awareness and building mentees’ confidence. Communicating your knowledge in this way and collaborating with others to strengthen the infrastructure will provide a more sustainable and effective animal health system worldwide.
Preventative measures and risk management schemes
“Detecting zoonotic diseases early and managing them before they jump into the human population is essential,” highlighted Klara. But she also observed that “vets play a role not only in detecting disease of pandemic potential, but also in the day-to-day control of the kind of diseases that don’t make the headlines but, left unchecked, cause severe suffering for animals and humans”. Thus, the risk management schemes and preventative measures put in place by veterinary teams play an essential part in the role of vets in pandemic control.
Restrictions and lockdowns
While the COVID-19-related lockdowns were a novel experience for humans, lockdowns and regionalisation are very common practice for animal outbreaks
Putting in place restriction zones is a key example that is currently being used to minimise the spread of avian influenza in the UK. While the COVID-19-related lockdowns were a novel experience for humans, lockdowns and regionalisation are very common practice for animal outbreaks. “It was quite frustrating to think … we could come to the table and help, and tell you about some of the things we’ve learnt [about], not technically how to do it, but how to communicate it to people,” stated Christine. She explained that when you suspect a potentially infectious case you immediately put down restrictions on that farm, and when the case is confirmed, you control the movement of animals within 3 and 10km zones, minimising the potential spread of an outbreak.
Horizon scanning
Horizon scanning is also a crucial aspect of surveillance for veterinary teams according to Christine. Being aware of what is going on internationally, collating the soft and hard information and sharing this data with medical colleagues and other professionals such as the government’s scientific advisors can provide a “heads-up” to start planning and processing.
“We do it in the animal space,” she stated, “but we also do it jointly every month with our human colleagues and with the Met Office.” Horizon scanning demonstrates that “if there is an earthquake going on here, actually people might move, that might spread human disease – they might take their animals with them, and starting to link [things] up.” Furthermore, in the UK “we are looking to join this [process] up with our international colleagues so that it is not just the information we perceive … but it is [a] much more robust, international, global information process,” the CVO declared.
Conclusion
The veterinary profession continuously learns from past experiences when putting in place risk management systems. One example given by Christine is the creation of the Veterinary Risk Group, which was a response to the Anderson review of the foot and mouth disease outbreak of 2001, and the suggestion that there was a need for a “regular, consistent, systematic, understanding approach to identifying and assessing animal health risks”. Another example of this is the development of HAIRS, the Human Animal Infection and Risk Surveillance group, which assesses the risk specifically for zoonotic threats as part of the UK’s risk management cycle.
The veterinary profession continuously learns from past experiences when putting in place risk management systems
“More people are now aware of the pandemic potential of spill-over disease and that 75 percent of emerging human infections are of animal origin,” observed Klara. So, as the risk of zoonotic disease rises, the knowledge and expertise that vets have gained from their experience in combatting, managing and preparing for large disease outbreaks will be essential for a One Health approach to minimising the risk to animal and human health alike.
