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3 Drivers of Zoonotic Diseases “A transcendent moment nears upon the world for a microbial perfect storm. Unlike the meteorological perfect storm—happening just once in a century—the microbial perfect storm will be a recurrent event. The two events share a common feature; a combination of factors is the driving force behind each.” —Microbial Threats to Health: Emergence, Detection, and Response (Institute of Medicine, 00) Zoonotic disease emergence is a complex process. A series of external factors, or drivers, provide conditions that allow for a select pathogen to expand and adapt to a new niche. The drivers for the most part are eco- logical, political, economic, and social forces operating at local, national, regional, and global levels. Regions where these factors are most densely aggregated, most highly prevalent, and where risk of a disease event are most intense can be considered zoonotic disease “hotspots.” In this chapter, the committee reviews many of the drivers underlying this process of disease emergence and reemergence. Though not an exhaustive review, it reveals the multiplicity and the complexity of their inter-relationships. OVERVIEW OF ZOONOTIC DISEASE EMERGENCE AND REEMERGENCE Zoonotic disease emergence often occurs in stages, with an initial series of spillover events, followed by repeated small outbreaks in people, and then pathogen adaptation for human-to-human transmission. Each stage might have a different driver, and therefore a different control measure. As mentioned in Chapter 2, human immunodeficiency virus-1 (HIV-1) emerged from chimpanzees in Africa, spilling over to humans repeatedly before its global spread (Hahn et al., 2000). This initial phase of emergence was driven by bushmeat hunting and was the primary driver of its emergence. A second phase of emergence was driven by increased urbanization and 

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 GLOBAL SURVEILLANCE AND RESPONSE TO zOONOTIC DISEASES road expansion in Central Africa beginning in the 1950s, and dispersal of index cases harboring prototype HIV-1 infections that were transmissible from person to person. The virus then entered the rapidly expanding global air travel network and became pandemic, with its emergence in North America, Europe, and Asia, accelerated by changes in sexual behavior, drug use, trade in blood derivatives, and population mobility. Nipah virus is another example of a recently discovered paramyxovirus with fruit bat reservoir hosts. It caused a large-scale outbreak in Malaysian pig farmers in 1998. It is a growing threat due to its broad host range, wide geographical distribution, high case fatality, reports of human-to-human transmission, and the lack of vaccines or effective therapies (CDC, 1999; Eaton et al., 2006; Gurley et al., 2007). A recent analysis of food-animal production data from the index site—a commercial pig farm in Malaysia— before and during the outbreak shows that the emergence was likely caused by repeated introduction of Nipah virus from the wildlife reservoir into an intensively managed, commercial pig population site planted with mango trees (Daszak et al., 2006). This repeated introduction led to changes in infection dynamics in the pigs and a long-term, within-farm persistence of virus that would otherwise have died out. This causative mechanism has been previously proposed as a driver of highly pathogenic avian influenza (HPAI) H5N1 dynamics in poultry and the emergence of other pathogens (Pulliam et al., 2007). An overview of how certain factors lead to disease emergence and reemergence is outlined in Figure 3-1. There is currently a great deal of interest in studying the underlying drivers of emerging diseases, from the proximal to the primary, to better target control programs. THE HUMAN–ANIMAL–ENVIRONMENT INTERFACE Historical Perspective on the Human–Animal Interface The hunter-gatherer lifestyle supported early human societies for mil- lennia, and this lifestyle could support an estimated 4 million people world- wide. About 10,000 years ago, hunter-gatherers began to settle, planting crops and husbanding wild animals to the point of domestication. This pat- tern continued more or less uninterrupted until the end of the 17th century when Thomas Malthus wrote in An Essay on the Principle of Population that human growth would soon outstrip the ability of the world to feed it. Fortunately, Malthusian predictions proved untrue, largely because of the change in agricultural systems from extensive to intensive. This change was accelerated by the growth of large urban centers and the invention of the railway, allowing food to move more freely from the farm to the table.

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Human Domain Human Health Issues Behavior, At titudes, Preferences, Culture Lifest yle, Economics, Technology Movement, Transpor t, Trade Human-Animal Interface : Human- Environment Interface : Companion Animal Ownership “Built Environment” Animals as Food, Husbandr y Practices Pollution (Air, Water, Noise, Light, Solid Waste) Wildlife Management Practices Urban/ Periurban Development Habitat Encroachment Non-animal Farming Practices (Crop Choice, Irrigation) Disease Emergence Re - emergence Persistence Environmental Domain Animal Domain Long -term Climatic Change Non-human Animal Health Issues Global Weather Influences ( ENSO) Behavior, Geographic Range, Local/ Regional Weather Patterns Biodiversity Loss, Predator-prey Altitude, Temperature, Humidity Balance, Habitat and Feeding Soil and Vegetation Type Preferences or Requirements Animal- Environment Interface: Expansion/ Loss of Range Invasive Species Environmental Ef fect on Immunity Ef fect of Environmental Conditions on Lifespan and Reproduc tion (especially vectors) FIGURE 3-1 Overview of the driver-pathogen interactions that contribute to the emergence of infectious zoonotic diseases.  SOURCE: Treadwell (2008). Figure 3-1.eps broadside

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0 GLOBAL SURVEILLANCE AND RESPONSE TO zOONOTIC DISEASES The “Green Revolution”1 further increased crop yields and the separation of humans from the source of their food. Since the 1960s, the production of food animals has grown phenom- enally. Global milk production has doubled, meat production has tripled, and egg production has increased four-fold. Part of this is due to greater numbers of animals. However, genetic enhancement has also played a role, leading to higher overall production per animal. Current Trends in Animal Protein Production World demand for animal protein is increasing, and projections for con- sumption are staggering. Between 2000 and 2030, global meat production is expected to increase by approximately 2 percent per annum until 2015 and then slightly more than 1 percent per annum until 2030 (Steinfeld, 2004). Most of this demand is expected to come from the developing world, where rapid population expansion and higher per-capita incomes will drive people to change from a diet of rice, beans, and corn to one that incorporates more animal protein, a phenomenon known as the “nutrition transition” (Delgado, 2003). How will this demand be met? Most recent growth in intensive agriculture and projected growth for the next 30 years is mostly in the developing world, where intensive food-animal production facilities are being set up. These facilities are almost entirely based on feed grain, and in Asia, feed grain is imported from other parts of the world (see discussion later in this chapter on Global Food Systems and Food Safety). These collective changes in agricultural production and distribution, re- ferred to as the “Livestock Revolution,” are driven by globalization and the developing world’s emerging middle class. The Livestock Revolution is characterized by vertical integration, the introduction of large supermarkets in developing countries, regional concentrations of animals, and a move to locate production facilities geographically at the farthest reaches permitted by regulations (Steinfeld, 2004). Fueled by a growing population, rising incomes, and related urban- ization, the consumption of meat and milk in the developing world grew slightly more than 3 and 2 percent per year, respectively, from 1992 to 1 The term “Green Revolution” was coined by the director of the U.S. Agency for Interna- tional Development in 1968 to describe the phenomenal growth in production of rice and wheat. The Rockefeller and Ford foundations made research investments to improve breeding varieties combined with expanded use of fertilizers, other chemical inputs, and irrigation. This led to dramatic yields of these grains, particularly in Asia and Latin America, in the late 1960s. Although heralded as a major achievement in establishing levels of national food security for developing countries, it is also criticized for causing environmental damage, including pol- luting waterways with chemicals, affecting the health of farm workers, and killing beneficial insects and wildlife (IFPRI, 2002).

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 DRIVERS OF zOONOTIC DISEASES Year FIGURE 3-2 Projected production of animal meat by species, 1961–2025. SOURCE: Newcomb (2004). Reprinted with permission from Bio Economic Re- search Associates, LLC (bio-era™). All -2 color.eps Figure 3 rights reserved. bitmap image 2002.2 Growth was particularly strong in China, where over that same period meat and milk consumption grew by nearly 6 and 8 percent per year, respectively. Most of the growth occurred in poultry and swine; beef consumption grew at a much lower rate (see Figure 3-2). In contrast, per- capita total meat consumption in the developed world remained practically static in the same period, although there has been a slight shift from beef to chicken. This strong expansion and resulting concentration of meat and milk production in the developing world has consequences for global human and animal health, which is explored in more detail later in this chapter. The shift of production to the developing world transfers the industry to a region with generally weak public services and regulatory oversight 2 The underlying quantitative parameters driving this growth over the period 1992–2002 are (1) population increases of 1.7 percent per year in the developing world versus 0.4 in the developed world; (2) per-capita gross domestic product increase of 3.9 percent in the develop- ing world versus 0.4 percent in the developed world; and (3) expenditure elasticity (percentage increase in expenditure on an item with a 1 percent increase in total expenditure) for meat in low-income countries of 0.78 percent, in middle-income countries of 0.64 percent, and in high-income countries of 0.36 percent (Searle et al., 2003).

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 GLOBAL SURVEILLANCE AND RESPONSE TO zOONOTIC DISEASES mechanisms, which were unprepared for fast growth and major structural changes. Intensified food-animal production has epidemiological consequences (see Box 3-1). Natural herds often have a low rate of reproduction and production. Humans have domesticated animals to ensure a more regular, safer, and convenient food supply. The objective of husbandry is to reach a natural balance between the host and its parasites while promoting efficient and economical production. Any increase in production must be matched with a refinement of management and disease control strategies. Although the factors listed under a “man-made ecosystem” (Box 3-1) are caused by influences of human intervention, their adjustments or maintenance are not necessarily under human control, and could lead to higher levels of disease risk. But at the same time, the level of risk could be reduced through more intensively managed and maintained factors with respect to animal health and well-being. BOX 3-1 Epidemiological Factors Comparing Natural and Man-made Ecosystems Natural Ecosystem Man-made Ecosystem • andering herds grazing W • erds are permanently housed (zero H extensive areas grazing) • ntermingled species so that I • ixed herds have become single M mixed grazing occurs species • ifferent species unaffected by D • xcreted pathogens are available to E the parasites of others others of the same species • n the open air, expiratory droplet I • nimals are crowded on limited land A infections are of little importance • atural avoidance distances N • rowding allows closer contact C minimize direct contact • redators remove diseased P • redators are eliminated; sick are P animals early in the course of the helped to survive while excreting disease pathogens • osts and parasites reach a H • alance is upset as new niches are B balance so that both live with little created harm • pidemics occur only when E • ncreased risk of disease I populations increase past a certain point

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 DRIVERS OF zOONOTIC DISEASES DRIVERS INFLUENCING EMERGING AND REEMERGING ZOONOSES Human Population Growth and Distribution Global Population Growth The second half of the 20th century was a time of unprecedented popu- lation growth. According to United Nations (UN) estimates and forecasts, the world population more than doubled from an estimated 2.5 billion in 1950 to more than 6.5 billion in 2005 (see Figure 3-3), an annual average growth rate of 1.72 percent (United Nations, 2007). Although growth rates peaked in the late 1960s at slightly more than 2 percent and had declined to slightly more than 1 percent in the first 5 years of the 21st century, annual population increments continued to increase in the late 1980s and were projected to peak at about 8 billion by 2050. The UN’s medium variant forecast, based on the assumption of continued fertility declines in low- income countries, shows the world population continuing to increase to slightly more than 9 billion by 2050. Year FIGURE 3-3 World population projections, median variant forecasts. SOURCE: United Nations (2007). Reprinted with permission from the Population Reference Bureau. Figure 3-3.eps bitmap image

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 GLOBAL SURVEILLANCE AND RESPONSE TO zOONOTIC DISEASES Population growth has been unevenly distributed around the globe and is expected to become even more so in the next few decades. The developed countries—essentially Europe, North America, Australia, Japan, and New Zealand—represented nearly a third of the total growth in 1950, a propor- tion that had declined to less than 19 percent by 2005 (see Figure 3-3). Sub-Saharan Africa has shown the highest growth rates, averaging nearly 3 percent per annum in the late 1980s. The bulk of the absolute population increments have occurred in Asia, with annual increases reaching 57 million around 1985, declining only to slightly less than 50 million by 2005. More than half of these annual increases are now accounted for by South Central Asia, predominantly India, Pakistan, and Bangladesh. The bulk of future population growth is expected to occur in developing countries. The share of world population of the developed countries is forecast to decline to less than 14 percent by 2050, while sub-Saharan Africa is forecast to increase to nearly 20 percent. By 2050, of the global annual increment of 37 million, 22 million will occur in sub-Saharan Africa, whose population will still be increasing by more than 1 percent per annum, and 12 million will occur in South Central Asia (United Nations, 2007). Population Mobility Once a zoonotic disease has emerged, its spread in the human popula- tion is likely to be facilitated by population movements. Migration, also called long-term population resettlement, is likely to spread diseases that have a long period of latency or duration of infectiousness, whereas short- term mobility for periods of days or weeks, typical of “travel” patterns, may rapidly spread diseases with short resolution periods. The latter is il- lustrated by the spread of severe acute respiratory syndrome (SARS) from Hong Kong to Toronto within weeks in spring 2003, and the spread of the influenza A(H1N1) virus from Mexico to New York in April 2009. Measurement of both intra- and international migration is poor, with most estimates coming from census data on birthplace. The global count of foreign-born persons now living in a different country has increased moder- ately, from about 75 million in 1965 to about 175 million in 2000 (United Nations, 2002). This growth is somewhat misleading, however, because a portion of the increase resulted from the break-up of the Soviet Union. About half of the world’s international migrants have moved between de- veloping countries. As of 1990, the United Nations (2002) estimated that about 13 percent of international migrants were living in Africa, 36 percent in Asia, 21 percent in Europe, 20 percent in North America, 6 percent in Latin America, and 4 percent in Oceania. Population displacements as a result of conflict or natural disaster are likely to create conditions of crowding and poor sanitation that are highly

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 DRIVERS OF zOONOTIC DISEASES conducive to the spread of infectious diseases. As of 2007, the Office of the United Nations High Commissioner for Refugees reported a total of 16 million refugees, under its or the United Nations Relief and Works Agency mandates, 26 million persons reported internally displaced as a result of con- flict, and 25 million reported internally displaced as a result of natural disas- ters (UNHCR, 2009). Given the caveat that definitions and data collection procedures have varied over time, the numbers of refugees and internally displaced persons have not changed dramatically over several decades. Human travel associated with tourism, business, and other moves not associated with changing residence have increased rapidly over the past 50 years and are projected to continue to increase. As shown in Figure 3-4, the revenue passenger kilometers represent the total number of passengers traveling globally multiplied by the number of kilometers they commercially fly, illustrating the increasing number of people and goods that are traveling farther and faster around the globe. Human movement has significant implications for human and animal health. Not only are travelers (tourists, businesspeople, and other workers) at risk of contracting communicable diseases when visiting tropical coun- tries, but they also can act as vectors for delivering infectious diseases to a different region or potentially around the world, as in the case of SARS. Refugees have become impoverished and more exposed to a wide range of health risks because of their status (Toole and Waldman, 1997), and 10000 Revenue Passenger-Kilometers ( Billions) 9000 8000 7000 6000 5000 4000 3000 2000 1000 0 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 Year FIGURE 3-4 Volume of global air traffic, 1985–2001, and projection of future trends, 2001–2021. Figure 3-4 alt.eps SOURCE: Adapted from Daszak and Cunningham (2003).

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 GLOBAL SURVEILLANCE AND RESPONSE TO zOONOTIC DISEASES their populations have been reported to harbor hepatitis B, tuberculosis, and various parasitic diseases (Loutan et al., 1997). Immigrants may come from nations where infectious diseases such as tuberculosis and malaria are endemic, and refugees may come from situations where crowding and mal- nutrition create ideal conditions for the spread of diseases such as cholera, shigellosis, malaria, and measles (CDC, 1998). Urbanization Populations in urban areas are typically less exposed to animal contact than rural populations, depending on the market structures and production systems of live food animals, but urbanites may also live in more crowded conditions conducive to disease transmission. The increase of global popu- lation over the past 50 years has been roughly paralleled by an increase in the level of urbanization. In 2005, the world’s population was nearly 50 percent urbanized, a figure forecast to rise to nearly 70 percent by 2050 (United Nations, 2008). Developing countries as a whole, and South Cen- tral Asia and sub-Saharan Africa in particular, are somewhat less urbanized than the global average, though the differences have narrowed over time. By contrast, in all regions except sub-Saharan Africa, the rural population is forecast to be declining by 2050, and has probably been declining since the early 1990s in Latin America. Of course, cities grow in part by encroaching on surrounding farmland. The combination of reduced population incre- ments and declining rural populations is likely to increase pressures on land resources in the future. Human Behavior and Cultural Factors Researchers have identified several social and cultural factors as drivers of emerging zoonotic diseases (Mayer, 2000; Patz et al., 2000; Daszak et al., 2001; Macpherson, 2005). Changing demographics and unprecedented population movement, as well as increased global flow of people, goods, food-animals, food products, and domestic and wild animals, all affect “microbial traffic” and emerging viral, bacterial, and parasitic zoonoses (Morse, 1993; Mayer, 2000). Social changes resulting in altered land and water-use patterns, intensified agricultural practices, deforestation and re- forestation, and human and domestic animal encroachment on wildlife habitats also affect the movement of pathogens. These factors contribute to cross-species pathogen transmission and the emergence of new epidemic diseases that affect humans and animals, including the transmission of zoo- notic diseases to humans and the anthropogenic movement of pathogens into new geographic spaces affecting the health of wildlife (Daszak et al., 2001).

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 DRIVERS OF zOONOTIC DISEASES Natural and Built Environments The built environment—environments made, modified, and used by humans—is characterized by a sense of cultural aesthetics that influences how buildings, gardens, ponds, and parks are constructed. Environments are modified not only for aesthetic reasons, but also for utilitarian needs to provide a larger, general population with access to a public good or utility, such as dams for hydroelectric power or canal-building for transportation. Built environments have provided breeding sites for disease vectors such as Aedes aegypti, the mosquito which transmits dengue fever. Culture, society, and religion influence the kinds of foods people eat, how foods are prepared, and the demand for foods at particular times (Shanklin, 1985). For example, each year 2–4 million Muslims from more than 140 countries make the pilgrimage to Mecca in Saudi Arabia for the Hajj or for Umrah (year-long lesser religious rites). During the religious fes- tivals of Eid al-Adha,3 up to 10–15 million small ruminants or 64 percent of the global trade of live sheep (Shimshony and Economides, 2006) are ritu- ally slaughtered in various countries, including Saudi Arabia where Mecca is located, but even outside urban areas such as Washington, DC, to feed an estimated 12–15 million people. Most of these animals are shipped alive to the Arabian peninsula from countries across the Red Sea in East Africa and the Horn of Africa, where diseases that affect both humans and animals, such as the mosquito-borne disease Rift Valley fever (RVF), are endemic (Ahmed et al., 2006; Davies, 2006). Because animals are dispatched rapidly to preserve their value and the incubation period of diseases such as RVF is days longer than the transport time, conditions are ripe for disease spread. In 2000–2001, RVF was reported in Saudi Arabia (CDC, 2000) and has the potential to become an epidemic if not carefully monitored. Challenges to disease surveillance include not only heavy human and animal traffic and crowded conditions in ports and pilgrimage sites, but also political instability in the region and lack of cooperation among countries, which undermines the reporting of sick animals. Food Preferences Taste is a cultural phenomenon that influences food preparation and is also a driver of zoonotic disease transmission and infection. Globalization has also fostered the taste for foods from other cultures that contain raw meat or fish (e.g., sushi), and this can facilitate a number of parasitic zoo- noses (Macpherson, 2005). In both Indonesia and China, a preference for 3 Eid al-Adha (Arabic for “Festival of the Sacrifice”) is a major Islamic festival that takes place at the end of the Hajj observed by Muslims throughout the world to commemorate the faith of Ibrahim.

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0 GLOBAL SURVEILLANCE AND RESPONSE TO zOONOTIC DISEASES as “growth promoters,” and as a treatment in a very minor proportion. The use of antibiotics for growth promotion began in the 1940s when the poultry industry discovered that the use of tetracycline-fermentation by- products resulted in improved performance (Stokstad et al., 1949), although the mechanisms for improved performance are not completely understood. Research has suggested that growth promotion works by affecting changes in intestinal tract microorganisms, resulting in better absorption of nutri- ents and consequently improvements in weight gain (Stock and Mader, 1984; Preston, 1987; Elam and Preston, 2004). Poultry and swine produc- tion systems account for most of the use of antibiotics in feed, with 44 and 42 percent of all growth-promotant antibiotics used in these two species, respectively. Beef production is responsible for the remaining 14 percent (Mellon et al., 2001). The discontinued use of fluoroquinolones and mac- rolides in U.S. broiler production could predispose people to greater health risks as a result of increased illness rates in animals, greater microbial loads in servings from affected animals, and hence increased potential for human illness (Cox and Popken, 2006). Other investigators have found direct links between the feeding of an- tibiotics and the presence of resistant bacteria in the vicinity, with potential spread to humans. Tetracycline resistance was found in 77 percent and 68 percent of E. coli and Enterococci isolated from samples obtained at a swine concentrated animal feeding operation (CAFO) in the United States (Stine et al., 2007). In a Danish study (Smith et al., 2002), the application of pig manure as fertilizer for farmland resulted in the detection of elevated occurrences of tetracycline-resistant bacteria in the soil immediately after pig manure slurry was spread. Gibbs and colleagues (2006) evaluated the air plume downwind from a CAFO and found a greater concentration of antibiotic-resistant bacteria within and downwind of the swine facility than upwind. Some reports have postulated an association between human and animal health, food-animal antibiotic resistance, and antibiotic resistance in clinical isolates (Teuber, 2001; Smith et al., 2002). Clearly there is concern regarding low-level antibiotic use in food-producing animals, and more scientific data are needed to develop meaningful policies and procedures to protect both human and animal health while optimizing food-animal production. Biotechnology and Lack of Biosecurity Biotechnology has precipitated disease emergence in three ways: (1) through medical innovations; (2) as a result of laboratory escapes; and (3) through personal contact with laboratory animals or biological agents in a research setting. A further area of concern is bioterrorism and the manipu- lation of microbiological agents to make them more readily contagious or infectious among humans.

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0 DRIVERS OF zOONOTIC DISEASES Medical Innovations In recent years, transplantation has resulted in several cases of zoonotic diseases infecting transplant recipients. Perhaps the most widely cited in- stance was an organ donor who was infected with rabies. His organs subse- quently infected and killed four transplant recipients (Burton et al., 2005). A second instance involved two clusters of unusual disease in transplant recipients, in which lymphocytic choriomeningitis virus was eventually di- agnosed, with seven or eight transplant recipients dying. The organ donor kept a pet hamster that had a strain identical to those isolated from some of the transplant recipients (Fischer et al., 2006). Xenotransplantation is the transplantation of living organs, tissues, or cells from one species to another, and is considered by some as a solution to the shortage of human organs and tissues. In the late 1990s, several companies were working with pigs that were genetically modified to have a human gene to help decrease the organ rejection response. These pigs were bred to fill the supply–demand gap for human organ transplantation. However, the discovery of an endogenous porcine retrovirus slowed the enthusiasm for this developing field because it proved extremely difficult to create a population of pigs without this retrovirus. The retrovirus is present in the genome in multiple copies. Researchers feared the virus could emerge from porcine-origin cells in intimate apposition within the circulation of the recipient human and adapt to create a transmissible epidemic (Boneva et al., 2001). Laboratory Escapes The SARS virus was grown and studied in numerous laboratories around the world. Spread outside of the laboratory has occurred on sev- eral occasions, including accidents in Taiwan, Singapore, and China. The incident in China was particularly worrisome as it resulted in three cycles of person-to-person transmission (Lim et al., 2006). Perhaps the most no- table and devastating example of laboratory escape is the 1979 incident at Sverdlovsk, Russia, where anthrax spores were disseminated within a population due to inadequate biosecurity and failure to change filters in a timely and adequate manner. This escape resulted in nearly 70 human deaths (National Security Archive, 2001). Laboratory Animals or Biological Agents in Research As biotechnology grows and studies in animals continue, there is always the possibility of zoonotic disease occurring in the scientific staff who are responsible for the care of the animals, or in laboratory workers engaged in microbiological aspects of the disease. There have been numerous instances

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0 GLOBAL SURVEILLANCE AND RESPONSE TO zOONOTIC DISEASES of humans becoming infected with a zoonotic agent within a laboratory, either through contact with animals or working with the infectious agent. To date none of these has resulted in subsequent person-to-person spread. Examples include glanders, tularemia, Q fever, Venezuelan equine encepha- litis, and herpes B (Hall et al., 1982; CDC, 2000; Rusnak et al., 2004). Bioterrorism Though intentional release and use of pathogens to threaten a nation’s security is also beyond the scope of this study, it is important to mention that it as a driver for zoonotic diseases. In fact, many of the CDC Category A, B, and C bioterrorism agents—such as anthrax, plague, tularemia, bru- cellosis, and cryptosporidium—are zoonoses. Much has been written about the potential of biotechnology to create a “superbug,” an organism that could pass rapidly through the population, causing massive morbidity and mortality. To date there is little scientific evidence that this is easily achiev- able, but the threat remains. INADEQUATE GOVERNANCE Inadequate governance systems at the local, national, and international levels are another driver. For purposes of this report, “governance” refers to the structures, rules, and processes that societies individually and col- lectively use to organize themselves to prevent, prepare for, and respond to human and animal health threats. Each driver analyzed in this chapter raises its own set of governance issues within countries and in the relations between nations. The most effective way to prevent zoonotic disease threats is to bring the various drivers of such threats under better control. However, increasing fears of zoonotic disease emergence and spread underscore the lack of confidence in the legal, regulatory, and enforcement mechanisms es- tablished by nations to address the political, economic, and cultural trends that exacerbate zoonotic threats. Poor governance that undermines a country’s ability to prevent zoo- noses from emerging and to control the harm their spread might cause flows from many factors. These include the absence of needed regulatory authority, antiquated rules, uncoordinated policy and governmental capaci- ties, lack of resources to devote to addressing difficult health, social, and economic problems, and the speed and scale of globalization. Governance capacities are crucial to fund, organize, and operate the rules, personnel, laboratory capabilities, information networks, and re- sponse interventions needed to identify zoonotic threats early and to act swiftly against them. Crafting and sustaining integrated human and animal health governance capacities locally, nationally, and globally proves difficult

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0 DRIVERS OF zOONOTIC DISEASES for many reasons ranging from complacency in developed countries to the debilitating effects of widespread poverty in least-developed nations. De- spite these difficulties, these capabilities need support by strong governance strategies and mechanisms because they serve national interests for human and animal population health; thus governmental bodies need to take re- sponsibility for disease prevention, surveillance, and response. Failure to do so not only contributes to the emergence and spread of zoonotic pathogens, but also creates a blind spot in any attempts to establish a global system of disease surveillance, prevention, and control. Chapter 7 provides an in- depth discussion about the governance challenges facing countries and the international community. CONCLUSION The drivers of zoonotic disease can be quite complex—individually and collectively. Although some of these drivers may be understood in isolation or in their simpler, temporal interactions with each other (e.g., food insecu- rity for workers in a logging or mining camp in Africa, leading to increased hunting and consumption of bushmeat), the complex ways in which they change over time (sometimes in lengthy intervals as with HIV) and how they interact are not well understood. Constant with the coexistence of humans on the planet are the challenges that the drivers present for when, how, and where zoonotic diseases will emerge. The committee concludes that there are few efforts for regular or sys- tematic review of the scientific information about these drivers. Such a re- view is needed to inform strategic action that can mitigate the consequences of drivers by national and global policymakers or international donors dedicated to global development and poverty reduction. The efforts are also minimal when governments or governance entities negotiate international treaties for activities or interests not specifically geared toward protecting human and animal health, but which may impact them. The committee also concludes that dedicated attention and resources to improve our recognition of and comprehension about these factors is a significantly noticeable gap in global zoonotic disease surveillance, reporting, and response efforts. REFERENCES Adeola, M. O. 1992. Importance of wild animals and their parts in the culture, religious fes- tivals, and traditional medicine of Nigeria. Environ Conser 19:125–134. AERC (Agro-Economic Research Centre, Visvabharati). 2005. Analysis of trends in opera- tional holdings: Consolidated report. Department of Agriculture and Co-operation, Min- istry of Agriculture, Government of India. http://agricoop.nic.in/study7.htm (accessed July 1, 2009).

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