Contingency planning for animal disease outbreaks: Why we need the humanities.

Dr. Lisa Boden

* I am a quantitative veterinary epidemiologist

Disclaimer*

Main Messages

I.  Epidemiology: A “web without a spider”.

II.  Animal health is a social and political problem, not just a technical one.

III.  Integrated modes of interdisciplinary enquiry are necessary to successfully assess, communicate and manage risks. •  Resilience •  Effective translation •  Ethical outcomes

Changing Risks

HORIZONSCANNINGWeather,Geology,Defence,AnimalandPublicHealth,Interna;onalpoli;csandevents

OIEFAOWHO

MONITORINGANDSURVEILLANCE-  PublicHealthInfrastructure-  Diagnos;cfeasibility-  Stakeholderopinion-  Legisla;on

CONTROLANDERADICATIONAnimalandPlantHealthAgency

DEFRA,HPS

CONTINGENCYPLANNINGChiefVeterinaryandMedicalOfficers,

MinistersCentresofExper;se,AdvisoryBodiesandStakeholders

Localpartners

Globalpartners

Opera;onal

Tac;cal

Strategic

Diseasefreedom

Interna;onalstandards

WTO

SPS Agreement 1995

A enabler/inhibitor for free trade

Onus on country of

origin to meet international standards.*

*Brugere et al. (2017) People matter in disease surveillance. Aquaculture

“Animal health policy must be science-based!”

“This rallying cry is heard from animal health professionals around the world. The second verse of this mantra is often ‘science, not politics’, as if science is unquestionably ‘good’ and politics ‘evil’.

Antipathy toward politics is worn as a badge of honour.“*

Will Hueston Gareth Davies Lecture

SVEPM 2003 Please note that this quote was taken out of context. This lecture was

an elegant exposition on why scientists should care about policy.

“The field of epidemiology suffers from the absence not only of a clearly articulated and comprehensive epidemiological theory, but it seems, even the awareness that it lacks such a theory. The science is …viewed as a collection of methods to be applied to particular problems involving ..diseases and health.”

Krieger (1994) Epidemiology and the web of causation: Has anyone seen the spider? Soc. Sci. Med.

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ECONOMIC ANALYSIS

RISK ANALYSIS

SPATIAL & NETWORK ANALYSIS

MATHEMATICAL MODEL

STATISTICAL MODEL

DESCRIPTIVE STATISTICS

REVIEW

Veterinary Epidemiology: A Brief History in Data

Boden, L.A. “A History in Data.” SVEPM 2010 Poster presentation

Social Sciences – become more

visible in contingency planning and

epidemiology after FMD 2001

ISESSAH in 2017

Risk Governance Framework and the Humanities

*Risk perception and evaluation

Risk management

Risk assessment

Framing the risk question

Risk Communication

* International Risk Governance Council Framework *World Health Organization. WHO guidelines on ethical issues in public health surveillance.

I. Resilience Future-proofing Contingency Planning

D O O U T B R E A K M O D E L S H AV E A

S H E L F - L I F E ?

Boden (2015) Scenario planning. Forestry Seminar

Scenario Planning

Highly Complex Challenges

What is the future of animal health surveillance in 2030?

– Detection and description

– Data sharing – Resources – Legal-ethical issues

Scenario planning challenges

our …”unspoken assumptions

about the future” and lifting the

"blinders that limit our creativity and resourcefulness.”

Mar

kets

Resources

Low connectivity

High connectivity

Public goodPrivate good

A highly competitive industry-led future - Reduced public resources for support.

A government-led future

-Increased innovation.

A fragmented professional

industry future - Reliant on

government support.

An opportunistic future -Erosion of industry knowledge and heritage.

Boden et al. (2017) Year 2030: What is the future of animal health surveillance in Scotland. Available at www.epicscotland.org

II. Effective Translation

“It seems that the problems of the world boil down to me not

understanding others and them not understanding me, and that’s a

humanities problem.”

Professor Daniel Rockmore

Judth Hertog (2017) “Why we need the humanities. Right now. More than ever.”

Dartmouth Alumni Magazine

“Funding the Arrows”*

*Boden et al. (2014) Working at the science-policy interface. Vet Record p165 *Campbell (2006) The Australian natural resource management knowledge system.

**Brown et al. Interdisciplinarity: How to catalyse collaboration, Nature 2015

BROAD knowledge

DEEP know

ledge T-shaped Scientists**

Necessary for ‘Design Thinking’

“STEM” should be “STEAM”*

•  Soft power: Influencing behaviour

•  Engagement with at-risk populations and beneficiaries

*Credit to Lee Innes and Scottish Crucible

Global Epidemic? Quick, Call a Graphic Designer!

Nancy Durant, The Times

August 17, 2017

Communication “Sans Frontières”

Exhibition: Can Graphic Design Save Your Life? At the Wellcome Collection

Ascus – non-profit dedicated to Art and Science So-called because it is “ the place in lichen where spores are produced that go on to colonise barren areas”

Artists are Risk-Takers… Be Prepared to Take Risks

Artwork by Tony McKay

Artists are Risk-Takers… Be Prepared to Take Risks

Artists are Risk-Takers… Be Prepared to Take Risks

Artwork by Tony McKay

Artists are Risk-Takers… Be Prepared to Take Risks

Collaboration not commission

“I’d like to meet the artist … he must know a lot about our profession and the farming

industry now.”

III. Ethical Outcomes

“For the privileged, the humanities can foster a greater understanding

of those less fortunate.”*

*Judth Hertog (2017) “Why we need the humanities. Right now. More than ever.”

Dartmouth Alumni Magazine

Models as Evidence for Policy

•  Access to “Big Data” offers potential to fast-track decision-making during outbreaks.

•  Foreseeable nature of outcomes + lack of

accountability for risk management creates potential for a moral vacuum occupied by scientists.*

*Boden and McKendrick (2017) “Model-based Policy-making” Frontiers in PH Policy

Ethical Principles Apply to Models of Disease Control and Surveillance*

•  Independence •  Transparency •  Beneficence/maleficence •  Justice

*Beachamp and Childress (2009). Principles of Biomedical Ethics. *Boden and McKendrick (2017) Model-based policymaking. Frontiers in PH Policy

*World Health Organization. WHO guidelines on ethical issues in public health surveillance.

Justice

•  Professional obligations to consider equitable and non-discriminatory benefits and burdens of research.*

•  Epidemiological recommendations should not worsen or create new inequalities.

•  Variability should be accounted for in model design and in the impact of interventions.**

. *Council for International Organizations of Medical Sciences 2008

**Boden and McKendrick (2017) Frontiers in PH Policy *** Equity versus equality meme – credit to Craig Froehle

Equality

Equity

Accountability

•  Risk assessment versus risk management.

•  “Duty of care” – Liability versus

culpability. Tribune dell’Aquila crim. Sec.,

22 October 2012

A Forward Look

Multi-disciplinary but Myopic?

Veterinary OR human medicine,

biology, physical sciences,

microeconomics

Animal Health

Global (human) Health

Outbreaksolu;ons

A Shifting Paradigm (I)

Now integrates

human health and social

science

Veterinary OR human medicine,

biology, physical sciences,

microeconomics

Animal Health

One Health

Global (human) Health

Outbreaksolu;ons

A Shifting Paradigm (II)

Now integrates

human health and social

science

Now incorporates health of the environment, political, legal

and social systems

Veterinary OR human medicine,

biology, physical sciences,

microeconomics

Animal Health

One Health

Planetary Health*

Global (human) Health

* Lancet August 2017

Outbreaksolu;ons

Macro- epidemiology

Butshouldwestrivetobehere

ScoOshPriori;es

To ignore the humanities, is to ignore the important influence of humans in animal disease surveillance and control …and the impacts of human existence on the dynamics of the system at risk.

Collaborators

•  Scenario planning –  Harriet Auty, Aaron Reeves, Gustaf Rydevik, Paul Bessell, Iain

McKendrick, Scribes, Participants

•  Art –  Tony McKay

•  Science-policy communication –  Harriet Auty and Dom Mellor

•  Ethics –  Iain McKendrick

DR. LISA BODEN AB, BVSc, LLM, PhD, MRCVS, MANZCVSc, DipECVPH

Specialist in Veterinary Public Health

Tweet @Lisa_A_Boden and @EpicScotland