Volume 45 Issue 1, Spring 2018, pp. 38-42

Understanding of global systems is essential for veterinarians seeking to work in realms outside of their national domain. In the global system, emphasis remains on the public sector, and the current curricular emphasis in developed countries is on private clinical practice for the domestic employment market. There is a resulting lack of competency at graduation for effective engagement internationally. The World Organisation for Animal Health (OIE) has created standards for public sector operations in animal health, which must be functional to allow for sustainable development. This public sector, known as the Veterinary Services, or VS, serves to control public good diseases, and once effectively built and fully operational, allows for the evolution of a functional private sector, focused on private good diseases. Until the VS is fully functional, support of private good services is non-sustainable and any efforts delivered are not long lasting. As new graduates opt for careers working in the international development sector, it is essential that they understand the OIE guidelines to help support continuing improvement. Developing global veterinarians by inserting content into the veterinary curriculum on how public systems can operate effectively could markedly increase the potential of our professional contributions globally, and particularly in the areas most in need.

Globalization has created a world in which professionals from one country need to understand how their colleagues in other nations function. Movement of people, goods, and animals has ensured that we are all now enmeshed in the matrix of complex interdependence. Both our collective security and prosperity require that we understand how the global systems operate and that we view the other nations sharing this planet through a distinct global lens, rather than strictly from our own “developed world” viewpoint. Several authors have written of the importance of ensuring that graduates of developed countries receive training to help them engage with their counterparts in other countries.13 This article aims to explain how the globalization of animal health has evolved, what impact the World Organisation for Animal Health (also known as OIE) has had on delivery of services in animal health, and how our graduates might more successfully engage for the greater good, using a public good/private good mental framework.

The Advent of Globalization and the Formation of the WTO

Globalization had its beginnings with the advent of the shipping container in the late 1950s and then satellite communications in the 1960s, which together paved the way for orderly transport of goods from one country to another with convenient and paperless tracking. Two champions of neoliberalism in the 1980s, Prime Minister Margaret Thatcher in the UK and President Ronald Reagan in the US, helped to spur trade by liberalizing many key government regulations. Trade really began to grow, and private companies benefited greatly, with marked improvement in overall economies across the globe. This international trade was regularized and expanded with the institution of the World Trade Organization (WTO) in 1995.a The advent of the WTO largely removed the political barriers to trade, and governments, rather than being central in trade, simply became gatekeepers for negotiations between private enterprises. There were strict guidelines regarding this gatekeeping function, with intellectual property and human/animal health concerns being the primary reasons for closing the proverbial gate. Because of the increased avenues and opportunities for trade, today global consumers benefit from access to the highest quality goods at the most economical price. Many emerging markets have developed, and numerous struggling economies have been positively transformed, sprouting a growing middle class in numerous countries that were historically and predominantly poor.

The central tenet of the WTO is simple: all member countries are to be treated as “most favored nation.” What this means is that all member nations are to be treated as equal; there can be no favorites because every single member is a favorite. However, the founders understood that increased trade had to allow for protection from harm. They were worried about the public health and so they created an agreement to help ensure safeguards against disease incursions due to trade in animals, plants, and food products. This particular WTO agreement is known as the Sanitary and Phytosanitary (SPS) agreement.5 “Sanitary” refers to the health of animals and animal products, and “phytosanitary” refers to the health of plants and plant products. With only 14 articles spanning seven single-spaced pages of print, the SPS is a very brief document outlining basic concepts that countries should consider when trading in animals and plants—transparency, equivalence, risk assessment, and so on.6 In their wisdom, the WTO originators tasked scientifically technical intergovernmental organizations with writing the extensive standards that would be used to make decisions on SPS issues. For this interpretation (i.e., standard writing), the WTO charged the OIE with the task of creating the standards for animal health.

The OIE

The World Organisation for Animal Health (formerly known as the Office International des Epizooties, and still known by the OIE acronym) was established in 1924 to help European countries with control of rinderpest after an outbreak due to German war reparations, in the form of cattle, which spread the disease across the Continent. Today, the OIE is a global organization, with 181 member countries, and it serves as the lead intergovernmental organization for animal health.b As with all intergovernmental organizations, it is supported by member countries, each of which sends a government representative to help create and sign on to consensus agreements. Each government representative is referred to as the “delegate” and is usually the Chief Veterinary Officer (CVO) of the country represented. The CVO is the lead person in each country, almost always a high-ranking employee, usually a veterinarian, within the Ministry or Department of Agriculture, and this person has major responsibility for guiding animal health policy and disease control decisions.

When the OIE was charged with interpreting the SPS agreement, the delegates began in earnest to flesh out standards that could be used to gauge compliance with SPS. What they developed were the OIE Codes and Manuals, voluminous documents with extensive detail on how a national Veterinary Service (VS) should operate.8 These Codes and Manuals extend over 2,800 pages and are the standards now in use for trade decisions. An importing government can open or close the gate for trade based on how well the exporting country meets the standards outlined in the Codes and Manuals.

National Veterinary Service

An effective VS is a three-part system including a CVO and associated policy colleagues, public field veterinarians, and publicly funded laboratories all working together to improve disease detection and response. The CVO and his/her coterie work with government to garner support for and enact overall disease control programs. The public field veterinarians look out for disease occurrence at the farm level. The laboratory maintains the capacity to diagnose all the diseases of national interest. All three sections work together to improve disease detection and response, with passive surveillance being the cornerstone linking them together (Figure 1). Quality surveillance leads to early detection, which translates to more timely and efficient disease control.9

Figure 1: VS framework, demonstrating all public good functions

Public Good/Private Good

The VS in every country focuses on the diseases of public good, namely those diseases that might harm trade, the national economy, or the public health. In general, public good diseases are not treatable, may be zoonotic, and can damage the overall national economy through disrupting trade. Many are capable of rapid spread. Examples of public good animal diseases include all the transboundary animal diseases (such as foot-and-mouth disease, highly pathogenic avian influenza, and brucellosis, among many others). The public good diseases, with rare exceptions, are not treatable and therefore provide no economic incentive for engagement of private practitioners. But in developed countries, the practitioners' codified connection with the VS requires them to immediately report the presence of a public good disease so that the government animal health system can take care of the problem. In the US, this connection is through USDA accreditation of private veterinarians, who maintain an awareness of public good diseases and the channels/requirements for reporting them.10 It is the private veterinarians who serve as lookouts for bad disease, which allows the public sector field force to contract, saving the government much needed resources (Figure 2).

Figure 2: VS framework with extensive private support

In contrast, private good diseases are those that damage the individual farmer or owner's single animal, herd/flock, or pocketbook. Most private good diseases are treatable or preventable, and so there is economic gain for the private practitioner through diagnosing and then administering appropriate therapeutics. In addition, most private good diseases will not affect trade, and so the values of the national herds and flocks are unaffected by their presence. Examples in the category of private good disease include shipping fever, blackleg, or coccidiosis. As private practitioners provide economically valid services to farmers, they continue to invest in the private goods delivery service sector, and a virtual circle of agricultural economic wealth evolves. This private good/private sector system is what predominates in most developed countries, and so understandably serves as the model for many veterinary curricula.

In many countries around the world, animal health is solely supported by the public sector and there is no viable private sector for animal health.11 These countries are not able to set up a fully functional and economically viable private sector until the VS is working properly to control public good diseases, because the public good diseases continue to cause serious economic damage to the animal health sector.

Building a Sustainable VS: The US Example

As previously mentioned, veterinary medicine in the US is regarded largely as a private sector enterprise. With the eradication of key public good diseases, including bovine babesiosis, classical swine fever, vesicular exanthema of swine, highly pathogenic avian influenza, and exotic Newcastle disease, and the very close control of limited areas of brucellosis and tuberculosis, the tremendous success of our US VS in the last century has allowed the animal agriculture industries to flourish and focus on enhanced growth and productivity. Our animals and animal products became ever more efficient to produce and in turn became prized commodities in the international marketplace. The private veterinary sector grew accordingly, and the original ratio of 10 government veterinarians to every privately employed veterinarian was slowly but surely completely inverted. As a result, most veterinarians in the US, with its strong private market forces for animal health, are understandably insufficiently cognizant of the very important role that the VS plays in overall animal health in any particular country.

It is not reasonable to expect new graduates from developed countries to be able to contribute to global health if they have no understanding of OIE and VS structure and function. The OIE recognizes this and so has promulgated a list of Day One Competencies for a Global Animal Health Veterinarian.12 Comparing these competencies to those promoted by the AVMA highlights some striking differences (Table 1).13 The majority of entry-level competencies from the AVMA COE standards focus on private good delivery of services, whereas the majority of competencies from the OIE are oriented toward the VS and the public good. The OIE recommends that all graduates have baseline understandings of transboundary animal diseases, disease prevention and control programs, certification procedures, and veterinary legislation, which are all key components of the public good system, whereas the AVMA COE does not include any of these competencies among its standards. However, it is generally recognized that in order for graduates to be effective and engaged in resource-poor foreign environments, they also need competencies in cross-cultural communication, emotional intelligence, and technical disease knowledge.

Table

Table 1: Comparison of AVMA Competencies and OIE Day One Competencies

Table 1: Comparison of AVMA Competencies and OIE Day One Competencies

OIE recommendation on the competencies of graduating veterinarians AVMA COE entry-level competencies for graduate veterinarians
Epidemiology Comprehensive patient diagnosis (problem-solving skills), appropriate use of clinical laboratory testing, and record management
Transboundary animal disease Comprehensive treatment planning including patient referral when indicated
Zoonoses (including foodborne diseases) Anesthesia and pain management, patient welfare
Emerging and re-emerging diseases Basic surgery skills, experience, and case management
Disease prevention and control programs Basic medicine skills, experience, and case management
Food hygiene Emergency and intensive-care case management
Veterinary products Understanding of health promotion and biosecurity, prevention and control of disease including zoonoses, and principles of food safety
Animal welfare Client communications and ethical conduct
Veterinary legislation and ethics Critical analysis of new information and research findings relevant to veterinary medicine
General certification procedures
Communication skills

OIE Performance of Veterinary Services

The OIE, in its efforts to help animal health in developing countries, has created a program of evaluation for a country's VS. The Performance of Veterinary Services (PVS) is a comprehensive appraisal that examines and scores many different parameters.14,15 The PVS tool assesses a country based on the standards laid out in the OIE Codes and Manuals. PVS evaluators, specifically trained through a rigorous OIE program, thoroughly examine a multiplicity of areas within the VS, and the resulting PVS report, often 40–50 pages in length, details the strengths and deficits in the country's VS.

As of December 2, 2016, 136 countries have requested evaluation, and 130 of those requests have been completed.16 Countries open up their records to the OIE and allow them to document weaknesses and strengths of the VS. Although it may be slightly embarrassing to have your flaws documented, the CVO of the country often welcomes the evaluation to validate the need for more funding and other resources from officials higher in the government. These PVS documents can provide valuable guidance for developed-country donors and veterinary specialists aiming to work in a particular country. The PVS is essentially a roadmap for a sustainable VS. Matching specific areas of need outlined in the PVS (e.g., more rigorous slaughter inspection or more continuing-education offerings in diagnostics) could be matched with appropriate subject matter experts (e.g., food safety specialists or laboratory diagnosticians, respectively), for great value added. Veterinarians from developed nations should be strongly encouraged to review the PVS report from any country in which they will work, as this document provides a roadmap for how to sustainably support and build the VS, which is the first step toward the economic viability of animal health.

In most developing nations, the VS is not sufficiently able to monitor or control public good diseases. Farmers do not profit enough from their animals because public good diseases continue to decimate flocks and herds. Smallholder incomes, national economic benefits from trade, and food security all suffer. The private sector of veterinary care is nascent and cannot emerge successfully until the public good diseases are controlled. Veterinarians tasked with international aid will need to focus on the VS and work hand in hand with the host nation VS to implement sustainable improvements to the system.

Working to support the VS also ensures more safety from disease incursions for developed countries. All countries are undeniably connected through the ever-increasing bonds of trade. Although the SPS agreement allows countries to block imports of animals and animal products from countries with numerous public good diseases, diseases nevertheless sneak into new areas at an ever-increasing rate. The past 20 years have seen a plethora of new pathogens in the US alone—West Nile virus, contagious equine metritis, SARS, H1N1 influenza, porcine epidemic diarrhea, screwworm, H3N2 canine influenza, and H5N8/H5N2 avian influenzas, among others. With this increased potential for disease movement, US animal health and economic viability remain vulnerable. Helping nations with fewer resources to develop better VS and surveillance systems can only decrease the global burden of public good diseases and provide greater benefit to all.

For our own economic security as well as the economic livelihoods of the world's poorest, helping with control of public good diseases in all nations represents a viable path forward. Veterinarians from developed nations are well positioned to help with those tasks, provided that they are thoroughly cognizant of the various regulatory mechanisms involved in animal health at both global and national levels. Ensuring that our new graduates receive some of this information during their matriculation would markedly enhance what our profession contributes.

The opinions or assertions contained herein are the private ones of the author and are not to be construed as official or reflecting the views of the Department of Defense or the Uniformed Services University of the Health Sciences.

NOTES

a World Trade Organization (WTO), Geneva, Switzerland, https://www.wto.org/

b World Organisation for Animal Health (OIE), Paris, France, http://www.oie.int/

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