A New Integrated Veterinary Service to Control HPAI Outbreaks in Eastern Thailand.
Eastern Veterinary Research and Development Center

The Problem

The outbreak of Highly Pathogenic Avian influenza (HPAI) of the H5N1 virus subtype was first reported in Thailand in January 2004. It widely spread throughout the country causing severe morbidity and mortality in poultry, restrictions of domestic and international trade of poultry products, and impacts on farmers’ livelihoods and socioeconomics. From 2004-2006, Thailand had experienced four waves of HPAI outbreaks, the first wave resulted in 320,000 birds culled, the second wave 63 million birds culled, the third wave 450,000 birds and the fourth wave resulted in a limited number of culls. The disease has major social and economic impacts, from Jan-Jul 2004, HPAI outbreaks cost Thailand 54 billion baht and affecting 1.2 million people. The disease is also a potential threat to a global human influenza pandemic with 25 infected human cases and 17 death reported in Thailand. Avian influenza virus (AIV) is highly contagious, infected birds shed viruses in high concentration in cloacal and nasal discharge. The virus can spread from flock to flock through the movement of infected birds, farm equipment, egg cartons and feed, farm workers, and etc. Controlling HPAI at source is the essential prerequisite for protecting Thai farmers and poultry industries and ensures a safety of poultry products for consumers.

The Department of Livestock Development (DLD) has direct responsibility to control and mitigate HPAI. DLD has developed the National Strategic Plan for AIV prevention and control by assigning the responsibility of averting and potential eradication of HPAI to National Institute of Animal Health (NIAH), seven regional VRDCs and DLD network of veterinarians. Before this project, the seven VRDCs were mainly responsible for laboratory diagnostics and epidemiology, but following HPAI outbreaks, regional VRDCs’ responsibilities also included containment of the disease by implementing rapid diagnosis and management of future outbreak risk. DLD has strictly implemented a stamping-out policy (i.e. culling of all flocks within 5 kilometer radius of confirmed cases) with compensation and other control measures (i.e. movement restriction, disinfection), to eradicate the disease. A use of vaccination against HPAI is prohibited in Thailand.

Some 20 percent of total poultry agribusiness in Thailand resides in the Eastern region (9 provinces and a population of 5.2 million). In addition to several large commercial farms, poultry meat processing, parent stock and feed mills, there are many small-scale poultry farmers who raise native chickens, fighting cocks and free-grazing ducks (the latter are reservoirs of infection), and these activities are essential source of income in the form of direct sells and job opportunities. Initially, DLD’s official containment policy has led to low uptake of control measures and the less willingness from smallholder poultry producers in the region to report potential “new cases”. This low uptake was exacerbated by the farmer’s lack of knowledge on HPAI transmission pathways and the poor access to appropriate veterinary services and mixes of different poultry species. All these factors greatly increased the risk and spread of AI and thus provided an option for EVRDC to implement better veterinary service in order to control HPAI outbreaks systematically.

Solution and Key Benefits

 What is the initiative about? (the solution)
The solution for the problem is to implement a new integrated veterinary service that focused on the smallholders/farmers in the region. The new model emphasized (1) an effective partnership and networking to encourage stakeholders’ cooperation (2) high quality and rapid diagnostic services both on farm and in the laboratory and (3) transforming EVRDC administration structure and process to streamline reporting and increase capacity for responding to emergency disease incursions.

This project was the first veterinary program to contain the HPAI outbreak in Thailand which had significant adverse effects on the livelihoods of smallholders/farmers and their families (e.g. death of 60 million chickens and 5,200 million baht in compensation to farmers in 2004). In 2004-5, more than 300 cases occurred in the Eastern region. Since this project has been implemented, the HPAI cases were significantly reduced and since Jan 2006, Eastern region reported no HPAI case as judged by routine surveillance data of more than 100,000 samples per year. It has also led to the establishment of a new veterinary service that is responsive and sustainable and has now been adopted by other VRDCs. The experience drawn, as well as the competence and know-how built during the project is applicable to other emerging disease outbreaks.

Besides obvious animal health benefits, this project has resulted in building trust between rural poor (backyard owners of less than 100 animals) and EVRDC personnel. Positive performance indicators from farmers in form of questionnaires (years 2006-10) came back with 97.8% for staff satisfaction, 96% for veterinary diagnostic capability and 95.6% for services indicate strong support for the project from clients. The project has resulted in culture changes among villagers with regard to reporting disease cases (instead of kill) and increased awareness of infected carcasses effecting on health (instead of consuming as food). But above all, this initiative has had an essential role in maintaining livelihood incomes for smallholder poultry producers by reducing their vulnerability to HPAI.

With the new integrated data capture and management systems and the introduction of new molecular diagnostic technology, EVRDC is able to handle more than 1000 cloacal swap samples per day (increased from 20) and decrease the number of staff on duty from 40 staff to 10. In addition, the project has reduced HPAI diagnostics turnaround time (sample receipt until result is ready) from 3-14 days to 1-3 days.

The project has also resulted in the change in the containment policy. Initially, DLD has adopted the OIE containment policy of destroying all poultry products within 5 kilometer radius of confirmed case which resulted in severe economic loss to smallholders/farmers and some did not resume farming after their flocks were culled. Moreover, most farmers were not fully compensated for the loss especially for the backyard structures that has housed chicken. The implementation of the project by EVRDC has contributed to the re-evaluation policy mandates to only those flocks considered confirmed cases are to be culled and flocks within a 5 kilometer radius are to be tested.

Actors and Stakeholders

 Who proposed the solution, who implemented it and who were the stakeholders?
Native chickens are raised by the smallholder/farmers as a source of protein and extra income for the family. These poultry are often free-ranging which increase a risk of AI infection. With full support of DLD, EVRDC has implemented a new integrated veterinary service targeted disease infection in native poultry. The main stakeholders for this project were vulnerable rural poor who keep native chickens for food and recreation and small-scale farmers and backyard poultry producers who experience significant chicken deaths from the outbreaks. The project allowed access to disease-free chicken meat therefore promoting rural public health, and also build confidence in governmental officers’ advice and transparency.

The project has also greatly benefited commercial chicken and breeding farms of Layer Parent Stock and Broiler Parent Stock, and duck farming as HPAI often spreads from native chicken to other poultry husbandry categories. The implementation of the program also helped protect mammals from HPAI infection (e.g. tigers in Sriracha Tiger zoo were infected in Oct 2004 with 147 deaths from total 441 animals). Finally, the project has impact upon chicken meat consumption in Thailand and the growth of commercial poultry companies has increased significantly as the demand for poultry products revived following successful stamping-out of HPAI. Investment in poultry business has also grown, including at the small-scale and cooperative levels.

Specifically, the implementation of the new veterinary service by EVRDC has following benefits:

Stakeholder 1: EVRDC
1. Increase management efficiency by reducing administrative waste such as paper work, process time and staff required to process paper work.
2. Increase efficiency of laboratory diagnosis from 13,950 samples tested in 2004 involving 40 personnel by egg inoculation method to 131,909 samples tested in 2007 involving 10 persons by combining cell culture, egg inoculation and real-time PCR technology.

Stakeholder 2: smallholders/farmers poultry producers
1. Increased knowledge on HPAI transmission pathways, and how to prevent virus incursions
2. Better access to veterinary extension service and greater participation and adoption of control measures
3. Help maintaining livelihood outcomes by reducing vulnerability to HPAI and improved food safety and security

Stakeholder 3: General Public
1. Reduce the general public from emerging zoonotic risk
2. Promote food safety for consumers of chicken meat and poultry products

(a) Strategies

 Describe how and when the initiative was implemented by answering these questions
 a.      What were the strategies used to implement the initiative? In no more than 500 words, provide a summary of the main objectives and strategies of the initiative, how they were established and by whom.
Main objectives:
• Promote communication between villagers and veterinary public service unit
• Increase the speed of response to emergency disease incursions
• Improve accessibility of smallholders to quality veterinary services
• Increase diagnostic efficiency and infrastructure
• Improve field and laboratory data management

The strategies implemented by EVRDC to achieve these objectives are:

(1) Community cooperation. With coordination and facilitation of EVRDC and local communities, the surveillance network has been established at village and district levels. The networks of native poultry farmers, animal health volunteers, provincial and district livestock government officers, local government representatives, and public health representatives were organized by EVRDC. Several workshops and public awareness campaign were launched to give knowledge and information to native chicken farmers and livestock stakeholders.

(2) Rapid response. EVRDC implemented a rapid veterinary service by setting up a MVRRT (Mobile Veterinary Rapid Response Team) to monitor and respond to outbreaks among backyard and smallholder poultry producers. When any suspected case of HPAI was reported, MVRRT immediately responded and investigated on the suspected premise. An Influenza A rapid test was performed immediately and then control measures were implemented. MVRRT also provided advice to farmers to protect themselves from the disease. Swab samples and carcasses were sent to laboratory for confirmatory diagnosis. All data of infected farms were collected and entered into a database at EVRDC for further analysis.

(3) Rapid and efficient diagnosis. EVRDC has increased routine diagnostic efficiency by incorporating ISO/IEC17025 diagnostic preparedness and the introduction of molecular diagnostic technology (real-time PCR) and cell culture into routine diagnosis.

(4) Increase administration efficiency. EVRDC has introduced barcode and Laboratory Collection Sample System (LCSS) to improve data collection and management. All data from specimen collection, history and farm location, and diagnostic results are entered into the system. The aim is to improve risk management component, and limit downstream disease risks and encouraging upstream reporting of new cases. These activities reduce number of steps and labor from specimen collection to disease identification and also allow a more accurate reporting of cases.

(b) Implementation

 b.      What were the key development and implementation steps and the chronology? No more than 500 words
• Set up MVRRT to monitor for outbreaks among backyard and smallholder poultry producers (Oct 2004)
• Utilized existing network of veterinary personnel, community leaders and smallholder poultry producers to increase knowledge on HPAI control and surveillance (Oct 2004)
• Developed of key HPAI diagnostics in the laboratory, transfer from only egg inoculation to real-time polymerase chain reaction (Jul 2005)
• Created and installed Laboratory Collection Sample System (LCSS). Introduced bar-code and software, streamlining sample collection and register process. This change has resulted in 2 staff able to process (registration) up to 1000 samples/day (Mar 2007)
• Accredited laboratory complying with ISO/IEC17025 and the requirement of the Bureau of Laboratory Quality Standards for veterinary diagnosis (Accreditation Number 1106/50) (Apr 2007).

(c) Overcoming Obstacles

 c.      What were the main obstacles encountered? How were they overcome? No more than 500 words
Although improving veterinary service significantly increased participation and reporting cases, a main obstacle has been the difficulties in communicating the benefits of the project to smallholders. Greater interaction between EVRDC staff and farmers were required to understand the new veterinary service system. However, prompt and on-call mobile service (e.g. arrival within 3 h following notification of sick or dead animals) has helped building trust and confidence of the project among smallholder farmers. This project has resulted in culture changes among villagers in reporting disease cases and this new behavior once adopted has aided in the continued surveillance of not only HPAI but other emerging infectious diseases.

Initially EVRDC lacked suitable infrastructure and staff knowledge concerning new diagnosis technology. To solve this problem EVRDC sent 5 staff to NIAH to train in molecular virology and 3 staff to the Veterinary Research Institute, Ipoh, Malaysia to attend the workshop on HPAI Diagnosis. VRDC also sought additional funding for the purchase of new equipment.

(d) Use of Resources

 d.      What resources were used for the initiative and what were its key benefits? In no more than 500 words, specify what were the financial, technical and human resources’ costs associated with this initiative. Describe how resources were mobilized
Resources used for the surveillance and control of HPAI in the Eastern region include:

• 25 million baht annual budget from DLD (2004-2007). The budget was used for diagnostic equipment, test kits and consumables. The budget also provided for administrative costs related to workshops and training sessions
• 2.4 million baht for real-time PCR machine from DLD
• 0.3 million baht for biosafety cabinet equipment budget from DLD
• 1.98 million baht donation from Chonburi Province Administration
Organization. This budget was used to purchase a mobile service van equipped with basic diagnostic equipment
• 1.94 million baht from DLD for LCSS package, Window server and cost of computer programmers
• 1.36 million baht donation from Asia Pacific FAO for mobile vet service car

In order to develop an effective veterinary service system, 41 EVRDC staff were initially involved in the project, consisting of 7 veterinarians and 34 scientists and support personnel. Presently EVRDC has allocated 6 personnel (stand-by) for the mobile team and 10 scientists for routine diagnostic activities. The involvement of several EVRDC staff at the beginning of the project was to ensure the presence of skilled extension personnel on farm and capable diagnostic scientists in the laboratory to allow for rapid response and risk reduction measures. In addition to EVRDC own staff, EVRDC also recruited local government officers and local communities in the management and potential eradication of HPAI. The latter group has contributed knowledge on local conditions and resources.

Sustainability and Transferability

  Is the initiative sustainable and transferable?
The initiative is sustainable and transferable as evident by:

• EVRDC‘s model of integrated veterinary service has now been adopted by other VRDCs in regional Thailand. We have provided workshops to demonstrate our new capabilities to other DLD Bureau. The community network, MVRRT and improved diagnostic & preparedness capability have now been practiced routinely in other regional VRDCs. However, the installation of LCSS is still under planning (waiting for DLD approval of budget). This transfer has resulted in the increase of overall animal samples tested for diseases in Thailand, resulting in the establishment of an effective and reasonable veterinary service program nationally. This very efficient veterinary service has increased the uptake of control measures & participation among smallholders, and improving market access of poultry products. The project also promotes sustained production of traditional poultry varieties in Thailand, contradicting the pressures from conventional HPAI policy to phase out this product.

• This veterinary service model has also been of interest to other public sectors in Thailand. For example the Department of Disease Control, Ministry of Public Health regional staff visited EVRDC to examine the model and discussed the possibility of collaboration. As HPAI is capable of producing fatal disease in humans. While HPAI control measures have so far focused on implementing prevention and eradication measures in poultry populations, there is fear that the virus may mutate into strain capable of sustained human-to-human transmission. EVRDC and the regional Department of Disease Control now established the collaboration and exchange of information in order to monitor the HPAI human transmission situation and other diseases with epidemic potential (zoonoses), which inevitably has major social and economic impacts. The Ministry of Public Health (Thailand) has agreed to fund a proof-of-concept (One Health) collaborative, surveillance research.

• Demonstration of the model by EVRDC to various visiting international organizations working in animal health area such as OIE (Mar 2010), JICA (Indonesia) and experts from JICA Japan (Mar 2010), Lower Mekong Working Group for FMD Zoning and Animal Health Movement Management (Nov 2010).

• Recognition of the new model by FVO Animal Health Inspector (Dr Stefano Sotgia) for assessment of poultry products exporting to EU countries in Feb 2010.

Lessons Learned

 What are the impact of your initiative and the lessons learned?
EVRDC‘s dedication to the new veterinary service, increase efficiency and quality improvement has won the organization many awards:

• “Best Practice Winner” from the Office of the Public Sector Development Commission, 2010
• “Best Practice Honorable mention” from the Office of the Public Sector Development Commission, 2009
• “Best of Save Energy Government Organization” from King Mongkut’s University of Technology, 2009
• “5 S Winner” DLD, 2008 and 2009
• “Best Website” DLD 2005, 2006 and 2007
• “Information Technology Winner” National Institute of Animal Health (NIAH), 2007
• “Management Winner” NIAH, 2007
• Accredited ISO/IEC 17025: 2005 by Department of Medical Sciences, Ministry of Public Health, 2007 and 2008

Lessons learned:
• Increase moral and productivity among EVRDC staff as staff feel connected to the organization’s clearly defined mission. Increased workload leads to a more productive and more experienced service among EVRDC staff.
• Building trust among smallholders/farmers is very important aspect of the project. To promote adoption process leading to better HPAI prevention, EVRDC staff acted professionally and in the interest of the poor farmers.
• Leadership quality leading to new international collaboration. This project has transformed & modernized veterinary service in DLD as evident by the transfer of the model to other VRDCs. More importantly it has transformed EVRDC from having supporting veterinary role to a leader of veterinary service provider in Thailand. An example of international collaboration includes the collaborative project between EVRDC, AusAID, the Commonwealth Scientific, Industry and Research Organization (CSIRO) and Prince of Songkla University in a project aimed to strengthen the emerging infectious disease surveillance in Thailand and South East Asia.

Contact Information

Institution Name:   Eastern Veterinary Research and Development Center
Institution Type:   Government Department  
Contact Person:   Dr Somchuan Ratanamungklanon
Title:   Director  
Telephone/ Fax:   +(66) 38 742 116-9
Institution's / Project's Website:   +(66) 38 742 120
E-mail:   somchuanr@yahoo.com  
Address:   844 Moo 9 Tumbol Klongkeaw Ampur Baan Bueng
Postal Code:   20220
State/Province:   Chonburi
Country:   Thailand

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