OS16 - 1.2.b A 'readiness rating' for balancing biosecurity priorities in FMD preparedness and response - R. Horwitz

1. OS16 A ‘Readiness Rating’ for Balancing Biosecurity Priorities in FMD Preparedness and Response by Richard Horwitz for the Open Session of the European Commission for the Control of FMD Cascais, Portugal – October 27, 2016
2. OS16 Topics • Tension in Response Priorities • SMS Project in New England • Readiness Rating 2
3. OS16 Objectives, Benchmarks and Risks in Managing Milk Movement OBJECTIVE What is the main aim of biosecurity in SMS permitting? BENCHMARK How high should the bar be set to allow milk movement? RISK What hazard lies on the “safe side” of error? DISEASE CONTROL HIGH and FIRM Up to a standard that best eliminates risk of infection TOO DISRUPTIVE Shut down too many operations BUSINESS CONTINUITY FLEXIBLE Up to a standard that a critical mass of stakeholders can meet TOO PERMISSIVE Shut down too few operations 3
4. OS16 Routine Traffic to/from Dairy Farms 4
5. OS16 Dairy Farming: Iconic New England 5
6. OS16 Dairy Farm-to-Market Traffic in New England 6
7. OS16 Stakes, If Dairy Traffic Interrupted in New England 7
8. OS16 8 Regional Agreement
9. OS16 On-line Resources 9 nesaasa.weebly.com
10. OS16 Decision Tree for Determining ‘Eligibility’ for Permit to Move Milk / COB 10
11. OS16 11 Biosecurity – Concept / Ideal
12. OS16 12 Biosecurity – Avatar
13. OS16 13 Bottom of NESAASA “Project” Page
14. OS16 14 White Paper – Justification and Discussion
15. OS16 15 Key Points – Defend difference in New England Plan: flexible and feasible. – Anticipate conflict in aims: disease control vs. business continuity. – Recognize limits of “science” and resources in response and remediation. – Extend lessons of “infection-control” in human health care facilities.
16. OS16 16 A “Pareto View” of Biosecurity: Effort, Results, and the “Point of Diminishing Returns”
17. OS16 17 SMS Biosecurity Criteria Readiness
18. OS16 18 Readiness Rating with Weighted Components Readiness Rating (0.0 - 1.0) Security of Perimeter 19% Sanitation of Lane 23% Capacity to C & D 58%
19. OS16 Objectives, Benchmarks and Risks in Managing Milk Movement OBJECTIVE What is the main aim of biosecurity in SMS permitting? BENCHMARK How high should the bar be set to allow milk movement? RISK What hazard lies on the “safe side” of error? DISEASE CONTROL HIGH and FIRM Up to a standard that best eliminates risk of infection TOO DISRUPTIVE Shut down too many operations BUSINESS CONTINUITY FLEXIBLE Up to a standard that a critical mass of stakeholders can meet TOO PERMISSIVE Shut down too few operations 19
20. OS16 20 Progress in Assessment of Farms Coverage – about 70 % of all licensed dairy farms in six states
21. OS16 21 Ideal Readiness 21 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1 ShareofFarmsAtorAboveRating Readiness Rating Business Continuity Ideal Disease Control Ideal Ideal Preparedness Range: 1.0 - 1.0 Average: 1.0
22. OS16 22 Actual Readiness, 2016 22 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1 ShareofFarmsAtorAboveRating Readiness Rating Range: .12 - .97 Average: .61
23. OS16 23 Exercises 2014 in Concord, NH and 2015 in White River Junction, VT
24. OS16 24 Thanks to you and to . . .
25. OS16 25 Contact Information On-line at NESAASA.weebly.com

Editor's Notes

Thank you for allowing me to share some of the work that a region of the U.S. has been pursuing for quite a few years, with my assistance. The focus of that effort has been to improve cooperation among scientists, farmers, policy makers, and the public, especially in regard to environmental and agricultural challenges, such as preparation and response to Transboundary Animal Diseases like FMD.
Three main Topics today:
A tension that cries out for attention in emergency planning: finding a way to balance competing priorities, maximizing chances of BOTH business continuity and disease control. The tool that I am advocating is designed to manage inevitable disruptions of commerce so that responders do not, in effect, destroy villages to save them.
A bit of background on the Secure Milk Supply (SMS) Project in New England – six states in the U.S. Northeast that together represent typical and not-so-typical dairying circumstances elsewhere.
Readiness Rating – a specific tool that we in New England developed to help incident managers in an outbreak figure out which dairy farms should be permitted to move milk to market in an animal-disease emergency.
Objectives, Benchmarks and Risks in Managing Milk Movement
The chart is designed to represent the risk that erring on the safe or “precautionary” side of one priority increases risk of erring on the dangerous side of the other.
Objective – Which response objective is more important for a given decision? (as in issuing permits to pick up milk from an apparently uninfected herd of dairy cows that happen to be in a Control Zone).
Benchmark – how much remediation of the infection risk (e.g., how extensive should be requisite biosecurity) to allow a tanker to pick up milk from the bulk tank?
Risk – Anticipate the consequences of different priorities and heights of the biosecurity benchmark – basically too disruptive (if disease control over-emphasized) or too permissive (if business continuity over-emphasized).
Routine Traffic to/from Dairy Farms
This chart is one of many useful products from the Secure Milk Supply (SMS) effort, a collaboration of state and federal governments, academia, and industry affiliated with a larger set of SFS (Secure Food Supply) projects across commodities in the U.S. as a whole.
It portrays the large network of movements that are part of ordinary operations on a dairy farm, movements that are precisely those at-risk in issuing or denying movement permits in an outbreak.
At issue is how to sustain that network while preventing virus hijackers.
Dairy Farming: Iconic New England
Part of the background for response is also the wider, existing connection between dairying and everyday life as a whole.
In the six states where this tool – the Readiness Rating – was developed, dairying is distinctly important.
About 1600 farms with about a half-million cows that produce more than 400 million pounds of milk per month.
Although dairying is relatively minor vocations in each state, the total scale and mix of large and small farms in the region resembles the rest of the U.S.
Just as important, in these six states, agriculture IS dairying, part of the region’s culture, central to its identity for centuries.
Note historic paintings or the single most photographed farm in Vermont, which ranks 15th among the 50 states in dairy production.
Dairy Farm-to-Market Traffic in New England
Pretty intense, long-distance travel of milk from farm to processor every day.
Note, however, that unlike larger states, a huge share of those trips cross state borders. Production is concentrated in North states and processing in more southern states.
Key issue: it is the states that have the authority and responsibility to control who can come into their states, and the temptation will be great (for the sake of disease control) to stop movement at state borders.
Interrupt that flow for disease control measures (erring on the safe/”precautionary” side) for even a day or two, would bring the entire industry to a halt.
Stakes, If Dairy Traffic Interrupted in New England
If states decided to manage risk one state at a time (vs. as a region together), these charts show the potential consequences.
If farm-to-processor traffic were interrupted (say, to reduce the risk of disease spread or just to allow time for inspections or additional safe-guards), they show the millions of pounds of milk that would be turned from food to waste PER DAY!
Regional Agreement
Plainly, it makes more sense to manage milk movement as a region rather than state-by-state and the six states formally agreed to do just that in 2010.
Agreement signed by the Governors in 2010 and reaffirmed in 2014 by all the Commissioners of Agriculture.
They agreed to cooperate, using a single New England States Animal Agricultural Security Alliance (NESAASA) plan, if a TAD like FMD breaks.
On-line Resources
That plan and supporting documentation can be found on the NESAASA website.
E.g. See vulnerability assessment: “Foot-and-Mouth Disease (FMD) as a Hazard For New England Dairies” that I produced and have been updating for the region for most of the last decade.
Here, for example, is a decision tree for determining ‘eligibility’ for a permit to move milk and thereby encourage business continuity
In other words, this tree show how incident mangers can determine who is ELIGIBLE (vs. receives) a permit to move.
It shows where use of the Readiness Rating tool could best begin. (E.g., so far, not an infected, contact, or at-risk farm, but a disease free farm in a Control Area).
Biosecurity – Concept / Ideal
By nearly all accounts the key to balancing disease control and business continuity objectives is having proper biosecurity.
The concept rests upon the quality of the barrier between pathogens and potential hosts.
Good biosecurity means keeping the pathogen corralled around infected animals (containment) and away from uninfected animals (exclusion).
Biosecurity – Avatar
In practice, biosecurity has become a bit of an avatar, a faith-based solution to infection.
There is now abundant evidence that just about everywhere (except, normally BSL3 labs) that biosecurity is never perfect.
E.g., in recent outbreaks of poultry and swine disease in the U.S., the worst losses were concentrated in some of the most biosecure facilities in the country).
Nevertheless, faith in biosecurity remains tragic-comically high.
Bottom of NESAASA “Project” Page
So the six states through NESAASA began to survey their farms to see where they stand.
Each state sent a representative to licensed dairy farms to collect information of three sorts: contact information on farm and its main commercial links, normal production parameters, and biosecurity.
All this information would be collected on-site, in the presence of the farm owner or manager, and strictly voluntary. (Only a handful – fewer than a dozen – farms actually refused, despite a baseline of pretty profound hostility toward government interference.)
All that information put in a database, with each state restricted to its own data but able to release it to regional neighbors in an emergency.
If nothing else, a chance to keep farmers engaged in preparation for an outbreak.
White Paper
See white paper on justification and discussion of this approach, also linked on the NESAASA website.
Key Points
Defend difference in New England Plan: emphasizing flexible and feasible biosecurity requirements.
Anticipate conflict in aims of TAD response: disease control vs. business continuity.
Recognize limits of “science” and resources in response and remediation efforts.
Extend lessons of “infection-control” in human health care facilities, such as grading tactics by field- (even more than laboratory- or model-) tested experience.
E.g., note the promise of simple universal precautions over environmental microbicide.
E.g., note the limit of training and supervision vs. thoroughness in the face of imminent threat.
A “Pareto View” of Biosecurity: Effort, Results, and the “Point of Diminishing Returns” [with Vilfredo Pareto looking on]
One of the most important lessons of all of these experiences in preventing and responding to catastrophe is to prepare to recognize a point of diminishing returns on nearly all remediation efforts.
Get more bang for the buck by anticipating that remedies like biosecurity are helpful only up to a point. So, prepare to shift emphasis sooner or later.
SMS Biosecurity Criteria
Originally derived from my own field observations of public health veterinarians in action. Developed and tested a detailed model of their decision making on-site (e.g., I asked, would you let this farm ship milk? Yield yes or no, and I asked why.
Three main components:
Security of Perimeter
Sanitation of Lane
Capacity to Clean and Disinfect
Each of these components was further refined into about 50 questions, asking farmers, on-site, in the presence of a regulatory official, more specifically which biosecurity measures were (a) in-place or (b) could be in-place with a day’s notice and no additional help or (c) impossible.
Readiness Rating with Weighted Components
Each of the answers and each farm could be evaluated independently, but it was obvious that there are apt to be too many farmers and too few regulatory officials to evaluate each one-at-a-time.
Furthermore, there was remarkable agreement among the regulatory officials of all six states and epidemiologists affiliated with USDA-APHIS-VS (including folks from CEAH, the Center for Epidemiology and Animal Health) on their relative importance.
Used AHP (analytic hierarchy process via Decision Lens) to assign a weight to each answer, and establish a single composite measure (0 to 1) of the likely biosecurity of each farm – its “Readiness Rating.”
Here you see the weights of the “parent” components.
Analytic hierarchy process (AHP) is a technique for making complex, multi-criteria and multi-stakeholder decisions, based on mathematics and psychology. It was developed by Thomas L. Saaty in the 1970s and has been extensively studied and refined since then.
Reminder: Objectives, Benchmarks and Risks in Managing Milk Movement
Use Readiness Rating as a benchmark and production parameters to see the business continuity loss of different levels.
Progress in Assessment of Farms
Coverage – about 70 % (more than 1100 of about 1600 licensed dairy farms in six states).
Ideal Readiness
Way to have no conflict between COB and disease control is to have perfect biosecurity, as in all boxes check on a pass/fail form.
Basically every farm would need a readiness rating of 1.0.
Actual Readiness, 2016
In fact, not one of more than 1000 firms surveyed could meet the biosecurity standard (arguably lower than perfect, anyway).
In other words, if strict disease control measures required, all of the farms in New England would be out of business, food supply would be cut off, millions of gallons of milk (potentially with FMDv) would have to dumped every day for months, and there would be no milk checks to pay for veterinary care, much less to keep farms and processors in business.
Just as important, this database gave responders a measure of the continuity-of-business costs of requiring more or less stringent measures.
Annual Exercises
Gathered state veterinarians (the people with the authority and much experience administering quarantines and movement controls in the past) and invited federal representatives (district APHIS) and industry (the two major coops and a few processors) to observe.
Simulated local- and region-wide outbreak (the most likely).
In focal outbreaks, they decided stop as much as they possibly could from entering or leaving a farm. Preferred to visit each farm (assuming there were few) to asses if permits could be issued.
In a regional outbreak, when gathered to set permitting criteria,) decided to reason back from minimal commerce, setting requisite rating at 5.0 to allow about 85% of milk from eligible farms to move.
Our conclusion, it works!
Suggest that tools like the Readiness Rating be prepared for use in an outbreak.
Thanks to:
US Department of Agriculture and Food and Drug Administration who provided grants as well as expertise
The New England states, especially Rhode Island and Vermont, who partnered with USDA and FDA to administer their grants.
The Secure Milk Supply folks at Iowa State, U. of Minnesota, and UC Davis.
Industry partners, including the major dairy cooperatives in the region.
NESAASA
AND YOU!
Contact information

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