Wednesday 1 January 2014

A Disease of Economic Importance - Reflections on the Foot and Mouth Crisis of 2001

One afternoon in early 2001, Kate and I were sitting watching a news report about a disease outbreak on a farm in Essex.

            'Foot and mouth disease,' Kate said. 'That rings a bell. Which one is that?'
            I shrugged. 'Um... is it... it's the one with... er. It's notifiable, isn't it?'
            Kate looked pointedly back at the telly. 'Obviously.'
            I shrugged again. 'Well, I'm sure it'll be okay.'

            Hitherto, my sole encounter with the disease that would cause such destruction in Devon was while I was failing my public health examination in the fourth year. On the next page from the fabled 'Write short notes on the process of cheese making,' there had been an essay question on foot and mouth disease. In the exam I had wracked my brain to try and remember my crib notes, and splurged it all out onto the blank sheet in front of me: A viral disease - a picornavirus, to be precise. Very stable in the environment and highly contagious - the virus can potentially travel miles as an airborne particle - possibly even across the English Channel[1]. Predominantly affects ungulates. Causes fever, followed by ulcers in the mouth and around the feet. Rarely fatal in adults, but can cause heart problems in neonates. Otherwise self-limiting[2] in a few weeks. Not present in the UK at this time.

            I surrounded these bare bones with a fair amount of waffle, but that covered most of the things I knew about the disease... which is another reason I failed the public health exam. I had written my notes as if I was looking at an individual animal. I wrote (and knew) almost nothing about the economic implications of the disease.

            That was going to change in the Spring of 2001.

            Events moved quickly from that first diagnosis. A few days after the disease was confirmed in Essex, movement restrictions were placed in a five-mile radius around the site - no one could move animals in or out of the zone. By then, of course, it was already too late. A few days after that, a case was confirmed in Northumberland. The EU imposed a ban on the UK exporting any meat or meat products, and shortly after that, foot and mouth arrived in Devon. Within a week, cases had been confirmed in Scotland, Cornwall and Cumbria. It was becoming clear that the country was in the grip of a full-blown epidemic.

            The Ministry of Agriculture, Food and Fisheries (MAFF) appeared to be moving swiftly to combat the disease. They quickly instigated movement restrictions all over the country - not just for cattle, sheep and pigs, but for horses and dogs and humans too. Very soon into the crisis, they adopted a policy known as the 'contiguous cull' - every time a new case of foot and mouth was discovered, every cow, pig and sheep within a three mile radius was to be slaughtered.

            Kate and I watched the news unravel with some confusion. Foot and Mouth (and, from here on I'm going to use the accepted abbreviation FMD) was, in my mind, stored in a category along with kennel cough - highly contagious, but low severity. FMD wasn't a zoonosis - humans can't catch it.[3] It wasn't a pleasant disease to suffer from - what disease is?  - but it certainly wasn't in the same league as the horrors of rabies, or anthrax, or any number of other diseases that I could think of without even reaching for my large animal medicine notes. It was incredibly contagious, of course - but there was a vaccine available, wasn't there? I was sure there was. Quite an effective one, as I remembered. Why was the government behaving as if the dead had risen from the earth to feast upon the living?

            Nevertheless, with outbreaks popping up all over the place, and with us being repeatedly told what a dreadful disease the government was dealing with, we assumed there were good reasons behind all the measures. I had failed that exam, after all - I was hardly an authority on the subject.

            Within weeks it became clear that two counties had been particularly badly hit by the disease - Cumbria, and Devon. MAFF was rapidly running out of staff to help with the crisis, and the call went out for veterinary surgeons to assist in combating the disease. Locuming at the time, there was no reason for me not to help out - no reason, except that I was not an experienced cattle vet, and I was concerned that I wasn't really the sort of person that the ministry was looking for. I really wasn't sure that I wanted to be involved in this 'contiguous cull', however necessary it was. I was, after all, a vegetarian[4], and so to some extent had opted out of the system already - although I still drunk milk, and ate cheese, and I knew I was fooling myself if I thought that didn't make me complicit in a lot of the problems of modern farming. Nevertheless, it didn't seem like something I could help with.

            A few weeks into March, I changed my mind. I would dearly love to recount here that it was out of a sense of patriotism, or 'Blitz spirit'- wanting to do my part for the country. I would, more dearly, like to announce that the reason I became a Temporary Veterinary Inspector (TVI) for the Ministry of Agriculture, Fisheries and Food was because, if more slaughter was necessary, then I would do what I could to ensure the welfare of those to be killed was as good as it could be. There's some truth to both of these, but here's the main, rather depressing one: MAFF were so desperate that they announced they were doubling the pay of TVIs from £125 per day to £250. A fortune for me - a week's pay for working a couple of days.

            I applied, was accepted, fast-tracked, and within a few days found myself standing outside the MAFF building near Exeter, hoping that someone in charge would explain to me, in very simple terms, exactly what the hell I was supposed to do.

            While I was sitting in a large conference room, amongst many other vets - some large animal veterans, some dyed-in the wool small animal-types, some new graduates, and many, many Spanish vets, taking advantage of the sudden opportunity for work and pay far better than anything they might find in their home country - experiencing a very short induction lecture, arguments were raging across the county and the political landscape. The countryside had been, by this point, effectively shut down. People weren't supposed to travel into it unless absolutely necessary. Tourists stopped coming to the UK. Opposition party leaders were asking why MAFF hadn't imposed restrictions as soon as they had confirmed the disease in the Essex abattoir - as reports on the 1967 Northumberland epidemic were very clear that speed was of the essence in controlling the disease. Many members of the general public started asking the same question that had crossed my mind - what was so terrible about this disease that demanded the extreme response of the contiguous cull?

            As I sat, flipping through my induction pack, listening to the explanation of the disease control policy, a line from one of my favourite childhood films ran through my mind. In Aliens, when Ellen Ripley discovers that the colony on LV421 has been overrun by the terrifying creatures that wiped out her entire crew in the first film, her solution is simple but effective.

            'I say we take off, and nuke the site from orbit. It's the only way to be sure.'

            It occurred to me that someone high up in the ministry was a fan of the film too.


Despite my worries, the job itself was simple - far simpler than my normal day job. Every day we (myself and a technician) would be assigned a number of farms to check in Devon. We would drive to the farm entrances in our MAFF-assigned vehicles, park outside, then don disposable boiler suits, hats and masks, dunk our white Government-issue wellies into virucidal solution, and inspect every single animal on the farm for symptoms of FMD. If all was well, we would move on to the next farm. If we found anything suspicious, however, we would call in the back-up, who would slaughter the suspected animals and test them for the disease. If it was confirmed, then the contiguous cull would come into force - every cow, sheep and pig in a three-mile radius would be culled, and their bodies burned to prevent spread of infection.

            By the time I started at MAFF, there were a lot of bodies burning in Devon.

            If we ever found FMD, then we would be, from that point on, classified as 'dirty', and my veterinary services would then be required to assist with the culling, and the clean-up afterwards. By this stage, with up to fifty new cases being found every day, there was a lot of culling that needed to be done. The military had been called in to help, and 'clean' vets were becoming harder to find; hence the pay increase to attract new TVIs. Within a few hours of my training video, I was inspecting sheep on a farm near Okehampton, worrying that the few slides I had seen wouldn't be enough preparation for me to tell the difference between FMD and footrot. By now, the epidemic was at its height, and MAFF had introduced a 'suspected slaughter policy' - no more waiting for confirmation of the disease. If I saw lameness, would I be confident enough to cry wolf - and thus potentially condemn every livestock animal within a three mile radius to death?

            I was in a better position than some, however. A lot of the Spanish vets had never seen a case of orf - a relatively common disease of sheep in Devon, that caused blistering lesions around the teats, mouth and feet. If they suspected FMD, it didn't matter how many times the farmer pointed out they were actually looking at orf. All the animals on the farm would then be slaughtered, and if the case was deemed suspect enough, everything within three kilometres.

            Visiting a farm as a MAFF vet was a very different experience from visiting one as a normal vet. Some farmers were friendly and welcoming, but these were the exceptions. The majority were scared that we would find something on their farm, or suspicious that despite our extravagant precautions at their gate, we would bring the disease to them. Who could blame them? Farmers were compensated for the loss of their animals, but money doesn't go very far in alleviating the distress caused by watching everything on your farm get slaughtered and burned. Those were uncomfortable visits, farmers nervously showing you their animals, silently praying that you didn't suddenly order them to stop, to take a closer look at something, and speak the words that would mean destruction of everything they had built up.

            A couple of weeks into my work as a TVI, the Ministry for Agriculture, Food and Fisheries transformed into the Department of Environment, Food and Rural Affairs, or DEFRA. It must have been in the pipeline before the outbreak started - the wheels of government turn slowly - but at the time it felt like a response to the perception of poor handling of the crisis in the media. Don't worry - MAFF are no longer in charge of fighting the disease! DEFRA is on the case now. What it meant, in practical terms, was that one day I went to work to discover that all the headed paper had been changed from one logo to another.

            I worked for about two months as a TVI during the crisis, travelling from farm to farm - usually three or four a day, but some of the big units, especially large sheep farms, took up a whole day or more. I was lucky. The farmers I visited were lucky. I saw plenty of lameness; I saw footrot, and I saw orf, but I never saw anything that resembled foot and mouth disease. I made it through clean.


The final case of the outbreak was reported on a Cumbrian farm at the end of September. Movement restrictions were finally lifted in 2002, a year after the first case. DEFRA's contiguous cull policy had worked. FMD was once again eradicated from the United Kingdom, after the slaughter of around ten million sheep, cattle and pigs.

            I kept turning it over in my mind. FMD was a relatively mild, self-limiting disease in adult cattle. That was a hard thing to reconcile with the huge pyres of blackened, burning bodies that I, thankfully, only ever encountered on the news. The contiguous cull policy had worked. So would have taking off, and nuking the site from orbit.

            Here's the reason that FMD was taken so seriously by the Government: the economy, stupid. Affected cows suffer 'milk drop' - a reduction in the milk that they produce. This milk drop is usually temporary, but it can be permanent.

            There is, as I had suspected, all those years ago, a vaccine available for FMD. It's very effective, and relatively cheap. However, once you've vaccinated an animal, it is then impossible to test for the disease itself - the animal will test positive if the vaccine was effective. For this reason, the World Health Organization classifies countries according to their FMD status thusly: 1 - FMD present; 2 - FMD-free with vaccination; 3 - FMD-free without vaccination. The third and last group gets better access to export markets, so countries in this group work hard to stay there; it's fair to say that, in 2001, the UK worked very, very hard to stay there.

            There have been a lot of studies on the economies of the 2001 FMD outbreak - some of which say it was worth it, in economic terms, some of which strongly argue that it wasn't. It seems to be a close-run thing.[5] DEFRA has, since the outbreak, acknowledged that vaccination might be a sensible policy move faced with such an outbreak next time - vaccinations are allowed in some circumstances by the WHO in order to bring an epidemic under control.

            In case you missed it, I'll say it again - ten million animals were slaughtered during the FMD crisis of 2001 - the vast majority of them being sheep. It's since been confirmed that roughly one in three of the 'suspect' diagnoses were correct. Thanks to the contiguous cull policy, with the three-mile 'protection' zone, this means that something like ninety percent of those slaughtered were uninfected.

            Now, there's an argument to be made that all these animals would have been slaughtered anyway - we eat them, after all. As a counterpoint to that argument, consider this: slaughter in an abattoir is tightly regulated and controlled in order to minimise distress and discomfort to the animals. I have visited a number of abattoirs in my time. When it goes smoothly, the killing is painless, and very quick. It doesn't always go smoothly.

            At the height of the disease in Devon, ninety thousand animals were being slaughtered a day. Ninety thousand. On farms. By vets, by technicians, and by the army. If you think that it went smoothly, then I would suggest you are a poor student of human nature. None of the abattoir regulations were in place. Animals were not stunned prior to slaughter. They were not insensible at the moment of death, nor were they ignorant of the deaths around them. They were distressed, they were terrified, and then they were killed. Vets did what they could. Farmers did what they could. But that stark number of ten million animals, I can assure you, blurs an immense amount of suffering, fear, pain, and death into an easy-to-swallow statistic.

            Foot and Mouth is a disease of economic importance. I stayed clean during the epidemic of 2001. Somehow, I still feel dirty.

[1] I was very proud of remembering this point - it must have appealed to the SF writer in me; also, I honestly did remember that it was a picornavirus.
[2] a medical term, meaning 'it goes away by itself'
[3] Not strictly true - there have been a few reports of direct transmission from animals to humans, but these cases are very rare, not confirmed, and (just like FMD itself), get better very quickly.
[4] I won't mention it again, I promise!
[5] Here's some figures for the interested: getting the outbreak under control cost £8-10 billion pounds. Lost revenue for allowing FMD unchecked across the UK (and so ending up in the 'FMD present' group) could be £1.2 billion/year. Vaccination of all herds in the country would probably cost about £150 million. I can't find any figures for what the UK being downgraded to Group 2 would be.