Veterinary Public Health

Since the early 1970s, the PAHO/WHO Veterinary Public Health (VPH) program has been applying veterinary skills and knowledge to advance human health.

In the last ten years between 60% and 75% of human diseases (globally) have been caused by pathogens arising from animals and animal products. The VPH program at the Office of Caribbean Program Coordination (OCPC) has therefore been providing support to member States to address sub-regional policies and program planning and the adoption of measures to ensure that appropriate structures and persons are are available to make timely interventions.

The areas of concern to the Veterinary Public Health Program can be summarized as:

• Safety of foods for human consumption with emphasis on foods of animal origin
• Prevention and control of food-borne diseases
• Prevention and control of zoonoses of public health importance
• Strengthening of Animal Disease Surveillance Programs to facilitate public health prevention and control strategies
• Promotion of animal health to boost production, and enhance food security and socioeconomic development
• Promotion of environmental protection to minimize public health risks from the impact of animal health and production programs
• Development and promotion of biomedical models for health research

Strategic Planning

The VPH program at the OCPC has been making strides within the Caribbean sub-region in matters related to:

Technical cooperation is provided to sub-regional countries to reduce breeches in food safety, ranging from food contamination at the farm to [something at] the processing, manufacturing, preparation and distribution levels. The VPH program assists Member States in identifying and addressing food safety challenges caused by

• improper handling and unhygienic practices,
• animal contamination of the environment, and
• manufacturing or industry-driven activities (meat inspection, the use of food additives.)

Since the early 1990s, much work has been done in supporting countries to adopt principles associated with the Hazard Analysis Critical Control Point (HACCP) methodology.

Other VPH concerns include:

• public health risks arising during or after natural disasters from zoonotic or other diseases;
• monitoring the disposal of carcasses;
• handling surviving animals (inclusive of feeding and rearing); and
• prevention of accidents associated with animal bites (including snake bites and poisonings).

Considering that over thirty human cases of leptospirosis were associated with the 2005 flooding in Guyana, the sub-regional VPH program has been intensified to work with in the reduction of human infections/diseases (zoonoses) that can occur during or after such disasters, and to implement a preventive strategy based on minimizing endemic zoonoses through Interventions at the pre-disaster stage.

Health Sector Challenges

The VPH program is applied to issues surrounding the Essential Public Health Functions (EPHFs), developed by the World Health Organization, the Centers for Disease Control and the Pan American Health Organization to improve public health leadership practice.

It takes into account the findings of a 2001/2002 study that indicated Caribbean countries performed very weakly in "Quality Assurance in Personal and Population Based Health Services" and in "Public Health Research". In the latter case, the assessment showed that there was little or no allocation of resources to this function by Ministries of Health, and that there were poor linkages with the educational institutions to influence their research agendas. Not much has changed since the 2001/2002 assessment, but there is still a role for the VPH program in research activities, whether linked to communicable diseases or non-communicable diseases associated with veterinary drug residues and chemical additives in foods.

The VPH program is restricted by Human resource challenges including:

• regulation of health professionals,
• harmonization of training programs,
• high costs of training outside of the respective countries and the sub-region,
• the lack of human resource plans, and
• poor performance management.

The VPH program is committed to contributing to

• increase in the public health workforce,
• building leadership capacity, and
• fostering greater partnership and alliance with sub-regional tertiary institutions particularly in the areas of research and training.

Specific VPH Issues and Challenges

Within veterinary public health in the Caribbean sub-region, there is a lack of clear guidelines on the roles of various veterinary personnel. Veterinary public health matters in most member States must be dealt with through Veterinary Services Divisions in the Ministry of Agriculture since only three countries in the English-speaking Caribbean - Guyana, Jamaica and Trinidad and Tobago - have Veterinary Public Health Units, and all are small with broad-based responsibilities.

The sub-regional VPH program conforms to the Strategic Plan of PAHO/WHO proposed for 2008-2012, and revolves around the following strategic objectives:

The main problems to be addressed therefore are:

1. The lack of adequate surveillance information for measuring the burden of communicable zoonotic diseases and to assist in better preparedness for events such as disasters and pandemics in the Caribbean sub-region.
2. Insufficient core sub-regional capacity for monitoring and responding to challenges of increasing human and animal movement; a growing international trade in food and other products (inclusive of veterinary biologicals); advances in food processing technology; consumer habits and the increasing consumption of street foods; and the overall monitoring of infectious disease events in the Caribbean.
3. Meeting core sub-regional capacities to respond to veterinary public health challenges related to the new framework of the International Health Regulations (IHR) that went into force on June 15, 2007.
4. Inadequate country capacity in the Caribbean sub-region to:
   • avoid adverse effects on health and well-being, as well as on minimization of low levels of school attendance, poverty, and environmental problems, through an improved epidemiological surveillance and data-recording system for neglected zoonotic diseases; and
   • more easily and accurately estimate disease burden.
5. Weak programs for effective control of rabies transmitted by bats in Guyana, Suriname and Trinidad and Tobago; and by mongooses in Grenada.

Integrating Health and other Ministries

The link between health and agriculture is undeniable. Many health determinants are affected or directly linked to activities and programs that are executed outside the mandates of Ministries of Health.

Health concerns that require attention range from food safety issues to bioterrorism threats to which the Caribbean sub-region remains vulnerable.

The VPH program is closely linked to the tourism program in the sub-region, recognizing that the factors affecting the decline in agriculture have also contributed to tourism becoming a mainstay of the economies of many Caribbean states.

But by its very nature, tourism generates a high through-put of travellers, creating an expanding borderless sub-region exposed to health risks from imported emerging and re-emerging diseases of public health significance.

The VPH program therefore sees as one of its crucial roles to build strong partnerships and alliances with public and private sector partners to assist Member States to

• rationalize and maintain efficient and effective agricultural health and food safety systems aimed at facilitating their health and economic needs, and
• more recently to meet the challenges of expanding initiatives under the Caribbean Single Market and Economy (CSME) established by CARICOM.

These goals would be achieved thought efforts to;

• jointly eliminate hunger,
• reduce poverty,
• promote food safety and food security,
• prevent and control the emergence and spread of public health diseases, and
• enhance overall public health.

Achievements:

Opportunities have been created, through fostering alliances, to address political, technical and logistical concerns that affect trade and public health, inclusive of sub-regional issues related to

• policy, legislation,
• capacity building,
• laboratory support,
• risk assessment,
• risk communication and risk management,
• information systems and
• surveillance among other program areas.

In this regard, the competent authorities/experts in animal health, veterinary public health and environmental health have been meeting on a regular basis since December 2003, with support from PAHO/OCPC and networking with the CARICOM Secretariat to make recommendations on current and emerging VPH issues in strengthening animal health and food safety systems and infrastructure.

The Fourth Joint Meeting of the Chief Veterinary Officers, Chief Environmental Health Officers and Chief Veterinary Public Health Officers in Georgetown, Guyana, March 23-24 2005, considered ways to devise systems and mechanisms for more proactive, sub-regional representation internationally on animal health and sanitary issues; for greater collaboration in converging relevant measures, procedures and standards in safeguarding the health of animal human populations in the Caribbean from threats arising from agricultural trade; strengthening the emergency preparedness measures prior to and consequent on natural disasters and emergencies; and to support and facilitate relevant private sector industry needs.

The Joint Meeting Series on Animal Disease Surveillance and Preparedness hosted by PAHO April 3-7, 2006, in Port of Spain, Trinidad and Tobago focused on Avian Influenza (AI) in the Caribbean; specifically

• strengthening the CaribVET network, led by CIRAD, Guadeloupe
• planning and preparation for Avian Influenza in animals, co-hosted by HO, IICA, and the CARICOM Secretariat with input from CARDI and the Caribbean Poultry Association (CPA)
• hosted by the CARICOM Secretariat and PAHO/OCPC and attended by Chief Veterinary Officers, Chief Environmental Health Officers and Directors of Veterinary Public Health (CVOs/CEHOs/DVPH).

A standard certification process for food handlers - a success story with the Barbados Community College (BCC), the Ministry of Health, and the Pan American Health Organization partnering to establish a cadre of Food Safety Trainers certified by the college and now conducting all training for BCC certification of food handlers. A sub-regional forum is to be launched to address similar certification issues in the region, with potential for easy movement of trained persons within the sub-region.

While the Caribbean is considered free of many emerging diseases, controls are essential to prevent their introduction into the Caribbean sub-region. Through a TCC project of PAHO/WHO, selected Caribbean countries (Barbados, The Bahamas, Dominica, Jamaica, Saint Lucia, St Kitts and Nevis, and Trinidad and Tobago)are piloting the application of draft guidelines (May 2004) in port health surveillance and management at the national level. The overall objective of the project is to reduce potential public health risks from the movement of persons and goods at ports of entry.

In response to threats posed by the global occurrence of Avian Influenza, since February 2006, PAHO/WHO in association with Ministries of Health and Agriculture, and the Caribbean Poultry Association (CPA) has conducted workshops in Barbados, Jamaica, Trinidad and Tobago and the Bahamas on Risks, Crisis and Pre-Crisis Communication for Avian Influenza and a potential Human Pandemic Influenza. PAHO/Headquarters convened a meeting in July 2006 for communication and public education personnel to strengthen risk communication skills and develop a region-wide network of risk communicators.

Other Interventions

From February to April, 2006 PAHO OCPC and CAREC carried out an assessment of veterinary laboratories in The Bahamas, Barbados, Guyana, Jamaica, and Trinidad & Tobago seeking to provide assistance in building laboratory capacity. The assessment was a response to a proposal from the School of Veterinary Medicine at the University of the West Indies to establish a Caribbean Veterinary Laboratory Network to ensure appropriate sub-regional capacity for basic diagnosis of animal diseases, particularly AI.