69145 ECONOMIC AND SECTOR WORK PEOPLE, PATHOGENS AND OUR PLANET Volume 2 The Economics of One Health JUNE 2012 REPORT NUMBER 69145-GLB E C O N O M I C A N D S E C TO R WO R K PEOPLE, PATHOGENS AND OUR PLANET Volume 2 The Economics of One Health Report No. 69145-GLB © 2012 International Bank for Reconstruction and Development / International Development Association or The World Bank 1818 H Street NW Washington DC 20433 Telephone: 202-473-1000 Internet: www.worldbank.org This volume is a product of the staff of the International Bank for Reconstruction and Development/ The World Bank. The �ndings, interpretations, and conclusions expressed in this paper do not necessarily reflect the views of the Executive Directors of The World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Rights and Permissions The material in this work is subject to copyright. Because The World Bank encourages dissemination of its knowledge, this work may be reproduced, in whole or in part, for noncommercial purposes as long as full attribution to this work is given. Any queries on rights and licenses, including subsidiary rights, should be addressed to the Of�ce of the Publisher, The World Bank, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522-2422; e-mail: pubrights@worldbank.org. Cover photos: 1) ILRI (CC BY-NC-SA 2.0) – Local chicken in Togo. 2) ILRI/Ram Deka (CC BY-NC-SA 2.0) – ILRI pig production project in Nagaland. 3) Eggybird (CC BY 2.0) – Fruit bat. 4) One Health Global Network – Fish. C O NTE NTS III TABLE OF CONTENTS Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Abbreviations and Acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Chapter 1: Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 The Problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Current Knowledge on the Economics of Disease Control. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 One Health and Knowledge Gaps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Focus of Study and Target Audience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Caveats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Chapter 2: Objectives of the Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Chapter 3: Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Data—Sources and Collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Data Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Chapter 4: Data Limitations and Gaps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Chapter 5: Analysis and Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Avian Influenza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Allocation among Sectors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Allocation among Main Functions (prevention or control) within Sectors . . . . . . . . . . . . . . . . . . . .14 Allocation among Speci�c Tasks within Sectors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Other Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 OIE Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 The Gap Analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 Wildlife Health Service. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 All Zoonotic and Non-zoonotic Diseases Combined (Avian Influenza plus other diseases). . . . . . . . . . . . . .19 Other Analyses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Chapter 6: Extrapolating These Findings to a Global Scale . . . . . . . . . . . . . . . . . . . . . . . . 21 Main Assumptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 The Economic Bene�ts of a Global Zoonotic Disease Preparedness and Control System . . . . . . . . . . . . . 22 Chapter 7: Ef�ciency Gains from One Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 The Data Base . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Potential Savings through One Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 E C O N O M IC AND S E CTOR WORK IV C ONTENTS Chapter 8: Effectiveness Gains from One Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Chapter 9: Conclusions and Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Annexes Annex 1: Glossary of Terms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Annex 2: Additional Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Annex 3: Descriptive Summary of Main Activities in 14 Gap Analysis Studies Related to One Health. . . . . . . 41 Annex 4: Wildlife Services Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Annex 5: List of Countries Differentiated by Income Level. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Annex 6: Potential Savings from the Introduction of One Health Under Two Scenarios . . . . . . . . . . . . . . 49 PEOPLE, PATH OGENS A ND OUR PLA NET VOL. 2 C O NT E NTS V LIST OF TABLES Table 3.1: Budget Data Sources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Table 3.2: Description of Object of Expenditure Categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Table 4.1: Notes on Data Selection, Allocation, and Limitations/Gaps and Possible Suggestions for Future Improvements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Table 5.1: Allocation of Estimated Funding Needs (percent of overall budget) for the Different Prevention and Control Tasks in Animal and Human Health Sectors, Based on 23 Countries . . . . . . . . . . . . . . . .16 Table 5.2: Average Incremental Funding to Bring Veterinary Services Up to OIE Standards for 14 Countries as Reported In the Gap Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Table 5.3: Funding of Wildlife Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 Table 6.1: Estimated Incremental Funding Needs to Bring Prevention and Control of Zoonotic Diseases Up to OIE and WHO Standards in the Human and Animal Health Sectors (by income level) for the 139 World Bank Client Countries (60 low- and 79 middle-income countries) and Two Scenarios . . . . . . . . . . . . . . . . 22 Table 6.2: Annual Expected Rate of Return on Investments in Prevention . . . . . . . . . . . . . . . . . . . . . . . . 23 Table 7.1: Potential Savings Achievable through the Implementation of the One Health Concept in 139 World Bank Client Countries (60 low- and 79 middle-income countries) in Peacetime and Emergency Operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Table 8.1: Summary of the Bene�ts of Closer Coordination and/or Integration of Health Services between Sectors, from Published Case Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Table 8.2: Examples of Disease Outbreaks Where Poor Coordination and Integration Were Shown between Sectors and Impact This Had on the Human and Animal Sectors . . . . . . . . . . . . . . . . . . . . . . . 29 Table A.1: Detailed Economic Losses from Potential Emerging Zoonotics . . . . . . . . . . . . . . . . . . . . . . . . 39 Table A.2: Descriptive Summary of Main Activities in 14 Gap Analysis Studies Related to One Health . . . . . . . . . 41 Table A.3: Main Annual Budgetary Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Table A.4: Low-Income Countries (US$1005 and less) According to the World Bank Criteria . . . . . . . . . . . . . . 45 Table A.5: 139 Eligible Countries (60 low- and 79 middle-income countries) . . . . . . . . . . . . . . . . . . . . . . . 45 Table A.6: Potential Savings from the Introduction of One Health Under Two Scenarios . . . . . . . . . . . . . . . . . 49 LIST OF FIGURES Figure E.1: Early Control of Zoonotic Disease Is Both Cost-effective and Prevents Human Disease . . . . . . . . . . . . ix Figure 1.1: Estimated Costs of Emerging Zoonotic Diseases (1986–2006) . . . . . . . . . . . . . . . . . . . . . . . . . 2 Figure 1.2: Livestock Losses by Type of Disposal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Figure 5.1: Estimated Incremental Funding Needs (percent) to Bring Animal and Human Health Sectors Up to OIE and WHO Standards for the Prevention and Control of Avian Influenza (based on INAP reports from 45 countries) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Figure 5.2: Estimated Incremental Funding Needs per Head of Poultry and per Capita for the Prevention and Control of Avian Influenza (based on 45 countries and aggregate sample). . . . . . . . . . . . . . . . . . . . . . . .14 E C O N O M IC AND S E CTOR WORK VI C ONTENTS Figure 5.3: Calculated Funding Needs for Prevention and Control Tasks for HPAI in the Animal Health Service (US$ per country per year), Based on 23 Countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Figure 5.4: Estimated Funding Needs for Prevention and Control Tasks for Avian Influenza in the Human Health Sector (US$ per country per year), Based on 23 Countries . . . . . . . . . . . . . . . . . . . . . . . . . . .16 Figure 5.5: Estimated Funding Needs (US$ per VLU per year) for the Prevention and Control of Other Diseases in the Animal Health Sector, by Region and Income Group (based on aggregate numbers of nine countries) . . .17 Figure 5.6: Distribution (%) of the Calculated Requirements of 21 Countries by Five OIE Pillars . . . . . . . . . . . . . .18 Figure 5.7: Estimated Funding Needs (US$ per VLU per year) for the Prevention and Control of All Zoonotic and Non-zoonotic Diseases, across the Animal, Human Health, and Planning and Communication Sectors (based on averages of aggregate numbers of all countries) . . . . . . . . . . . . . . . . . . . . . . . . . . .19 Figure 8.1: Illustrative Relationship between Time of Detection of Emerging Zoonotic Disease and Total Cost of Outbreak. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 LIST OF BOXES Box 1.1: Steps in Establishing One Health at the Country Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Box 5.1: Funding a Global One Health Network . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Box 7.1: The Canadian Science Centre for Human and Animal Health, Winnipeg, Canada . . . . . . . . . . . . . . . 26 PEOPLE, PATH OGENS A ND OUR PLA NET VOL. 2 AC K N OW L E DGME NT S V II ACKNOWLEDGMENTS This report was prepared by the staff from the World Bank. The team was led by Jimmy W. Smith and subsequently Francois le Gall (World Bank) and consisted of Sarah Stephenson and Cornelis de Haan (both World Bank consultants). Special input was also provided by Jean Kamanzi (World Bank). The Canadian Science Centre for Human and Animal Health provided valuable information on its experiences in developing a One Health–oriented organization. Preliminary findings were presented at the First International One Health Congress in Melbourne, Australia. A group of high-level experts (Alain Dehove, OIE; Laura Kahn, Princeton University; William “Billy� Karesh, Ecohealth Alliance; Clare Narrod, IFPRI; Nick, H. Ogden, Public Health Agency of Canada; Antonio Rota, IFAD; Mirzet Sabirovic, Department for International Development, UK; Ulrich Sperling, Safe Food Solutions; Henrik Caspar Wegener, National Food Institute, Denmark; and Jakob Zinsstag, Swiss Tropical and Public Health Institute) together with World Bank Staff (Brian Bedard, Armin Fidler, Jean Kamanzi, Jimmy Smith, and Gunnar Larson), World Bank consultants (Cornelis de Haan and Sarah Stephenson), and the facilitators (Nancy White and Marketa Jonasova) reviewed, in a two-day workshop, the first draft. The peer reviewers included several of the group of high-level experts in addition to Brian Bedard (World Bank), Olga Jonas (World Bank), Joachim Otte (FAO), and Joyce Turk (USAID). Olga Jonas also provided significant inputs on the economics of a global zoonotic disease preparedness and control system. The valuable comments of these colleagues are, where feasible, integrated in this report. However, the final responsibility of the report remains with the World Bank. E C O N O M IC AND S E CTOR WORK VIII A B B R EV IATIONS A ND AC R ONY M S ABBREVIATIONS AND ACRONYMS ALive Partnership for African Livestock Development AI Avian Influenza AMA American Medical Association ASF African Swine Fever AVMA American Veterinary Medical Association BSE Bovine Spongiform Encephalopathy CBPP Contagious Bovine Pleuro-Pneumonia CDC Centers for Disease Control CSF Classical Swine Fever DPT Diphtheria, pertussis (whooping cough), and tetanus FAO Food and Agriculture Organization FMD Foot and Mouth Disease GDP Gross Domestic Product GMOs Genetically modified organisms HPAI Highly Pathogenic Avian Influenza H1N1 not an acronym; Pandemic Influenza A, subtype H1N1 H5N1 not an acronym; Influenza A, subtype H5N1 (HPAI Avian Influenza) IDRC International Development Research Centre IFPRI International Food Policy Research Centre INAPs Integrated National Action Plans LSU Livestock Standard Unit (see Annex 1) NPS National Protection Service ND Newcastle Disease OECD Organization for Economic Cooperation and Development OIE Office International des Epizooties (World Organisation for Animal Health) PHAC Public Health Agency of Canada PPR Peste de Petits Ruminants RP Rinderpest RVF Rift Valley Fever SARS Severe Acute Respiratory Syndrome TADs Trans-boundary animal diseases TOR Terms of reference USA United States of America USAID U.S. Agency for International Development VLUs Veterinary Livestock Units WAHID World Animal Health Information Database WHO World Health Organization PEOPLE, PATH OGENS A ND OUR PLA NET VOL. 2 E X E C U T I V E S UMMARY IX EXECUTIVE SUMMARY This report analyzes and assesses the benefits and the costs the economic losses would have been much higher, and of control of an important group of contagious diseases. they would have been accompanied by societal disruptions Zoonotic diseases are caused by pathogens that can infect and a possibly staggering human toll. A 2011 report by the both animals and humans, resulting in disease outbreaks, OECD shows that pandemics are a prime global catastrophic including epidemics in humans and epizootics in animals. threat—a finding that is consistent with a number of other These diseases account for 70 percent of emerging infec- assessments (OECD 2011). Potential losses resulting from tious diseases. In the absence of timely disease control, a severe influenza pandemic, for instance, that leads to zoonotic pathogens can cause pandemics, with potentially 71 million human fatalities would be US$3 trillion, or catastrophic impacts that are global in scale. The report also . 4.8 percent of the global GDP Preventing and controlling zoo- touches on food safety, but does not cover other risks and notic disease outbreaks thus benefits economies and public opportunities at the interfaces between humans, animals, health because epidemics and pandemics do not develop. In and the ecosystem, such as food security and pollution. addition, tackling endemic zoonoses would reduce a major Limiting its focus to this topic matter has important advan- source of human suffering and economic losses that dis- tages, particularly with respect to immediate relevance and proportionately affects many of the poorest households in relative simplicity. developing countries. Echinococcosis, for instance, imposes a human and economic burden in developing countries that The case for control of zoonotic diseases (zoonoses) is each year costs at least 1.5 million healthy life-years as well compelling. The economic losses from six major outbreaks as US$2 billion in livestock losses. of highly fatal zoonoses between 1997 and 2009 amounted to at least US$80 billion.1 If these outbreaks had been Control of a zoonosis requires early and rapid actions. A typi- prevented, the benefits of the avoided losses would have cal episode may involve a pathogen that originates in wild- averaged $6.7 billion per year. Fortunately, none of those life, then passes to livestock, and is then transmitted from outbreaks developed into a pandemic. If any of them had, livestock to humans. As figure E.1 shows, exposure to the pathogen in animals could be followed by symptoms in ani- 1 Nipah Virus (Malaysia), West Nile Fever (USA), SARS (Asia, Can- ada, other), HPAI (Asia, Europe), BSE (US, UK), Rift Valley Fever mals. Then there is a rise of exposure in humans, who subse- (Tanzania, Kenya, Somalia) quently could develop symptoms, may seek treatment, and FIGURE E.1: Early Control of Zoonotic Disease Is Both Cost-effective and Prevents Human Disease Cost of control Exposure Exposure Clinical outbreak in animals in humans signs Clinical signs in in animals humans Humans seek medical care Source: Adapted from IOM (2009). E C O N O M IC AND S E CTOR WORK X EX EC UTIV E S UM M A RY infect each other. If the disease reaches the point of spread-  In Chad, joint animal–human vaccination campaigns of ing among humans, the disease will have already done sub- DPT and polio in children and CBPP control in livestock stantial damage. Moreover, the spread of the disease among resulted in greater coverage in both humans and live- humans at that point may be difficult to slow or reverse, and stock, and pastoralists became more aware of public the cost of disease control will usually increase rapidly. This health services. pattern of progression is evident from the high and rising  In Jaipur, India, dog vaccination and sterilization cost of controlling HIV/AIDS, which is also of zoonotic origin. resulted in a decline of human rabies cases to zero Thus, effectiveness of zoonotic disease control requires early (whereas cases increased in other states that did not detection at the source of the disease in animals, an early have this campaign). The population of stray dogs and accurate diagnosis, and rapid disease control measures. declined by 28 percent. Delays substantially reduce effectiveness. The more effective  In Kyrgyzstan, public health and veterinary work- an approach is, the more lives it will save, and the higher ers together visit farms, resulting in lower costs of the benefits in terms of avoided losses. Authorities too often surveillance for brucellosis, echinococcosis, and other start looking for the disease in animals and undertake diag- zoonotic diseases. nostic and control efforts only after human cases and deaths  In Canada, the integration of animal and human have been observed. When disease surveillance and control health facilities led to a 26 percent reduction in take this form, humans essentially serve as a sentinel spe- operation costs, an improvement in efficiency that cies—human death and illness act as indicators of disease is not yet directly applicable in most developing in animals. countries. Because surveillance, diagnosis, and control of zoonotic A number of additional examples exist in which efficiency disease take place at the interface between animals and gains were achieved by arriving earlier, identifying the zoo- humans, systematic communication and substantial coordina- notic disease more accurately, and undertaking control tion between human, wildlife, and veterinary health services actions accordingly. These include the following: is an important practical necessity. And this communication  In Mauritania, public health and veterinary diagnostic and coordination also needs to extend to those services that services worked together to correct an initial diagnosis monitor food safety. One Health is an approach to ensure that (Yellow Fever) and establish the correct one (Rift Valley this critically important interdisciplinary collaboration occurs. Fever). This collaboration reduces the gaps between institutions and  In Madagascar, ministries of agriculture and of health disciplines that can cause costly delays, and even failures, in worked together on prevention and control of Rift disease detection and control. One Health refers to “the col- Valley Fever, which reduced the number of cases of laborative efforts of multiple disciplines working locally, nation- the disease in humans and resulted in improved pre- ally and globally to attain optimal health for people, animals diction and mapping of outbreaks. � and our environment. The technical agencies and organiza- tions that are responsible for this work have been working to  Confronting the H5N1 virus threat, since 2005 many develop implementation modalities in line with this definition.2 developing countries, especially those in Africa and Asia, developed multisectoral plans for responses to The conceptual case for early control of contagious diseases outbreaks in animals and humans, including collabo- at their animal source is robust. Numerous examples already ration between animal and human health systems. exist of more efficient and effective control of zoonotic dis- Although the cooperation did imply additional initial eases that is attributable to the type of interdisciplinary col- costs, the resulting preparedness and control capacity laboration that is prescribed by One Health. Efficiency gains, in the countries with such programs was significantly which involve either doing more with the same resources or improved, especially if the plans were exercised in doing the same with fewer resources, have been evident in a simulations or tested in actual outbreaks. number of these examples, including the following.  A number of integrated surveillance systems and data bases, such as ArboNet for West Nile Virus, GLEWS, 2 These institutions include: WHO, OIE, FAO, and the World Bank; and a number of national programs, for example, professional organizations such as AMA, AVMA, and the Euro- for rabies in India, have been developed, allowing pean Federation of Veterinarians; national institutions such as US CDC, the Canadian Science Centre for Human and Animal researchers and the authorities to more readily “con- Health, and the Danish Zoonosis Center; and academics at many � nect the dots, which is an essential step in activi- universities in the developed as well as the developing world. PEOPLE, PATH OGENS A ND OUR PLA NET VOL. 2 E X E C U T I V E S UMMARY XI ties ranging from risk assessment, to detection, to provides an estimate of funding required by all developing diagnosis. countries for the main prevention and control tasks in pub- lic, veterinary, and wildlife health services, as well as initial This report lists other examples of the benefits of One estimates of the cost savings and effectiveness gains from Health, as well as examples of cases where poor coordina- establishing the One Health approach. Because no compre- tion and weak integration between the relevant departments hensive study of the economics of One Health has been led to human deaths, illness, significant livestock losses, and undertaken before, this report aims, above all else, to stimu- other economic costs. late discussion of economic issues relating to One Health. Not only is a One Health approach to zoonotic disease more This will include identifying and describing existing gaps in effective, it is likely to be also more efficient as it entails shar- part to invite additional work in these areas. For instance, ing of some costs among the services responsible for animal, the cost data generated for this report can serve as bench- human, and environmental health. For instance, during a joint marks for reviews of expenditures on systems at country and vaccination campaign (such as that noted earlier for Chad), regional levels. some human capacities and equipment, as well as operating This report disaggregates costs by task, making explicit those costs, can be shared, resulting in lower costs for the joint activities that are critical for effectiveness and identifying campaign than for two separate campaigns. Laboratories, scope for efficiencies. The analysis draws on a range of data which have a key role in early detection of disease and sources and earlier work, including integrated national action accurate diagnosis, can also reduce costs through attention plans for, and World Bank staff appraisal reports on, avian and to how animal and human health work is carried out. This pandemic influenzas responses, a survey of the directors report is based on tentative assumptions (endorsed by the of wildlife services, assessments of veterinary systems in expert panel as “reasonable first assumptions�) about the developing countries, and OIE analyses of disease preven- cost savings attributable to the introduction of One Health. tion systems. The result is the most informative picture to These savings would range from 10 to 15 percent of the total date of the financial and economic aspects of preparedness costs of a global surveillance and disease control system, and control systems from a One Health perspective. As as presented in this report. Much of these potential savings noted earlier, timeliness and accuracy are critical in reducing would come from activities that both lend themselves well the total losses (including disease control costs), as in most to cooperation and are high-cost endeavors, such as surveil- diseases the costs will go up exponentially as more time lance and diagnostics. elapses between an outbreak and a correct identification Bringing disease prevention and control up to OIE and WHO and control method of the disease. The results underscore standards will require additional expenditures to build animal the substantial promise of One Health approaches and the and human public health systems and to sustain them in the benefits and savings that could be achieved through collabo- medium and long-term horizons. An initial estimate, prepared ration among human, animal, and wildlife health services. for the 2008 for the Sharm El-Sheikh ministerial conference The annual funding needs to bring the major zoonotic dis- on avian and pandemic influenzas, was that a system would ease prevention and control system in developing coun- cost US$1.3 billion per year for 139 developing countries.3 tries up to OIE and WHO standards—which are referred This estimate was not, however, based on disaggregated to as “One Health systems� in this report—range from costs of specific tasks, and covered only the costs of sur- US$1.9 billion to US$3.4 billion, depending on whether the veillance and early response to emerging and re-emerging risk of disease prevalence is low or high.4 These funds are zoonotic diseases, excluding the cost of fully controlling epi- needed for expenditures in 60 low-income and 79 middle- demic outbreaks. income countries, for that part of the global system that This report presents detailed information on the allocation of comprises the systems in these developing countries and funds between the human and animal health sectors. It also that delivers a public good to the whole world. The needs 4 This estimate is based on cost estimates over a five-year period 3 Contributing to One World, One Health: A Strategic Framework with a full depreciation of the investments over the same period. for Reducing Risks of Infectious Diseases at the Animal–Human– A similar level of investment will therefore be necessary after Ecosystem Interface, prepared by a group of international agen- the five-year period to maintain the capability. The figures cies that included FAO, OIE, WHO, and the World Bank, among of US$1.9 billion and US$3.4 billion per year can therefore be others, 2008. assumed as continuous over the medium-term future. E C O N O M IC AND S E CTOR WORK XII EX EC UTIV E S UM M A RY of wildlife health services could not be included because rel- The effectiveness gains presented in this report would be evant cost data are too limited. additional to substantial gains such as poverty reduction, improved food security, and improved food safety. Both the The required investments in One Health systems of between emerging and the neglected endemic zoonoses affect poor, US$1.9 billion and US$3.4 billion per year are substantially rural populations in particular. Addressing these zoonoses below the average US$6.7 billion per year in losses due to would therefore significantly improve the livelihoods of the the six major zoonotic disease outbreaks in 1997–2009, in poor. So, if a realistic assessment of pandemic risks is the particular considering that none of the disease outbreaks main driving force behind implementing One Health, this developed into a pandemic. The underlying risk factors approach will also reduce the large number of local epidem- behind such disease outbreaks are growing. The required ics arising from zoonoses. This will cause a substantial wel- investments in One Health systems are modest when com- fare gain, especially for marginalized poor people. pared to the costs of diseases of zoonotic origin that had unfortunately not been controlled at their animal source The following recommendations emerge from the analysis before they spread in humans. These include expenditures to in this report: control tuberculosis (US$5 billion annually) and HIV/AIDS (an  Countries should record and provide public access to estimated cost up to US$722 billion in 2009–2031, or US$28 their expenditures on public health services, prefer- billion annually) (Hecht et al. 2010). ably detailed by task (within prevention and control) across human and animal health sectors and for joint A cost-benefit analysis, which corrects for the very low proba- planning and communications, and by investment and bility of pandemics, shows that benefits far exceed costs in all recurrent costs. This work should be monitored by OIE plausible scenarios. For instance, if the international commu- and WHO and, when possible, be included in public nity invests at the upper end of the range (US$3.4 billion per expenditure reviews. year), the annual expected rate of return would be between  Because control of these zoonotic diseases is a global 44 percent and 71 percent (corresponding to, respectively, public good, constraints on prompt and complete half or all mild pandemics being prevented) and still a respect- reporting on disease outbreaks and control capacities able 14 percent when the system would prevent only one in should be addressed, through sets of positive (access five pandemics. A severe pandemic costing US$3 trillion may to international funding) and negative (regulation) occur, on average, once in a hundred years. If the investments incentives. in One Health systems are made and such a pandemic is prevented, the global expected benefits are US$30 billion per  The economic case for One Health approaches, and year. Every year, an investment of US$3.4 billion would pro- the qualitative evidence on benefits from closer col- duce an expected benefit of US$30 billion for the international laboration at the animal–human–ecosystem interface, community. The challenge confronting policy-makers is there- suggests future wider implementation. To this end, fore to review these and other assessments of the benefits sustainable funding mechanisms that were described of pandemic prevention and weigh them against the cost of in Volume 1 of this report will be required. prevention, as well as returns on other public investments.  Governments and international agencies may wish This report finds that investment in One Health systems for to review the estimated costs of investments in One prevention and control of zoonotic diseases offers extraordi- Health systems for pandemic prevention, compare narily high expected benefits, with rates of return far above them to the expected benefits, and suggest (to the those of other public and private investments. All countries World Bank or other stakeholders) what further analy- have an interest in realizing these benefits. ses or actions are required to substantially increase expenditures on pandemic prevention. PEOPLE, PATH OGENS A ND OUR PLA NET VOL. 2 C H A P T E R 1 — B AC KGROUND 1 Chapter 1: BACKGROUND THE PROBLEM A pandemic has the potential to have catastrophic effects Emerging and re-emerging diseases at the human–animal– on human and animal life, ecosystems, and whole national ecosystems interface have been occurring with alarming fre- economies, through direct and indirect losses. The recent quency. These include highly contagious trans-boundary dis- pandemics of SARS, H5N1, and H1N1 were reminders of eases that have the potential of becoming pandemic, as well the persistent risk of emerging infectious, zoonotic dis- as the many food scares that arise from animal-source food. eases, and the economic losses they cause. Information They also include less headline-grabbing, so-called neglected on the direct and indirect costs of emerging zoonotic or endemic zoonoses, such as bovine-induced tuberculosis, diseases has been documented in a number of reports, and a large number of parasitic diseases. including in IOM (2009) and World Bank (2010b). These costs vary from US$500 million to US$1 billion for Nipah Many factors contribute to the emergence of these dis- Virus–induced encephalitis, West Nile Virus Fever, and eases, and detailed overviews are provided in IOM (2009) the Plague to over US$10 billion for Bovine Spongiform and Volume 1 of this report of the World Bank (2010b). In Encephalopathy (BSE), Severe Acute Respiratory Syn- summary, in the environmental domain these factors include drome (SARS), and Highly Pathogen Avian Influenza. A habitat destruction and fragmentation, climate change, and study carried out as background for this report conserva- pollution. In the animal domain, they include illegal trade in tively estimated the total economic losses of six potential animals, intensification of livestock production, irregular use pandemics between 1997 and 2009 to have been about of drugs and vaccines, and spatial clustering of livestock US$80 billion (or about US$6.7 billion per year).1 Fig- farming. The irregular use of drugs and vaccines is associ- ure 1.1 illustrates these economic losses (the exact data ated with the emergence of drug-resistant disease varieties. are provided in Annex 2, table A.1). The issue of spatial clustering is associated with different scales of production and different levels of biosecurity. In Fortunately, none of these outbreaks developed into a global the human domain, contributing factors include, among pandemic; otherwise the human and economic losses others, increased population density and mobility, growing would have been much higher. The World Bank estimated inequality, and increasing numbers of susceptible groups. In the potential economic losses in a worst-case scenario for the human–animal interface, supply chains of animal-source an influenza pandemic involving 71 million human fatali- foods are rapidly becoming much longer and more compli- ties, or 1 percent of the global population, at US$3 trillion cated, expanding the channels through which pathogens (Burns et al. 2008). Animal losses from zoonotic diseases travel. Livestock farming has greatly increased in size and are also high. Fifty percent of the 762,212 Livestock Unit intensity, and much of it is in closer proximity to urban dwell- (LSU)2 losses reported on annual average by veterinary ser- ings than it has been in the past. vices to the OIE-WAHID data base in 2006–2009 were the result of zoonotic diseases (World Bank/Tafs s 2011). Given These pressures are exacerbated in the Bank’s client coun- that the global standing population of LSUs is somewhere tries, where past potential pandemics have significantly between 1.5 and 2 billion, this figure most likely grossly strained public veterinary and human health services. underestimates the real losses, because of underreporting Moreover, approximately 70 percent of all zoonotic diseases to WAHID. originate in wildlife populations (Jones et al. 2008) but have been neglected by the veterinary services there. It is there- Interestingly, the zoonotic diseases have a much higher per- fore no surprise that experts predict that the next major centage of slaughterings (43 percent) than the non-zoonotic pandemic will be of zoonotic origin, and that it will emerge in a developing country, where population growth is rapid and 1 Nipah Virus (Malaysia), West Nile Fever (USA), SARS (Asia, Can- ada, other), HPAI (Asia, Europe), BSE (US, UK), Rift Valley Fever land clearing and farming near wild ecosystems is common (Tanzania, Kenya, Somalia). and public services are weak. 2 See Glossary for definition of the Livestock Unit. E C O N O M IC AND S E CTOR WORK 2 C H A PTER 1 — B AC K GR OUND FIGURE 1.1: Estimated Costs of Emerging Zoonotic Diseases (1986–2006) SARS (Asia, Canada, rest of 50 the world) 2002 45 40 35 US$ billion 30 BSE (UK), 25 1986 HPAI (Asia), 2004 20 15 BSE (USA), 2004 10 Nipah Virus (Malaysia), 5 Plague (India), 1998 WNV, HPAI (Europe), 2005 1994 1999 0 1980 1985 1990 1995 2000 2005 2010 RVF (Kenya, Somalia, Tanzania), 2006 Source: Authors’ estimate from the literature. diseases of animals (6 percent), as can be seen in figure 1.2. CURRENT KNOWLEDGE ON THE ECONOMICS A country’s income level seems to be a major determinant OF DISEASE CONTROL of the share of losses from zoonotic diseases. The World Numerous available studies estimate the direct and indirect Bank/Tafs (2011) study found that the share of losses from costs and benefits of the control of animal and human dis- zoonotic diseases is 72 percent in high-income countries, eases. For animal diseases, the methodologies have been 64 percent in upper-middle-income countries, 35 percent reviewed by, for example, Umali, et al. (1994), Perry (1999), in lower-middle-income countries, and 38 percent in low- Otte and Chilonda (2001), Leonard, (2004), Rich et al. (2005), income countries. These findings suggest that the share of and Tisdell (2006). They are well summarized in the OIE/ losses that result from zoonotic diseases is lower in poorer World Bank publication Prevention and Control of Animal than in wealthier countries. This seems in contrast with the Diseases Worldwide, Economic Analysis—Prevention versus data on humans, where according to the Global Disease Data Outbreak Costs, Final Report, Part I. That report found that Base, the incidence of diarrhea-type diseases (used in this “when a comparison of prevention versus outbreak costs is study as a proxy for the importance of zoonotic diseases) is made, the majority of the reviewed studies conclude that the highest in those poorer countries. FIGURE 1.2: Livestock Losses by Type of Disposal Zoonotic diseases Non-zoonotic diseases 6% 16% 32% 43% 41% 62% Death Destruction Slaughter Source: World Bank/Tafs (2011). Note: Based on economic losses, with death (the animal died prior to be culled or slaughtered) allocated a value of 0.8 LSU, destroyed a value of 1.0 LSU, and slaughtered a value of 0.4 LSU. PEOPLE, PATH OGENS A ND OUR PLA NET VOL. 2 C H A P T E R 1 — B AC KGROUND 3 significant benefits that accrue from improved prevention zoonosis control in humans through interventions on the and control measures outweigh the cost of investment in animal side. They are summarized in tables 8.1 and 8.2, and animal health services to control the disease� (OIE 2007a). clearly demonstrate that “control at source� (i.e., at the ani- For example, in Latin America investment in improvements mal interface) yields higher returns than having to control to animal health of some additional US$157 million per year the human disease later. The information on the costs of over 15 years generates a net present value of US$1.9 bil- food safety control (an important aspect of zoonotic disease lion. In Africa it has been estimated that an investment of control) is more extensive. One overview is provided by €14.7 million to control CBPP could save €30 million annually Henson (2003). However, these studies focus on specific in losses from morbidity/mortality, leading to a net benefit animal or human diseases and the costs associated with of €15.4 million. In Asia eradication programs for FMD have controlling those diseases. They do not provide budget data been estimated to provide benefits in improved trade and on the total financing needs to bring human and/or veteri- market access that are worth several times the investment nary health systems up to OIE and WHO standards for all (OIE 2007a). Additional cost-benefit analyses of individual diseases. diseases have been prepared for Rinderpest in 10 African countries by Tambi et al. (1999), and for FMD comprehen- sively summarized by James and Rushton (2002). The con- ONE HEALTH AND KNOWLEDGE GAPS trol of African Sleeping Sickness (Trypanosomosis) has also A significant amount of thought has gone into how to been extensively evaluated. Summaries of these evaluations implement the One Health concept. The main techni- have been prepared by FAO,3 by the Tropical Institute for cal agencies concerned, the WHO, OIE and FAO, agreed Veterinary Medicine for DFID,4 and more recently by Shaw under a tri-partite concept note5 to share responsibilities (2009). All these studies arrive at high positive economic and coordinate global activities to address health risks at rates of return. Finally, the World Bank, with support from the animal–human–ecosystems interfaces. Regional orga- IFPRI and the Swiss government, is preparing a toolkit titled nizations, such as the European Union and Federation of “Assessing the Costs and Benefits of the Control of Zoonotic Veterinarians, have endorsed the One Health concept as Diseases. � a cornerstone of their veterinary strategy: “prevention is � better than cure. Similarly, national organizations such as For human diseases, zoonotic disease occurrence is docu- CDC of the United States have promoted the approach. mented by WHO, but the coverage is incomplete. Some The United States Agency for International Development examples are: In 2004, the prevalence of tuberculosis (TB) (USAID) is sponsoring a major international operation in in humans was about 14 million, with an estimated mortality over 20 countries to build a global early warning system of 1.7 million, and a loss in Disability Adjusted Health Years for pathogens that move between wildlife and humans (DALYs) of 36 million. A part will have originated in livestock. (PREDICT).6 This project seeks to bring health and wildlife Diarrheal diseases, besides those caused by poor-quality specialists together. As an activity of PREDICT, it recently drinking water, are often of zoonotic origin and cause a , brought the UNSIC, FAO, WFP and UNWTO together “to total of 73 million DALYs, whereas internal parasites cause capture the lessons that were learned from preparing for 4 million DALYs (WHO 2008). Echinococcosis causes at least an influenza pandemic, and inspire leaders to apply those 1.5 million DALYs and up to US$2 billion in livestock losses lessons and best practices to continuing and emerging per year (Torgerson et al. 2010). � threats. They published Beyond Pandemics: A Whole-of- Data on the economics of control are scarcer. As Zhang Society Approach to Disaster Preparedness (USAID 2011).7 (2009) noted, “[t]he influence of economics in guiding pub- The One Health concept also takes hold in developing lic health policy and programs has been sub-optimal, limited countries. For example, in Nigeria, a private initiative has by the perception that the discipline is overly theoretical established the One Health Nigeria group, which seeks sup- and not readily applicable to public health decision-making.� port from its federal government in the establishment of a Most studies focus on the economics of the control of a National Zoonoses Center. single disease, including DALYs as part of the costs. Zinstag et al. (2007) provide interesting cost-benefit analyses on 5 http://web.oie.int/downld/FINAL_CONCEPT_NOTE_Hanoi.pdf. 3 http://www.fao.org/DOCREP/006/Y4619E/y4619e04.htm. 6 http://www.vetmed.ucdavis.edu/ohi/predict/index.cfm. 4 http://www.dfid.gov.uk/r4d/SearchResearchDatabase.asp? 7 http://towardsasafer world.org/featured/beyond-pandemics- ProjectID=3721. whole-society-approach-disaster-preparedness. E C O N O M IC AND S E CTOR WORK 4 C H A PTER 1 — B AC K GR OUND As can be seen later in this report, the government of BOX 1.1: Steps in Establishing One Health at the Canada is practically the only government that has imple- Country Level mented the One Health approach, by actually integrated the human and veterinary diagnostic services at all levels 1. Identification of in-country champions. (from administration, to common services, to labora- 2. Joint priority setting and preparedness planning, tory research, to emergency response). The government including the identification of hot spots. of Denmark has integrated the surveillance for zoonotic and food-safety-related diseases in the Danish Zoonosis 3. Preparing and implementing of legislation that pro- Center. The World Bank has published a general overview motes One Health through obligatory disease report- in the first volume of this report, People, Pathogens and ing and decision-making processes, etc. Our Planet, and summarized its main findings from its 4. Establishing institutional frameworks that facilitate involvement in the HPAI campaign. That volume informed enhanced cooperation and communication among a subsequent report titled Towards One Health: Lessons human, animal, and ecosystem health agencies. This Learned from the Global Program on Avian and Human can range from setting up of memoranda of agree- Pandemic Influenza (H5N1)(World Bank/Ministry of Health/ ment between the services, to joint One Health task Ministry of Agriculture 2011). The latter includes step-by- forces or permanent teams, to partial integration of step recommendations on the introduction of One Health the services. (see box 1.1). Finally, on the request of the technical agen- cies, the World Bank is preparing a self-assessment tool to 5. Providing of an incentive framework, through the help countries determine their readiness for a One Health establishment of joint budgets of the services, and approach. the provision of special grant mechanisms for One Health activities. Although the importance and general concepts of One Health 6. Implementing joint surveillance and diagnostic sys- are now well accepted, it remains unclear how it should tems for pandemic and endemic diseases. be implemented and how much it will cost. Earlier studies (Addis Antenneh 1984; de Haan and Nissen 1985; Gauthier et . 7 Preparing and disseminating joint communications. al. 1999) have provided budgetary data for African Veterinary 8. Developing educational curricula, in particular at the Services. That data revealed the disproportional share of the university level, that integrate human, veterinary, and funds going to salaries, leaving little for operating costs to ecosystem health. enable the staff to work. However, these studies did not disaggregate the costs of specific diseases and tasks. Nor One needs to realize also that One Health is not all or did they provide estimates on the funding required to bring nothing but can be implemented incrementally, and these services up to OIE and WHO standards, under which countries can chose from various elements of integra- they would be able to effectively prevent and (in the case of tion and will benefit to different degrees, depending on an outbreak) control these emerging zoonotics. Later stud- the level of integration ies made some assessments on emergency support, but Source: Towards One Health, World Bank (2011). this was done only for sub-Saharan Africa, and mostly for H5N1 (OIE/Alive 2006). to be US$852 million per year for the 49 low-income coun- Country budget data on animal and human disease preven- tries and US$1.343 billion for 149 non-OECD countries.8 tion and control systems are not in the public domain and It was acknowledged, however, that preparing these esti- are not covered by the Bank’s expenditure reviews. The only � mates constitutes an “art not a science. For want of bet- global estimate is presented in Contributing One World, ter data, these estimates have been repeated in a number One Health: A Strategic Framework for Reducing Risks of other documents, such as Sustaining Global Surveillance of Infectious Diseases at the Animal–Human–Ecosystem and Response Systems for Emerging Zoonotics Diseases Interface, prepared by a group of international agencies published by the Institute of Medicine of the US National that includes FAO, OIE, WHO, the World Bank, and others. Academy of Science (2009) and the first volume of People, This so-called Framework Paper estimated the cost of a Pathogens and Our Planet (IOM 2009; World Bank 2010b). global surveillance system for the prevention of emerging and re-emerging zoonotic diseases and the control of HPAI 8 See Annex 5 for the list of countries. PEOPLE, PATH OGENS A ND OUR PLA NET VOL. 2 C H A P T E R 1 — B AC KGROUND 5 FOCUS OF STUDY AND TARGET AUDIENCE effectiveness gains to guide them in the decision-making This study aims to build on the findings from the previously process regarding the eventual introduction of One Health. mentioned studies, and seeks to provide more detailed infor- mation on the costs of the various functions and categories of expenditure involved in the establishment and operation of CAVEATS system for the prevention and control of emerging zoonotic A study of this kind, focusing on the economics (i.e., effi- diseases at country and global level. It will also seek to pro- ciency and effectiveness gains) of the implementation of vide information on efficiency and effectiveness gains that One Health has not been done before, in part because of would result from the introduction of a One Health approach. the lack of field experience and proven field data. Therefore, With these aims, the study has two target audiences: (a) this study, while using the limited field data that is avail- project planners, who would benefit from the information of able, depends largely on expert opinions. The information the costs of setting up surveillance and control systems to be provided should therefore be seen as very approximate. The used as benchmarks when planning preparedness and con- report is meant above all to stimulate the discussion around trol operations; and (b) policy planners at the decision-making the economics of One Health, and provide a benchmark and level, who would use the information on the efficiency and framework for further study. E C O N O M IC AND S E CTOR WORK C H A P T E R 2 — OB J E CT IVE S OF T HE ST UDY 7 Chapter 2: OBJECTIVES OF THE STUDY The objectives of this study were threefold: standards to address the H5N1 Avian Influenza  First, to make a further assessment of the fund- threat, using data from the 2006–2008 Integrated ing requirements to bring public human and animal National Action Plans (INAPs) and relevant World (domestic and wild) health services up to OIE and Bank Staff Appraisal reports; WHO standards. Although this study focuses entirely • Analysis of the costs of developing National on zoonotic diseases, a number of indirect benefits Disease Prevention Systems, carried out by the of an improved preparedness and control system for OIE with funding from the Development Grant zoonotic diseases will spill over to the management of Facility of the World Bank; non-zoonotic diseases as well. Further, such spillover • Quantitative evaluations of needs and priorities for effects will apply to enhanced food security and to the the Veterinary Services (gap analysis) prepared by promotion of poverty reduction. national Veterinary Services in collaboration with  Second, to assist planners of disease prevention and OIE; and control systems with information on the appropriate • Results from a survey under Directors of Wildlife amounts and allocation of funds among human, ani- Services, prepared in collaboration with the mal, and wildlife health services, between prevention EcoHealth Alliance. and control tasks, and on the average costs of differ-  Preparation of a summary of key cost components for ent functions within prevention and control systems. the prevention and control of prevailing and emerging  Third, to provide a quantitative estimate of the zoonotic diseases; potential efficiency and a qualitative description of the  Estimation of the cost for national and global preven- effectiveness gains resulting from the application of tion and control systems for those diseases; the One Health concept.  Estimation of the cost savings and efficiency gains from a closer coordination, and eventually through In order to achieve these objectives, the following tasks some degree of integration, between animal and were carried out: human health services, based on the authors esti-  Collection and analysis of data on the estimated fund- mates, validated by an international panel of special- ing needs for incremental investments for an efficient ists in human and veterinary health and environmental prevention and control system for zoonotic diseases in sciences; and the human, animal, and wildlife sectors. More specifi-  Demonstration of the effectiveness gains achieved cally, this involved: through the introduction of One Health. • Analysis of the funding required to bring human and animal health services up to OIE and WHO E C O N O M IC AND S E CTOR WORK C H A P T E R 3 — ME T HODOLOGY 9 Chapter 3: METHODOLOGY DATA—SOURCES AND COLLECTION Laboratories; and (5) Strengthening Organizational 1. Sources of budget data were identified and data Structure, and a further differentiation is made for collected integrated into a large data base. Data pillars (2, 3, and 4) on the allocations for zoonotic sources and their geographical distribution are shown diseases and food safety; in table 3.1. • For public health services: surveillance, diagnos- 2. Data was disaggregated by disease and by type of tic services, control/investigation, and control/ service. vaccination;  Disease: Avian Influenza and other zoonotic diseases • For wildlife services: total wildlife budgets and (these varied depending on the sample country but disaggregation by investment and recurrent costs typically included, in addition to H5N1, also H1N1, and also disaggregation by wildlife health and other anthrax, rabies, brucellosis, and tuberculosis). In the tasks, and within livestock health into surveillance, OIE report on the cost of animal diseases, other non- diagnostics, control, and other eco-risks (pollution zoonotic diseases (foot and mouth disease, sheep etc.); and pox) were also included. • For planning and communication: costs relating to  Type of service: animal, human, and wildlife health training and education of staff, meetings with gov- services. ernment/sectors/industries/communities, prepara- tion of background materials and draft guidelines,  Tasks within the disease prevention and control media and awareness campaigns. systems:  Funding source: domestic and external; and • For veterinary services: surveillance, bio-security, diagnostics, control (vaccination and hygiene  Object of expenditure: recurrent and investment costs programs), culling, and compensation. For the Gap as described in table 3.2. Analysis, the costs are distributed among the five pillars; (1) Strengthening Competencies for Trade; DATA ANALYSIS (2) Strengthening Competencies for Animal Health; The data of the INAPs, World Bank appraisal reports and (3) Strengthening Competencies for Veterinary OIE budget summary reports, OIE Gap Analysis studies, Public Health (Food Safety and Zoonoses); wildlife health service surveys, and other preparedness and (4) Strengthening Competencies for Veterinary response plans was then analyzed in three steps. TABLE 3.1: Budget Data Sources SUB- SAHARAN SOUTHERN AND EUROPE AND DATA SOURCE TOTAL AFRICA EASTERN ASIA LATIN AMERICA MIDDLE EAST Integrated National Action Plans (INAP Reports) 24 24 0 0 0 World Bank Staff Appraisal Reports 12 2 5 4 1 OIE Budget Summary Reports (OIE 2007c) 11 2 3 2 4 OIE Gap Analysis 14 8 4 1 1 Wildlife Health Service Survey 7 3 1 2 1 Other (Preparedness and Response Plans) 20 18 1 1 0 World Bank/Tafs Analysis All OIE member states Total 88 57 14 10 7 Source: General country data was obtained using FAOSTAT and Euro-monitor. E C O N O M IC AND S E CTOR WORK 10 CH A PTER 3 — METH OD OLOGY TABLE 3.2: Description of Object of Expenditure Categories INVESTMENT COSTS (OR CAPITAL EXPENDITURES) RECURRENT COSTS (OR OPERATING EXPENDITURES) Definition: Costs of purchasing fixed assets) that are typically used over a long Definition: Cost of day-to-day spending on salaries, consumables, and everyday period of time, i.e. over three years (OIE 2009). A depreciation period of five years items that get used up as the good or service is provided (OIE 2009). for investment items was assumed. In the Gap Analysis, this included the so-called “Exceptional Budget.� Typical examples: Investing in land and buildings; establishing laboratories, Typical examples: Government and council fee rates, rental fees, operation surveillance posts, and offices; and purchasing vehicles and equipment (laboratory, and maintenance (i.e. vehicles, laboratory, surveillance, and culling equipment), surveillance, and culling). Training, as investment in long-term human capabilities, reagents, disinfectants, vaccines and office supplies, salaries and wages, and is also considered an investment. compensation. How investment and recurrent costs were determined or separated from data: INAP reports listed costs by task or function (e.g., surveillance) and also provided a detailed description (often costs were differentiated into investment or recurrent costs). Where costs were not disaggregated into investment and recurrent costs, the detailed description was used together with the above guidelines to determine if the cost was an investment or recurrent cost. Step 1: Calculation of unit costs for different services: capita and VLU calculated under Step 1 to the global level,  By type of service (animal health, human health, under the following assumptions: wildlife health, and communications and planning)  The distribution of funds estimated earlier between and within type of service by function (prevention human and animal health services and investment vs. control) and within function by task (surveillance, and recurrent costs are the same for other zoonotic diagnostics, control, etc.); diseases as for HPAI; and • The analysis of the gap analysis documents cov-  The share of direct economic cost of animal (and ered all five pillars, but paid particular attention to human) losses due to zoonotic diseases is a proxy for the three pillars relevant to One Health: the share of funding allocated to zoonotic diseases (2) Strengthen Competencies for Animal Health; versus non-zoonotic diseases. (3) Strengthen Competencies for Veterinary Public Health (Food Safety and Zoonoses); (4) Strengthen Step 3: Estimations used for the economics of One Health Competencies for Veterinary Laboratories. In the were made by: analysis, the total budget was broken down by pil-  Identifying the most costly tasks in a disease preven- lar, by investment, and by recurrent costs. The pro- tion and control system for the animal health, human posed actions related to preparedness and control health, and communications and planning sectors; of zoonotic diseases were then summarized, thus  Collecting information from case studies where providing also a qualitative assessment of the kind personnel and other investments and resources were of gaps the veterinary services identified; shared between animal, human, and wild life health  By object of expenditure (investment and recurrent sectors, and identifying efficiency and effectiveness costs); and gains. Most data from the case studies originated  By key parameters, such as human and poultry popu- from existing literature, with the exception of a field lation numbers and Veterinary Livestock Units (VLUs),1 visit to the Canadian Science Centre for Human and per capita GDP livestock contribution to GDP and , , Animal Health. However, detailed data from this private-/public-sector veterinarians. source was considered too atypical and was therefore not included in the analysis; and Step 2: Estimation of the cost for national and global preven-  Developing assumptions on the degree of integration tion and control system for zoonotic diseases. This was done of the different services and validating those assump- by extrapolating (up-scaling) the estimated funding needs per tions in a round table discussion with high level specialists from veterinary and human health sectors and arriving at “best� estimates of the global costs of 1 Bovine (*1), buffaloes (*1), camels (*0.5), horses (*0,5), donkeys (*0.3), pigs (*0,2), sheep (*0.1), goats (*0.1), poultry (*0,01), rab- prevention and control systems and the potential sav- bits (*0,01). ings from One Health. PEOPLE, PATH OGENS A ND OUR PLA NET VOL. 2 C H A P T E R 4 — DATA L IMITAT IONS AND GA PS 11 Chapter 4: DATA LIMITATIONS AND GAPS There are data gaps and weaknesses, as shown in table 4.1. animal health side and the weaker data base on the human side. Until human health data are improved, there is little that Overall, it should be noted that the cost estimates in the can be done to improve the analysis on the human health previously mentioned studies are based on ex-ante data, side. Despite these setbacks, the previously noted data and reflect the budget needs for prevention and control of sources were all that was available and have led to a first zoonotic diseases in “peace time� or during minor disease attempt or initial recommendations and benchmarks that can outbreaks. Budgetary needs would significantly increase if a be improved in time (when additional data become available). major disease outbreak or pandemic were to occur, as mod- In addition, despite the livestock-centric focus of the data eled in the “Extrapolating these findings to a global scale� and analysis, significant efficiency and effectiveness gains section. Also the data and the resulting outcomes are live- have been demonstrated in the case studies. stock focused. This is due to the stronger data base on the TABLE 4.1: Notes on Data Selection, Allocation, and Limitations/Gaps and Suggestions for Future Improvements DATA SELECTION AND SUGGESTED APPROACH ITEM ALLOCATION BENEFITS AND LIMITATIONS/GAPS FOR FUTURE Data sources Restricted to data available INAPs: Prepared by joint teams of WHO/OIE/FAO experts on grant from Countries should be encouraged in the public domain. the World Bank. Comprehensively cover costs for incremental needs to record and collect data on a for the prevention and control of Avian Influenza across both human range of diseases to be disag- and animal health sectors. However, data are mostly from countries in gregated by task (prevention and Sub-Saharan Africa and do not include costs for prevention and control of control), by sector (human and other zoonotic or non-zoonotic diseases. It has been suggested that INAP animal health and joint planning reports might have been biased by the composition of the INAP teams and communications), and by and by the scope of their task. objective of expenditure (invest- Budget data from INAP reports represent the “ideal� amount of funding ment and recurrent costs). required to bring prevention and control of zoonotic diseases in the ani- mal and human health sectors up to OIE and WHO standards for “peace Encourage the collection of time� as well as actual outbreak control. These data do not represent wildlife and ecosystem data. funding amounts provided in the past nor do they represent what will be provided in the future (this will depend on what each country can afford). OIE reports: Prepared by OIE on a World Bank grant. Cover costs for a range of diseases in different regions of the world. However, data are only for “peace time�; therefore costs are mostly provided for prevention and only partially for control. In addition, costs are only provided for the animal health sector and not the human health sector. Gap Analyses: Prepared by OIE on request of governments as part of the OIE PVS Pathway. This is a global program for the sustainable improve- ment of a country's Veterinary Services' compliance with OIE standards. The budget data of the gap analysis refer to the incremental needs. It has good data on food safety capacity requirements, but does not distinguish in costing between zoonotic and non-zoonotic diseases in surveillance and diagnostic capacity requirements. It does not have data on human health capacity needs and covers prevention costs only, not control. Wildlife Health Surveys: Data are not based on the original documents, but are the result of a survey under directors of wildlife services (see Annex 2). Wildlife budgets did not always differentiate for diseases functions; directors were asked to provide estimates and provide breakdowns on budgets per function (surveillance, etc.) and objects of expenditure, but the data do not distinguish between zoonoses and non-zoonoses. Data are from actual budgets, which might not reflect actual needs. World Bank/Tafs Study is (i) exclusively based on 2006–2009 data, which are exceptional years because of the HPAI outbreak. Therefore the analysis is biased by this major crisis. (ii) It is based on official reporting to OIE and therefore suffers from underreporting. (iii) It covers 30 zoonotic diseases. (Continued) E C O N O M IC AND S E CTOR WORK 12 CH A PTER 4 — DATA LIMITATIONS A ND GA PS TABLE 4.1: Continued DATA SELECTION AND SUGGESTED APPROACH ITEM ALLOCATION BENEFITS AND LIMITATIONS/GAPS FOR FUTURE Countries Data were collected for as Restricted to data available in the public domain. As above. many countries as possible Variations occur between countries because of their different stages of (across a number of income development, population and livestock numbers, market access (domestic groups and regions). or export), disease prevalence or threat, as well existing infrastructure and resources. Diseases Data were collected for as Data suffer from underreporting, because of poor disease surveillance Need capacity building in sur- many countries and dis- capacity and adverse (mostly economic) incentives for accurate disease veillance and structural changes eases as possible (across a reporting. Data on wildlife diseases were particularly weak. to remove adverse incentives. number of income groups and regions, although excluding the developed countries), using OIE (WAHID), and WHO data bases. Data period On average, projects ran Restricted by availability of data in the public domain. for a three- to five-year period with, on average, a start date between 2006 and 2009. Currencies and Most data were listed in Inflation was not taken into consideration, as this was seen as being Consider inflation in future when conversion rates local currency but were insignificant in between 2006 and 2010. more precise data are available. converted to US$ using a conversion rate from June 1 for the year that the project commenced. Distributing Budget data were allocated Not all data sources listed animal and human health prevention and Encourage countries to record budget data into to human health, animal control tasks. and collect data in this way for categories health, or planning and future use. communications sectors. Under each sector data were allocated by preven- tion or control task. Investment and Where possible, under each Not all data sources listed investment and recurrent costs separately. Encourage countries to record recurrent costs task, investment and recur- and collect data in this way for rent costs were identified future use. and listed separately. Depreciation of Investment costs were No data available, but with fast-advancing technologies in this sector, When more precise data are investment costs depreciated in five years. and means of mobility an important component of the investment, a five- available, include a depreciation year average was considered appropriate. period for the main items. Funding Where possible, informa- Not all data sources provided information on funding, and not all services Encourage countries to record tion on funding sources have multiple sources of funding. and collect data in this way for (local and/or foreign) for future use. projects was collected. Source: This study’s analysis. PEOPLE, PATH OGENS A ND OUR PLA NET VOL. 2 C H A P T E R 5 — ANALYSIS AND RE SULT S 13 Chapter 5: ANALYSIS AND RESULTS AVIAN INFLUENZA funding, through a Global Fund, must be developed, as Allocation among Sectors proposed in World Bank’s People, Pathogens and the Planet (2010) and summarized in box 5.1. The following results were obtained through the analysis of mostly INAP data from 46 countries, mostly from Sub-  More specifically, the average incremental estimated Saharan Africa, with a few countries from southern Asia, funding needs to bring the animal and human health Latin America, and Europe and the Middle East.1 services up to OIE and WHO standards were (based  Of the total incremental budget allocated to bring the national systems for the prevention and eventual BOX 5.1: Funding a Global One Health Network control (if the prevention fails) of Avian Influenza (i.e.,  Because of its trans-boundary nature and major peace-time and outbreak control) up to OIE and WHO impact on poor people, the prevention and control of standards, 45 percent was allocated to animal health, emerging and re-emerging zoonotic diseases is gen- 41 percent to human health, and 14 percent to joint erally considered a global public good; planning and communication activities (figure 5.1).  Of the total incremental budget, 55 percent was allo-  In the past, such as with the H5N1 and H1N1 out- cated to recurrent costs and 45 percent to investment breaks, the international community has provided costs. This was even higher (82 percent in recurrent and large amounts of emergency funding (i.e., US$4.3 18 percent on investment) in the gap analysis. These billion between 2005 and end 2009; UNSIC 2010) to figures underscore the critical importance of the recur- control these diseases; rent budget in disease preparedness and control activi-  However, with a declining threat, international sup- ties, although these are often neglected in externally port is drying up, and much of the capacity that has funded projects because most donors assign priority to been built up will be lost. This current “boom-and- financing capital investments. Too often health services bust� model is therefore grossly inadequate; have been deprived of adequate recurrent expenditure budgets. More sustainable systems of recurrent cost  More sustainable funding mechanisms are therefore needed. This can be a combination of: 1 In the analysis, the largest number of countries with data avail- • National government contribution, in particular to able is used. Differences between similar parameters can be the result of difference in the number of countries with data avail- take responsibility for at least a part of the recur- ability. rent costs (such as the salaries); • International donor contribution linked to national FIGURE 5.1: Estimated Incremental Funding Needs government contribution, availability of operational (percent) to Bring Animal and Human Health Sectors Up preparedness plans, and full transparency regard- to OIE and WHO Standards for the Prevention and Control ing disease reporting and financial aspects of the of Avian Influenza (based on INAP reports from services; 45 countries) • Nonconventional sources of funding (foundations, etc.), preferentially in the form of endowment to 14% ensure sustainability; • Levies, for example, on meat exports or pharma- Animal Health ceutical products; although politically sensitive, a 45% Human Health levy of only $0.04 per kg would provide adequate 41% Communications, funding for at least the operating costs of the Coordination, and Planning global network. Source: People, Pathogens and the Planet, Volume 1 (World Bank 2010b). Source: This study’s analysis. E C O N O M IC AND S E CTOR WORK 14 C H A PTER 5 — A NALY S IS A ND R ES ULTS on the average of the aggregate total population) sector required US$2.7 million per country per year for the pre- US$0.15 per capita and US$0.13 per head of poul- vention and control of Avian Influenza, with about 70 percent try, respectively, and (based on the average cost per allocated to prevention and 30 percent to control. These differ- sampled country) US$0.35 and $0.33 (per capita and ences seem to be based on regional conditions: per head of poultry, respectively). The difference is  In Sub-Saharan Africa, the emphasis seems to be on caused by the preponderance in the sample of small a more reactive control strategy. These countries lack countries, which have a relatively high cost per unit. infrastructure and resources and have poor communica- The variation between countries was extremely large, tion facilities. An active and reliable surveillance system with US$0.02 and US$2.10 per capita per year and in Sub-Saharan Africa would be extremely costly and dif- $0.02 and $2.20 per head of poultry per year. The key ficult to maintain, hence more emphasis on control; and factors influencing this variation include:  In the rest of the world, the priority is given to preven- • Population density: countries with a low population tion to rigorously impose the necessary bio-security density required higher budgets per capita. measures, and thus avoid major losses from animal • Existing infrastructure and resources: the coun- diseases. In addition, some of these countries have tries in Sub-Saharan Africa required slightly higher strong meat export sectors, and the emphasis on budgets. On a per capita basis, calculated over the quarantine and other bio-security measures protects aggregate sample, the analysis showed an esti- their export interests. mated funding need of US$0.17 for Sub-Saharan Africa and US$0.13 for other developing regions The incremental funding needs for the different tasks of ani- and on a per-head-of-poultry basis US$0.15 per mal health services are provided in figure 5.3. head of poultry in Sub-Saharan Africa and US$0.07 In this context it is also interesting to present the results of a in the rest of the world (figure 5.2). recent study of OIE PVS evaluation from 12 developing coun- tries relating some critical competencies with efficiency and Allocation among Main Functions effectiveness in the control of HPAI (Swayne 2011). It shows (prevention or control) within Sectors that although economic indicators play a role in laboratory Animal Health Services capacity and diagnostic facilities, other factors such as envi- The analysis of the 23 countries for which data were available ronment, ecology, poultry production systems, veterinary for a more detailed breakdown by main function found that the services, and implementation of control measures play a vital animal health sector in Sub-Saharan Africa on average required role as well. Swayne (2011) reported: US$1.2 million per country per year (or about US$0.14 per head of poultry per year) for the prevention and control of  Negative correlation of staffing of veterinarians and HPAI. Of this, about 48 percent was allocated to prevention other professionals with eradication time, mortality and 52 percent to control. In other regions, the animal health rate, culling rate, and number of outbreaks; FIGURE 5.2: Estimated Incremental Funding Needs per Head of Poultry and per Capita for the Prevention and Control of Avian Influenza (based on 45 countries and aggregate sample) 0.18 0.16 Calculated funding needs 0.14 (US$ per year) 0.12 Sub-Saharan Africa 0.10 Other: Asia, Latin 0.08 America, Europe, 0.06 and Middle East 0.04 0.02 0.00 Estimated funding Estimated funding needs (US$/head of poultry/yr) (US$/capital/yr) Source: This study’s analysis. PEOPLE, PATH OGENS A ND OUR PLA NET VOL. 2 C H A P T E R 5 — ANALYSIS AND RE SULT S 15 FIGURE 5.3: Calculated Funding Needs for Prevention and Control Tasks for HPAI in the Animal Health Service (US$ per country per year), Based on 23 Countries 250,000 Estimated funding needs 200,000 (US$ per year) 150,000 Investment Recurrent 100,000 50,000 0 em e ke on ic y m , ng n ts ra ate st nc rv tor io os s ) es s) ar ti lli at ts sy illa og in m ec se ra lc Cu ns pr cc bo sp na ng ve pe e va an in la ni ur io m en n, at ity ar s tic d Co gi i w eld er ta os rm ur op hy on (fa sec gn rly fi s ea ry c al ia l( o- d ina er D ro Bi en nt an ter G Co Ve Sub-category Source: This study’s analysis.  Negative correlation of staffing of veterinary parapro- the prevention and control of Avian Influenza, with about fessionals with mortality rate; 36 percent allocated to prevention and 64 percent to con-  Negative correlation of professional competencies of trol. In the other developing regions, funding was higher, at veterinarians with mortality rate; US$3.4 million per country per year (or about US$0.20 per  Negative correlation of continuing education with capita per year), but with a similar distribution between pre- mortality rate; vention (31 percent) and control (69 percent) as was found for Sub-Saharan Africa. The priority on the human health side  Negative correlation of emergency funding with eradi- is therefore on control, which is also in line with the strat- cation time; egy of “prevention at source� (i.e., on the animal side), with  Negative correlation of epidemiological surveillance resources allocated to control if these primary defenses at with HPAI eradication time; the animal level fail.  Negative correlation of availability of veterinary medi- cines and veterinary biological products with culling Allocation among Specific Tasks within Sectors rate and number of outbreaks; The incremental funding requirements for the prevention  Negative correlation of transparency with culling rate and control of human HPAI, available from estimates from 23 and number of outbreaks; countries, were itemized by specific tasks, with the results  Negative correlation of disease prevention, control, presented in figure 5.4. and eradication measures with eradication time, cull- ing rate, and number of outbreaks; and Figures 5.3 and 5.4 show that in both sectors, the major cost  Increased critical competencies of veterinary services items for the upgrading of the prevention and control systems are associated with an improvement in the Avian for Avian Influenza are surveillance and diagnostic systems. Influenza outbreak control. In the “Efficiency gains from One Health� section, these tasks also emerge as having possibly the greatest efficiency Human Health Services and effectiveness gains through closer coordination and col- The human health sector in Sub-Saharan Africa on aver- laboration between the animal and human health sectors. A age required US$1.3 million per country per year (or on the detailed breakdown of the cost items for the control of HPAI aggregate sample about US$0.10 per capita per year) for (vaccination and hygiene programs) is provided in table 5.1. E C O N O M IC AND S E CTOR WORK 16 C H A PTER 5 — A NALY S IS A ND R ES ULTS FIGURE 5.4: Estimated Funding Needs for Prevention and Control Tasks for Avian Influenza in the Human Health Sector (US$ per country per year), Based on 23 Countries Calculated funding needs 120,000 100,000 (US$ per year) 80,000 Investment 60,000 Recurrent 40,000 20,000 0 em ly ic y an e d ra nd al rv tor ar inm an st ar er s es tin nt s og n a m sy d e en se ra qu ta n e) d on tio pr o bo G ng n e ati ni e a an (c tiga la en in tic ar c cc se es w llan os hy l va on nv gn ei gi sp l i ro rv ia re ro nt Su D d nt Co pi o ra C Sub-category Source: This study’s analysis. TABLE 5.1: Allocation of Estimated Funding Needs (percent of overall budget) for Different Prevention and Control Tasks in Animal and Human Health Sectors, Based on 23 Countries2 ANIMAL HEALTH HUMAN HEALTH PERCENT OF PERCENT OF INVESTMENT/ OVERALL BUDGET INVESTMENT/ OVERALL BUDGET TASK RECURRENT COST REQUIRED TASK RECURRENT COST REQUIRED Prevention (28 percent) Prevention (17 percent) Surveillance (16 percent) Investment 10 percent Surveillance (10 percent) Investment 5 percent Recurrent 6 percent Recurrent 5 percent Diagnostics (8 percent) Investment 5 percent Diagnostics (7 percent) Investment 3 percent Recurrent 3 percent Recurrent 4 percent Bio-security (4 percent) Investment 2 percent Recurrent 2 percent Control (24 percent) Control (31 percent) Quarantine, vaccination, and Investment 9 percent Rapid response and isolation Investment 6 percent hygiene programs (15 percent) (12 percent) Recurrent 6 percent Recurrent 6 percent Culling (3 percent) Investment 1 percent Vaccination and hygiene Investment 13 percent programs (19 percent) Recurrent 2 percent Recurrent 6 percent Compensation (6 percent) Investment 1 percent Recurrent 5 percent TOTAL 52 percent 48 percent 2 This table excludes communication; hence the share between human and veterinary health varies from the data in figure 1.2, where communication is included. Source: This study’s analysis. PEOPLE, PATH OGENS A ND OUR PLA NET VOL. 2 C H A P T E R 5 — ANALYSIS AND RE SULT S 17 FIGURE 5.5: Estimated Funding Needs (US$ per VLU per year) for the Prevention and Control of Other Diseases in the Animal Health Sector, by Region and Income Group (based on aggregate numbers of nine countries) 10 9 Calculated funding needs 8 (US$ per VLU year) 7 6 5 4 3 2 1 0 Sub-Saharan Other: Asia, Low income Middle income Africa Latin America, Europe and Middle East Region or income group Source: OIE (2007c). OTHER DISEASES • Export interests: Most non-African countries in The “other diseases� category covers zoonotic diseases other the sample export to Europe and the USA, which than Avian Influenza as well as non-zoonotic diseases. The dis- require higher but also more costly sanitary eases covered in the analysis varied, depending on the country, standards. This might explain, at least in part, but each country typically included data on about five diseases the difference between the estimated funding (e.g., anthrax, rabies, brucellosis, bovine tuberculosis, sheep requirements of rest of the developing world pox, etc.). The analysis covered two data sets: the OIE study (US$6.43 per VLU per year) and the middle- with data from nine countries,3 and the results of the analysis income countries (US$9.20 per VLU per year), as of the gap analysis of 14 countries.4 Because the data of these shown in figure 5.5. two sets are not fully compatible, they are reported separately. Like in the figures arrived at by the INAP analysis, these results show a strong effect of economies of scale, with, OIE Studies for example, Barbados and Belize, with less than 0.5 mil- The figures and trends that emerged from the analyses of lion VLUs, showing an average cost of veterinary services the nine countries are enumerated as follows, with strong of US$4.5 per VLU per year, whereas Uruguay, with 14 mil- caveats for the accuracy because of the limited data sets: lion VLUs, expends US$0.85 per VLU per year, in spite of its  The average funding requirement to bring the animal strong export orientation (OIE 2007c). and human health services up to OIE standards for the It is also interesting to note that although for HPAI, Sub- prevention and control of other diseases was US$2.55 Saharan Africa had a higher estimated funding requirement per capita per year, with a variation between US $0.52 than other regions of the world (see figure 5.2), for the other .96 and US$7 per capita per year. On a per VLU basis, diseases, the other regions of the world had a higher funding the average was US$5.53 per VLU per year with a requirement. This is probably to the result of: range between US$1.83 and US$10.50 per VLU per  The smaller poultry sector in Sub-Saharan Africa and year. The main factors influencing this variation include: its lack of infrastructure and resources. • Livestock population densities: Higher livestock  The higher and more costly sanitary standards densities offer economies of scale and therefore required for export interests in the “rest-of-the-world� lower per unit service costs; and category. 3 Argentina, Belize, Costa Rica, Kyrgyzstan, Mongolia, Morocco, Turkey, Uganda, and Vietnam. The Gap Analysis 4 Armenia, Belize, Cambodia, Cameroon, Guinea Bissau, Guinea Republic, Mali, Mauritania, Mongolia, Mozambique, Myanmar, A summary of the results from 21 countries’ gap analysis Nigeria, Senegal, and Vietnam. reports, prepared by OIE,(2011a) is provided in figure 5.6. E C O N O M IC AND S E CTOR WORK 18 C H A PTER 5 — A NALY S IS A ND R ES ULTS FIGURE 5.6: Distribution (%) of the Calculated Requirements of 21 Countries by Five OIE Pillars 50 45 40 35 30 Percentage 25 20 25 10 5 13.8 41.4 19.1 9.3 16.4 0 Trade Animal Veterinary Veterinary Management health public health laboratories and regulatory Source: OIE (2011a). Figure 5.6 shows that pillar 2 (Animal Health), which is the core TABLE 5.2: Average Incremental Funding to Bring of the veterinary service, has the highest budgetary require- Veterinary Services Up to OIE Standards ment to bring services up to OIE standards. This pillar has also for 14 Countries as Reported in the Gap the lowest coefficient of variability (0.38). Overall, the cross- Analysis country variability of the share of the total budget allocated AVERAGE FUNDING to the pillars is relatively small (0.38 to 0.75), except for the REQUIREMENT AVERAGE FUNDING Veterinary Laboratories pillar, whose coefficient of variation is (US$ MILLION PER (US $ PER VLU PER ITEM COUNTRY PER YEAR) YEAR) AND RANGE 0.90. A more in-depth analysis was carried out as part of this study on 14 countries and the results are provided in table 5.2. All pillars 16.0 1.95 (0.49–41.8) Pillar 1 (Competency 1.7 0.21 (0.02–13.21) A qualitative review of the same 14 countries’ gap analysis for Trade) reports shows that the main priorities and activities envis- Pillar 2 (Animal Health) 7.9 0.96 (0.07–6.61) aged, if the funding gap would be met, are as follows (see Pillar 3 (Veterinary 2.3 0.28 (0.01–5.12) also Annex 3): Public Health)  Although the non-zoonotic diseases, such as FMD, Pillar 4 (Diagnostic 0.7 0.08 (0.003–4.78) CPBB, and Newcastle Disease seem to get the overall Capacity) priority, 12 countries out of the 14 have surveillance Pillar 5 (Regulation 3.5 0.42 (0.03–12.15) and Management) for zoonotic diseases also high on their priority list of overall animal diseases to control. Moreover, the Investment/recurrent 18/82 cost ratio (pillars 1–5)% majority of countries envisage active surveillance, Funding US$ per $ livestock contribution to GDP for 0.02 rather than the passive slaughterhouse inspections. all pillars  Although the attention to active surveillance is encour- Source: This study’s analysis. aging, only a few countries had concrete plans with follow-up campaigns. Wildlife Health Service  Most food safety tasks envisaged concern meat The results of the analysis from the wildlife health service inspection and slaughterhouse improvement. questionnaire survey (see Annex 4) are provided in table 5.3.  For the diagnostic facilities, no differentiation between A total of eight countries5 provided budget data that could be zoonotic and non-zoonotic diseases is made. Costs used in this analysis. of an active surveillance system vary between US$0.4 million and US$0.7 million per year. 5 Chile, Ghana, Kenya, Malaysia, Sudan, Surinam, and Tajikistan. PEOPLE, PATH OGENS A ND OUR PLA NET VOL. 2 C H A P T E R 5 — ANALYSIS AND RE SULT S 19 TABLE 5.3: Funding of Wildlife Health Services ALL ZOONOTIC AND NON-ZOONOTIC DISEASES COMBINED (AVIAN INFLUENZA ITEM INVESTMENT OPERATING COSTS PLUS OTHER DISEASES) Average annual wildlife budget US$3.3 million US$5.0 million per country (US$) for: Before the previously noted findings could be extrapolated to  Disease surveillance US$9,700 a global scale, the estimated funding needs for the preven-  Disease diagnostics US$11,200 tion and control of HPAI were added to that of other diseases  Disease control US$4,300 and the aggregate average was taken for low- and middle-  Other aspects of ecosystems US$9,300 income countries. The results are as follows: health (pollution, etc.)  The combined INAP analysis and OIE studies result in Source: This study’s analysis. an average incremental funding need, for prevention and control of the prevailing and emerging zoonotic The conclusions from this analysis are: and non-zoonotic diseases (across the human health,  Government investment in wildlife services is mini- animal health, and planning and communication sec- mal. The figures in table 8 are heavily skewed by tors) for low-income countries, of US$4.38 per VLU the Kenyan wildlife services budget. Would that be per year and for middle-income countries of US$6.65 excluded, the total annual allocation in the seven other per VLU per year (figure 5.7). countries would be US$50,000 for investment and  The gap analysis (which is based on peace time, US$ 60,000 for recurrent costs. without control) provides an incremental requirement  Within this small overall amount, the share allocated overall of US$1.95 per VLU. A breakdown by country to wildlife health services is a paltry 5 percent. Most income level has not been done, because it is not services must therefore rely on the services of the relevant, with only two countries in the sample classi- animal health departments. fied as poor (of which one is an outlier with a very low The survey also inquired about the interaction between the livestock population). wildlife department and veterinary and human health ser-  OIE’s literature review of budgets for the public veteri- vices. The responses show that some countries lack contacts nary services in Latin America (OIE 2007c; i.e., inade- altogether, most contacts are informal and predominantly at quate peace-time allocations) shows that, on average, the research level, and three (Democratic Republic of Congo, the current expenditure is about US$1.20 per VLU per Ghana, and Kenya) have formal agreements, mostly in the year. It is interesting to note that this OIE study shows framework on an externally funded project (e.g., PREDICT, an additional expenditure of about US$9 per VLU per Arbovirus). year from private veterinary service providers. FIGURE 5.7: Estimated Funding Needs (US$ per VLU per year) for the Prevention and Control of All Zoonotic and Non-zoonotic Diseases, across the Animal, Human Health, and Planning and Communication Sectors (based on averages of aggregate numbers of all countries) 7 6 Calculated funding needs (US$ per VLU per year) 5 4 3 2 1 0 Low Middle Income Group Source: Analysis of this study. E C O N O M IC AND S E CTOR WORK 20 C H A PTER 5 — A NALY S IS A ND R ES ULTS  With these facts in mind, the real figure will most likely versus private physicians in the human health fall within the range of US$4 to US$10 per VLU per sector. year, depending on the country and available resources. • Asia, Latin America, Europe, and the Middle East As the One Health concept is implemented and more have significantly more veterinarians (public and data become available, more concrete figures for differ- private) as compared to Sub-Saharan Africa (aver- ent regions of the world would become available. age of 3,602 compared to 416 veterinarians per country, respectively). The remarkably wide range in values obtained in all the analy- • Similarly, middle-income countries have sig- ses reflects, at least in part, the differences among countries nificantly more veterinarians (public and private) in health service capacity, the priority assigned to the sector, compared to low-income countries (average of the stage of development, economic and health policy, and 10,757 compared to 710 veterinarians per country, other factors. But this wide range of values might also be respectively). the result of differences in standards (i.e., what each country regards as essential requirements), in spite of the OIE and  Relationship between the number of veterinarians and WHO efforts to promote standardization through the PVS the total funding needs for the prevention and control and IHR tools, respectively. of zoonotic diseases: • There was a positive relationship (r = +0.46) between the number of public veterinarians and OTHER ANALYSES the estimated funding needs. The strength of this relationship decreased if private veterinarians were The major data base that was set up as part of this study also added; and enabled a number of other analyses to be performed, with • There was a slightly negative correlation (r = –0.18) the following results: between the contribution of livestock to GDP and  Ratio of public to private veterinarians: the estimated funding needs. • On average, the ratio of public to private veterinar- ians was 4:1. No data could be found on public PEOPLE, PATH OGENS A ND OUR PLA NET VOL. 2 C H A P T E R 6 — E XT RAP OL AT ING T HE SE F IND I N G S TO A GLOB A L SC A LE 21 Chapter 6: EXTRAPOLATING THESE FINDINGS TO A GLOBAL SCALE MAIN ASSUMPTIONS • The stage of development of the country. As In order to approximate the total funding requirement to bring already shown by the data from GBD, low-income the prevention and control of zoonotic diseases up to OIE countries have a higher incidence of zoonotic and WHO standards in low- and middle-income countries, diseases, whereas on the livestock side, higher- numerous basic assumptions were made and the extrapola- income countries have a greater interest in tion from the data that was presented in the “Analysis and protecting their export trade, where non-zoonotic results� section was carried out. In this extrapolation, the diseases play the dominant role. INAP/OIE budget study is used because of its more com- With these considerations, this study (as a first attempt and plete data set (i.e., its inclusion of peace-time and control a low-prevalence assumption) assumes that in low-income costs) and the broader coverage among low- and middle- countries, on average, about 25 percent of the total fund- income countries. The wildlife data were too limited to ing required for the prevention and control of all diseases enable any extrapolation to a global level. The data of the gap would be needed to cover zoonotic diseases. The remaining analysis will be used only for comparative purposes. These 75 percent would be needed to cover other, non-zoonotic dis- assumptions should be refined as better data become avail- eases. In middle-income countries, on average, 15 percent of able. These assumptions cover: the total funding for all diseases would be needed to cover  The share of the public health, veterinary, and zoonotic diseases, with the remaining 85 percent needed for wildlife services’ total budgets allocated toward other, non-zoonotic diseases. The expert panel that reviewed the surveillance and control of zoonotic diseases. this report suggested a proportionately higher allocation to This is the parameter with the largest impact, and zoonotic diseases to cover higher-prevalence scenarios in about which the least is known. To estimate this both low-income and middle-income countries—to 40 per- share, several parameters can be used as proxies. cent in low-income countries and to 30 percent in middle- These include the following: income countries. • The share of livestock mortality due to zoonotic diseases (i.e., the 50 percent livestock mortality  The distribution of funding needs among the ani- due to zoonoses from the recent World Bank /Tafs mal and human health sectors. Here it is assumed Study [2011] study [“Background� section]); that the same distribution would apply as that found in • The significant attention given by national pub- the analysis of the HPAI budget data in the “Analysis lic veterinary services to the control of zoonotic and results� section (figure 5.1)—that is, the calcu- diseases, as shown by the gap analysis (“Analysis lated funding needs for human health services would and results� section); be 41 percent, animal health service needs 45 percent, and joint planning and communication • The share of human losses (i.e., number of DALYs needs 14 percent. lost to zoonotic disease). Regrettably, in this segment such data are not directly available, but  The distribution among investment and recurrent WHO’s Global Burden of Disease (GBD; 2008)1 costs. Again the same distribution as found in the provides a figure of 11 percent of total DALYs, INAPs (i.e., 45 percent and 55 percent, respectively) worldwide (9.3 percent for the middle-income and among different tasks of an animal and human and 16.5 percent for the low-income countries), health prevention and control system (i.e., the tasks that are due to diarrheal and respiratory diseases, in figures 5.3 and 5.4) would apply to other zoonotic which are the broad disease groupings and cover diseases. zoonotic diseases; and This implies that for zoonotic diseases, on average, the cal- 1 http://www.who.int/healthinfo/global_burden_disease/GBD_ culated funding needs to bring animal health services up to report_2004update_full.pdf. OIE standards in low-income countries are estimated to be E C O N O M IC AND S E CTOR WORK 22 C H A PTER 6 — EX TR A POLATING TH ESE FIND INGS TO A GLOB A L S C A LE US$1.10 per VLU per year (25 percent × US$4.38 per VLU omission of control measures other than the control of HPAI. per year for all diseases) and in middle-income countries The high-case-prevalence assumption would amount to an would be US$1.00 per VLU per year (15 percent × US$6.65 incremental funding need of US$3.4 billion per year. per VLU per year for all diseases). This is using an assump- tion of lower limit (i.e., lower disease prevalence). For results based on a higher disease prevalence assumption level, see THE ECONOMIC BENEFITS OF A GLOBAL table 6.1. ZOONOTIC DISEASE PREPAREDNESS AND CONTROL SYSTEM These total estimated funding needs are significantly lower RESULTS than the actual historical costs of emerging and re-emerging Using the previous assumptions and extrapolating collected zoonotic diseases of about US$6.9 billion per year described data, the estimated funding needs for the prevention and in the “Background� section. This cost savings is particularly control of zoonotic diseases in 139 World Bank client coun- evident when one considers that this amount reflected only tries (60 low- and 79 middle-income countries) are provided six emerging zoonotic diseases. It included neither neglected in table 6.1. zoonoses nor non-zoonotic diseases, which would also ben- efit from such a global system. Thus, the total estimated funding needs to bring the global zoonotic disease prevention and control system up to OIE These estimated required funding levels are also low when and WHO standards is approximately US$1.9 billion per year considering the benefits of averting a pandemic. To illustrate in the low-prevalence assumptions. As the services in the the range of the magnitudes of these benefits, consider two high-income countries can be expected to already meet cases: a severe and less likely pandemic and a milder, more the OIE and WHO standards, this figure would also signify likely, one. If the likelihood of a severe pandemic occurring total global need. The US$1.9 billion compares with the in any year is 1 percent (a “once-in-100-years event�), then US$1.35 billion per year required for the same 139 eligible the expected value of annual potential savings is US$30 bil- countries estimated in the Strategic Framework paper pre- lion (i.e., 0.01 multiplied by US$3 trillion of the severe pan- pared by FAO, OIE, WHO, and the World Bank and further demic cost cited earlier). In this case, an annual expenditure reported in IOM (2009) and World Bank (2010b). The dif- of US$3.4 billion on prevention (the high-case-prevalence ference could be explained by the Strategic Framework’s assumption noted earlier) will have been cost-effective if TABLE 6.1: Estimated Incremental Funding Needs to Bring Prevention and Control of Zoonotic Diseases Up to OIE and WHO Standards in the Human and Animal Health Sectors (by income level) for the 139 World Bank Client Countries (60 low- and 79 middle-income countries) and Two Scenarios ANIMAL HUMAN HEALTH HEALTH COMMUNICATIONS TOTAL ESTIMATED TOTAL VLUS FUNDING NEEDS INCOME GROUP AND DISEASE PREVALENCE (MILLIONS) (US$/VLU/YR) TOTAL ESTIMATED FUNDING NEEDS (US$ MILLIONS/YR) Low income (low prevalence) 822 $1.10 $405 $369 $126 Low income (high prevalence) $1.75 $648 $590 $202 Middle income (low prevalence) 965 $1.00 $433 $395 $135 Middle income (high prevalence) $2.00 $866 $789 $269 Total (low prevalence) 1,787 $1,862 Total (high prevalence) 1,787 $3,364 Source: This study’s analysis. PEOPLE, PATH OGENS A ND OUR PLA NET VOL. 2 C H A P T E R 6 — E XT RAP OL AT ING T HE SE F IND I N G S TO A GLOB A L SC A LE 23 every eighth severe pandemic is averted. If a larger propor- TABLE 6.2: Annual Expected Rate of Return on tion of severe pandemics is prevented, then the returns to Investments in Prevention the investment in prevention would be very high indeed, DISEASE OUTBREAKS BEING PREVENTED reflecting a global net benefit of up to US$26.6 billion MILD PANDEMIC SEVERE PANDEMIC annually. For a mild pandemic, with an economic impact of Low High Low High US$600 billion and occurrence every 40 years, the expected preventive preventive preventive preventive annual benefit of prevention is US$15 billion (i.e., 0.025 effort effort effort effort multiplied by US$600 billion). The annual expenditure of Reduction 20% 31% 14% 49% 25% in expected US$3.4 billion on prevention will have been cost-effective if disease 50% 65% 44% 88% 57% thereby one mild pandemic out of four is prevented. Higher outbreak success at prevention will increase benefits. For example, if impact 100% 97% 71% 123% 86% one-half of mild pandemics are prevented, then the global Source: This study’s analysis. net benefit is a substantial US$4.1 billion per year (i.e., 0.5 multiplied by 15, or US$3.4 billion). Prevention of all mild pandemics would yield a net global benefit of US$11.6 billion annually. Because the establishment of robust public health where spending on prevention is US$1.9 billion, and a sec- and veterinary systems in all countries will prevent at least a ond where this spending is US$3.4 billion, as described in significant number of new outbreaks and some pandemics, this paper. These annual costs of prevention as well as the these favorable ratios need to be communicated widely to costs of disease impact are assumed to grow at 2 percent decision makers. per annum, to reflect expected growth in the economy and in disease risks. Finally, in the calculations, no ben- The expected rates of return of these investments are efits from disease risk reductions are assumed to appear shown in table 6.2. The calculations show two main sce- before year 5 (without this assumption the rates of return narios: one for a mild pandemic that would cost the world would be much higher). The rates of return range from high US$600 billion and a second for a severe pandemic that (14 percent) to very high (123 percent), indicating that invest- would cost US$3 trillion. If no preventive measures to ments in prevention are strongly justified. For instance, strengthen systems for early disease detection and effec- under a plausible expectation that improved systems could tive control at the source are taken, a mild pandemic could detect and control half of incipient pandemics, the rates of occur with a probability of 3 percent in any year. A severe return range from 44 to 88 percent, which is well above pandemic would occur with a probability of 1 percent the returns available on nearly all other public spending and in any year (a “once-in-100 years� event). The expected private capital markets. costs of other major disease outbreaks would continue to be about US$6.7 billion per year, as discussed earlier. These highly favorable ratios show that One Health invest- The table shows the rates of return if the probabilities ments should be undertaken without delay. In allocating of a pandemic (and thus expected costs) are reduced by resources, decision makers should consider the extraor- 20 percent (only some outbreaks are prevented), 50 percent dinarily high returns to pandemic prevention through early (half of outbreaks are prevented), and 100 percent (perfect detection and effective control of zoonotic diseases at their prevention). Two figures are shown for each scenario: one animal source. E C O N O M IC AND S E CTOR WORK C H A P T E R 7 — E F F ICIE NCY GAINS F ROM ON E H EA LTH 25 Chapter 7: EFFICIENCY GAINS FROM ONE HEALTH THE DATA BASE efforts between the animal and human health sectors to col- Actual data on the savings from the introduction of One laborate. Moreover, this table does not include joint planning Health do not exist in the public domain. This is first because and communication activities, where even further savings only a couple of countries have actually implemented the One could be achieved. Health approach and second because these data are often confidential (due to trade and other economic interests). POTENTIAL SAVINGS THROUGH ONE HEALTH One example where One Health has been implemented Using the basic costs data from this report and the assump- .1) (see box 7 provided some data, but they are too unique tions validated by the panel of experts, the cost savings to be extrapolated to a broader scale. This study team has achievable through the implementation of the One Health therefore postulated a set of assumptions and their justifi- approach in the 139 World Bank client countries are signifi- cations (see table 7 .1), which were endorsed by the panel cant (see table 6.2). � of high level experts as “reasonable. The levels of savings listed in the next section are preliminary estimates, consid- Applying those estimated cost savings to the calculated bud- ered by the majority of the expert panel as “reasonable first get sum for the 139 World Bank client countries (combining � estimates, but are to be validated by field data as the One .1, tables 5.1 and 7 see for more details Annex 6) to deter- Health concept is implemented. They also strongly depend mine total savings, in the low-prevalence scenario, this could .1 on local conditions. In any case, table 7 demonstrates lead to a savings of US$184 million per year, or 10 percent that considerable savings can be made, even under modest of the total costs, about equally divided between low- and TABLE 7.1: Potential Savings Achievable through the Implementation of the One Health Concept in 139 World Bank Client Countries (60 low- and 79 middle-income countries) in Peacetime and Emergency Operations INVESTMENT/ TASK RECURRENT COST SAVINGS % SPECIFIC AREAS OF SAVINGS Surveillance Investment 10–30% Joint transport and communication systems, as has been demonstrated in HPAI and other campaigns Surveillance Recurrent 20–40% Shared front-line staff, as already has been demonstrated in many countries with para- veterinary systems Bio-security Investment 5–20% Shared border control and abattoir and market inspection in buildings and equipment, as already done in several countries; sharing also possible with plant sanitary service Bio-security Recurrent 10–30% Shared border control and market inspection, with clear agreement on responsibilities. Sharing also possible with plant sanitary service Diagnostics Investment 5–25% Joint facilities and equipment, as already done in a number of countries Diagnostics Recurrent 15–30% Shared support staff, as already done and recommended in other countries Control (vaccinations, Investment 5–15% Shared quarantine of infected areas, as successfully done in HPAI campaigns hygiene, and rapid response) Control (vaccinations, Recurrent 10–30% Shared staff and hygiene and awareness programs hygiene, and rapid response) Culling Investment/recurrent 0% Compensation Investment/recurrent 0% Additional costs Training 5–10% Of total budget Research 5–10% Of total budget � Source: Authors’ assumptions, endorsed by expert panel as “reasonable first estimates. E C O N O M IC AND S E CTOR WORK 26 CH A PTER 7 — EFFICIENC Y GA INS FR OM ONE H EA LTH middle-income World Bank client countries. In the high- areas of planning and communication, education, and the prevalence scenario the savings could amount to US$506 .1, extra costs of training or research. In table 7 training and million per year, or 15 percent. It should be noted, however, research are each budgeted at 5 percent of the total costs that these figures do not include potential savings in the (i.e., about US$95 million per year). BOX 7.1: The Canadian Science Centre for Human and Animal Health, Winnipeg, Canada The Canadian Science Centre for Human and Animal Health in Winnipeg is one of the few institutes worldwide that has effectively sought to integrate animal and human health to promote efficiency and effectiveness. It is the first organization in the world to house, in one facility, the laboratories for human (Public Health Agency of Canada’s National Microbiology Laboratory) and animal (Canadian Food Inspection Agency’s National Center for Foreign Animal Disease) disease research at the highest level of bio-containment. Construction of the facility began in 1992 and it was officially opened in 1999. The design of the facility (separate blocks within the one facility) provides the necessary separation between the animal and human health sectors for high-level bio-containment work. Containment Level 3 and 4 areas contain air-tight rooms with interlocking and air-tight bio-seal doors with damper systems, and the facility features state-of-the-art security as well as air filtration and waste steriliza- tion and disposal systems. Whilst some level of separation is required, the design of the facility (common areas joining the two blocks) provides a unique environment that promotes collaboration among researchers in the human and animal health sectors. Finally and most important, the facility provides significant cost savings to both sectors. After 11 years of operation, the main conclusions that Canadian Science Centre for Human and Animal Health has drawn around One Health are that:  The One Health concept can be implemented successfully, although the level to which services can be shared will depend on the country and its resources. For example, establishing a Level 3 and 4 containment laboratory like that in Canada will be restricted to very few locations worldwide. However, lower-level containment laboratories and sharing of common services (outlined next) can be implemented in most locations worldwide;  The greatest efficiency gains (i.e., savings) can be made through: • Greater collaboration between the animal and human health sectors for surveillance activities (facilities, field staff, and communication); • Establishing one facility for animal and human health diagnostics. Significant savings are made through sharing the costs of common services. These include sample reception/dispatch, library, information technology, emer- gency response, operation and maintenance of the facility (wash-up, cleaning, air filtration, disposal of bio-waste, hydro power and generators), common area staff, safety, training, quality assurance, communication, media, and so forth. More specifically, the operational (recurrent) costs of two separate diagnostic facilities (one for the animal health sector and one for the human health sector) would amount to US$19.55 million per year (i.e., .25 US$12.3 million for the human health facility and US$7 for animal health facility); • The operational costs of a joint facility amount to US$14.5 million per year, a saving of about US$5 million, or 26 percent (with about 6 percent coming from the human health services and 20 percent from the veterinary ser- vices). These data do not include costs and their respective savings on investments, nor on surveillance, control, communication, and other joint activities; and • Further efficiency gains can be made through sharing one electronic software system across animal and human health sectors and across national, provincial, and local levels. This improves communication flow and knowl- edge sharing. � Source: Authors’ assumptions, endorsed by expert panel as “reasonable first estimates. PEOPLE, PATH OGENS A ND OUR PLA NET VOL. 2 C H A P T E R 8 — E F F E CT IVE NE SS GAINS F RO M O N E H EA LTH 27 Chapter 8: EFFECTIVENESS GAINS FROM ONE HEALTH No rigorous scientific, testable information is available on Malaysia, where this relationship is demonstrated. In all of increased effectiveness (i.e., faster identification of emerging these cases, closer communication between human and diseases, which results in reduced disease spread and lower animal health services would have led to a faster and/or control costs of an eventual emerging disease outbreak) from more accurate diagnosis. the introduction of One Health. To produce such empirical Table 8.1 covers a variety of situations, from where “control information would require a with/without comparison under at source� (Mongolia, brucellosis; India rabies) led to more similar ecological conditions, which would be almost impos- efficient and effective control of human health risk, to where sible to establish. Even a before/after comparison would be close cooperation led to a better diagnosis (Mauritania, affected by the complex epidemiology of any emerging dis- Rift Valley Fever), to where the collaboration of services ease, as, at any moment in time, its evolution is the result of led to more efficient and effective control (Chad, various an unique set of ecological and social conditions. diseases; Kyrgyzstan, brucellosis) or better epidemiologi- However, in principle, the cost of control grows progressively cal tools (Tanzania, tuberculosis and brucellosis; Kenya and (although with the rate of increase depending on the specific Madagascar, Rift Valley Fever). disease) as time between the outbreak and its detection and Table 8.2 covers three reported case studies where a lack control increases. This is demonstrated in figure 8.1. of interaction seemingly caused a delay in either the diagno- The description of the benefits will therefore have to be sis or effective control of the disease, acknowledging that mostly qualitative. They can be differentiated in two cat- the qualification of the time lapse between emergence and egories. First, in table 8.1, positive experiences—that is, identification of the disease and its control, as being late or where a closer integration of human, animal, and wildlife timely, can be argued as being arbitrary. health services led to a more accurate or faster diagno- The most important effects of improved One Health systems sis—are summarized. Second, table 8.2 describes a num- will often be seen in the faster and more accurate identifi- ber of situations where lack of communication and interac- cation of health risks. Among the most significant indirect tion between human, animal, and wildlife services led to a effects will be market access, food security, poverty reduc- delay in the accurate identification of the source of the dis- tion—especially given that many zoonotic diseases are, quite ease outbreak, and possibly an increase in control costs. appropriately, called the “diseases of the poor�—reduced There are several cases, for example in West Nile Fever loss of biodiversity, and increased income from tourism. in the USA, Q fever in the Netherlands, and Nipah Virus in FIGURE 8.1: Illustrative Relationship between Time of Detection of Emerging Zoonotic Disease and Total Cost of Outbreak Cost of control Exposure Exposure Clinical outbreak in animals in humans signs Clinical signs in in animals humans Humans seek medical care Source: Adapted from IOM (2009). E C O N O M IC AND S E CTOR WORK 28 C H A PTER 8 — EFFEC TIVENESS GA INS FR OM ONE H EA LTH TABLE 8.1: Summary of the Benefits of Closer Coordination and/or Integration of Health Services between Sectors, from Published Case Studies QUANTIFIABLE COUNTRY DISEASE ACTION RESULT NONQUANTIFIABLE RESULT REFERENCE Chad Anthrax, pasteurel- Joint vaccination campaigns Costs of joint campaign Increased vaccination coverage in both E. Schelling et al., losis, blackleg, and reduced by 15% humans and livestock; Emerging Infectious CBPP in livestock; compared with separate Increased awareness of pastoralists of public Diseases, 13( 3), diphtheria, pertussis campaigns, cost health services March 2007, http:// tetanus per vaccinated child www.cdc.gov/eid (DPT) and polio in reduced from €30.3 to children €11.9 India (Jaipur) Rabies Vaccination and sterilization Human cases declined J. F. Reece and S. campaign for dogs to zero, vs. increase in K. Chawla, The other states; Veterinary Record, stray dog population 159, 2006, p. 379 declined 28% Kenya Rift Valley Fever Multidisciplinary group Risk-based contingency planning tool devel- with human, veterinary, and oped; emergency fund and communication wildlife institutions formed channels established Arbovirus Incidence and Diversity group Kyrgyzstan Brucellosis On-farm visits detecting Reduced surveillance Other zoonotic or livestock diseases assessed J. Zinsstag et al., brucellosis in humans and costs at the same time (e.g., echinococcosis) Veterinaria Italiana, animals 45(1), 2009, pp. 121–133 Madagascar Rift Valley Fever Integrated approach between Improved prediction and mapping of out- Ministries of Agriculture and breaks; reduced number of human cases Health Mauritania Rift Valley Fever Cooperation of human and Shift from erroneous diagnosis of Yellow J. Zinsstag and veterinary diagnostic services Fever to correct one of Rift Valley Fever M. Tanner, Ethiop. J. Health Dev. (Special Issue), 2008, p. 22 Mongolia Brucellosis Mass vaccination of livestock 49,207 DALYs averted at A cross-sector cost-benefit and cost-effective- J. Zinsstag et al., an inversion of US$8.3 ness analysis of brucellosis control in Mongolia View Point, 366, million, with US$26.6 shows that whereas a 10-year mass vaccination December 2005, million in economic of livestock is not profitable, if all the benefits, http://www. benefits including private health cost, loss of income, and thelancet.com increase in agricultural production are included, the societal benefit-cost ratio is 3.1; if cost of intervention is shared proportionally to benefits, the public health sector would contribute 11% of the intervention cost, which would result in a cost-effectiveness of 19 USD/DALY averted Spain Echinococcis Improved control of stray 75% reduction in Jimenez et al., dogs, echinococcidal treat- prevalence in sheep; 2002 ments of working sheep the rate of diagnoses of dogs, providing means for new cases in humans safe disposal of slaughtered dropped by 79%, from sheep offal and safe disposal 19 to 4 per 100,000 of dead sheep in sanitary pits population; cost-benefit of 1.96 Southern DPT plus polio and Joint use of cold chain Increased coverage of children Ward et al., 1993 Sudan rinderpest in cattle facilities Sub-Saharan HPAI Joint planning and implemen- Improved preparedness and control capacity Africa tation of Avian Flu campaigns Tanzania Tuberculosis and Multidisciplinary team Improved understanding of epidemiology and http://www brucellosis focused on medical, spatial distribution of diseases and pastoral .haliproject ecological, socio-economic, perception of disease led to better control .wordpress.com/ and policy issues driving the system (Continued) PEOPLE, PATH OGENS A ND OUR PLA NET VOL. 2 C H A P T E R 8 — E F F E CT IVE NE SS GAINS F RO M O N E H EA LTH 29 TABLE 8.1: Continued QUANTIFIABLE COUNTRY DISEASE ACTION RESULT NONQUANTIFIABLE RESULT REFERENCE Africa Rabies Rabies control by human Costs 50 USD per DALY This examples show the power and added J. Zinsstag et al., postexposure treatment averted; but an effective value of One Health by taking a cross-sector PNAS 106, 2009, dog mass-vaccination perspective, which shows economic results pp. 14996–15001. campaign, capable of that could not be achieved by a single-sector interrupting transmis- perspective alone sion, becomes cost- effective after 6 years, reaching 32 USD per DALY(2). General Culling activities are some- Reduced culling costs through utilizing trained Panel experts times performed by trained human health professionals human health professionals in times of a disease outbreak TABLE 8.2: Examples of Disease Outbreaks Where Poor Coordination and Integration Were Shown between Sectors and the Impact This Had on the Human and Animal Sectors COUNTRY DISEASE KEY DELAYED ACTION RESULT REFERENCE Malaysia Nipah Lack of interaction between human, veteri- More than 100 people died and over 1 http://rsif.royalsocietypublishing.org/ nary, and wildlife services caused delay in million pigs culled content/early/2011/06/01/rsif.2011.0223. understanding role of fruit tree habitat for full?sid=00c0299e-6937-4c10-81c2- bat-to-swine transmission d3630a47a8a8 Netherlands Q Fever Lack of interaction between veterinary and Likely increased disease spread (more M. Enserink, “Questions Abound in Q-Fever human health services than 2,000 human cases) and over Explosion in the 40,000 goats culled Netherland,� Science, 327(5963), January 2010, pp. 266–267 USA West Nile Delayed interaction linking human cases Delayed and initial erroneous control http://www.gao.gov/products/HEHS-00-180 Fever with dead birds, and refusal of CDC to program of intermediate host and http://sciencebulletins.amnh.org/ check birds, because of its mandate biobulletin/biobulletin/story1378.html restrictions E C O N O M IC AND S E CTOR WORK C H A P T E R 9 — C ONCL USIONS AND RE COM MEN DATIONS 31 Chapter 9: CONCLUSIONS AND RECOMMENDATIONS Emphasizing the multiple caveats regarding the limitations record and collect data, with costs split by task (prevention and gaps of the data sources described in the “Data limi- versus control), function (surveillance, etc.), object of expen- tations and gaps� section, and the resulting tentative and diture (investment versus recurrent costs), and disease approximate character of the result, the analysis of several category (zoonoses versus non-zoonotic disease). With the different sources of budget information on animal and human control of emerging pandemics, and with One Health gener- health service needs demonstrates the following: ally considered a global public good, the existing constraints  Roughly equal allocation of funds among animal and in capacity and the perverse incentives that have been human health sectors (45 percent to animal health, described in this document should be more purposefully 41 percent to human health, and 14 percent to joint addressed. The existing gap in essential data also needs to planning and communication); receive greater attention in public expenditure reviews.  An allocation of funds between investment and recur- The total calculated incremental funding needs to bring the rent costs of approximately between 40 and 50 percent zoonotic disease prevention and control system up to OIE and 50 and 60 percent, respectively (with a minimum/ and WHO standards in World Bank client countries ranges maximum of 20/80 percent, respectively); and from US$1.9 billion per year (under modest assumptions of  An allocation in the animal health sector of 50 to the importance of zoonotic diseases) to US$3.4 billion (under 70 percent for prevention and 30 to 50 percent for higher-disease-prevalence assumptions). This calculation is control activities. For the human health sector, this is based on the extrapolation of data from the 60 low-income approximately 70 percent for control and 30 percent and 79 middle-income countries treated in this report, apply- for prevention activities. ing a number of preliminary assumptions that were explained in the results section. Given the advanced state of these These findings point to balanced investments and a com- prevention and control services in high-income countries, plimentary role between the sectors, with the priority for the calculation made for the 139 low- and middle-income “prevention at the source� at the animal side, and a more countries is a close approximation to the total global funding control-focused approach at the human side. requirement. Middle-income countries show higher calculated incremen- For the low-prevalence case, this is higher than the tal funding needs for prevention and control of zoonotic US$1.3 billion per year recommended for the same 139 diseases than low-income countries. This is because their developing countries in Contributing One World, One Health: economies are to a greater extent driven by larger agricultural Strategic Framework because the study that led to that industries and export interests that require and must comply Framework document included only the surveillance and early with stricter and therefore more costly sanitary standards. response costs and omitted control and eradication measures However, economies of scale can bring this cost down sig- for diseases other than HPAI. However, the cost range of $1.9 nificantly. Low-income countries show lower requirements, to $3.4 billion is much less than the annual average US$6.7 bil- mostly aimed at strengthening control systems. lion of economic losses from major outbreaks that have been The most costly activities in both the animal and human incurred historically. And it is vitally important to note that this health sectors for the prevention of zoonotic diseases are historic annual figure of US$6.7 billion does not include the surveillance, followed by diagnostics, and then bio-security. severe impacts that zoonotic diseases have inflicted on rates They are also the activities where cooperation is easiest. On of poverty reduction and food security. The calculation more- the control side, the most costly activities are vaccination over reveals a highly positive expected rate of return varying and hygiene programs followed by investigation and rapid from 14 to 123 percent annually, depending on the assump- response in the human health sector, and compensation and tions regarding the reduction of the disease risk, the severity culling in the animal health sector. of the outbreak, and the prevalence of the disease. The data base on costs in the human, animal, and wildlife Based on conservative assumptions that were considered health services is weak. Countries should be encouraged to reasonable “first estimates� by the expert panel, efficiency E C O N O M IC AND S E CTOR WORK 32 CH A PTER 9 — C ONC LUSIONS A ND REC OMMENDATIONS gains between US$184 million and US$506 million per interactions need to be drastically strengthened if One year, or 10–16 percent, could be engendered if cooperation Health is to make a meaningful contribution to efficiency between the sectors through One Health is established. and effectiveness gains in the early detection and control of zoonotic diseases. A mounting although still limited body of evidence from case studies suggests that significant effectiveness gains For the future, the following recommendations emerge from can also be achieved through One Health. Some notewor- the analysis: thy examples of these efficiency gains include: (a) control  Countries should be encouraged to record and pro- at source (i.e., in the animal ecosystem) is often more cost- vide public access to information about their public effective than combating the disease in humans later (rabies, expenditures on health services, preferably detailed tuberculosis, brucellosis); (b) cooperation in surveillance and by task (within prevention and control) across human diagnostics often leads to faster and more accurate diag- and animal health sectors and for joint planning and nosis (Rift Valley Fever, West Nile Virus); (c) cooperation in communications, and by investment and recurrent prevention measures, such as vaccination, often leads to costs. Data availability is heavily constrained by capac- increased coverage (DPT, CBPP); (d) detailed and immedi- ity constraints and by perverse incentives, often in the ate communication reduces the number of human cases (Q form of trade and other economic interests opposing Fever, West Nile Virus). requirements to provide full disclosure regarding the prevalence of certain diseases or limitations in the This study of the economics of One Health is the first of its capacity of some institutions. These influences mili- kind. Despite the limitations of the available data, the prelimi- tate against greater transparency. They tend to lose nary results this study arrived at underscore the importance traction, however, when broad consensus emerges of One Health and the potential benefits and savings pro- recognizing the control of zoonotic diseases as a moted through better collaboration among human, animal, public good. This consensus can generate substantial and wildlife health services. The most important outcome leverage for control—both through positive measures of these preliminary results is to provide a basis for further that can, for instance, lead to access to international discussion, with a clearer understanding of existing gaps and funding, and through more negatively defined mea- issues that need to be resolved. sures such as regulation. This is also an area for future Current budgets for wildlife health surveillance and control work in the public expenditure reviews, which up to are extremely low, in spite of wildlife being the principle now have neglected detailed expenditure reviews on source of zoonotic diseases rather than livestock (the sec- health services. ond most important source). Wildlife is not only a source  With efficiency and effectiveness gains (qualitatively, of risk, however. Wildlife itself is at significant risk of zoo- and to some extent quantitatively, proven), discussion notic diseases. Ecotourism involving wildlife provides a of One Health needs to move from the conceptual significant source of revenue in many developing countries. stage to implementation. This will include the imple- Interaction between the wildlife health sector and other mentation of the sustainable funding mechanisms that departments is also minimal. Resources and cross-sectoral were detailed in Volume 1 of this report. PEOPLE, PATH OGENS A ND OUR PLA NET VOL. 2 REFERENCES 33 REFERENCES Addis Antenneh. (1984). Financing animal health services in some . Jimenez, S., A. Perez, H. Gil, P M. Schantz, E. Ramalle, and R. A. African countries. Pastoral development network. ILCA, Addis Just. (2002). Progress in control of cystic echinococcosis in La Abeba. Rioja, Spain: Decline in infection prevalences in human and ani- mal hosts and economic costs and benefits. Acta Tropica, 83(3), AVMA (2008) Towards One health A new Professional Imperative The pp. 213–221. 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World Organization for Animal Health (OIE): www.oie.int Washington, D.C.: World Bank. PEOPLE, PATH OGENS A ND OUR PLA NET VOL. 2 A N N E X 1 — GLOS SARY OF T E RMS 35 Annex 1: GLOSSARY OF TERMS Active Surveillance: Purposeful and comprehensive search- outbreak. The specific losses of costs (direct, indirect) ing for evidence of disease in animal populations (FAO, http:// included depend on country policies. www.fao.org/DOCREP/004/X2096E/X2096E05.htm). Control: Disease control by way of investigation, quarantine, Animal disease prevention: In the context of the study, this vaccination, hygiene programs, culling of infected livestock, term is understood as precautionary measures, such as sur- and compensation for loss of livestock. veillance, bio-security, and border controls, aimed at minimiz- Costs of animal diseases include: ing the risks of outbreaks of epidemic diseases. This includes prevention of trans-boundary animal diseases (TADs), but is  Direct costs and losses: from the culling and disposal not limited to them (Horst et al. 1999; Otte, Nugent, and of animals, control costs, and consequential farm McLeod 2004). This report focuses on one group of trans- losses (i.e., fall in breeding stock, restricted move- boundary diseases, the zoonotic diseases. ments, loss of value of animals etc.);  Indirect costs: domestic market and export losses, Average on aggregate data: Average based on the total spillover to tourism and wider society (i.e., food avail- population of the sample of countries included in the analysis. ability, environment, economic losses from higher human mortality) and ripple effects on upstream and Average on country data: Average based on the average of downstream industries (i.e., breeders, feed supply, each country in the sample. processors, retailers, consumers) (OIE 2007a). Benefits of improved prevention and control systems Culling or stamping-out: Carrying out under the authority include: of the veterinary authority, on confirmation of a disease, the  Enhanced food security and poverty alleviation (from killing of the animals that are affected and those suspected improved production systems); of being affected in the herd and, where appropriate, those in  Improved market access; and other herds that have been exposed to infection by direct ani-  Savings in potential outbreak costs (OIE 2007a). mal-to-animal contact, or by indirect contact of a kind likely to cause the transmission of the causal pathogen (OIE 2008a). Bio-security: Bio-security is a strategic and integrated approach that encompasses the policy and regulatory frame- Disinfection: The application, after thorough cleansing, of works (including instruments and activities) that analyze procedures intended to destroy the infectious or parasitic and manage risks in the sectors of food safety, animal life agents of animal diseases, including zoonoses; this applies and health, and plant life and health, including associated to premises, vehicles, and different objects that may have environmental risk. Bio-security covers the introduction of been directly or indirectly contaminated (OIE 2008a). plant pests, animal pests and diseases, and zoonoses; the introduction and release of genetically modified organisms Early detection system: A system for the timely detection (GMOs) and their products; and the introduction and manage- and identification of an incursion or emergence of diseases/ ment of invasive alien species and genotypes. Bio-security is infections in a country, zone, or compartment. An early detec- a holistic concept of direct relevance to the sustainability of tion system should be under the control of the veterinary agriculture, food safety, and the protection of the environ- services and should include the following characteristics: ment, including biodiversity (FAO 2003). (a) representative coverage of target animal populations by field services; (b) ability to undertake effective disease inves- Border inspection: Veterinary border control to ensure that tigation and reporting; (c) access to laboratories capable of the live animals and products of animal origin entering a diagnosing and differentiating relevant diseases; (d) a train- country are safe and meet the specific import conditions laid ing program for veterinarians, veterinary paraprofessionals, down by that country in legislation. livestock owners/keepers, and others involved in handling animals for detecting and reporting unusual animal health Compensation: Money provided as payment for loss of incidents; (e) the legal obligation of private veterinarians to income from livestock because of a contagious disease E C O N O M IC AND S E CTOR WORK 36 A NNEX 1 — GLOS SA RY OF TER M S report to the veterinary authority; and (f) a national chain Livestock Unit (LSU): As defined in the World Bank Tafs command (OIE 2011b). Atlas on Animal Diseases: 1 camel or “other camelid� 1.1 LSU; 1 cattle 0.9 LSU; 1 buffalo 0.9 LSU, 1 horse or mule Effectiveness gains: In this report, faster, more accurate (equidae) 0.8 LSU, 1 pig 0.25 LSU, 1 sheep 0.1 LSU, 1 goat diagnosis and control of a specific disease measurable, for 0.1 LSU, 1 poultry bird 0.015 LSU. example, in the number of days between the emergence of a zoonotic pathogen and the days it is formally reported and/ Monitoring: The intermittent performance and analysis of or a full campaign is under way. routine measurements and observations, aimed at detecting changes in the environment or health status of a population Efficiency gains: In this report, providing an increased sur- (OIE 2011). veillance effort with the same resources, or the same level of surveillance with less resources. This can be measured National prevention system (NPS): Sum of all services and by the number of staff involved in surveillance per thousand activities of the public veterinary services and other relevant humans or livestock. public providers at national and subnational levels allowing early detection and rapid response to emerging and re- Emerging disease: A new infection resulting from the evo- emerging animal diseases, including the services of accred- lution or change of an existing pathogenic agent, a known ited private veterinarians undertaking public service missions infection spreading to a new geographic area or population, financed from the public budget (OIE 2009). or a previously unrecognized pathogenic agent or disease diagnosed for the first time and that has a significant impact Notifiable disease: A disease listed by the veterinary author- on animal or public health (OIE 2011). ity, and that, as soon as detected or suspected, should be brought to the attention of this authority, in accordance with Endemic: A disease that is constantly present to a greater or national regulations (OIE 2011). lesser degree in people of a certain class or in people living in a particular location. OIE Standards: As defined in the OIE tool: performance of veterinary services. Epidemic: When new cases of a disease, in a given human population, and during a given period, substantially exceed One Health: The collaborative efforts of multiple disciplines what is expected based on recent experience. The disease is working locally, nationally, and globally to attain optimal health not required to be communicable. for people, animals, and our environment (AVMA 2008), or diverse collaborations of inter-professional and international Epidemiological surveillance: The investigation of a given health care professionals working at multiple levels of govern- population or subpopulation to detect the presence of ment and in private practice that can improve human, environ- a pathogenic agent or disease; the frequency and type of mental, and animal health (Hodgson 2010). surveillance will be determined by the epidemiology of the pathogenic agent or disease, and the desired outputs (OIE Other diseases: The non-zoonotic diseases, mostly the so- 2008a). , called diseases of trade (FMD, CBPP etc.). Eradication: The elimination of a pathogenic agent from a Outbreak of disease or infection: The occurrence of one or country or zone (OIE 2008a). more cases of an epidemiological unit (OIE 2011). Investment costs or capital expenditure: Incurred when Passive surveillance: Routine gathering of information on money is spent to buy fixed assets (e.g., land, buildings, and disease incidents from sources such as requests for assis- equipment) that are typically used over a long period of time, tance from farmers, reports from field veterinary officers that is, over three years (OIE 2009). See also the “Data limi- and livestock officers, submission of diagnostic specimens tations and gaps� section. to laboratories, and the results of laboratory investigations. Routine disease reports may also come from other sources, Laboratory: A properly equipped institution staffed by tech- such as abattoirs and livestock markets (FAO, http://www. nically competent personnel under the control of a special- fao.org/DOCREP/004/X2096E/X2096E05.htm). ist in veterinary diagnostic methods who is responsible for the validity of the results. The veterinary authority approves Pandemic: An epidemic of infectious disease that is spread- and monitors such laboratories with regard to the diagnostic ing through human populations across a large region—for tests required for international trade (OIE 2011). instance, a continent, or even worldwide. PEOPLE, PATH OGENS A ND OUR PLA NET VOL. 2 A N N E X 1 — GLOS SARY OF T E RMS 37 Pathogen: Any disease-producing agent (especially a virus, buffalo = 1 VLU; sheep and goats = 0.1 VLU; pigs = 0.2 VLU; bacterium, or other microorganism). poultry, ducks, geese, guinea fowl, and turkeys = 0.01 VLU; horses, donkeys, mules, camels, and other camelids = 0.5 Preparedness: The state of having been made ready or pre- VLU (OIE 2011b). pared for use or action (in this case having disease preven- tion and control strategies in place). Veterinary paraprofessional: A person who, for the purposes of the OIE Terrestrial Code, is authorized by the Recurrent costs or operating expenditures: Relate to day- veterinary statutory body to carry out certain designated to-day spending, that is, spending on recurring items. This tasks (dependent upon the category of veterinary para- includes, for example, spending on consumables and every- professional) in a territory, and delegated to them under day items that get used up as the good or service is provided the responsibility and direction of a veterinarian. The tasks (OIE 2009). See also “Data limitations and gaps� section. for each category of veterinary paraprofessional should Trans-boundary animal diseases (TADs): “Those [diseases] be defined by the veterinary statutory body depending on that are of significant economic, trade and/or food security qualifications and training, and according to need. (OIE importance for a considerable number of countries; which 2011b) can easily spread to other countries and reach epidemic Veterinary services: The governmental and nongovernmen- proportions; and where control/management requires coop- tal organizations that implement animal health and welfare eration between several countries� (Otte et al. 2004). This measures and other standards and recommendations in the report focuses on trans-boundary zoonotic diseases Terrestrial Code and the OIE Aquatic Animal Health Code in Vaccination: The successful immunization of susceptible the territory. The veterinary services are under the overall animals through the administration, according to the manu- control and direction of the veterinary authority. Private- facturer’s instructions and the Terrestrial Manual, where sector organizations, veterinarians, veterinary paraprofes- relevant, of a vaccine comprising antigens appropriate to the sionals, or aquatic animal health professionals are normally disease to be controlled (OIE 2011). accredited or approved by the veterinary authority to deliver the delegated functions (OIE 2011b). Veterinarian: A person registered or licensed by the relevant veterinary statutory body of a country to practice veterinary WHO standards: As defined in the international health regu- medicine/science in that country (OIE 2011b). lations by WHO. Veterinary Livestock Units: As defined by OIE: equiva- Zoonosis: Any disease or infection that is naturally transmis- lence unit for the estimate of annual veterinary cost and sible between animals and humans (IOM 2009). care. Conversion coefficients for calculating VLU: cattle and E C O N O M IC AND S E CTOR WORK A N N E X 2 — ADDIT IONAL TABL E S 39 Annex 2: ADDITIONAL TABLES TABLE A.1: Detailed Economic Losses from Potential Emerging Zoonotics PERIOD DISEASE (COUNTRY) ESTIMATE (US$) 1986–2009 Bovine Spongiform Encephalopathy (UK) 15,500,000,000 1997–2009 BSE (UK) 6,100,000,000 1994 Plague (India) 2,000,000,000 September 1998–April 1999 Nipah Virus (Malaysia) 671,000,000 January 1999–December 2008 West Nile Fever (USA) 400,000,000 November 2002–July 2003 Severe Acute Respiratory Syndrome (Canada, China, rest of the world) 41,500,000,000 January 2004–January 2009 Highly Pathogenic Avian Influenza (Asia) 20,000,000,000 2003–2007 Bovine Spongiform Encephalopathy (USA) 11,000,000,000 October 2005–January 2009 Highly Pathogenic Avian Influenza (Europe) 500,000,000 November 2005–January 2009 Highly Pathogenic Avian Influenza (Africa) November 2006–May 2007 Rift Valley Fever (Tanzania, Kenya, Somalia) 30,000,000 1 Total 1986–2009 97,701,000,000 Total Period 1997–2009 80,210,000,000 1 Incomplete for this period. Source: Authors’ assessment from various World Bank and other documents. E C O N O M IC AND S E CTOR WORK A N N E X 3 — DE S C RIP T IVE SUMMARY OF M A I N ACTIVITIES IN 14 GA P A NA LYS IS STUD IES RELATED TO ONE H EA LTH 41 Annex 3: DESCRIPTIVE SUMMARY OF MAIN ACTIVITIES IN 14 GAP ANALYSIS STUDIES RELATED TO ONE HEALTH TABLE A.2: Descriptive Summary of Main Activities in 14 GAP Analysis Studies Related to One Health COUNTRY PILLAR 2 PILLAR 3 PILLAR 4 Armenia Active epidemiological surveillance for brucellosis, tuberculo- Infrastructure for slaughtering Upgrading diagnostics central sis, and leucosis. lab Belize A national herd test for bovine TB and brucellosis, followed by Strengthening the meat, fish, and dairy inspec- Lab support for surveillance of active surveillance for these diseases and for BSE across the tion services; residue testing of meat and TB and brucellosis, US$433,000 cattle population; passive surveillance will continue for rabies improved control of zoonotic diseases Cambodia Assess current disease/infection situation for zoonoses; rabies Enhance food safety through registration and Lab support for surveillance control program record keeping of throughput in abattoirs, moni- of HPAI and other zoonoses, toring, reducing residues and hormones; rabies US$700,000 control program. Cameroon Passive surveillance for echinococcosis, TB, and cysticercose; Meat, milk, and residue inspection in cooperation An expected 25,000 food future active surveillance on TB and brucellosis, eventually with the Ministry of Health, also joint control for samples expected, but outside followed up with control campaigns; establishment of a rapid rabies; awareness raising at producer level for competence of veterinary alert system and a compensation fund for HPAI control hygiene of food of animal origin service Guinea Passive surveillance for echinococcosis, TB, and cysticercose; Control of zoonoses ( echinococcosis Support for diagnostics on zoo- active surveillance HPAI and Rift Valley Fever; establishment of TB, cysticercose) in collaboration with the noses (Rift Valley Fever, rabies, a rapid alert system fund for HPAI, joint programs on rabies; all Ministry of Health; slaughterhouse improvement HPAI, blackleg) delegated to private veterinarians Guinea Bissau Active surveillance on brucellosis Meat inspection and slaughterhouse Construction/rehabilitation improvement and quality control system of national veterinary lab, for an expected 500 samples (brucel- losis) eventually to be sent outside the country Mali Training and implementation of epidemiological surveys in par- Public awareness on, in particular, milk and meat No specific zoonotic-related ticular in dairy cattle for TB and brucellosis, and for Salmonella hygiene; meat, milk and residue inspection activities mentioned in poultry; establishment of risk analysis capacity; follow-up control (vaccinations) to be charged to the farmers Mauritania No specific zoonotic-related activities mentioned No specific zoonotic-related activities mentioned No specific zoonotic-related activities mentioned Mongolia No specific zoonotic-related activities mentioned No specific zoonotic-related activities mentioned No specific zoonotic-related activities mentioned Mozambique Rift Valley Fever: Emergency plan and a program including Control of zoonoses (rabies, tuberculosis, No specific zoonotic-related epidemiological surveillance; HPAI: active surveillance plan brucellosis, cysticercosis), sanitary inspection at activities mentioned targeting migratory bird sites and nearby chicken farms and slaughtering level, and sanitary control at establishment of compensatory measures for economic losses manufacturing and distribution level for meat experienced by small farmers (peasants); bovine brucellosis: and milk products, feed control and reduce the disease prevalence to levels; rabies: to prepare a joint public health program considering annual vac- cination covering approximately 80% of canine population Myanmar Control of brucellosis, TB, rabies, ND, IBD, IB, CSF, Marek, Monitoring and control of rabies and Japanese No specific zoonotic-related leptospirosis, babesiosis as “Group 2� priority diseases encephalitis (JE); residues and meat inspection activities mentioned improvement Nigeria Active surveillance on brucellosis, tuberculosis Meat, milk, and residue inspection No specific zoonotic-related activities mentioned Senegal Control of rabies, active surveillance of Rift Valley Fever and Improve meat inspection; start traceability Improve quality control of foods HPAI; active surveillance for brucellosis in dairy recommended system of animal origin Vietnam HPAI and rabies control Meat, milk, and residue inspection No specific zoonotic-related activities mentioned E C O N O M IC AND S E CTOR WORK A N N E X 4 — WIL DL IF E SE RVICE S SURVEY 43 Annex 4: WILDLIFE SERVICES SURVEY TOWARD AN ASSESSMENT OF THE COSTS Interaction with the Other One Health Partners AND BENEFITS OF CONTROL OF ZOONOTIC Coordinating and cooperating mechanisms with public DISEASES—A SHORT QUESTIONNAIRE ON human and animal health services: WILDLIFE DISEASES  Please describe institutional framework (contact on General Information personal basis, memorandum of agreement, joint Name of country or state: teams, etc.)  Please describe joint activities with human and animal Currency: health services (joint surveillance, diagnostics, etc.)  Please describe any evidence where working with Year: the human and animal health services increased the effectiveness of disease identification and control, or Importance of wildlife in the national economy (income from where the absence of such collaboration delayed an wildlife tourism): early identification of an emerging disease.  Please provide references for publications relating to Protected wildlife area (km2): using the One Health approach from your organiza- tion or country, or any others that you may know from Main wildlife health risks: elsewhere. Budget Please list the four main items included respectively in invest- ments and operating costs. TABLE A.3: Main Annual Budgetary Items INVESTMENT OPERATING ITEM COSTS2 COSTS3 COMMENTS Total wildlife department budget Budget within wildlife health services department for: Disease surveillance If figures are not available, estimates of the percentage of the total budget would be useful Disease diagnostics Same Disease control Same Other aspects of ecosystems Same, but please specify which specific aspects health (pollution, etc.) Total staffing Please provide a breakdown by category Budget for wildlife health services Please specify which (i.e., animal health, human health) within other departments Total staffing Please provide a breakdown by category (professional, paraprofessional, veterinarian, biologist, etc.) 2 Investment costs: Items with a useful life of three years or more, such as buildings, cars, laboratory equipment. 3 Operating costs: Items with a shorter useful life, such as salaries and allowances, fuel, laboratory consumables, etc. E C O N O M IC AND S E CTOR WORK A N N E X 5 — L IST OF COUNT RIE S DIF F E RE NTI ATED BY INCOME LEV EL 45 Annex 5: LIST OF COUNTRIES DIFFERENTIATED BY INCOME LEVEL TABLE A.4: 49 Low-Income Countries (US$1005 and less) According to the World Bank Criteria Afghanistan Haiti Rwanda Bangladesh Kenya São Tomé and Principe Benin Korea, Dem Rep. Senegal Burkina Faso Kyrgyz Republic Sierra Leone Burundi Lao PDR Solomon Islands Cambodia Liberia Somalia Central African Republic Madagascar Tajikistan Chad Malawi Tanzania Comoros Mali Togo Congo, Dem. Rep Mauritania Uganda Côte d’Ivoire Mozambique Uzbekistan Eritrea Myanmar Vietnam Ethiopia Nepal Yemen, Rep. Gambia, The Niger Zambia Ghana Nigeria Zimbabwe Guinea Pakistan Guinea-Bissau Papua New Guinea , Source: FAO, OIE, World Health Organization, UN System Influenza Coordination, UNICEF and the World Bank. (2008). Contributing One World, One Health: A strategic framework for reducing risks of infectious diseases at the animal–human–ecosystem interface. World Bank, Washington D.C. TABLE A.5: 139 Eligible Countries (60 low- and 79 middle-income countries) LOW-INCOME COUNTRIES (60) MIDDLE-INCOME COUNTRIES (79) Afghanistan Argentina Angola Botswana Bangladesh Brazil Benin Cape Verde Burkina Faso Chile Burundi China Cameroon Costa Rica Central African Republic Croatia Chad Djibouti Congo, Democratic Republic Ecuador Côte d’Ivoire (Ivory Coast) Egypt, Arab Republic Eritrea Gabon Ethiopia Guatemala Gambia Indonesia Ghana Iran Guinea Republic Iraq E C O N O M IC AND S E CTOR WORK 46 A NNEX 5 — LIST OF COUNTR IES D IFFER ENTIATE D BY INC OM E LEV EL LOW-INCOME COUNTRIES (60) MIDDLE-INCOME COUNTRIES (79) Guinea-Bissau Mauritius Haiti Mexico India Morocco Kenya Namibia Kyrgyz Republic Peru Lao PDR Russian Federation Lesotho (Kingdom of) South Africa Liberia Swaziland Madagascar Turkey Malawi Uruguay Mauritania Albania Mongolia Algeria Mozambique Antigua and Barbuda Nepal Armenia Nicaragua Azerbaijan Niger Belarus Nigeria Belize Rwanda Bolivia, Plurinational State of Senegal Bosnia and Herzegovina Sierra Leone Colombia Sudan Dominica Tanzania Dominican Republic Togo El Salvador Uganda 1 Fiji Vietnam 1 Georgia Zambia Grenada Zimbabwe Guyana Bhutan Honduras Cambodia Jamaica Comoros Jordan Congo (Republic) Kazakhstan Equatorial Guinea Kiribati Mali Korea, Republic of Moldova Kosovo Myanmar Lebanon Pakistan Libyan Arab Jamahiriya Papua New Guinea Macedonia, the former Yugoslav Republic of Sao Tome and Principe Malaysia Solomon Islands Maldives Somalia Marshall Islands Tajikistan Micronesia, Federated States of PEOPLE, PATH OGENS A ND OUR PLA NET VOL. 2 A N N E X 5 — L IST OF COUNT RIE S DIF F E RE NTI ATED BY INCOME LEV EL 47 LOW-INCOME COUNTRIES (60) MIDDLE-INCOME COUNTRIES (79) Timor-Leste Montenegro Uzbekistan Palau Yemen Republic Panama — Paraguay — Philippines — Saint Kitts and Nevis — Saint Lucia — Saint Vincent and the Grenadines — Samoa — Serbia — Seychelles — Sri Lanka — Suriname — Syrian Arab Republic — Thailand — Tonga — Trinidad and Tobago — Tunisia — Turkmenistan — Ukraine — Vanuatu — Venezuela, Bolivarian Republic of Source: World Bank, http://data.worldbank.org/about/country-classifications/country-and-lending-groups. E C O N O M IC AND S E CTOR WORK A N N E X 6 — P OT E NT IAL SAVINGS F ROM T HE I NTR OD UC TION OF ONE H EA LTH UND ER TWO S C ENA RIOS 49 Annex 6: POTENTIAL SAVINGS FROM THE INTRODUCTION OF ONE HEALTH UNDER TWO SCENARIOS TABLE A.6: Potential Savings from the Introduction of One Health Under Two Scenarios SAVINGS IN LOW-PREVALENCE SCENARIO (US$/YR) TOTAL SPENT ($ PER VLU) 1.09 1.00 1.09 1.00 INVESTMENT/ RECURRENT SPECIFIC AREAS SAVINGS (US$ 000s/YR) IN SAVINGS (US$ 000s/YR) IN THE SAVINGS TASK COST SAVINGS % OF SAVINGS THE ANIMAL HEALTH SECTOR HUMAN HEALTH SECTOR (US$ 000s/YR) Middle Low income Middle income Low income income Total Surveillance Investment 10% Joint transport and $9,412.03 $10,069.89 $3,858.93 $4,128.65 $27,469.51 communication systems Surveillance Recurrent 20% Shared front-line $11,294.44 $12,083.87 $9,432.95 $10,092.27 $42,903.52 staff Bio-security Investment 5% Shared border $705.90 $755.24 $0.00 $0.00 $1,461.14 control and market inspection Bio-security Recurrent 10% Shared border $1,882.41 $2,013.98 $0.00 $0.00 $3,896.38 control and market inspection Diagnostics Investment 5% Joint facilities and $2,117.71 $2,265.73 $1,500.70 $1,605.59 $7,489.72 equipment Diagnostics Recurrent 15% Shared support $4,235.41 $4,531.45 $4,502.09 $4,816.76 $18,085.72 staff Control Investment 5% Shared quarantine $4,235.41 $4,973.98 $8,789.79 $9,404.16 $27,403.35 (vaccinations, of infected areas hygiene, and rapid response) Control Recurrent 10% Shared hygiene $8,470.83 $9,947.96 $17,579.58 $18,808.32 $54,806.69 (vaccinations, and awareness hygiene, and programs rapid response) Culling Investment 0% Culling Recurrent 0% Compensation Investment 0% Compensation Recurrent 0% TOTAL $42,354.14 $46,642.10 $45,664.04 $48,855.75 $183,516.03 (Continued) E C O N O M IC AND S E CTOR WORK 50 ANNE X 6 — P OT E NTI A L SAV INGS FROM TH E INTR OD UC TION OF ONE H EA LTH UNDER TWO S C ENA R IOS TABLE A.6: Potential Savings from the Introduction of One Health Under Two Scenarios, Continued SAVINGS IN HIGH-PREVALENCE SCENARIO (US$/YR) TOTAL SPEND ($ PER VLU) 1.8 2.0 1.8 2.0 INVESTMENT/ RECURRENT SPECIFIC AREAS SAVINGS (US$ 000s/YR) IN SAVINGS (US$ 000s/YR) IN THE SAVINGS TASK COST SAVINGS % OF SAVINGS THE ANIMAL HEALTH SECTOR HUMAN HEALTH SECTOR (US$ 000s/YR) Low income Middle income Low income Middle income Total Surveillance Investment 30% Joint transport and $28,236.10 $30,209.67 $11,576.80 $12,385.96 $82,408.53 communication systems Surveillance Recurrent 40% Shared front-line $22,588.88 $24,167.73 $18,865.89 $20,184.53 $85,807.04 staff Bio-security Investment 20% Shared border $2,823.61 $3,020.97 $0.00 $0.00 $5,844.58 control and market inspection Bio-security Recurrent 30% Shared border $5,647.22 $6,041.93 $0.00 $0.00 $11,689.15 control and market inspection Diagnostics Investment 25% Joint facilities and $10,588.54 $11,328.63 $7,503.48 $8,027.94 $37,448.58 equipment Diagnostics Recurrent 30% Shared support $8,470.83 $9,062.90 $9,004.18 $9,633.53 $36,171.43 staff Control Investment 15% Shared quarantine $12,706.24 $14,921.95 $26,369.38 $28,212.47 $82,210.04 (vaccinations, of infected areas hygiene, and rapid response) Control Recurrent 30% Shared hygiene $25,412.49 $29,843.89 $52,738.75 $56,424.95 $164,420.08 (vaccinations, and awareness hygiene, and programs rapid response) Culling Investment 0% Culling Recurrent 0% Compensation Investment 0% Compensation Recurrent 0% TOTAL $116,473.89 $128,597.67 $126,058.48 $134,869.39 $505,999.43 Source: This study, based on the assumptions in table 7.1. PEOPLE, PATH OGENS A ND OUR PLA NET VOL. 2 A G R I C U L T U R E A N D R U R A L D E V E L O P M E N T Agriculture and Rural Development (ARD) 1818 H Street, NW Washington, D.C. 20433 USA Telephone: 202-477-1000 ARD AGRICULTURE AND RURAL DEVELOPMENT Internet: www.worldbank.org/ard