Disease Control, Public Health and Food Safety: Food Policy Lessons from Sub-Saharan Africa
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This chapter reviews the agro-economic environment in Sub-Saharan Africa as it relates to animal production, public health, and disease control to contextualize the concept of risk and food safety. Drawing mostly from the experience of Zambia, it analyzes food safety actors and interests in Sub-Saharan Africa, and provides an outline of the general regulatory framework that is in place on the continent, to explain how food safety governance is impacted by different interest groups and agendas. Two case studies are provided, zoonotic tuberculosis and avian influenza. The chapter demonstrates how the two zoonoses, both important food safety concerns, have been prioritized differently in the case of Zambia, as a result of multiple socio-political and economic factors. The chapter concludes that, in order to be useful, a definition of food safety risks should include multiple contextual issues and stakeholders along the food supply chain. It is important to keep in mind what national food safety governance actors perceive the risks to be, and how their definitions fit into the broader picture of food safety in general. Food safety governance regulatory processes should take into consideration local realities, local food supply chains and local food safety threats to ensure the appropriateness and sustainability of any and all disease control measures instituted. Context will always matter, and therefore, local ecological, biological and policy considerations should be given primacy.
42.1 A Risk Management Approach to Examining Food Safety, Disease Control and Public Health
Taking an African perspective on food law and food safety, this chapter tackles the concept of risk as it relates to food derived from animals. To bring the various issues that impact risk and food safety in Sub-Saharan Africa into focus and highlight the pertinent concerns for disease control, it is necessary to provide both a descriptive and an explanatory analysis of the issues surrounding food safety on the continent. This chapter’s explanations are rooted in the analysis of the narratives of food safety actors and interests, and includes some detail on the general regulatory framework that is in place in the region, how it is influenced by different interest groups and agendas, and the politics of the policy process. These provide important lenses for understanding food policy in Africa. In order to deepen this discussion, some of the perceptions of risk and policy issues concerning the African agroecosystem in general are also highlighted. This chapter does not purport to provide a complete analysis. It merely provides contextual depth to case studies from a perspective of animal disease control, public health and food safety to illustrate important food policy lessons for the African region.
Food-borne diseases remain a significant problem for public health around the world. An estimated 70 % of diarrheal incidents across the globe are due to biological or chemical contamination of food.1 The burden of food-borne illness is borne by both developed and developing countries. However, the literature suggests that the incidence is highest in the African region.2 Over the last 15 years, according to the World Health Organization Regional Office for Africa (WHO-AFRO), the African region has suffered several major food-borne disease outbreaks, including aflatoxicosis in Kenya, anthrax in Zimbabwe, bromide poisoning in Angola and chemical intoxication in Nigeria.3 WHO-AFRO suggests that the vast majority of food-borne incidents in the African region are unreported. Therefore, the true extent of this public health problem is unknown.
In Africa, an appropriate establishment and consistent maintenance of adequate food safety infrastructure would go a long way in reducing the burden of the public health threat of food-borne illnesses. But multipartite food supply chains make food safety a complex policy issue to unpack, particularly in the era of globalization. Therefore, the evolving issues around food safety and the complexity of global food supply chains4 require the development of context-appropriate food safety and disease control structures and policies that appropriately mitigate the myriad threats to public health presented by food and food trade. This is because, the various stakeholders along the food chain—producers, retailers, consumers and regulators—all play a role in assuring that food is safe, sound and wholesome.
Food of animal origin carries multiple risks. In the case of food-borne illnesses, these risks can generally be grouped under intoxications or infections. The livestock production related threats to public health include acaricides used for tick control, antibiotic residues in meat and milk, infectious diseases, and pollutants from agricultural runoff. Other important public health threats are zoonotic diseases. Rudolf Virchow, the pioneer of the concept of One Health,5 first coined the term zoonosis in 1855.6 Originally, zoonoses were defined according to the direction of disease transmission. Additional important terminology included zooanthroponosis, infections humans could acquire from animals, and anthropozoonosis, diseases that humans could transmit to animals.7 This conceptualization of zoonoses, however, failed because the two terms were used indiscriminately, leading to an expert committee decision to abandon them. Instead, the committee recommended that the term zoonoses should be defined holistically as diseases and infections naturally transmitted between vertebrate animals and humans.8
Animal health is only one link in a long food production chain that contributes to the final quality of food. The promotion of animal health is vital to the enhancement of the quality and quantity of products derived from this source. This is especially true for food supply chains with global dimensions. Chemical and biological contamination can occur at any point from production to consumption. Through their associated impacts within the food production chain, animal breeding, feed, fertilizer and pesticide use, producers, processors, and retailers all add to or subtract value from the final product.
Globalization, economic development, expansion and diversification of agricultural food trade form causal links that increase public health risks, food safety hazards, and the spread of diseases.9 Globalization transcends the nation state,10 and brings with it social phenomena such as power and politics. Furthermore, in most low-income countries in the African region, economic considerations11 are given primacy over health concerns.12 This is reinforced in global context, where trade considerations run ahead of the implementation of measures that protect health.13 Additionally, due to the process of globalization, policy-makers have seen a decline in their ability to control the determinants of health. Power relationships in many low-income countries are complicated by external relationships with advisors, experts, aid donors and financial institutions and internal institutional relationships characterized by large power gaps between actors,14 with power and politics playing a role in shaping the process.15
This chapter examines zoonoses through multiple and layered lenses, the first of which is the concept of “the human-animal interface,”16 with the goal of better capturing the broad socio-economic and political landscape of food safety. The understanding of the human-animal interface, as it relates to infectious disease governance, is important from two standpoints: First, the human-animal interface facilitates the examination of the relevant public health risks related to animals and their products in different contexts. Second, through food governance, and its relationship to risk enabling policy activities, the human-animal interface further adds to the understanding of the complexities associated with risk management. The corresponding risk enabling activities include the governance of land use, wildlife use and livestock production and chosen routes for economic growth and trade promotion. These activities both foster and enhance disease transmission.17 Specific examples are provided through case studies of two zoonoses, one of which is a neglected disease, bovine tuberculosis (BTB), and the other an emerging disease, highly pathogenic avian influenza (HPAI, a.k.a. bird flu).
42.1.1 Overview of the Epidemiological Framework for Disease Control and Public Health in Food Safety
Epidemiology is defined as the study of the distribution and determinants of disease in defined populations. Disease determinants include risk factors for emergence which are both multifactorial and highly contextual. While epidemiology studies the dynamics of disease in defined populations, it also seeks solutions to disease problems to mitigate their impact on individual and public health. This chapter focuses on food safety within a disease prevention framework.
In a disease prevention framework, three levels of prevention are important: primary, secondary and tertiary prevention.18 In primary prevention, the focus lies on averting incidents of disease in the first place. Secondary prevention strives to avert clinical manifestation of the disease state. Tertiary prevention tries to avert the complications of a disease state, such as extended morbidy, secondary infection or death.19 These levels are also dependent on access to interventions, i.e. health system or government capacity and response, and do not factor in the role that industry, for instance, plays in disease prevention.
The three levels of prevention are, of course, permeated by food safety governance, which reinforces the importance of this discussion within this book. For instance, primary prevention in food safety would involve the removal of chemical, physical or biological hazards from food before it is consumed. This includes the establishment of herd health programs for food animals, provision of safe feed, monitoring antibiotic use in animals, physical control mechanisms such as abattoir inspections and milk pasteurization, and the development and enforcement of food safety standards. Secondary prevention may include mechanisms for early health system response to food-borne disease outbreaks, institutional capacity to conduct timely food-borne illness outbreak investigations, food product recalls, destruction of contaminated produce or quarantine of implicated markets, farms, or animals to contain outbreaks. Tertiary prevention includes the appropriate treatment of food-borne illnesses, such as administering the correct medication to treat zoonotic tuberculosis. This prevention framework does not easily accommodate the roles that multiple stakeholders play in disease prevention, particularly those stakeholders that lie outside traditional food safety and health systems, but still impact the social determinants of health.20 Logically, this begs the question; how can multiple stakeholder interests and influences be incorporated in this basic prevention framework?
One way of looking at disease prevention and management is to utilize a risk-based epidemiological model. In the epidemiological framework for disease control and public health in food safety, a risk based framework considers multiple risk factors along the food supply chain, from farm to fork, and the holistic impact of stakeholders on food safety and food-borne disease management. However, the concept of risk and its understanding is highly contextual, as our case studies will demonstrate. Risk is socially constructed. Therefore, risk identification and assessment are both innately human and dependent upon social activities that generate meaning. In other words, risk perception is contingent upon a shared understanding of reality.21
Risk is also “politicized” through several social processes, which separate risk from the actual dangers presented by various hazards.22 But, the use of scientific information to inform policy is difficult. Paradoxically, one of the reasons for the difficulty to use science to inform policy on risk is scientific limitation to only the objective assessments of risk.23 As Stirling and Scoones24 contend in their 2009 paper on risk assessment and knowledge mapping, scientific assessments of risk often attempt to aggregate complex social and biological phenomena into a set of probabilities and outcomes, thereby often structuring the phenomena to become policy, rather than inform it. This also applies to risk assessment as applied in food safety and food policy.
Food-borne disease risks and their implications for holistic management require a multi-sectoral or shared understanding of Africa’s food safety problems with a goal of a pragmatic development of solutions. Conceptually, the integration of the socio-political structures of disease risk and risk management should provide a useful framework for understanding food safety, disease prevention and public health in the African region. In other words, to be useful, an epidemiological framework for disease control and public health in food safety needs to be inclusive and open to multiple perspectives of African food safety problems. In order to succeed, it is important to properly frame food safety problems, and identify the different stakeholders involved along the food chain. Additionally, it is crucial to recognize the various stakeholders’ roles and capacity for risk facilitation or management, as influenced by their institutional norms, priorities and ideas. The goal is to develop a consensual view of risk. In reality, however, the various stakeholders force aggregates of complex social and biological phenomena into risk metrics to which food governance systems are expected to somehow respond.
To create a usable disease control, response coordination and risk management framework, a proper understanding of both institutional power and the food policy framework are critical. Using this simplified risk-based epidemiological model, this chapter explains the various issues affecting food-borne diseases, their impact on public health and the policy implications of food safety governance. Fragmentation unfortunately is the complicated reality of many legal and policy issues at local, national and international levels. In applying this framework to the African region’s multi-sectoral context, the boundaries between sectoral or “silo” responses to food safety will blur. Nonetheless, it should be clear by the end of the chapter that a one-cap-fits-all solution to food safety problems in the African region is unlikely effective.
42.1.2 Food Policy Regulatory Framework: Actors, Interests and Conflicts
The African continent’s position on the development continuum puts it in the precarious state of having to deal with a double burden of disease,25 i.e. both chronic, or diseases of affluence and infectious diseases.26 Within this spectrum of disease threats, are food-borne illnesses. In turn, food-borne diseases remain a significant problem for the region, given its high levels of poverty and urgent nutritional needs for its most vulnerable citizens. As highlighted in the introductory section, food-borne diseases are frequently reported in Africa, with high incidence. Most cases of food-borne diseases remain unreported. There are several factors responsible for this. In many countries in the region, there is the existence of poor food safety surveillance systems and weak obligatory reporting mechanisms for food-borne disease outbreaks, outside high profile diseases such as cholera. Reporting is also inaccurate in some cases, with only a handful of countries reporting incidence of food-borne illnesses. These knowledge gaps mean that an accurate picture of incidence is nonexistent, which limits our understanding of the public health impact of food-borne diseases in the region.
There are multiple stakeholders in food safety governance in the African region. These include both national and international actors. From the multilateral trade environment, characterized by overlapping regional trading blocs at continent level to professional rivalries at national and local levels, the food safety governance environment is fairly complex. Furthermore, the continent’s myriad problems, make prioritizing food safety difficult. For instance, the WHO asserted that food-borne diseases and food safety do not feature very highly on national agendas although both have a major public health impact throughout the region. This assertion is based on a weighting of the paucity of resources directed at the issue. In fact, it is the political impetus to focus on food-borne diseases in the African region that is often absent.27
African regional and subregional economic partnerships
Algeria Morocco Libya Tunisia Mauritania
Arab Maghreb Union
Ghana Nigeria Cape Verde Gambia
Economic Community Of West African States
Benin Togo Niger Mali Côte d’Ivoire Burkina Faso
West African Economic and Monetary Union
Liberia Guinea Sierra Leone
Mano River Union
Chad Cameroon Central African Rep. Gabon Equat. Guinea Rep. Congo
Communauté Économique et Monétaire de l’Afrique Centrale (Central African Economic and Monetary Community)
Economic Community of Central African States
The Economic Community of the Great Lakes Countries/Communauté Économique des Pays des Grand Lacs
South Africa Botswana Lesotho Namibia Swaziland
Southern African Customs Union
Southern African Development Community
Angola Malawi Zambia Zimbabwe Mauritius Seychelles Mozambique
Somalia Ethiopia Eritrea Sudan Kenya Uganda
Inter-Governmental Authority on Development
Common Market for Eastern & Southern Africa
Angola Egypt Burundi Rwanda
Malawi Zambia Zimbabwe Mauritius Seychelles
Burkina Faso Chad Libya Mali Niger Sudan Central African Republic Eritrea Djibouti Gambia Senegal Egypt Morocco Nigeria Somalia Tunisia Benin Togo Ivory Coast Guinea-Bissau Liberia Ghana Sierra Leone
Comoros Guinea Kenya São Tomé and Príncipe
The Community of Sahel-Saharan States
Egypt Sudan Ethiopia Uganda Kenya Tanzania Burundi Rwanda the Rep. Congo Eritrea
Nile Basin Initiative
Tanzania Kenya Uganda
East African Community
Understanding the role that external influences play in the policy processes for food safety and management in the African region is equally important. In many developing country settings, policy actors are forced to balance the external desires of funding agencies and international bodies as well as contend with internal power struggles.31 Therefore, a hindrance to the management of risk in food safety in the African region is its dependence on development partners. External partners play a key role in defining national development agendas, by focusing their support on water delivery, primary healthcare, or particular infectious diseases such as tuberculosis, HIV and malaria. The dependence on development partners and the politics of aid has implications for the capacity of African countries to control the focus of funding.32 The assistance provided by donors towards food safety may not foster ownership among local stakeholders, given that the focus is donor driven and not aligned with existing needs and local realities.33 In addition, the WHO states that development partners are not always willing to commit to sustaining the strengthening of food safety management systems.
42.1.3 Key Stakeholders and Mandates for Risk Management and Food Safety in Africa
There are contextual differences in food control system implementation across the African continent. In general, however, the existing food safety and control systems do not provide the policy coherence necessary for stakeholder agencies to synergistically prevent food safety problems. International guidelines such as the Codex Alimentarius34 do not have the supporting legislative framework in many African countries. Many of the laws governing food safety are outdated, inadequate or fragmented.35 The provisions relating to animal health, for instance, can be found in multiple statutes, codes and standards (both legal and voluntary), which spurs institutional rivalries and blurs the boundaries of responsibility. There is inadequate protection of consumers from contaminated food products, fraudulent practices and the importation of substandard food for domestic markets.36 Furthermore, enforcement of food law remains an important concern. The absence of a coherent policy framework for food safety has created an environment in which these government agencies operate according to their own institutional perspectives on food safety, often leading to effort duplication.37
The African Regional Office of the WHO highlights the inadequate address of food safety concerns in national policies in the African region and recommends national food safety policy coherence to be the foundation for effective food safety management systems.38 While linked, these are, in reality, two different issues. The letter of food safety policies, i.e. policy content, are based on regulation inherited from Africa’s former colonial masters. Food safety governance in the region, like many institutions on the continent, cannot be easily separated from the legacy of colonialism.
Many existing laws are rooted in legislation that was created during the colonial period and are, therefore, not properly oriented towards contemporary realities. So, while secondary legislation through statutory instruments may help address some concerns, it is the underlying definitions, institutions and authorities that form the basis of the foundational legislation that needs to be reformulated. Therefore, while it is true that the inadequate address of food safety concerns in national food safety regulations hampers the effectiveness of government responses to the issue, the lack of movement may also be due to the myriad of issues governments have to deal with using limited resources.
These issues are also symptomatic of a fragmented polity. Some researchers39 explain that fragmentation is the norm in contemporary policy, where different sectors of government work as so-called silos, pursuing individual sector interests and mandates. As would be expected in a fragmented polity, the key institutions involved in food safety governance and the implementation of risk management for the protection of public, animal and environmental health, all operate with different priorities, agendas and mandates. Each institution along the supply chain has a different value system. How various stakeholders perceive food safety, i.e., as either “low politics” or “high politics,”40 also affects overall policy coherence. Others41 suggest that while issues of “high politics” or those of macro or systemic importance may be formulated and imposed by a narrow group of elites, those of “low politics” are subject to the influence of many different groups. Certainly, the interaction of low and high politics amongst the various international and national stakeholders involved in food safety governance in the African region provide an interesting dynamic to the management of food-borne risks to public health.
The food safety governance boundaries in the African region are also shaped through legislation and international standards adopted within the respective mandates of national and international institutions. The confusion only increases when regional and global actors in food safety governance come into play. A WHO study examining the status of food law in Africa suggested that in most African countries, there existed a discord between national food law and international requirements, such as the Codex Alimentarius. The study further states that this discord has led to the rejection of food exports from the region.42 Such complex phenomena, however, cannot be treated as mere events, but should be considered institutionally embedded processes with distinct histories that need to be uncovered to help illuminate more general problems,43 especially where many countries in the region face several non-tariff barriers that limit their ability to export their produce. These include Sanitary and Phytosanitary (SPS) requirements, technical barriers to trade, quotas, and market standards, restrictive rules of origin and complex tariff structures and import requirements.44 The enforcement of import controls and inspections is also problematic for most governments, which presents the risk of importing unsafe and substandard food and food products.45 A report46 on Zambia, for example, argues that European Union (EU) and United States of America SPS standards are “dynamic” and have resulted in the rejection of Zambian goods at ports of entry. Others47 state that EU standards for food safety are high to meet the perceived requirements of its affluent consumers. The following will shed further light on the case of Zambia.
42.2 Legislative Overlap in Food Law Governance
42.2.1 The Case of Zambia
First, the key ministry in charge of food safety in Zambia is the Ministry of Health, which is responsible for the review of law and policies, as well as the mobilization of resources to monitor and evaluate the quality of the health care delivery system. Enshrined in law (The Public Health Act Cap 29548 and The Food and Drugs Act, Cap 30349 of the Laws of Zambia), the Ministry is charged with protecting the public from food hazards, be they chemical, physical or chemical agents. To achieve this, the Ministry monitors food quality and safety along the production chain using set standards, usually developed by the Zambia Bureau of Standards (ZBS). Interestingly, while the health ministry operates under compulsory legal guidelines such as the Public Health Act and the Food and Drugs Act, the standards created by the ZBS are voluntary.50 Consequently, industry is under no obligation to comply with ZBS standards.
Second, Zambia’s Agricultural Ministry’s mandate focuses on animal and plant health. Its responsibility is animal disease control and the prevention of novel plant pest incursions into the country. The veterinary department, under the Ministry of Agriculture, is responsible for controlling hazards that may enter the food chain through food of animal origin. The Ministry of Agriculture draws on the Stock Diseases Act Cap 252 of 2010, which repealed the Stock Diseases Act of 1961,51 and the Control of Goods Act Cap 421. Local government is responsible for meat inspection in abattoirs, the setting up of appropriate structures for animal slaughter and municipal waste management under Cap 28152 of the Laws of Zambia. These legal mandates all empower these arms of government in food safety governance. It should be easy to see that there is considerable overlap when it comes to inspection of food of animal origin. Furthermore, the Public Health Act in Zambia does not cover many modern public health concerns in food processing and the Food and Drugs Act is superseded by international standards or country of export legal provisos, in cases of multilateral trade. This structure is fairly typical of many African countries.
In countries like Zambia, the informal sector, which plays a key role in food supply to the general population, is mostly considered to be outside the purview of official control mechanisms, except municipal authorities.53 The sector is thus usually beyond the purview of official control and falls prey to substandard practices in the marketing of food products. In some cases, foods are processed and sold in unhygienic environments with little regard for cold chain requirements and pest control, for instance in the case of the street vending of raw and cooked food, a significant risk for food safety. Given the complicated mix of actors affecting the regulatory environment for food safety in Africa, in addition to the continent’s rampant and myriad disease problems, inadequate or outdated legislation, solutions to the continent’s problems in food safety are difficult to find.
42.2.2 The World Organization for Animal Health and Food Safety
An important international body in food safety regulation with regard to food of animal origin is the World Organization for Animal Health (OIE).54 It was established on January 25, 1924, and is headquartered in Paris, France. It is not a United Nations body, like the Food and Agricultural Organization (FAO) and WHO, but the World Trade Organization (WTO) recognizes the OIE as a reference organization.55 Thus the OIE has adopted an active pro-trade stance in their address of issues surrounding trade, health protection and food safety. In its Terrestrial Animal Health Code, the OIE lists international animal health standards that are the basis for facilitating safe trade in animals and animal products, standards that are recognized under the Sanitary and Phytosanitary (SPS) Agreement of the WTO.56 Countries that are involved in animal and animal product trade are expected to comply with the SPS Agreement in order to reap the full benefits of international trade.57 The SPS Agreement states that public health measures to ensure food safety and to control plant or animal diseases should be based, as far as appropriate, on international standards.58 In addition, the SPS Agreement sets forth that measures to protect public health, animal health and plant health should only minimally interfere with trade. On issues of food safety, however, it must be noted that produce from developing countries, particularly those from the African region, cannot easily enter the more lucrative Western markets. Furthermore, both weak national food governance legislation and the facilitative intent of the SPS Agreement biased towards trade, may compound the problem of the importation of substandard food and food products. Therefore, the view that measures to protect health should only minimally interfere with trade remains problematic.
The OIE’s Terrestrial Animal Health Code prescribes the role that national veterinary services of member countries should play in food safety governance. It is the OIE’s position that a veterinarian’s background and training places him or her in a unique position as far as the assurance of food safety of foods of animal origin is concerned, emphasizing the proper training of veterinarians to meet the challenges in food safety. It also provides guidelines for evaluating national veterinary services. Interestingly, the OIE’s veterinary services evaluation process sets independence from political influence as a primary benchmark.59 The OIE’s aim of separating science from politics is impractical. In fact, it has been suggested that the veterinary profession is likely limited by its dependence on scientific or authoritative opinion and its exclusion of political and social phenomena.60 For food safety in particular, influencing policymaker perceptions on the human risks of diseases from livestock, cannot only be an exercise in science, it must also recognize politics.61
42.3 The African Agroecosystem: International Legal Perspectives of Epidemiology and Disease Control
Now we examine the international policy scenario as it relates to the African agroecosystem and disease control. Globalization under the current multilateral trading system has created vast inequalities between the world’s richest and poorest nations.62 Even the OIE’s perspective on global issues, particularly its views on trade, has significant impacts on developing countries such as those found in the African region. Before the OIE disease lists were revised, of the 15 “List A Diseases” considered to be transboundary in nature and prioritized as threats to global animal health in the trade of livestock products, 12 were endemic to sub-Saharan Africa.63 The presence of transboundary animal diseases in the African region and their unlikely eradication in the foreseeable future means that under WTO global trade rules, these countries will continue to be excluded from involvement in international trade.64 Many countries in the African region have to deal with a range of animal diseases simultaneously, and are likely to continue doing so. This makes technical considerations and regulation of trade extremely difficult, even within a facilitative global trade environment.65 Some publications,66 for example, suggest that the global distribution of Foot and Mouth Disease (FMD) interestingly mirrors the global economic make-up with industrialized countries generally being free of the disease while developing countries are endemic. Furthermore, reviews of WTO agreements and their effect on livestock production and trade in Africa, highlight the lack of transparency and equality among negotiating countries that has excluded many developing countries.67 Sub-Saharan Africa has given out more concessions on tariff reduction than what it received from its trading partners.68 This state pushes trade in a North–south direction and, unfortunately, international standards have been used to reinforced this direction of trade, primarily on health grounds.69
As was the case with food safety monitoring mechanisms, developing countries such as those found in the African region have serious problems in their surveillance systems and veterinary infrastructure.70 With these problems, Africa’s trading partners automatically assume that products exported from the continent are risky.71 Focusing on development, some researchers72 have argued that WTO SPS measures marginalize the world’s poor producers the most and may even contribute to global poverty and disease. A review of the history of free trade73 argues that current approaches to global trade deny poorer countries the opportunity to implement policies that fostered the development of the world’s wealthy economies. These arguments suggest that developing countries are not only purposefully restricted from participating in global trade in reciprocal ways, their development opportunities are also restricted by these multilateral systems.
The dominant international perspective is that the African region and similar developing world contexts, pose the greatest risk as sources of infectious diseases.74 Some75 state, for instance, that the FAO’s philosophy is to control these diseases at their developing country source. This view that resource-constrained countries are the biggest sources of infectious disease risks for the rest of the globe also suggests that disease control efforts would focus on the “global impacting” disease problems. It further implies a fostering of particular methods of control that may not be appropriate for different settings, which could actually harm local livelihoods or worse, encourage further disease spread.76 The issues that lie at the confluence of health and trade also impact food safety and food safety governance.
The resulting “controlling-risk-at-source” narrative obscures the cultural, disease management and stigmatization challenges that the African region faces when its member states strive to embrace these global perspectives on trade and infectious disease control. For instance, livestock in many countries in the African region are not just kept as articles of commerce, but have cultural significance as well, what some77 term multifunctionality; where they serve such functions as assuring domestic food security, provide access to nutrition for the less privileged and play key roles in the maintenance of distinctive rural cultures and ways of life.78 Furthermore, compared to more industrialized countries where there are mechanisms for farmer compensation following livestock culling, this is not usually possible in resource-limited countries because of a dependency on livestock for rural livelihoods and difficulties in obtaining replacement stock.79 In addition, although the two systems are sometimes loosely integrated, it must be understood that both traditional and commercial production practices co-exist in many of these contexts. Finally, it is possible that the diseases and risks prioritized in the global West are not necessarily the ones of most significance in these contexts. Therefore, part of the problem with this global aversion to infectious disease risk is that there is little effort made to understand the context in which developing countries attempt to negotiate global imperatives, be they public health, animal health or trade concerns. In the context of food safety in particular, not much has been done to investigate context-relevant ways of addressing these problems.80
42.3.1 Zoonotic Tuberculosis and Food Safety in Africa
To explain the links between zoonotic tuberculosis and food safety in Africa, it is important to first define and describe the wildlife-livestock interface. The wildlife-livestock interface can be simply defined as an area in which both wildlife and livestock commonly reside.81 This definition, however, does not adequately capture the dynamic nature of this interface. Its nature is best defined by the context in which it exists. Kock,82 provides several interesting contextual descriptions of what constitutes a wildlife-livestock interface, including migratory bird contact with intensive pig operations in North America, China and Europe, and pastoral cattle foraging in African wildlife sanctuaries. The key descriptors of the interface include health, conservation, culture and economics. In the next segment, this chapter will focus on cattle production, the transmission dynamics of bovine tuberculosis (BTB) between cattle and wildlife reservoirs, the pertinent food safety concerns in the agroeconomy of wildlife-livestock interface and their implications for public health. It will also attempt to highlight key cultural and economic details of the interaction of these myriad facets that are important for food safety governance.
42.3.2 Epidemiology of Zoonotic Tuberculosis
Mycobacterium bovis is a member of the mycobacterium tuberculosis complex.83 The bacterium causes Bovine tuberculosis (BTB), a zoonosis characterized by the development of specific granulomatous lesions in the lung, lymph nodes and other tissues.84 Comparative genomics suggest that M. bovis evolved from Mycobacterium tuberculosis, the primary cause of human TB, but has since developed a capacity for infecting a large host range.85 BTB’s susceptible species range spans domestic and wild animal species, and man.86 Although the specifics of the evolutionary biology of the two infectious agents remain controversial,87 one school of thought is that the deletions in the M. bovis genome that occurred from its evolution from M. tuberculosis increased its host range.88 Mycobacterium bovis is hardy, and can survive outside the host depending on environmental conditions. It can survive for up to 2 years in the environment, 1 year within dung pats, and between 5 and 7 months in manure, slurry or water.89
In Africa, approximately 85 % of cattle and 82 % of humans live in areas where BTB is either partly controlled or not controlled at all.90 Like many of the African region’s disease problems, a clear picture of the extent of the problem is yet to be developed. There is a paucity of data on the prevalence of BTB in cattle, a lack of species differentiation of human TB isolates and the presence of significant wildlife reservoirs.91 The epidemiology of the condition in cattle is as follows: A vast majority of cattle excrete M. bovis almost from the inception of a lesion.92 However, it is still not fully understood to what extent tuberculosis latency exists in cattle and the associated problems of this potential source of infection. BTB will persist in cattle as long as the bovine host lives.93 A single bacillus that becomes aerosolized is sufficient to establish infection, droplet size being more important than number of bacilli.94 With droplet nuclei as a vector, animals do not need to be in close contact with a tuberculosis disseminator to become infected.95 We must cross reference this scientific fact with the social role that cattle play in African rural culture and livelihood i.e. not as a source of food, but a status symbol. This is important for understanding disease transmission in the wildlife-livestock interface.
In humans, tuberculosis caused by M. bovis is similar to M. tuberculosis.96 Infection occurs via aerosol inhalation due to close contact with infected cattle,97 oral consumption of infected food, and through skin wounds.98 In a broad sense, these routes of infection are all important, but it must be understood that BTB is predominantly a milk-borne zoonosis.99 During the pre-eradication period in western countries, milk was the main source of infection for human beings, especially children.100 Studies have been done where M. bovis has been isolated from milk in Africa.101 In cases were the bacillus enters a human being orally, i.e. through the ingestion of unpasteurized and BTB contaminated milk or milk products, disease manifestation is mainly extra pulmonary with abdominal, bone and joint forms, as well as infection of cervical and mesenteric lymph nodes.102
Humans in close contact with infected cattle may acquire M. bovis via the respiratory route.103 Gibson et al.104 discuss a case from Gloucester in which a 20 year-old male became infected with M. bovis following inhalation of infectious aerosols. He was frequently sprayed with nasal mucus from cattle. He is thought to have later infected his sister who was diabetic and pregnant, thus immunocompromised. Similar transmission may occur in pastoral communities in individuals who frequently handle their livestock or infected wildlife meat and secretions.
Meat from infected animals may also contain viable M. bovis105 that could pose a risk of infection for humans. Specific tissues such as liver, spleen, kidney, mammary glands and lymph nodes may contain sufficient organisms detectable by culture or guinea pig inoculation, even though not showing evidence of infection at necropsy.106 Haematogenous spread is believed to be responsible for secondary lesions.107 Thus meat and blood from infected animals pose potential risks of zoonotic infection if not properly prepared or if consumed raw.108
In Africa, the relative proportion of human tuberculosis cases caused by M. bovis is unknown because differentiation from infections caused by M. tuberculosis is not commonly performed.109 However, significant risk factors for the transmission of M. bovis occur in communities where there is close human-to-livestock contact.110 Some111 estimate that in countries where pasteurization of milk is rare and bovine tuberculosis is common,112 10–15 % of human cases are caused by M. bovis. In many rural parts of the African region, BTB control is nonexistent and poor food hygiene practices, husbandry methods, and consumption of raw milk still present risks of human infection.113 Infection in these areas is by ingestion of unpasteurized milk, poorly cooked meat and close contact with infected animals, tissues or secretions.114 In pastoralist communities of Northern and Southern zones of Tanzania, for instance, 16 % of culture-positive mycobacteria isolates from human cases were M. bovis.115 Kazwala116 states that there was a definite link between the number of cattle owned and the incidence of non-pulmonary tuberculosis in the human population. Similarly, the ownership of reactor cattle herds in Zambia was shown to be statistically associated with human tuberculosis cases,117 although in other countries no statistically significant association between reactor cattle and associated households was found, even though there were human tuberculosis cases in households that owned reactor cattle.118
Grange119 cites other studies that exemplify human cases of M. bovis in Africa. This includes surveys where 0.4, 5.4 and 6.4 % of pulmonary tuberculosis cases respectively were due to M. bovis in Egypt, while 3.9 % of 102 isolates of pulmonary tuberculosis was due M. bovis in Nigeria. Prior to effective tuberculosis control in cattle in developing countries, the positive correlation between human prevalence and infection was well recognized. Up to 6 % of human pulmonary tuberculosis cases were attributed to infection of bovine origin in the south of England between 1931 and 1937.120 In one review,121 pulmonary disease was found to be more common in rural areas of England and Wales in the early part of the twentieth century, possibly due to aerogenous infection from cattle. The current situation in Africa is thought to be similar to the pre-eradication era in Europe.122
Finally, although human-to-human transmission is considered rare,123 other humans with M. bovis infection may be potential sources of disease. The highest risk groups for acquiring M. bovis are individuals with concomitant HIV/AIDS infection.124 Thus the high prevalence of HIV/AIDS in sub-Saharan Africa is an added risk. Transmission among HIV infected individuals may be particularly high because immunosuppression increases susceptibility to infection.125 Some researchers126 suggest that most TB cases in African HIV/AIDS patients are due to exogenous re-infection rather than reactivation of endogenous M. tuberculosis and could have a similar risk of exogenous disease upon exposure to M. bovis. In such individuals, it may be difficult to determine if the zoonosis is a reactivation or a new infection.127
42.4 Malevolence or Benevolence? Issues at the Nexus of Food Safety and Food Security in the Wildlife-Livestock Interface of Southern Zambia
In Zambia the incidence of HIV has been steadily declining since the 1990s. However, according to country statistics, the HIV prevalence still stands at 12.7 % while human TB is at 433 per 100,000 of the population.128 The reduction in HIV incidence is a result of control strategies instituted by the government, with the support of donor agencies such as the Global Fund to Fight AIDS, Tuberculosis and Malaria. In this country, research has demonstrated that BTB may be an important neglected disease whose impact on public health is underestimated because of the high prevalence of human TB coupled with the ongoing HIV/AIDS pandemic.129
One area where BTB may be significant is in a wildlife-livestock interface area in the south of Zambia, in the flood plains of the 6500 km2 Kafue Flats. Lochinvar and Blue Lagoon national parks are two contiguous Game Management Areas in the catchment of the Kafue Flats in which human settlement, small-scale agriculture, livestock production and fishing are permitted. This area brings the nexus of food safety, disease control and risk into sharp focus. The risk factors for the zoonotic transmission of the disease to humans in this area include livestock management methods, food preparation and hygiene methods, and socio-economic and health status.130
The Tonga and Ila tribes constitute the largest ethnic groups living in this area. Their main economy is livestock production.131 Their cattle are kept for prestige, milk, draft power, dowry, savings and to offset crop failure132 and are rarely slaughtered except during ceremonies.133 Cattle rearing in this area is predominantly pastoral with grazing based on the cycle of flooding in the floodplains, which provides year-round pasture. Nearly three quarters of the area’s cattle graze in the floodplains for 6 months out of every year.134 There are three contiguous herding systems practiced in this area. In village resident herding, cattle are reared in and around villages. Transhumant grazing involves the trekking of cattle into the floodplains during the dry season. These herds return to the villages when the rains start and pasture becomes abundant closer to the villages. The last herding system is interface herding. These are large herds of cattle whose numbers cannot be supported by pasture around the villages.135 Transhumant and interface cattle interact freely with wildlife such as the Kafue lechwe (Kobus leche kafuensis).136 This is a highly sociable semi-aquatic marsh antelope that can only be found in the floodplains in and around Lochinvar and Blue Lagoon National Parks.137 It is138 estimated that the herd level prevalence of BTB in cattle from this area at 49.8 %, while the individual cattle prevalence was estimated around 6.8 %.
The first zoonotic TB food-borne risk comes from cattle as a milk source for local communities and human contact with infected herds. As stated earlier, BTB is primarily a milk-borne zoonosis. Some139 estimate that 50 % of milk derived from these cattle is consumed locally. Pasteurization is able to kill M. bovis in milk140 but where this is not done, human infection is likely to occur. The milk consumed in the wildlife-livestock interface is rarely pasteurized and is sometimes consumed as curdled or soured milk, which is considered a delicacy. The local breeds of cattle are not bred for milk production, and, hence, have low outputs. Thus, milk pooling is a common practice, which increases the risk of humans acquiring BTB from milk. Although only 1 % of cattle with BTB excrete M. bovis in their udders, infected milk from a single cow can contain enough viable bacilli to contaminate milk from up to 100 cows if pooled.141 Furthermore, M. bovis has been shown to survive in soured milk for up to 14 days.142
The second zoonotic food-borne risk comes from wildlife. The predominant species and primary wildlife maintenance host for BTB is the Kafue lechwe.143 There is a single population of lechwe in the floodplain coexisting with humans and livestock herds.144 Dated reports on BTB burden in lechwe are varied, estimating the prevalence around 14 and 30 %.145 In a 2010 study,146 Munyeme and his colleagues estimated the prevalence of BTB in hunter-harvested lechwe to be around 24.3 %. These findings represent the risk to public health for the communities living in and around the wildlife-livestock interface.
The food safety significance of lechwe lies in the fact that, of all the wild animal species in Zambia, this small antelope is the most sought after species for game meat.147 The legal off-take of lechwe amounts to around 800 lechwe a year.148 An estimated 47.7 tonnes of lechwe meat is produced annually and consumed by about 39,780 people.149 Poaching, of course, remains a significant problem for this and other species of wildlife. However, the concern here is that even meat obtained legally (through the official quota utilization system) by members of the community is not subject to food safety enforcement mechanisms such as meat inspection. In Africa, abattoir inspected meat is usually consumed in urban areas150 while rural communities do not routinely submit their animals for meat inspection. For Zambia, wildlife conservation usually occurs in areas remote to veterinary services.151 The result is that game continues to be consumed, and wildlife trophies handled, without veterinary clearance. The implication of this is that, while providing local communities access to meat from the Kafue lechwe offers an important source of supplementary protein, the food derived from this source also carries the risk of transmission of zoonotic tuberculosis.
Of course, there are other routes available for the zoonotic transmission of BTB, as the aforementioned epidemiological review of M. bovis has tried to demonstrate. Therefore the food safety and infectious disease dangers to the communities living in and around the wildlife-livestock interface are very real. Clearly, BTB may play a role in the epidemiology of human TB, particularly in the context of HIV and AIDS. However it is rarely, if ever, linked to the policy narratives that focus on the big three; tuberculosis, HIV and malaria. Furthermore, while the scientific literature has linked wildlife management, community nutrition and livestock husbandry to BTB epidemiology and risk, the relevant policy actors in this triad have not been appropriately engaged and thus BTB remains a neglected disease with real consequences. Based on data extrapolated from other countries and the prevalence of human tuberculosis in the region, it was estimated that over a 10 year period, around $1.5 million (US) are costs attributable to the treatment of zoonotic tuberculosis in this area.152
42.4.1 Avian Influenza: The Zambian Experience of Pandemics and Food
22.214.171.124 The Epidemiology of Highly Pathogenic Avian Influenza H5N1 Spread and the International Response
The infamous H5N1 highly pathogenic avian influenza (HPAI)153 was first identified at a goose farm in Guangdong Province, southern China in 1996.154 Subsequently, high H5N1-related mortalities were reported on three chicken farms in Hong Kong, just adjacent to Guangdong Province, between March and early May, 1997.155 In May of the same year, a child died of viral pneumonia, the first reported case of zoonotic H5N1 influenza.156 Following the identification of 17 more human infections that resulted in five deaths between November and December of 1997,157 H5N1 became recognized as a zoonosis of possible public health concern. As a result, in December 1997, total and rapid depopulation of all poultry in markets and chicken farms in Hong Kong was carried out to control the outbreak, a move that both policy and virology experts believed had averted a potential human pandemic.158 Arguably, live poultry markets were important in the transmission of the H5N1 virus to other avian species and humans during these outbreaks.159 The control measures instituted, i.e. the total culling of all farmed chickens and all poultry in markets in Hong Kong, appeared effective, as the responsible genotype of H5N1 (A/goose/Guangdong/1/96) has not been reported since the execution of these controls.160 However in February 2003, during the SARS epidemic, and after a 6-year hiatus, three more human H5N1 infections with two fatalities were identified in China. This suggested viral persistence, despite the control measures that had been instituted in 1997.161 An epidemiological review162 states that outbreaks had continued to occur in poultry in Hong Kong from 2001 to early 2002, caused by a different H5N1 lineage. While there is some suggestion that the H5N1 problem had been subdued in 1997,163 it was, in fact, entrenching itself in the poultry systems of Hong Kong, and likely elsewhere in Southeast Asia, between 1997 and 2003.
Between December 2003 and February 2004, the first wave of an H5N1 panzootic in poultry was reported nearly simultaneously in eight countries in South and Southeast Asia, most of which occurred in commercial poultry establishments. This was followed by a second wave of spread from July 2004.164 The WHO states that the second wave was associated with more rural settings.165 The countries initially affected were China, Indonesia, Cambodia, Japan, Laos, Korea, Thailand and Vietnam, with a ninth country, Malaysia, joining the list in August 2004.166 The pro-poor advocacy group, GRAIN, states that the initial outbreaks in Vietnam, Thailand, Cambodia, Laos and Indonesia all occurred in closed, intensive factory farms.167 During the first wave, millions of poultry either died or were culled in an effort to control the disease.168 Human infections were then reported in Hanoi, Vietnam, in January, 2004, a few days prior to a report of massive H5N1-related poultry mortalities in two poultry farms in the south of the country.169 Vietnam had initially experienced an H5N1 outbreak in 2001.170 In early 2004, during the first wave of the panzootic, the WHO declared the outbreak an unprecedented catastrophe for agriculture in Asia and a “global threat to human health.”171
Coinciding with the second wave of the panzootic, the period between August and October 2004 saw eight more human deaths in Thailand and Vietnam.172 The third wave began in December 2004, involving new poultry outbreaks in Indonesia, Thailand, Vietnam, Cambodia, Malaysia and Laos.173 Fresh human cases were reported in Vietnam, Thailand and Cambodia.174 At this point, after reviewing the unfolding situation, a writing committee of the WHO consultation on human influenza established that Vietnam led the human death toll.175 According to a WHO pandemic threat report,176 by 2005, H5N1 had crossed the species barrier three times, namely in 1997, 2003, and the period between 2004 and early 2005, which recorded the largest occurrence of human H5N1 cases of the period in question. With the report of migratory birds being affected with H5N1 in Mongolia and China, particularly at Lake Qinghai in China in April 2005, concern grew that this posed a potential risk of southward and westward spread of the virus in poultry.177 Around 6345 birds of different species died in the weeks following the Qinghai outbreak.178 This is probably the single most important event linking H5N1 to migratory bird spread. This outbreak singularly raised the profile of the role of migratory birds in the global spread of H5N1.
H5N1 had spread through the diverse market and poultry production systems of Southeast Asia. There is much debate around the primary causes and drivers of the H5N1 problem, revolving around poultry production and marketing practices. An important factor in the Asian panzootic is that ducks appeared to have played a key role in the maintenance of the virus, primarily as silent carriers of H5N1. While outbreaks in poultry were still possible, this suggests that in areas where duck production was less significant, the chances of endemicity could be lower. By 2005, H5N1 had become endemic in the duck population of poultry, providing a reservoir of the virus for other poultry species as asymptomatic shedders of H5N1 influenza.179
As of November 11, 2010, H5N1 HPAI had claimed a cumulative 508 confirmed cases and 304 human deaths.180 The panzootic cost the global poultry industry well over $10 billion (US) in losses and continued to persist in poultry populations of parts of Europe, Southeast Asia, Egypt and Nigeria.181 The primary public health concern had been H5N1’s likely candidacy for the next human influenza pandemic, which many experts believed was overdue.182 Interestingly, it was the rapid spread, public health and economic ramifications of the SARS outbreak in 2003 that appear to have alerted the global health community to the conceivable need for pandemic preparedness.183 In the wake of SARS, H5N1 presented an unprecedented challenge to the animal health, public health and trade policy communities, identified as a threat to the poultry industry, a pharmaceutical interest, a trade-related epidemic, public health threat, and a human pandemic concern.184
For avian influenza, one185 explanation is that public health experts and epidemiologists did not know whether an H5N1 human pandemic was actually imminent, only that it was plausible. Adding to the complexity was the need to determine how exactly to respond to a potential H5N1 pandemic. Reviewing available surveillance data on past human influenza pandemics, there was no pattern to the epidemiology of occurrence,186 or standard manifestation of pandemics, including which segments of the population would be affected the most.187 This suggests that there is no clear precedent for definitively predicting how the next pandemic will behave.
Despite these uncertainties, a multi-sectoral approach to H5N1 management and pandemic preparedness across the policy sectors affected was advocated at national, regional and international levels. The purpose of such an approach was to foster a coherent response to H5N1.188 Correspondingly, the main thrust of the H5N1 avian and pandemic influenza response was the coordination of public health and animal health agencies at national and international levels with the goal of developing preparedness interventions for those areas that had not yet been affected. An alternative goal was to reinforce control measures in locations where the disease had become endemic, where, based on WHO pandemic preparedness guidelines, OIE recommended control measures and FAO devised surveillance strategies.189 However, H5N1 presented unique challenges for pandemic planning, involving the weighing of sector-specific risk against wider ecological and socioeconomic interests that challenged the traditional public health and animal health based interventions of the pre-SARS era. Global infectious disease governance post-SARS dictated, at least in the context of avian and pandemic influenza preparedness, the attempt to balance the interests of pharmaceutical, conservationist, transnational business and commercial poultry as well as bridge the previously growing divide between public and animal health.190
In the policy domain, many of the concerns over a pandemic began to sound apocalyptic. The often-cited comparator was the 1918 Spanish flu pandemic which one health policy scholar suggests killed over 50 million people.191 This particular pandemic was said to have its origins in Kansas military camps and was spread to Europe by US troops during the war in 1918.192 With contemporary concerns focusing on human population growth, increased intensity of production systems and the unprecedented nature of globalization, which many have argued allow for the faster and further transmission of infectious disease threats,193 there was a fear that a pandemic in modern times could kill millions. Some researchers,194 on the other hand, held the view that a pandemic now is likely to result in considerably lower deaths than the one that occurred in 1918. The WHO195 estimated that a pandemic arising from H5N1 could result in two-seven million deaths at the minimum. Other commentators were skeptical196 and dismissed the avian influenza issue, and SARS before it, as elaborate political conspiracies of corporate and pharmaceutical interests disguised as national security threats and pandemic concerns. There was, therefore, a lot of politics surrounding the issue of avian and pandemic influenza.
In the debates on global responses to avian influenza, some researchers197 mapped recurring themes and summarize the four themes characterizing the core political issues: (1) risk and uncertainty, (2) economy and livelihood impacts, (3) effects on health and extent of disease, and (4) effects on food and farming. Drawing from these four issues, there are six linked debates identifiable in the international policy discourse concerning avian and pandemic influenza. The first debate involved the scientific uncertainty of the likelihood of the occurrence of a pandemic caused by H5N1. As mentioned above, some authors198 state that public health experts were uncertain of its likelihood. The concern over a possible pandemic resulted in called to focus control on the likely source of this risk, such as Southeast Asia, where most of the impact of H5N1 had been felt. In fact, some authors have referred to Southeast Asia as an “influenza epicenter.”199 Of course, a complex interplay of cultural factors and production practices led to the exposure and eventual succumbing of humans in this region to H5N1.200 These factors have been identified and reviewed in various context-specific network analyses,201 HPAI risk mapping studies,202 risk factor studies203 and risk analysis.204 However, in some reviews of infectious diseases risk management and governance of global risks,205 it was argued that although surveillance had focused on H5N1, there was still a lot of uncertainty about both its evolution as a zoonosis and its effects on public health.
The second debate involved linking poultry production practices, HPAI epidemiology and disease spread through trade, poultry and poultry product and migratory bird movement. According to the epidemiological reviews by Capua and Alexander206 and Alexander,207 recent increases in intensive poultry production practices were responsible for the increasing incidence of highly pathogenic influenza in the world. It was stated by van den Berg208 that all parts of the world were at risk of H5N1 incursions as a result of the globalization of trade. Some authors took the view that it was migratory birds that would spread H5N1 across the globe,209 yet others claimed that wild birds were only capable of short range spread.210
The third debate involved the ‘One Health’ approach response to mitigate the pandemic threat. This was characterized by calls to strengthen veterinary control systems in addition to human pandemic preparedness, addressing the pandemic risk at-source but involving other sectors to mitigate the risk.211 A key question here was how do countries incorporate other policy sectors in risk mitigation? As one study demonstrated, each sector, and indeed each country, would view the HPAI problem differently.212 In addition, while the international community recommended ‘at-source’ controls, the ‘standardized’ approaches adopted worked in some areas and failed in others.213 In their examination of the epidemiology of H5N1, Yee, Carpenter and Cardona,214 state that control measures such as culling, disinfection and stamping out had been successful in controlling H5N1 outbreaks in Europe, but were not as effective in Southeast Asia.
The fourth debate involved the potential effects of a human pandemic on the global economy. This resulted in HPAI risk mitigation responses perceived to largely affect only the livelihoods of those in outbreak areas.215 The brunt of these control efforts was largely felt by poor farmers, impacting on food security, livelihoods and farming. Stirling and Scoones,216 for example, estimated that over 2 billion birds were slaughtered with the greatest losses suffered by the poor. Nicoll217 states that the effect of H5N1 was mostly felt in the social sphere, particularly in Southeast Asia, where several countries (e.g. Thailand) had their poultry exports prejudiced and rural livelihoods affected by control interventions. This has links to contentions between business and livelihood interests and controversies over the role of intensive vs. backyard farming in disease spread.218
The fifth debate involved pharmaceutical interests, covering influenza virus sharing and concerns that genetic sequence information collected from outbreak areas would be used to create vaccines for market that would not be distributed equitably in case of a pandemic.219 The policy response involved Western countries scrambling to stockpile antiviral drugs and vaccines for ‘high level pandemic preparedness efforts’, the vaccines of whose production depended on H5N1 virus strains recovered from outbreak centers in developing countries.220 In an effort to globalize this policy response, there were calls for affected countries to either develop pharmaceutical capacity or consider non-pharmaceutical interventions.
Linked to this was the sixth debate, involving the ‘securitization’ framing of the avian and pandemic influenza issue, which, Elbe221 argued, contributed to, and caused difficulty in resolving, the controversy over influenza virus sharing . In implementing this ‘securitization’ approach, Western countries spent massively on pandemic preparedness. Burgos and Otte’s (2008) study222 citing Jonas’s study223 state that the US and European countries had spent approximately US$2.8 billion ‘at home’ versus US$950 million ‘abroad’ for disease control ‘at-source’ by the end of 2008. This forms the background against which developing countries generated their avian and pandemic influenza intervention policies guided by the WHO global pandemic preparedness plan.224
The African response was coordinated by the WHO African Regional Office (WHO-AFRO), the African Union Inter-African Bureau for Animal Resources (AU-IBAR) and some regional trading blocs such as the Southern African Development Community (SADC), with funding from the African Union and the World Bank.225 This was under the global coordination of United Nations System Influenza Coordinator (UNSIC), with the main participants being WHO, OIE and FAO.226 These global and regional actors set out a framework to guide the development of national avian and human influenza prevention and control responses. Among these guidelines was a recommendation for multi-sectoral integration.227 By 2007, response plans on the African continent were at different stages of development with most aimed at containment of avian influenza in poultry to the neglect of pandemic preparedness.228
42.4.2 Chicken: A Cheap Source of Protein or a Pandemic Threat?
At the height of the global avian influenza crises, a WHO AFRO risk assessment made comparisons between Asian and African poultry production systems to justify the continent’s risk of an incursion as well as recommend similar control measures to those used in Southeast Asia.229 The statement read in part, ‘Though the densities of human and poultry populations are generally lower in Africa than in south-east Asia, the poultry production systems have many similarities which could create multiple opportunities for human exposure, if outbreaks occur in African poultry’.230 Despite the different contextual realities, such as the role that ducks, mixed farming, and wet markets played in the evolutionary epidemiology of avian influenza,231 or the fact that Southeast Asia is considered to be a viral mixing pot most likely to be the epicenter for the emergence of novel viruses such as H5N1,232 the unexamined underlying assumptions of this statement are what formed the mould for preparedness efforts in Africa.
In Zambia, the international call for pandemic preparedness was met first by local media reports of possible avian influenza outbreaks in Zambian poultry. The result was a nearly $7 million (US) loss to the poultry industry over a 3 month period as production scaled down.233 Producers reduced their production, consumers feared the consequences of eating infected chicken and this had knock-on effects on the feed industry, the veterinary pharmaceutical industry and poultry breeders.234 The reports of outbreaks in poultry turned out to be false. Under WHO and FAO oversight, the Zambian government commissioned a 20-person multi-sectoral task force on avian influenza at the end of October 2005, to be the nation’s eyes and ears concerning avian and human influenza and prepare for what they perceived to be an inevitable incursion of H5N1 in the country.235
Early in the evolution of Zambia’s response to avian and pandemic influenza, the threat of an incursion of H5N1 was successfully presented as an imminent threat. Between 2005 and 2009, this framing of the H5N1 threat as an emergency led to both government and academic scientists in the country searching for the elusive virus in both traditional poultry and wildlife.236 The public response to media reports suggests a perception of a food safety concern. The perception of policy makers, however, reflected their institutional standpoints. For example, stakeholders from the Ministry of Health viewed it as a pandemic concern and a potential triage strain for the health system should human infections occur. The Agricultural Ministry, represented by the veterinary department, viewed it as an exotic poultry problem with the potential for zoonotic transmission. It was also viewed as likely to emerge from poor poultry producers with no knowledge of biosecurity. The Trade Ministry and poultry industry viewed it as a threat to both Zambia’s poultry sector as a whole and Zambia’s international trade opportunities.237
Around 64 % of Zambia’s households keep chickens.238 It provides an affordable source of protein for many of the country’s citizens. Production is primarily traditional, based on the rearing of indigenous breeds with around 10–15 of chickens per household. The commercial sector in the country is a mix of backyard producers, emergent broiler and layer farmers supplied by locally produced feed and imported breeding stock.239 The production capacity of the Zambian commercial sector in 2010 was estimated at 30 million broiler birds annually and 6 million eggs monthly.240 Production is nowhere near the levels found in Southeast Asia. Furthermore, the agricultural ministry was oriented to focus on cattle and cattle diseases and not poultry and poultry problems.
External partners had a disproportionate role in influencing the pandemic preparedness policy process in Zambia. International finance, evidence and prescriptions provided a preconceived view of how pandemic preparedness should be pursued over what should have been a response based on a contextualized understanding of Zambia’s policy structure, priorities, and material needs. The result was a one-size-fits-all policy that reflected global narratives that were at odds with Zambia’s needs. In retrospect, the confluence of interests surrounding pandemic preparedness and economic development in Zambia presented unique challenges which required careful weighing in the financing and development of the country’s avian and pandemic influenza prevention and control policy. Even at the stage where it became evident that H5N1 was unlikely to affect Zambia, international influences continued to emphasize avian influenza as a poultry problem and imminent threat, pushing agriculture to the fore and inadvertently underplaying what the issue was truly about: the pandemic concern.
42.5 Policy Issues for Food Policy and Risk Management
Our case studies presented two very different food safety risks. In the case of bovine tuberculosis, the issues highlighted a problem obscured by bigger health concerns, i.e. HIV/AIDS and human tuberculosis. The second case was that of an indeterminate risk of incursion of a disease alien to Zambia. Both presented interesting cases for food safety. The BTB case study presented a twofold risk to communities living in and around the livestock interface. First, there is a public health risk from the consumption of uninspected meat from lechwe, a wildlife species known to be a maintenance host for BTB, and second, there is the major risk from consumption of unpasteurized milk derived from tuberculosis positive herds. Milk, as previously stated, is known to be the primary means of zoonotic conveyance to humans. Of course there are other risks of acquiring BTB in this area, including aerosols from cattle with active tuberculosis lesions in their lungs, during the evisceration of infected cattle or lechwe carcasses and during the consumption of undercooked meat contaminated with Mycobacterium bovis. However, the two risks highlighted, and the related food processing and handling practices of the area are pertinent concerns for food safety and zoonotic risk management.
Because lechwe meat provides communities with a supplementary source of protein, lechwe that are culled for consumption within wildlife-livestock communities actually bolster local food security. This service, however, is perhaps being provided at the expense of public health. The provision of meat inspection services would help address this concern, but requires a concerted response by local health, wildlife and veterinary officials. Although meat inspection is not very sensitive and up to 60 % of discrete tuberculosis lesions may go undetected,241 it is still necessary to mitigate the food safety risks to public health in rural livestock keeping communities such as those found in Zambia’s wildlife-livestock interface. The difficulty in controlling the condition in lechwe means that the disease is unlikely to be eliminated in cattle. Food hygiene thus seems to be the primary prevention mechanism available for food governance stakeholders in the area. A long term solution would require exploring control mechanisms in the lechwe population, in addition to control of the disease in cattle.242
On the other hand, avian influenza presents a food safety issue that occupies a different level of importance, particularly for the international donor community, when compared to BTB. An important risk question that was not asked in rolling out the avian and pandemic influenza response in Zambia was how the country was linked to the global poultry industry. The focus of control instead was on the Zambia’s traditional and backyard production systems, a response that addressed a risk scenario mirroring the Southeast Asian H5N1 experience where backyard production was strongly implicated in the maintenance and spread of H5N1. A few key elements where missing from Zambia, the mixed farming systems, use of wet markets and duck production.243
Fortunately, an outbreak of zoonotic avian influenza H5N1 never occurred in Zambia. The abatement of the threat, however, served to highlight some significant policy conflicts. Poultry and poultry production were low priorities for the Zambian Agricultural Ministry, whose veterinary department had a long list of diseases of national economic importance to tackle. The man-hours spent in pursuit of the elusive H5N1 were thus viewed as wasteful. In short the donor-driven response was not properly aligned with local economic realities.244
These two case studies demonstrate the complexity of issues surrounding food governance. In the case of bovine tuberculosis, there is an apparent lack of understanding for the need for its control in rural populations, despite the myriad studies demonstrating the risk to humans living in contact with infected wildlife and livestock. Some of the reasons, presumably, are based on larger health problems (human tuberculosis and HIV/AIDS), an absence of veterinary support, and a wildlife management system that is incognizant of the risks to public health. In the case of H5N1, there was no real local risk, but international interest and finance pushed its importance up the government agenda. Outside Egypt and Nigeria, the African countries that had been most impacted by H5N1, other countries in the region responded to the avian and pandemic influenza more or less because of international finance. In areas where H5N1 was a problem, there were notable food security repercussions. For example, in Nigeria, a ban in poultry and poultry product movement resulted in those regions with low poultry production unable to obtain poultry and poultry meat from the high poultry producing areas. The impact was the reduced availability of the cheapest and commonest source of protein for low-income consumers.245
42.6 Key Learning Points for Public Health and Food Policy
This chapter sought to describe and explain the confluence of complex issues surrounding the issue of animal health, public health and food safety governance in the African region. The background sections served to demonstrate that politics is rife around food governance and food law in the African region. Using a risk-based epidemiological model, the chapter highlighted the various problems African countries face in addressing food safety concerns, including resource constraints, legislative overlap and redundancy, donor dependency, trade rule complexity, different perceptions on livestock use, problem overload and globalization.
Because food-borne diseases and food safety are important concerns in the African region, there remains an urgent need to understand both the public health and economic impact of food-borne diseases on the continent in general and in its various countries in particular. This knowledge, however, is not a guarantee for the adequate address of food safety on national governmental agendas. It must be understood that food governance policy coherence is not a state, but a process. It is a bargained ‘collective’ construct, requiring a level of oversight, coordination and consensus among actors for whom coherence is relevant.246 Therefore, considerable advocacy and policy entrepreneurship is required to garner the necessary support for food safety reform both in the African region and with the international donor community. Furthermore, it is difficult to develop a coordinated and sustainable approach to the holistic management of food safety in the African region, especially when the impact of food safety on public health and the general economy have not been adequately assessed. Therefore, while important, getting the various stakeholder institutions to understand the public health benefits of coordinated and improved food safety mechanisms remains a fundamental challenge. This is because, as alluded to earlier, modern polity is fragmented as a matter of necessity. Viewing government as a unitary body that must generate knowledge on the economic and public health impacts of food safety and develop coherent national and international food safety policies in consultation with all stakeholders along the food supply chain is difficult.
Fundamentally, a flexible structuring of food safety risk in ways that is stakeholder inclusive is what is required. It is also important to include local ecological, biological and policy considerations. A clear picture of key stakeholders needs to be developed for effective food-borne disease risk management. This could include wide stakeholder consultation in understanding food safety risks and their assessment.247 In the case of food safety governance in the African region, there is a need to have a multi-actor view of the food supply chain, and to develop context and time specific definitions of food safety problems that would help inform food safety agendas for both national governments and the global public health community.
The Bovine Spongiform Encephalopathy (BSE) crisis in the United Kingdom provides interesting lessons for understanding the governance needs of food-borne disease risk management, particularly as it relates to zoonoses.248 In the context of the BSE/Creutzfeldt-Jakob Disease crisis in Europe, it was found useful to assess public perceptions through the lens of lay epidemiology249 where the understanding of risk problems mirrored expert knowledge.250 For zoonosis control, such a conceptualization of risk can be extended to accommodate multiple decision-makers along the food supply chain. That is, each decision-making body, with its institutional norms and ideas, can contribute their expertise and understanding of food-borne disease risk and understanding specific to the role they play along the food chain. Of course, this requires a deliberative approach emphasizing dialogue, particularly in defining the problems and analyzing and evaluating food safety risk issues.
In conclusion this chapter has hinted at the fact that defining food safety risks and, indeed the process of problem identification, could be developed by considering multiple contextual issues and stakeholders along the food supply chain. It is also important to keep in mind what they perceive the risks to be, and how their definitions fit into the broad picture of food safety in general. Certainly, the application and utility of the disease prevention framework presented in the conceptual section of this paper would be greatly advanced. However, because disease control is highly politicized, a more inclusive approach is required to use evidence to support responses to global disease concerns aligned with local priorities and realities.251 As in the case of general disease control, food safety governance requires the right questions to be raised to foster the socio-political and economic change that the international community expects from the African region.252 As one study argues,253 the process of instituting change cannot remain the “purview of the global North, especially when the questions asked, and the responses advocated, favor a Northern perspective of globalized risk over the ‘real’ needs of the global South.” Context will always matter and therefore, local ecological, biological and policy considerations should be given primacy. In conclusion, food safety governance regulatory processes should take into consideration local realities, local food supply chains and local food safety threats to ensure appropriateness and sustainability of any and all disease control measures instituted.
Buzby and Roberts (2009), pp. 1851–1862.
see Kimball (2006).
The American Veterinary Medical Association has defined One Health as “the collaborative effort of multiple disciplines — working locally, nationally, and globally — to attain optimal health for people, animals and the environment.” American Veterinary Medical Association, One Health (2008), available at https://www.avma.org/KB/Resources/Reports/Documents/onehealth_final.pdf (last accessed Jan 2015).
Kahn et al. (2007), pp. 5–19.
Krauss et al. (2003).
Lee et al. (2002).
Walt and Gilson (1994), pp. 353–370.
Lee and Koivusalo (2005), p. e8.
Walt and Gilson (1994).
Navarro (1998) pp. 742–743.
Greger (2007), pp. 243–299.
Id., pp. 13−14.
The social determinants of human health are the conditions of the environment where people live and work (Exworthy 2008).
Horlick-Jones (1998), pp. 64–67.
Douglas and Wildavsky (1982).
Mwacalimba (2012), pp. 391–405.
Stirling and Scoones (2009).
A double burden of disease is a state in which the prevalence of risk factors for chronic diseases (diabetes, heart diseases and cancers) increase at the same time that traditional health problems such as maternal and child deaths caused by infectious diseases are still major public health threats for the majority of the population.
Wilson and Otsuki (2001).
Muma et al. (2014).
Statutory Instruments are a means of creating delegated or secondary legislation.
Walt and Gilson (1994).
The Codex Alimentarius Commission was established jointly by the United Nations’ (UN) Food and Agriculture Organization (FAO), and the World Health Organization (WHO).
Omamo and Farrington (2004).
Barling and Lang (2004).
The date of the original text for this law is April 11th, 1930. It was last consolidated in 2006. The Act ‘makes provision with respect to matters affecting public health in Zambia including prevention and suppression of infectious diseases including diseases communicable from animal to man, sanitation, protection of food, supply of water, protection from mosquitoes and pollution in general.
The Minister is granted certain regulation-making powers in respect of infectious diseases. Importation of animals may be restricted. The Act also prohibits the sale of unwholesome food and grants in general regulation-making powers to the Minister especially for the control of quality and hygiene of food. Water shall be kept in such a manner so as to avoid stagnant water. Local authorities shall take all possible measure for the prevention of the pollution of water and to purify any polluted water supply. The Minister may make, on the recommendation of the Central Board of Health, certain Orders for the protection of milk.
Descriptors (Livestock): animal health; pests/diseases; data collection/reporting
Descriptors (Food): food quality control/food safety; hygiene/sanitary procedures; milk/dairy products
Descriptors (Water): water supply; freshwater quality/freshwater pollution
Descriptors (Waste & hazardous substances): pollution control; waste disposal’ Cap 295 of the Laws of Zambia.
This act originated as S.I. No. 244 of 1972 as at 2006. The Food and Drugs regulations ‘prescribe that no manufacturer or distributor of, or dealer in, any article shall sell such article to a vendor unless he gives to the vendor a warranty in a form set out in the Schedule and applicable to such sale. “Article” in the Act means any food, drug, cosmetic or device and any labelling or advertising materials in respect thereof or anything used for the preparation, preservation, packing or storing of any food, drug, cosmetic or device.
Descriptors (Livestock): animal health; drugs
Descriptors (Food): food quality control/food safety’ Cap 303 of the Laws of Zambia.’ Source: http://faolex.fao.org/.
The year this law was repelled is revealing. Zambia only became independent on October 24th, 1964.
In some by-laws of this act, animal health and food safety is addressed. For instance, concern the slaughtering of animals and sale of meat in the area under the jurisdiction of the Katete District Council. They also provide for the control of stray animals.
‘Butcheries shall be approved by the District Council. A person shall not expose, offer, deposit, accept or have in his or her possession for resale any meat unless such meat has been examined and passed by the Meat Inspector as fit for human consumption and stamped and marked accordingly.
Descriptors (Livestock): grazing/transhumance; slaughtering
Descriptors (Food): food quality control/food safety; meat; slaughtering; inspection’ Source: http://faolex.fao.org/.
This is the French acronym (Office International des Epizooties—OIE).
Thiermann (2005), pp. 101–108.
Zepeda et al. (2005), pp. 125–140.
e.g. Vallat and Pastoret (2009), pp. 503–510.
Hueston (2003), pp. 3–12.
Stiglitz (2009), pp. 363–365.
Thomson et al. (2004), pp. 429–433.
Upton and Otte (2004).
Rweyemamu and Astudillo (2002), pp. 765–773.
Tambi and Bessin (2006).
see also MacDonald and Horton (2009) pp. 273–274.
Tambi and Bessin (2006).
Hall et al. (2004), pp. 425–444.
Domenech et al. (2006).
see Scoones (2010).
Smith et al. (2002).
Mwacalimba et al. (2013), pp. 274–279.
Zinsstag et al. (2007), pp. 527–531.
Grootenhuis and Olubayo (1993), pp. 55–59.
O’Reilly and Daborn (1995), pp. 1–46.
Ayele et al. (2004), pp. 924–937.
Niemann et al. (2000), pp. 152–157.
Brosch et al. (2002), pp. 3684–3689.
Hancox (2000), pp. 87–93.
Cosivi et al. (1998).
Ayele et al. (2004), pp. 924–937.
Menzies and Neill (2000), pp. 92–106.
Menzies and Neill (2000).
Unger et al. (2003).
Unger et al. (2003).
Gibson et al. (2004).
Aranaz et al. (2004), pp. 2602–2608.
FSAI Scientific Committee (2003), http://www.fsai.ie/publications/other/zoonotic_tuberculosis.pdf.
Neill et al. (2001).
Moda et al. (1996).
cited by Unger et al. (2003).
Tamiru et al. (2013), pp. 288–295.
Kazwala et al. (2001).
Cook et al. (1996).
O’Reilly and Daborn (1995).
cited by Ayele et al. (2004).
Zumla et al. (2000), pp. 259–268.
Cook et al. (1996).
Chabwela and Mumba (1998).
Munyeme et al. (2008).
Munyeme et al. (2008).
Mumba et al. (2011), p. 137.
Kells and Lear (1959).
Munyeme and Munang’andu (2011).
Siamudaala et al. (2003).
Simasiku et al. (2008).
Siamudaala et al. (2003).
Siamudaala (2004), pp. 48–52.
Avian influenza exists in two forms, highly pathogenic avian influenza (HPAI) and low pathogenic avian influenza (LPAI). Continuous existence of LPAI virus in avian populations may provide chances for the virus to undergo mutation and convert to a highly pathogenic form. Highly pathogenic avian influenza, especially of the H5 and H7 subtypes, has the potential to infect human beings.
Shortridge et al. (1998), pp. 331–342.
Shortridge et al. (1998).
Sims et al. (2005), pp. 159–164.
Sims et al. (2005).
Sims et al. (2005).
Beigel et al. (2005), pp. 1374–1385.
Osterholm (2005), pp. 1839–1842.
Monto et al. (2006), pp. S92–S97.
Nicoll (2005), pp. 210–211.
Morens and Fauci (2007), pp. 1018–1028.
see Hampson (1997).
Gilbert et al. (2008), pp. 4769–4774.
Yupiana et al. (2010), pp. e800–e805.
e.g. Kasemsuwan et al. (2009).
Pitrelli and Sturloni (2007), pp. 336–343.
Capua and Alexander (2004), pp. 393–404.
van den Berg (2009), pp. 93–111.
See e.g. Webe and Stirlianakis (2007), pp. 1139–1143.
Mwacalimba and Green (2014).
Scoones and Forster (2008b).
Yee et al. (2009), pp. 325–340.
Elbe (2010), pp. 476–485.
Burgos and Otte (2008).
Jonas (2008) cited by Burgos and Otte (2008).
Id., p. 7.
Mwacalimba (2012), pp. 391–405.
Munang’andu et al. (2012).
FSAI Scientific Committee (2003).
Mwacalimba and Green (2014).
Muma et al. (2014).
Stirling and Scoones (2009), http://www.ecologyandsociety.org/vol14/iss2/art14/.
See Dora (2006).
This describes the processes through which health risks are understood and interpreted by laypeople. Allmark and Tod (2006).
Dowler et al. (2006).
Colvin (2011), pp. 253–256.
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