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Emergency Preparedness & Strategic Risk Management

Mad Cow (BSE & vCJD) Case Study for Policy-Makers
Alain Paul Martin and Dr. J. Brian Morrissey

Prereading materials for Advanced Government Policy.
The publication of any part of this document in electronic or
printed form without the written permission of the author is prohibited.
© Alain Paul Martin and J. Brian Morrissey, May 2003. All rights reserved.
Sections 3, 4 and 7 subject to the copyright provisions of their respective authors.

Related document: Strategic Risk Management & Crisis Communications (www.executive.org/bse)

1. What Business are we in?

Use the following road maps and the Strategy Checkerboard to brainstorm your mission, vision, a balanced portfolio of targets and strategy.
Harvard University Global System: Turning Strategy into Value
Harvard University Global System: Building a Great Nation

Harvard Strategic Management Template: Strategy Checkerboard (previously Harvard Strategy Grid)

The “Role of the State” includes the following functions:

  • Protect the Nation e.g. Keep Mad Cow/vCJD out,
  • Protect People e.g. Keep people safe from disease,
  • Protect Property e.g. Keep livestock free from diseases requiring compulsory slaughter,
  • Protect against Market Failure
  • Provide Information that is not available from the private sector e.g. regular sharing of what is known and what is not known on Mad-Cow disease.
    • Prevent Monopoliese.g. Avoid government presenting itself as the sole source of information on the scientific understanding of this disease. Thus, allow all sources of knowledge to be heard.
    • Provide “Public Goods” e.g. Provide goods/services which the nation needs, but which the private sector cannot provide at a profit. For example, access to high-tech laboratories at a moments notice to investigate and diagnose this disease.
    • Prevent “Public Bads” e.g. Prevent the private sector form imposing costs on society that are external to the private sectors bottom line – ensure air or water table are not contaminate contaminated by Mad Cow carcass disposal.

2. Objective – Eradicate Mad Cow

Apply the following template to validate objectives, define the deliverables, the grey areas beyond your control and related risks
Harvard Strategic Management Template: Change Definition Grid
Apply the Road Map developped for each of the following Risk Identification, Assessment and Mitigation tasks.
Harvard University Global System: Risk Managment Road Map

  • Key Result Areas:
    • Risk Identification: Agents, Sources (accidental, negligence, criminal, bioterror, special interests), Alternate Means (clinical, lab); Actions; Potential Problem Prevention,
    • Risk Assessment: Alternate Means (model, professional judgment); Actions; Potential Problem Prevention, Residual Risk and Collateral Damage Assessment
    • Risk Management: Alternate Means (quarantine, vaccination); Actions; Potential ProblemPrevention
    • Risk Communication: Alternate Means (press releases, virtual communities, visible and invisible Webs, public forums, advertizing, educational institutions, direct mailing via financial institutions, utilities, governments); Actions; Potential Problem Prevention, Residual Risk and Collateral Damage Disclosure Policy
  • Implementation, Re-assessment, Correction
3. BSE Risk Management in the UK
  • Statement made by the Minister:
    On December 3, 1995, Minister of State for Health of the UK, Stephen Dorrell, stated: “There is no conceivable risk of BSE being transmitted from cows to people.”
  • Contrast the above statement with the following observations of the Spongiform Encephalopathy Advisory Committee:

    Source: www.cjd.ed.ac.uk/seac.htm

    “The Spongiform Encephalopathy Advisory Committee has considered 10 cases of CJD which have occurred in people aged under 42 which have recently been identified by the CJD Surveillance Unit, Edinburgh.

    The Committee has concluded that the Unit has identified a previously unrecognized and consistent disease pattern. A review of patients' medical histories, genetic analysis to date and consideration of other possible causes, such as increased ascertainment, have failed to explain these cases adequately.

    Although there is no direct evidence of a link, on current data and in the absence of any credible alternative the most likely explanation at present is that these cases are linked to exposure to BSE before the introduction of the SBO ban in 1989. This is cause for great concern.

    CJD remains a rare disease and it is too early to predict how many further cases, if any, there will be of this new form. Continued surveillance is of the utmost importance and the Committee are actively seeking further data from both the UK and abroad to help assess the full significance of the Unit's findings.

    The Committee emphasized it is imperative that current measures to protect the public health are properly enforced and recommend constant supervision to ensure the compete removal of spinal cord.

    The Committee also recommended:

    • Carcasses from cattle aged over 30 months must be deboned in licensed plants supervised by the Meat Hygiene Service and the trimmings must be classified as SBOs.
    • Prohibition on the use of mammalian meat and bonemeal in feed for all farm animals.
    • HSE and ACDP, in consultation with SEAC should urgently review their advice in the light of these findings.

    The Committee will urgently consider what further research is necessary. The Committee does not consider that these findings lead it to revise its advice on the safety of milk.

    If the recommendations set out above are carried out the Committee concluded that the risk from eating beef is now likely to be extremely small.”

    Source: www.cjd.ed.ac.uk/seac.htm

4. BSE in the UK: Findings and Key Conclusions
   Executive Summary of the Report of the Inquiry into BSE
  • BSE has caused a harrowing fatal disease for humans. As we sign this Report the number of people dead and thought to be dying stands at over 80, most of them young. They and their families have suffered terribly. Families all over the UK have been left wondering whether the same fate awaits them.
  • A vital industry has been dealt a body blow, inflicting misery on tens of thousands for whom livestock farming is their way of life. They have seen over 170,000 of their animals dying or having to be destroyed, and the precautionary slaughter and destruction within the United Kingdom of very many more.
  • BSE developed into an epidemic as a consequence of an intensive farming practice - the recycling of animal protein in ruminant feed. This practice, unchallenged over decades, proved a recipe for disaster.
  • In the years up to March 1996 most of those responsible for responding to the challenge posed by BSE emerge with credit. However, there were a number of shortcomings in the way things were done.
  • At the heart of the BSE story lie questions of how to handle hazard - a known hazard to cattle and an unknown hazard to humans. The Government took measures to address both hazards. They were sensible measures, but they were not always timely nor adequately implemented and enforced.
  • The rigour with which policy measures were implemented for the protection of human health was affected by the belief of many prior to early 1996 that BSE was not a potential threat to human life.
  • The Government was anxious to act in the best interests of human and animal health. To this end it soughtand followed the advice of independent scientific experts - sometimes when decisions could have been reached more swiftly and satisfactorily within government.
  • In dealing with BSE, it was not MAFF's policy to lean in favour of the agricultural producers to the detriment of the consumer.
  • At times officials showed a lack of rigour in considering how policy should be turned into practice, to the detriment of the efficacy of the measures taken.
  • At times bureaucratic processes resulted in unacceptable delay in giving effect to policy.
  • The Government introduced measures to guard against the risk that BSE might be a matter of life and death not merely for cattle but also for humans, but the possibility of a risk to humans was not communicated to the public or to those whose job it was to implement and enforce the precautionary measures.
  • The Government did not lie to the public about BSE. It believed that the risks posed by BSE to humans were remote. The Government was preoccupied with preventing an alarmist over-reaction to BSE because it believed that the risk was remote. It is now clear that this campaign of reassurance was a mistake. When on 20 March 1996 the Government announced that BSE had probably been transmitted to humans, the public felt that they had been betrayed. Confidence in government pronouncements about risk was a further casualty of BSE.
  • Cases of a new variant of CJD (vCJD) were identified by the CJD Surveillance Unit and the conclusion that they were probably linked to BSE was reached as early as was reasonably possible. The link between BSE and vCJD is now clearly established, though the manner of infection is not clear.

  • http://www.bseinquiry.gov.uk/index.htm

5. Lancet 1996 Article on vCJD

A new variant of Creutzfeldt-Jakob disease in the UK (Lancet 1996; 347: 921- 25): This article presents the background, the methods, the findings and interpretation of current and past clinical and neuropathological profiles of CJD in the UK and elsewhere. More information available at: www.cjd.ed.ac.uk/index.htm

6. Important Milestone in vCJD Intelligence

Letter dated 21 March 1996 to neurologists from Dr R G Will, of the National Creutzfeldt-Jakob Disease Surveillance Unit: www.cjd.ed.ac.uk/letter.htm

7. Current situation

The following table is anexcerpt from the UK Department of Health
Press Release 2003/0182 dated May 6 2003.
www.info.doh.gov.uk/doh/intpress.nsf/page/2003-0182?OpenDocument

Definite and probable CJD cases in the UK

Referral of suspect CJD

Deaths of Definite and Probable CJD

Year

Referrals

Year

Sporadic

Iatrogenic

Familial

GSS

*vCJD

Total Deaths

1990

53

1990

28

5

0

0

-

33

1991

75

1991

32

1

3

0

-

36

1992

96

1992

45

2

5

1

-

53

1993

78

1993

37

4

3

2

-

46

1994

118

1994

53

1

4

3

-

61

1995

87

1995

35

4

2

3

3

47

1996

134

1996

40

4

2

4

10

60

1997

161

1997

59

6

4

1

10

80

1998

154

1998

63

3

4

1

18

89

1999

170

1999

62

6

2

0

15

85

2000

178

2000

49

1

2

1

28

81

2001

179

2001

55

3

2

2

20

82

2002

159

2002

67

0

3

1

17

88

2003*

57

2003*

14

1

1

0

8

24

Total

1699

Total Deaths

639

41

37

19

129

865


* As of May 6, 2003. The next table will be published on Monday June 2nd, 2003
Deaths from definite vCJD (confirmed): 96.
Deaths from probable vCJD (without neuropathological confirmation): 30
Deaths from probable vCJD (neuropathological confirmation pending): 3
Number of deaths from definite or probable vCJD (as above): 129
Number of probable vCJD cases still alive: 6
Total number of definite or probable vCJD (dead and alive): 135
Source: www.info.doh.gov.uk/doh/intpress.nsf/page/2003-0182?OpenDocument
8. References


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