Dear All

For a few years now I have been gently promoting a concept I have referred to as "3 for 1" that would combine vaccination against PPR, brucellosis and sheep and goat pox in small ruminants where the three represent threats, which is across quite wide areas.  The most expensive part of disease control by vaccination is the establishment and maintenance of the cold chain and the cost or getting the personnel to the animals in order to give a vaccine. The cost-effectiveness can be improved by delivering other preventive treatments at the same time. In small ruminants there are at least two other important disease for which a single vaccination can provide lifelong protection; Brucella melitensis and sheep and goat pox (SGPX). If it can be shown that simultaneous vaccination against two or more is effective, these other diseases can also be addressed.
Brucellosis would allow us to tap into the much greater funding available for zoonotic disease control as compared to livestock disease control.  As has been pointed out, the owners of small ruminants are often, whilst not the poorest of the poor, less well off than those who own cattle and therefore often with less influence in the system. That is also partly in many countries it is women who own small ruminants. So we need strong arguments to unlock funds and resources both internationally and nationally. A multiple disease approach will help with this.
 
We could then link this to the Millennium Goals of improving human health, women and children's welfare and food security of the poorest people (poorer families may have small ruminants but often don't have cattle, although of course the poorest of the poor may not even have  a goat) to try and leverage funds.  I know at least one country where the veterinary authorities had little interest in PPR but would have been motivated by a combined SGPX / PPR campaign and earlier in the discussion, the importance of SGPX in Yemen was mentioned.
Delivering more than one vaccine or treatment at the same time will help to make individual cost slower and enable us to present a package that will be attractive to keepers in various situations as well as addressing a range of priorities for individual governments.  Is there any experience of giving vaccines against SGPX, PPR and brucellosis at the same time? Are they effective when given at the same time? Does PPR vaccine cause sufficient  leucopoenia to limit other immune responses? If there is insufficient evidence on this, it would be relatively easy to arrange trials.

The finding from Cameroon that intestinal helminthosis is economically second to PPR in that country might open up the possibility of also undertaking strategic dosing against helminths. When we looked at that in Zimbabwe in the 80s, it was clear that the dry season there gave a good opportunity to dose strategically during that time rather than trying to ties strategic dosing to the much less predictable start of the wet season. This type of quick benefit may also help to motivate farmers to participate.

Related to this is how we deliver this campaign. I think we need to build a partnership to deliver PPR vaccination, with or without 3 for 1. Vaccine delivery is likely to be more complicated than for RP and will be made much more effective and efficient by ensuring we have local knowledge on board by working with community animal health workers where they exist and owners. Governments could provide vaccine supplies, most of the cold chain, training and public awareness. Final delivery of the vaccine could then be done by local community animal health workers where these exist, as they do in many places. This will help to strengthen that system with hopefully a knock on effect of strengthening local animal health services and clinical surveillance. It has been the experience in many countries, including the UK, that government funded disease control has been the backbone supporting large animal veterinary services.

There will be (many) areas where community animal health workers don't exist or have been tried and failed and we need something that will work in those areas. Governments doing the vaccination in those areas sounds OK, but are there really the resources needed?

I know this is an incomplete "vision", but I think it might be a start of how we might actually leverage funds to work towards PPR eradication and establish sustainable delivery systems.

Regards

Nick Honhold
BVSc MSc PhD MRCVS DipECVPH
Independent veterinary epidemiologist





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