Dear Mary:
Thanks for your note. I thought I should reply at some
length over the Holidays. I will mostly reply in terms of
the US since I am not familiar enough with the EU or UK to
make comments on specifics of your situation.
When I became Director of the Plum Island Animal Disease
Center in 1987, I went to visit the APHIS leadership in
Washington to ask what our only customer required from our
research program (I was Director of the Center and of the
ARS research program: APHIS' diagnostic lab was a tenant and
I had no role in their program). To my surprise, APHIS said,
"Nothing. In the event of an FMD outbreak we will
diagnose the disease by cell culture at Plum Island as we
have always done, and we will slaughter without vaccination,
as we have always done. We don't want new tests and we don't
want new vaccines." I asked, "What then is the
function of the ARS research program?" And I was told,
"Public relations, to make it look like USDA is doing
something new."
My belief is that the generation of young men who halted
the 1946 to 1952 Foot and Mouth epidemic in Mexico carved US
policy in stone during their professional careers over the
next 30 years and then fossilized the policy after they
retired and had lots of free time to attend USAHA
conferences for the last 25 years. The slow opening to new
ideas now is connected to this generation fading from the
stage.
APHIS was resolute in sticking to its old ways throughout
my time in USDA - until I left in 2004. Of course, I did not
see things the APHIS way. It was crystal clear to many
people that mass slaughter in the US would be a debacle in
modern agricultural markets and that new tools that allowed
for vaccination and rapid response to limit the scale of the
problem would be needed when the US policy eventually
changed. Our hope was that the policy would be changed in
advance of any FMD epidemic here, not in the middle of a
disaster. So that is why the ARS group headed by Fred Brown
devised the differential test for FMD vaccination and
previous infection in 1994 (ironically, the lead on this was
Juan Lubroth, an APHIS scientist and the work was also
supported by Alex Thiermann when he was head of APHIS
International Programs). We also developed the portable real
time PCR tests for FMD and other infections in 2000 and
started to look at safer vaccines that could be made in the
US. Several viable vaccine candidates have been on the shelf
for years - the problems are that the US does not buy
significant amounts of FMD vaccine and thus has no influence
on the manufacturing interests (why would companies
manufacture a vaccine designed for use under North American,
EU and Australasian constraints when these nations don't use
vaccines?) and the fact that the pharmacopoeia standards for
FMD vaccine efficacy are designed for vaccines that will be
used in countries where the disease is endemic, not absent
or very rare. Does the US really need a vaccine that lasts
the life of the animal or one that works immediately and
vanishes after 6 months? The known potential vaccines are
probably good enough for our use.
With regard to the real time PCR tests, an analogy I
often use is that of the word processor and the IBM
Selectric typewriter. If one had held a meeting with
Executive Secretaries in 1983 and proposed to replace the
IBM Selectric typewriter (with its two fonts) on their desks
with a keyboard, a bulky screen like a television, a big box
under the desk, and a bulky printer in another room to which
they would walk to collect the written paper, they would
have said the new system was useless. To persuade them, one
might have said, "The computer has 100 fonts (but we
only ever use two), corrections are easy (but we rarely make
mistakes), your boss will also have one and type his own
documents (are you totally crazy!!), and by the way it costs
three times as much as an IBM and requires novel technical
support (you just proved why it will never catch on)".
The point is that the PC was not just a replacement for the
IBM Selectric - it was a transforming technology that
totally changed what was possible and opened up completely
unforeseen ways of doing business. As a result, as happens
with all transforming technologies, the IBM all but
disappeared.
FMD diagnostic technology of the late 20th century
depended upon tests that involved live virus or reagents to
perform the tests that were derived from live virus and thus
were confined to biological safety level 3 (BSL 3)
diagnostic laboratories for biological safety reasons to
prevent accidental escape of live virus contaminating the
reagents (no one bothered to safety test the reagents to
show there was no live virus contaminant so they could be
moved out of biological containment). These tests could have
been moved out of BSL3 labs like Pirbright or Plum Island
but there was no incentive: APHIS were the only ones who
would use them in the US, they had them in BSL3 at Plum and
did not want to move them out to the mainland. In the 1990s,
when ARS tried to move reagent components to the mainland,
APHIS would not grant a permit. When the new Plum Island
buildings were dedicated in 1995, I wanted to have the
Deputy Secretary of Agriculture detect (dead) FMD virus in a
sample during his boat ride to the island. APHIS would not
let us set up this demonstration - the fear was that this
might indicate that the APHIS lab was not necessary anymore.
In the 1990s, FMD seemed a remote threat in the US, EU and
Australia/NZ. The world of diagnostics was a small and
traditional club in which people talked only to each other
in a circle of mutual assurance and mutual congratulation.
There was certainly an element of job protection in this
internationally in that these were labs that governments
could not easily privatize - nor could governments transfer
the test reagents to private companies outside the physical
limits of the BSL 3 labs. Reviews of one country's
capability were performed by club members from other
countries. The idea that these labs might all use the same
tests and reagents prepared for the group was unthinkable.
The PCR tests completely changed this cozy arrangement.
But development and testing of PCR tests would not have been
possible without people knowledgeable of FMD etc and with
access to viruses in BSL 3 - there is clearly a continuing
vital need for BSL 3 national facilities and skilled foreign
animal disease scientists, it's just that the diagnostic
role of central government labs has changed from test
performance to quality control and quality assurance of a
distributed system of laboratories that can respond very
quickly. Many FMD viruses representative of all 7 serotypes
were genetically sequenced by Dan Rock's team at Plum Island
and the sequence information was transmitted electronically
to Tetracore in Maryland. Rock and Tetracore worked together
to compare the complete sequences of many different viruses
simultaneously to find regions of the sequence that were
identical between all the different viruses - these common
regions would be targets for PCR tests. Tetracore have some
proprietary software that eases this comparison. Having
identified likely targets, Tetracore made reagents to these
targets and Rock tested these with real viruses at Plum
Island. From this, the ARS Tetracore FMD PCR test was
developed, and this did not require any materials that had
ever been in contact with live viruses. The key factor was
that electronic information was sent to Tetracore from Plum
Island - this information did not require an APHIS permit.
The reagents were made without BSL 3 containment off Plum
Island and sent back for testing. Certainly, had it been
necessary to send any piece of the virus or any reagent
derived from virus to Tetracore, APHIS would have denied a
permit to do this and this generation of tests would not be
available today. But the computer technology of sequence and
transmission over the Internet overcame the longstanding
APHIS barrier.
APHIS was totally uninterested in new tests for FMD -
particularly PCR. There was no interest when the tests were
being developed and none immediately after (ARS developed
these tests for national security purposes as part of a
wider government activity). When ARS told APHIS in 2000
about the new FMD PCR test, the response was an angry
enquiry from the Head of APHIS Veterinary Services as to how
FMD components had been taken off Plum island without an
APHIS permit and why ARS had done something to overturn the
APHIS policy of testing being done only by APHIS at Plum,
particularly something that might enable the states to
assume an APHIS function. In January 2001, Dave Huxsoll,
Plum Director, and I arranged to meet with the Vet Services
Head in his office in DC to bring him up to date on new
technology but despite long advance notice he never turned
up! When the FMD PCR test was demonstrated in the USDA HQ in
DC in February 2001, after the UK FMD outbreak started, the
Head of Vet Services complained that APHIS would now have to
buy a PCR machine for each of 50 states. (By the way, I kept
copies of all these USDA memos when I left and have them
available if this record is challenged). At this same
meeting, APHIS declared that the ARS PCR test could not be
used because it had not been validated by APHIS. I had taken
the precaution of calling the APHIS Biological Licensing
group in Ames Iowa the day before this meeting to ask for
advice on how to demonstrate validation and obtain an APHIS
license for a PCR test to be used in the US. I was told that
APHIS had no validation protocol for any PCR test and had
never licensed any PCR test for diagnosis of any animal or
plant disease in the US, nor was any application in the
pipeline. APHIS was at that time diagnosing FMD and other
diseases in its own labs using APHIS-derived PCR tests -
none of these PCR tests had been validated, they were
developed with far less stringency than the ARS tests, there
was no validation protocol, and the Head of Veterinary
Service stated that his agency was exempt from APHIS
licensing rules and did not need to do any validation.
Ironically, USDA Secretary Veneman was being advised by the
California State Veterinarian, who was also opposed to
providing the new FMD test and equipment to the states: of
course, a year or so later, California was using its own
Newcastle disease real time PCR test (not validated by
APHIS) to control a disease outbreak there. California did
not need to invent an inferior real time PCR test for
Newcastle disease in an emergency - the ARS Newcastle PCR
test, which is far superior to the California test (as
proven by trials later), was already sitting on the APHIS
shelf where it had been since 2001 as a result of USDA and
Secretary Veneman's policy.
I am not arguing in any way that diagnostic tests should
not go through an independent validation process to validate
the claims of their makers. Indeed, I was astonished to
discover that APHIS actually did not have such a process.
What happened with the FMD and other PCR tests is that
"validation" became a smokescreen to preserve
monopoly and jobs. And as was demonstrated by California,
all the waffle from those insisting on "further
validation" and federal not state responsibility
disappears out the window when the fire starts in their own
homes.
Currently, I understand that the ARS Tetracore FMD PCR
test is very close to approval by USDA and OIE, a matter of
months I hear. I hope there is a clear regulatory process
after that so that future test manufacturers will know what
standards they need to meet for validation, so we don't have
APHIS and others moving the goalposts. The Department of
Homeland Security deserves some credit for forcing APHIS to
enter the 20th century of laboratory diagnosis (that is not
a typo for 21st century by the way).
It is clear that until about 2003 APHIS was in a job
preservation mode, unwilling to allow states to perform FMD
PCR tests. This was always a silly policy that was bound to
change once technology allowed it and need arose. California
as a state has an economy that is in the top 10 of all
countries - it makes no sense that this state does not have
the human resources or need to diagnose diseases itself
rather than send samples 3000 miles away. (The role of APHIS
should be to ensure through quality control and assurance
processes that a diagnosis of FMD is absolutely the same in
all 50 states, APHIS should not be the sole performer of
diagnosis.) So USDA, prompted by Homeland Security, is
grudgingly setting up a network of foreign animal disease
diagnostic capabilities using PCR in certain state labs. I
used to work in the State of Washington's animal disease
diagnostic lab, which is in Pullman, WA, on the Idaho border
in the southeast corner of the state. The dairy industry in
Washington is strong and located about 350 miles away, in
the northwest corner of the state north of Seattle. So
putting a PCR machine in Pullman to protect the Washington
dairy industry is like putting one in Paris to protect
England. The state of Oregon, for example, is about the size
of the UK, so providing a PCR machine at the Oregon
diagnostic lab in Corvallis is certainly an improvement over
sending samples to Plum Island. But don't forget that this
means that Oregon is now in the same boat as UK so the
problem of rapid, timely diagnosis is still there!
I will accept the proposal that samples from a cow that
has FMD in the northeast corner of Washington State could be
rushed to the nearest small airport and immediately carried
on a chartered plane to get to Pullman in 4 hours or less so
that a diagnosis could be made in 6 hours or so. But I don't
think this is what will happen in practice. I was assured
that this would be the case in UK when I met in 2004 with
the DEFRA science advisor - he told me that PCR capability
at Pirbright could serve all the UK with samples being taken
at all speed to Pirbright from all corners of UK. But this
did not happen in Ireland or Penrith, and probably
elsewhere. High speed air transport is always available - in
theory.
The question that should be uppermost is: "What will
you do with a rapid PCR test giving results in 45 minutes
that you can't do now with cell culture?" I don't see
any serious policy attempts to answer this question and the
distributed US lab network will likely have minimal impact
on the speed of diagnosis and no impact at all on what
happens after. The US still does not have vaccine stocks to
protect any significant number of animals, and neither does
the UK. So there will still be mass slaughter based on
geographical proximity to the initial infected herd. I don't
believe there will be any attempt to test herds for FMD with
PCR before deciding to slaughter them (it will be
interesting to find out whether the US will be able to
sustain a slaughter policy in the courts when immediate
testing is available but unused.). As you know from my
papers, I believe the PCR offers a transforming moment for
FMD control by which one can monitor all the herds in an
area continuously and only slaughter those where there is
infection (and I believe in vaccination immediately also).
Let me just touch on the differential test for FMD
vaccination and infection, such as that developed by UBI on
Long Island, New York. This arose from the work done by Fred
and Juan Lubroth. In 1998, I asked APHIS how they would
produce tests kits for the US should the need ever arise - I
was told they would be made by APHIS itself in its own labs
and no further APHIS test validation was required. Plainly,
this was preposterous - APHIS has no facilities or equipment
for such mass production. UBI tried very hard to get APHIS
validation assistance in the late 1990s for their
differential test and peptide vaccine - they got little
assistance and many roadblocks, principally because these
were not APHIS priorities since the US did not intend to
vaccinate and would need neither a vaccine nor a
differential test with this policy. This was the same in the
UK. I had to laugh when I heard British vet authorities
stating that they could not use the differential test
because it had not been validated for UK! Whose job exactly
is it to protect British agriculture against foreign disease
threats with the very best technology? Why would a US
company go to the expense of getting regulatory approval in
the US and UK for products that the only customers in those
countries opposed and had no intention of buying? Can
British veterinary authorities claim today that they are
constantly scrutinizing the world of science for better
means to protect UK agriculture? If not, why not?
Between the Spanish Armada in 1588 and Jutland in 1916,
naval warfare consisted of two lines of opposing warships
sailing parallel to each other and firing their guns at
close, visual range. By 1943, at Midway, this was all over
and has never been seen again. The technology totally
changed. I actually believe the battle for PCR diagnosis of
FMD and foreign animal diseases outside a handful of
specialist labs belonging to a select club is over, and the
new technology won. People are kicking and screaming, and
keeping the blocks in place with their fingernails, but it's
all over. However, the true battle was never over tools - it
was always about outcomes. And this battle remains to be
fought.
I am not bound to real time PCR - technologies change all
the time and there are new and better ones already - not in
terms of what they do but in how they allow you to achieve
your desired outcome - but if your outcome is not clear,
it's not clear how technology helps.
I believe it is a serious mistake for public interest
groups to focus on tests and technologies for FMD control in
the US or UK. They will get mired in trivia and scientific
details. Public interest is all about outcomes. If the US
and UK policy were that mass slaughter would not be adopted
and financial costs were minimized, we could judge
government plans and preparations on how well they can
assure us that these outcomes will be met. If a government
does not have vaccine stocks to protect over 50% of
susceptible livestock against all the potential virus types,
it is not credible that mass slaughter can be avoided. If
there were a series of time goals for all the key steps in
detection and control, we could examine their credibility -
if the government can plan and achieve transport of samples
from anywhere in UK to Pirbright within 4 hours of report, I
will accept that timeline (it won't solve other problems) -
but the plans to achieve outcomes are vague and not
quantifiable, so they are not really plans at all.
Currently, in the field of FMD control, never have so many
spent so much to do so little for so few, as Winston
Churchill might have said. The need for new science and
technology policy has never been greater because the threats
have never been greater. The amount of money devoted to
agricultural defense is now astonishing, but the scientific
talent pool and ideas have never been as shallow. I have no
confidence that the US or UK is any better prepared for FMD
today than in 2001. So sad given what might have been.
If you wish to post this for a wider audience, that's
fine.
Roger Breeze