Reclassify anthrax from a private to public good disease

Summary

Currently, anthrax is classified as a “private good disease” which means that the management and control of anthrax in Uganda is done by farmers. Unlike other diseases like foot and mouth disease, Contagious bovine pleuropneumonia (CBPP) and Rabies which are state controlled diseases, anthrax is not. The control of anthrax is still a challenge which has resulted into several anthrax outbreaks in both animals and humans all over the country in districts such as Kween, Kiruhura, Isingiro, and Arua in 2017 & 2018 (1) .
Ministry of Agriculture, Animal Industry and Fisheries (MAAIF) through the National Animal Disease Diagnostics and Epidemiology Centre (NADDEC) is responsible for policy development, management and guidance on animal disease diagnosis, vaccine development, epidemiology/surveillance and control. Much as this mandate stretches over a number of animal diseases, management and control are limited to a few public good diseases leaving majority including anthrax entirely to the private sector.
Reclassifying anthrax as a public good disease will ensure state control and management of anthrax thus reducing on the frequency of outbreaks reported among animals and humans across the country. In addition, meat and milk production will increase due to improved management of livestock as a result of anthrax reclassification. Thus, the main objective of this policy brief is to high light the relevance of reclassifying anthrax as a public good disease which is paramount in the prevention and control of future anthrax outbreaks in Uganda.

Context and importance of the problem

Anthrax is a bacterial zoonotic infection which is of great public health concern and a global health security issue (2). It is caused by Bacillus anthracis (B.anthracis) and transmitted to humans through contact with animals and their products such as milk, meat, skins and hides (3).

Its spread is facilitated by natural calamities such as seasonal drought which drives both domestic and wild animals to graze communally. In addition, seasonal floods carry the spores and natural fauna from one settlement to the other. Once anthrax is in domestic animals, then the likelihood of crossing over to humans is very high through consumption of contaminated meat, inhaling spores and handling infected carcasses with bare hands among others.
Over 80% of Uganda’s population is engaged in agriculture with 58% of these individuals involved in livestock farming (4). Uganda has an estimated 14.3 million cattle, 15.7 million goats, 4.3 million sheep, and 4 million pigs, which generates a lot of revenue to the government and income to the farmers. The population heavy engagement in agriculture indicates increased interaction be-tween livestock and humans which is a ground for trans-mission of anthrax. Additionally, farmers in rural areas have encroached on game parks/reserves thus further increasing the interaction between livestock, wildlife, and humans
Uganda is vulnerable to zoonotic diseases due to its unique biological diversity, and population increase which is associated with encroachment of game parks and reserves which facilitates close contact between humans and animals (domestic and wild) across the country(4).

The Ministry of Agriculture, Animal Industry and Fisheries division of epidemiology designed a surveillance system for anthrax in 1994. Standard pretested data collection tools were designed by the ministry on which district veterinarian officers were trained to capture information on anthrax cases. The tool was sent to all districts to use for routine surveillance from each district regarding anthrax which is sent electronically to the epidemiology centre (MAAIF) together with any accompanying samples (blood or tissue). On a monthly basis, suspected anthrax alerts are reported per district including animal deaths and human cases. In addition, the Uganda Wild-life Authority has a reporting system where suspected animal deaths as a result of anthrax infection are reported.

Through the surveillance system, it has been document-ed that cattle corridor districts and their surroundings have been reporting anthrax outbreaks since 1969 in Uganda(5). Several wild animals including buffalos, wart-hogs, Zebras among others died due to anthrax in Queen Elizabeth National Park, Lake Mburo National in the past decade(6). This hampered income generation from the tourism activities that take place in those national parks. More recently, anthrax outbreaks have been re-ported in Arua, Kween and Kiruhura Districts which resulted in 186 suspected human cases and 236 livestock deaths (1). To note, there are new anthrax cases which are reported through the “6767” electronic messages from the Emergency Operations Centre (MOH) with the most recent case reported in February 2018. Indeed, human cases of anthrax have continued to be reported, indicating ongoing outbreaks in several districts such as Isingiro, and Mbarara(1). The frequent occurrence of anthrax outbreaks in Uganda requires an urgent policy response to deal with the prevention, management, and control of anthrax spearheaded by government to avoid future outbreaks which are associated with heavy loses of both humans and animals. The revised policy should include routine vaccination of anthrax catered for by the government, providing re-fresher training to community health animal workers to en-sure prompt detection of suspect anthrax cases in affected areas.

Critique of policy options

In developed countries such as USA, Canada, Australia, and some parts of Asia, anthrax management is being done by state. This is due to the fact that anthrax is a potential weapon for bioterrorism. So many decades ago, several anthrax outbreaks were reported in the USA including inhalational anthrax among humans which resulted into several deaths. The frequent anthrax outbreaks resulted into a massive surge in critical analyses of detection, diagnostic, epidemiological, decontamination, treatment and prophylaxis procedures for anthrax done by the state due to the nature of the disease and thus a reduction of the number of outbreaks reported(7).

Due to state management of anthrax in developed countries, national programmes such as mass animal vaccination result-ed in a global reduction of anthrax (2). However, in Sub Saharan Africa, the disease still remains a major public health problem where outbreaks continue to occur due to poor management of anthrax. This is explained by the fact that the prevention, management and control of anthrax is the responsibility of the farmer which makes it difficult to manage the disease. Farmers have to buy the vaccines and drugs to treat exposed animals or call on private veterinary practitioners to treat their animals which is expensive for most of them. In addition, during anthrax outbreaks, safe carcass disposal is not affordable to many farmers hence leaving carcasses open on the ground which increases the risk for infection to healthy animals and humans. Infection prevention and control during outbreaks is also hard to be maintained by farmers due to practices such as communal grazing which are prevalent in most rural districts. As a result, one animal death can result into a big outbreak.
Management of anthrax requires embracing the One Health approach which will bring different disciplines together from human health, animal health, and wildlife if the disease is to be reclassified as a public good disease. In order to control future anthrax outbreaks in Uganda, it is important that the state takes full responsibility of investigation, detection, vaccination of animals, and health education of communities on dangers of anthrax.

Policy Recommendation

In order to prevent future anthrax outbreaks in the country, reclassifying anthrax as a public good disease will assist in collective actions using the one health approach by all responsible bodies including ministries of; Ministry of Agriculture, Animal Industry and Fisheries (MAAIF), Ministry of Health and authorities like Uganda Wildlife Authority, and Uganda’s National One Health Platform, and Zoonotic Dis-ease Coordination Office for control and management of an-thrax in Uganda.

References

1.CDC. Experts Team Up to Tackle Deadly Anthrax Across Uganda. 2018.
2. WHO. Anthrax in humans and animals. World Organ Anim Heal. 2008;
3. Doganay M, Demiraslan H. Human Anthrax as a Re-Emerging Disease. Recent Pat Antiinfect Drug Discov. 2015;
4. UBOS. National Population and Housing Census 2014. 2016.
5. Dahmani M, Davoust B, Benterki MS, Fenollar F, Raoult D, Mediannikov O. Development of a new PCR-based assay to detect Anaplasmataceae and the first report of Anaplasma phagocytophilum and Anaplasma platys in cattle from Algeria. Comp Immunol Microbiol Infect Dis. 2015;39(February):39–45.
6. Mburo L, Parks N, Wafula MM, Patrick A, Charles T. Managing the 2004 / 05 anthrax outbreak in Queen. 2007;24–31.
7. WHO. Anthrax in humans and animals:FOURTH EDITION. WHO publications. 1937.