Foot and mouth disease (FMD) is one of the most devastating viral animal diseases affecting cloven-hoofed animals such as cattle and swine, and has occurred in most countries of the world at some point during the last century. Although the disease has no human-health implications, it can have enormous economic and social consequences, as recent outbreaks in the United Kingdom and Taiwan have demonstrated. These consequences occur because the international community values products from countries that are FMD-free and generally restricts international trade in FMD- susceptible products from countries affected by an outbreak. Most FMD- affected countries, therefore, take whatever measures necessary to regain their FMD-free status as quickly as possible. In the United States, the U.S. Department of Agriculture (USDA) has primary responsibility for protecting domestic livestock from animal diseases such as FMD. The U.S. Customs Service supports USDA in these efforts. FMD—a highly contagious viral disease affecting primarily cloven-hoofed animals, such as cattle, sheep, swine, and goats—has 7 types and over 80 subtypes. Immunity to, or vaccination for, one type of the virus does not protect animals against infection from the other types. FMD-infected animals usually develop blister-like lesions in the mouth, on the tongue and lips, on the teats, or between the hooves, which causes them to salivate excessively or become lame. Other symptoms include fever, reduced feed consumption, and abortions. Cattle and pigs are very sensitive to the virus and show symptoms of the disease after a short incubation period of 3 to 5 days. The incubation period in sheep is considerably longer, about 10 to 14 days, and the clinical signs of the disease are usually mild and may be masked by other conventional conditions, thereby allowing the disease to go unnoticed. The mortality rate for nonadult animals infected with FMD varies and depends on the species and strain of the virus; in contrast, adult animals usually recover once the disease has run its course. However, because the disease leaves them severely debilitated, meat-producing animals do not normally regain their lost weight for many months, and dairy cows seldom produce milk at their former rate. The disease therefore can cause severe losses in the production of meat and milk. The FMD virus is easily transmitted and spreads rapidly. Prior to and during the appearance of clinical signs, infected animals release the virus into the environment through respiration, milk, semen, blood, saliva, and feces. The virus may become airborne and spread quickly if pigs become infected because pigs prolifically produce and excrete large amounts of the virus into the air. Animals, people, or materials that are exposed to the virus can also spread FMD by bringing it into contact with susceptible animals. For example, the virus can spread when susceptible animals come in contact with contaminated animal products, such as meat, milk, hides, skins, and manure; transport vehicles and equipment; clothes or shoes worn by people; and hay, feedstuffs, or veterinary biologics. The FMD virus has a remarkable capability for remaining viable for long periods of time in a variety of animate and inanimate objects. For example, the virus can persist in the human nasal passages for up to 36 hours, manure for 1 to 24 weeks, fodder for 1 month, and on shoes for 9 to 14 weeks. The ability of the virus to persist in the environment and other products depends on the temperature and potential of hydrogen (pH) conditions. Generally, the virus can survive freezing but cannot survive at temperatures above 50° Celsius (122° Farenheit) and at pH levels of less than 6, or greater than 9. Table 1 shows the various lengths of time that the FMD virus can survive in some selected products. FMD can be confused with several similar but less harmful animal diseases that also produce blisters and cause animals to salivate, such as vesicular stomatitis, bovine viral diarrhea, and foot rot. Two foreign swine diseases are also clinically identical to FMD—swine vesicular disease and vesicular exanthema of swine. The only way to distinguish between FMD and these other diseases is through laboratory analyses of fluid or tissue samples. FMD is also sometimes confused with mad cow disease or bovine spongiform encephalopathy (BSE). BSE is a fatal, neuro-degenerative disease found in cattle in 23 countries around the world. Cattle contract the disease through animal feed that contains protein derived from the remains of diseased animals. Scientists generally believe that an equally fatal disease in humans—known as variant Creutzfeldt-Jacob Disease—is linked to eating beef from cattle with BSE. However, unlike mad cow disease, FMD has no known human health implications. FMD is present in about 60 percent of the countries in the world and endemic in many countries in Africa, the Middle East, Asia, and South America. The relatively few areas that are considered free of FMD include North and Central America, Australia, New Zealand, and the Caribbean. Figure 1 shows the presence of FMD worldwide for the period 1992 through 2002. In 2000 and 2001, over 40 countries reported outbreaks of FMD, and during the first 5 months of 2002, five countries reported outbreaks. The spread of certain strains of the virus also demonstrates how quickly it is spreading throughout the world. For example, the FMD virus serotype O, known as the Pan-Asia strain, was first identified in northern India in 1990 and was subsequently found in Nepal in 1993. It then spread westward into Saudi Arabia during 1994 and, subsequently, throughout the Near East and into Europe (Thrace region of Turkey, Bulgaria, and Greece) in 1996. The Pan- Asia strain was also found in Bangladesh in 1996 and in Bhutan in 1998. In 1999 it was reported in mainland China and then detected in Taiwan. By late 1999 and in 2000, it had reached most of Southeast Asia. Most recently, the Pan-Asia strain was found in the Republic of Korea, Japan, the Primorsky Territory of the Russian Federation, and Mongolia (areas free from FMD since 1934, 1908, 1964, and 1973, respectively). The Pan-Asia strain is also responsible for the 2001 outbreak of FMD in the United Kingdom that subsequently spread to France, Ireland, and the Netherlands. Figure 2 shows the incidence of four types of FMD virus worldwide, including the type O Pan-Asia strain. In North America, the last outbreaks of FMD for the United States, Canada, and Mexico occurred in 1929, 1952, and 1953, respectively. The United States has worked closely with both Canada and Mexico to eradicate FMD from North America. The Office International des Epizooties (OIE)—an intergovernmental organization created in January 1924 by an international agreement signed by 28 countries—was established to guarantee the transparency of information on the animal disease status of member countries. In addition, OIE collects and analyzes veterinary scientific information and disseminates it to member countries, provides expertise and promotes international solidarity for the control of animal diseases, and guarantees the sanitary safety of world trade by developing rules for international trade in animals and animal products. In May 2001, OIE had 158 member countries. OIE classifies member countries (or certain zones within these countries) as being FMD-free with or without vaccination if they meet certain criteria detailed in the OIE International Animal Health Code. For example, to obtain FMD-free status without vaccination, a member country should (1) have a record of prompt animal disease reporting; (2) send a declaration that it has been FMD-free and has not used vaccination for 1 year; (3) present evidence that it has an effective system of surveillance; (4) implement regulatory measures for the prevention and control of FMD; and (5) provide evidence that no vaccinated animals have been imported into the country, since such animals can become the source of future infections. Similarly, to obtain FMD-free-with-vaccination status, a country should (1) have a record for prompt animal disease reporting, (2) send a declaration that there have been no outbreaks of FMD for 2 years, (3) provide evidence that the country has effective surveillance systems and has implemented necessary regulatory measures to prevent and control FMD, (4) provide proof that routine vaccinations are carried out and that the vaccines comply with OIE standards, and (5) have an intensive and frequent system to detect any viral activity. When FMD occurs in an FMD-free country or zone where vaccination is not practiced, the affected country must reapply after the outbreak to regain its FMD-free-without-vaccination status from OIE. OIE standards require a country to wait until 3 months after the last reported case of FMD when a “stamping out approach” (immediate slaughter of diseased and exposed animals with no vaccination) is used to eradicate the disease before the country can apply for reinstatement of its FMD-free status. As part of this process, surveillance results of laboratory-screening tests (serological surveillance results) must be provided to OIE to prove that the disease has been eradicated. If vaccination was used to control the outbreak, then the country must wait until 3 months after the last vaccinated animal is slaughtered and serological surveillance results prove that the disease has been eradicated before reapplying for FMD-free status. The international community generally places a high value on products from countries that are FMD-free without vaccination. Such countries can export both live animals and animal products easily to other FMD-free countries. In contrast, countries that have an FMD-free-with-vaccination status are restricted to trading animal products that can be treated to ensure that the virus is inactivated. As a result, most countries that are FMD-free without vaccination resort to a stamping out process to eradicate the disease if an outbreak occurs. The United Kingdom and Taiwan followed this process in 2001 and 1997, respectively. Similarly, if an outbreak were to occur in the United States, the current U.S. policy requires all infected and exposed animals to be immediately slaughtered and disposed of by incineration, burial, or rendering. In recent years, the international community has been encouraging the acceptance of regionalization policies for international trade. Regionalization involves declaring one or more areas of a country FMD- free while other areas are responding to an outbreak. Under a regionalization policy, in the event of an FMD outbreak in the United States, even if one state or area was infected, the nation as a whole might not lose its FMD-free status, and trade restrictions might not be enforced on all of our FMD-susceptible products. An FMD outbreak could cost the U.S. economy billions of dollars in both direct and indirect costs. Direct costs to the government would include the costs of disease control and eradication, such as the maintenance of animal movement controls, control areas, and intensified border inspections; the destruction and disposal of infected animals; vaccines; and compensation to producers for the costs of disease containment. However, government compensation programs may not cover 100 percent of producers’ costs. As a result, direct costs would also occur for disinfection and for the value of any slaughtered animals not subject to government compensation. According to recent U.K. government estimates, the direct costs for control and eradication of the 2001 outbreak was about $4 billion. According to several estimates, the direct costs of controlling and eradicating a U.S. outbreak of FMD could range up to $24 billion in current dollars, depending, among other things, on the extent of the outbreak and the control strategy employed. The value of lost export sales in the event of an FMD outbreak would represent a significant portion of the total direct costs to the U.S. economy. According to USDA officials, a single case of FMD in the United States would cause our trading partners to prohibit U.S. exports of live animals and animal products. This ban could result in losses of between $6 billion and $10 billion a year while the United States eradicated the disease and until it regained disease-free status. These losses may be mitigated to some extent by increased domestic sales of meat from disease-free portions of the United States that may otherwise have been exported. However, USDA officials believe that many people in the United States would refuse to eat meat during an FMD outbreak, thus the offset probably would be minimal. Indirect costs of an FMD outbreak would include those costs affecting consumers, ancillary agricultural industries, and other sectors of the economy. For example, if large numbers of animals are destroyed as part of a control and eradication effort, then ancillary industries such as meat- processing facilities and feed suppliers are likely to lose revenue. Furthermore, an FMD outbreak would result in adverse effects such as unemployment, loss of income (to the extent that government compensation does not fully reimburse producers), and decreased economic activity, which could ripple through other sectors of the economy as well. For example, the loss of agricultural income could result in reduced sales of consumer goods. In the United Kingdom, according to government estimates, the 2001 outbreak resulted in losses to the tourism industry of over $5 billion that were comparable to the losses sustained by the food and agriculture sector. In addition, not only may consumers have to pay higher prices for the remaining supply of animal products affected by an FMD outbreak, but the price of substitutes is likely to rise, as well. For example, as the price of FMD-free meat increases, some consumers are likely to buy poultry or other meat substitutes, thus causing the prices of these substitute products to rise. However, the higher prices that consumers pay for substitutes do not result in a net cost to the economy because these higher prices result in increased revenues for poultry producers and others. An FMD outbreak can have significant social impacts, such as enormous psychological damage, especially on families and localities directly affected by the outbreak, as the U.K. experience in 2001 illustrates. For example, in May 2001, the Welsh Institute of Rural Health found that individuals affected by the FMD outbreak experienced a range of symptoms, including tearfulness, lack of sleep, loss of appetite, increased anger, irritability, and general depression. An increase in marital discord was also noted. One general practioner reported that 50 percent of his patients affected by the FMD outbreak required antidepressant drugs. Some farming families even sent their children away from home during the outbreak rather than have them witness the slaughter and disposal of the family’s livestock. Consumer confidence in the safety of the U.K. food supply was also adversely affected by the outbreak. A survey by the United Kingdom’s Institute of Grocery Distribution determined that because of the FMD and mad cow disease outbreaks, many consumers in the United Kingdom now consider meat and dairy products to be unsafe. As a result, these consumers have changed their grocery-buying habits. An outbreak also significantly disrupts daily life. Normally busy livestock producers suddenly had almost nothing to do because their animals had been destroyed and their properties were quarantined. According to one study of the effects of FMD on farm life in the Cumbria area of the United Kingdom, most farming households had to curb their usual daily activities, and only the most essential movements on and off the farms were permitted. Lost income caused stress to families because they had to cut back on their household expenditures and some had to renegotiate loans. The study notes that the enforced isolation caused by the quarantines added to the tensions and stresses already being experienced by both adults and children. Within USDA, the Animal and Plant Health Inspection Service (APHIS) has the lead responsibility for protecting the nation’s livestock from foreign animal diseases, which are diseases not native to the United States as well as those thought to have been eradicated. Assisting APHIS in this endeavor are USDA’s Foreign Agricultural Service, the Food Safety and Inspection Service, and the Homeland Security Council. Within APHIS, several groups share responsibility for protecting U.S. livestock from the incursion of foreign animal diseases such as FMD: International Services. Working with its counterpart organizations in foreign countries, this group seeks to reduce the international spread of animal and poultry diseases. Its goal is to protect U.S. livestock and poultry by reducing risk abroad through disease-management strategies provided to exporting countries before they send their animals and products to the United States. Veterinary Services. To protect and improve the health, quality, and marketability of our nation's animals, animal products, and veterinary biologics, this group seeks to prevent, control, and/or eliminate animal diseases, and monitor and promote animal health and productivity. This group administers laws and regulations on importing animals and animal products, including embryos and semen, to ensure that imports are free from certain disease agents. In addition, Veterinary Services provides training for state and private veterinarians on foreign animal diseases of concern and provides animal disease diagnostic and surveillance testing. Veterinary Services has primary responsibility for inspecting and ensuring the safety of live animal and animal product imports to the United States. Within Veterinary Services, the Emergency Programs unit coordinates efforts to prepare for and respond to animal disease outbreaks, including FMD, and in the fall of 2001, published a draft plan for responding to an FMD outbreak. It employs veterinarians trained to detect and respond to an FMD outbreak. Emergency Programs also provides federal and state veterinarians and others with training on foreign animal diseases. Plant Protection and Quarantine. Inspectors in this group are USDA’s primary presence at 144 of the 301 ports of entry in the United States, as well as 8 foreign ports. According to USDA, inspectors are present at all major ports of entry, and staffing is based on risk assessments and supplemented with tools such as detector dogs, X-rays, and hand-held remote-sensing equipment. USDA inspectors screen and physically inspect animal products and other cargo arriving by air, sea, or land, as well as international passengers and their luggage arriving via air, sea, or land border crossings. Most notably, the beagles in Plant Protection and Quarantine’s Beagle Brigade sniff travelers' luggage for prohibited fruits, plants, and meat that could harbor harmful plant and animal pests and diseases. According to USDA, by the end of this year, it will have increased the number of dog teams to 123, which is double the level available 2 years ago. In commenting on a draft of this report, USDA stated that by the end of this year, APHIS will also have increased the number of its safeguarding personnel to approximately 3,870—an increase of 50 percent over its fiscal year 2000 staffing levels. Moreover, USDA told us that it has hired 18 additional veterinarians who are conducting port-of-entry reviews, working with state counterparts, and providing technical guidance and training on working with and handling animal products and byproducts and international garbage that could pose a threat of foreign animal diseases. In addition, USDA’s Foreign Agricultural Service (FAS) operates programs designed to build new markets and improve the competitive position of U.S. agriculture in the global marketplace. FAS is responsible for USDA’s overseas activities, such as market development, international trade agreements and negotiations, and the collection and analysis of statistics and market information. FAS supports U.S. agricultural interests through its network of agricultural counselors, attachés, and trade officers stationed in many foreign countries. FAS officials primarily deal with agricultural trade issues and meet with host government and industry officials to discuss and facilitate agricultural trade. USDA’s Food Safety and Inspection Service (FSIS) has primary responsibility for ensuring the safety of imported and domestic meat and meat products meant for human consumption. FSIS stations inspectors at ports of entry to conduct sampling and inspection functions on imported meat products. FSIS also has responsibility for approving countries that are eligible to export meat products to the United States. In fulfilling this responsibility, FSIS conducts periodic reviews of eligible countries. According to USDA, FSIS’s inspection of livestock before slaughter is an important surveillance tool for detecting the presence of FMD in the United States. Finally, USDA’s Homeland Security Council is responsible for leading and coordinating USDA’s activities to plan for and manage agriculture-related crises as well as emergency programs. This council serves as USDA’s primary contact with the Federal Emergency Management Agency and facilitates coordination with other federal agencies, state and local governments, and private-sector organizations. The U.S. Customs Service (Customs) is the nation’s primary enforcement agency for preventing the entry of a number of potentially harmful products into the United States, including FMD-contaminated products. In addition to their Customs responsibilities to ensure that proper duties or tariffs are paid on imported products, Customs inspectors work to enforce the regulations of about 40 federal agencies, such as those of USDA. Customs inspectors review paperwork, such as manifests and bills of lading, and physically inspect cargo and international passengers and their luggage. Customs has inspectors stationed at all 301 ports of entry throughout the United States, including international airports and seaports and land border crossings along the Canadian and Mexican borders. Customs also has inspectors at some foreign locations, such as the international airport in Toronto, Canada, where they perform preclearance inspections of passengers and their luggage prior to entry into the United States. Customs inspectors also examine international mail and packages arriving in the United States at the 14 facilities handling mail of foreign origin. Senator Tom Daschle asked us to determine whether (1) U.S. processes to obtain and disseminate information on foreign FMD outbreaks are adequate and timely, (2) U.S. measures for preventing FMD from entering the country are effective and comparable with those of other selected countries, and (3) the United States could respond quickly and effectively to an outbreak of FMD if it were to occur. To address the first question, we obtained and reviewed relevant documents, and we interviewed USDA and Customs officials. In particular, we reviewed the adequacy and timeliness of the information obtained and disseminated by USDA after the 2001 FMD outbreak in the United Kingdom. For the second question, we reviewed relevant legislation, regulations, and other USDA documents. We also interviewed USDA, Customs, and state officials. To observe the preventive measures for international cargo, we visited three large seaports in Elizabeth, New Jersey; Baltimore, Maryland; and Houston, Texas. To observe the preventive measures for international mail, we visited international mail-processing facilities in New Jersey and Virginia and one international express package carrier in Kentucky. To observe the preventive measures for live animals imported through U.S.-Canadian and U.S.-Mexican land ports of entry, we visited the Sarnia, Ontario, and Nuevo Laredo, Mexico, border crossings. To observe the preventive measures for international passengers, we visited Dulles International Airport, and obtained information on the preclearance procedures used to process international passengers entering the United States via Canada at the international airport in Toronto, Canada. We also gathered information on how garbage from international carriers is handled at airports and seaports. In addition, we visited two nearby county and two state fairs in Maryland and Virginia to observe how USDA’s guidance for biosecurity measures to prevent the spread of disease at U.S. livestock and agricultural shows was implemented. As a result of the heightened level of security at airports after September 11, 2001, and because our review was largely conducted after the U.K. outbreak had ended, we were unable to implement a portion of the review as originally planned. In particular, we were unable to survey passengers who were returning to the United States from the United Kingdom, during the outbreak, at the airport after they left the passenger-processing area. Instead, we surveyed by telephone 60 passengers who visited the United Kingdom during the time of the outbreak (Mar. through Sept. 2001). We asked them to recall various aspects of their return trip and the processing they underwent at U.S. airports. These results cannot be generalized and represent only the experiences of the people whom we surveyed. In addition, because we asked people to recall events after the passage of 4 to 6 months, their recollections of certain events and processes might not have been as clear as they would have been immediately upon arrival. Furthermore, to respond to our second question, we compared the preventive measures used by Canada, Mexico, and the United Kingdom with those used by the United States. We selected Canada and Mexico for our review because the ability of the United States to protect its livestock from FMD also depends on the ability of our neighbors to prevent the disease; according to USDA officials, if any of the three countries has an FMD outbreak, the other two are also likely to have an outbreak. We included the United Kingdom in our analysis because it is a major U.S. trading partner and because of its recent experience with FMD. To obtain information on the preventive measures used by Canada and Mexico, we visited these two countries, met with federal officials, and obtained and reviewed relevant documents. While in Canada and Mexico, we visited airports, seaports, international mail-processing facilities, and border crossings to observe the preventive measures used by these countries. To obtain information on the United Kingdom’s preventive measures, we reviewed and summarized legislation and regulations for the European Union and the United Kingdom, as well as other publicly available documents. To ensure the accuracy and completeness of our information, we shared the summaries that we prepared on the preventive measures used by the three countries with officials in these countries and asked for their review and comments. The information on these foreign countries’ preventive measures does not reflect our independent legal analysis. Finally, for our third question, we reviewed federal and state emergency response plans as well as other key documents and federal legislation and regulations. We interviewed USDA officials, industry representatives, and state officials. We also interviewed a group of selected veterinarians and animal health technicians who were part of the U.S. contingent that supported the United Kingdom’s response efforts in 2001 to obtain their perspectives on U.S. preparedness and observations on lessons learned from the U.K. outbreak. We interviewed the state veterinarian in six states that are major U.S. livestock producers to obtain their perspective on their state’s preparedness efforts as well as the overall U.S. ability to respond to an outbreak if it were to occur. We also attended a USDA training session and a conference organized by the Western States Livestock Health Association that included information on U.S. preparedness and response to an FMD outbreak. We provided USDA and Customs with a draft of this report for review and comment. The written comments we received from USDA are presented in appendix V, and those we received from Customs, in appendix VI. In addition, we received technical comments from USDA that we have incorporated throughout the report as appropriate. We conducted our work from August 2001 through May 2002 in accordance with generally accepted government auditing standards. USDA relies on a wide variety of sources to obtain information on outbreaks of FMD overseas. Its sources include APHIS and FAS staff stationed abroad, official notifications from international trade or animal health organizations, and notifications from affected countries. But USDA’s dissemination of this information is more problematic because it has no formal process—detailed procedures and protocols—for sharing information on foreign FMD outbreaks with Customs, which provides the first line of defense against potentially contaminated products entering U.S. ports. USDA does, however, share the information it develops with agencies within the department, states, public and private veterinarians, industry groups, and the public through various methods, including E- mails, postings to USDA’s Internet site, telephone calls, and media alerts. U.S. measures to prevent an FMD outbreak—control and eradication overseas and the port of entry screening of livestock, animal products, and passengers—have been successful since 1929. Nevertheless, the United States remains vulnerable to an FMD outbreak because of the nature of the virus, the many pathways by which it can come into the country, and the growing magnitude and volume of both legal and illegal passengers and cargo entering the country. Other countries face similar challenges in protecting their livestock from FMD and use preventive measures that are comparable to those the United States uses. However, the United States could also build on the experiences of other countries to improve its preventive measures. As a first line of defense to safeguarding U.S. animal resources against the introduction of pests and diseases, USDA helps prevent, control, and eradicate agricultural health threats where they originate outside the United States. By helping other nations eradicate or control these outbreaks, USDA reduces the risk of agricultural pests and diseases reaching U.S. borders. In North America, U.S. efforts to eradicate and control FMD have largely focused on Mexico, because of our shared border and the possible threat of the FMD virus’s moving overland from South America, where the disease is endemic in some countries. USDA has staff located in Mexico working with the Mexico-United States Commission for the Prevention of Foot and Mouth Disease and Other Exotic Animal Diseases. The commission, formed in 1947 as a combined U.S.-Mexican effort to eradicate FMD from Mexico, built Mexico’s animal health infrastructure and successfully eradicated FMD from Mexico in 1954. Today, USDA and Mexican veterinarians work together, through the activities of the commission, to provide disease surveillance, diagnostic testing, and training for Mexico to ensure that the country remains FMD-free. According to USDA officials in Mexico, the United States initially covered about 80 percent of the costs for the joint program; however, as the Mexican government assumed greater responsibility for the program, the U.S. share has decreased to about 20 percent. In fiscal year 2001, USDA provided about $160,000 in funding for the commission’s activities. According to USDA officials, this funding supports the commission’s high-security laboratory in Mexico City by providing training, supplies, and equipment. In addition, for over 30 years, the United States has held regular meetings on animal health issues with the governments of Canada and Mexico to harmonize North America’s import requirements and, more recently, to coordinate preventive actions and emergency response activities in the event of an FMD outbreak. For example, in 2000, the three countries held joint exercises—known as the Tripartite Exercise 2000—to test their FMD communication and response plans, and to assess their response systems. As a result of this exercise, the three governments signed a memorandum of understanding to formally establish the North American Animal Health Committee. This committee represents animal health issues for the North American Free Trade Agreement and seeks to harmonize live animal and animal product import requirements for North America. The committee will also plan emergency response activities and perform joint test exercises to ensure that all three countries remain prepared to respond to an FMD outbreak. The United States also supports efforts to establish FMD-control zones in Central and South America. For example, to help alert countries in Central and North America about the potential incursion of FMD from South America, USDA has established cooperative programs with Panama and Colombia. In Panama, USDA supports the U.S.-Panama Cooperative Program for the Prevention of Foot and Mouth Disease, which maintains the Darien Gap area of Panama free from FMD and other foreign animal diseases. This program conducts field surveillance at high-risk border points and annual training, analyzes technical data, and improves the infrastructure. The program also provides support for the Investigative Laboratory for Vesicular Disease, which provides bio-containment, diagnostic, and detection capabilities for vesicular and other foreign animal diseases in Central America. Through the Colombian program, USDA helps maintain an FMD-free barrier along the Colombia-Panama border. This barrier serves as the "first line of defense" for preventing the spread of FMD northward into Central America, Mexico, and the United States, which are all FMD-free. Until FMD is eradicated from South America, USDA believes that maintaining this barrier will prevent the disease’s northward spread. USDA provides technical assistance and half of the funding for the program. As part of its disease exclusion activities for the region, USDA also has cooperative agreements with all the other Central American countries to support joint monitoring and surveillance activities, including field investigations and the collection of laboratory samples for FMD and other foreign animal diseases. Through these agreements, USDA helps transfer surveillance and detection technologies to these countries. When FMD strikes other nations—as it did recently, for example, in Argentina and the United Kingdom—the United States may assist in controlling and eradicating the disease. For example, a total of 327 U.S. animal health professionals, including over 300 veterinarians, helped eradicate the 2001 outbreak in the United Kingdom. The Americans came from USDA, other federal agencies, and state governments. Beginning in March 2001, they traveled to the United Kingdom, generally in groups that averaged about 10 per week, and assisted with the response for about a month. At the peak of the outbreak during March and April, about 100 U.S. animal health professionals were assisting in the U.K. response. The U.S. responders with whom we spoke participated in surveillance activities, such as collecting blood samples, and epidemiology tasks, such as tracking and predicting the path of new disease outbreaks. They also issued permits and licenses to move animals and products such as silage. By providing such assistance, the United States not only helps ensure that the disease is eradicated quickly, but also helps reduce the potential for FMD-infected products to arrive at U.S. ports of entry. Preventive measures at U.S. borders provide the second line of defense against the incursion of FMD into the United States. USDA has identified several key pathways by which the FMD-virus could enter the United States. To respond to the risk posed by these pathways, USDA implemented measures designed to ensure that animals, products, passengers, and equipment arriving at U.S. borders are free of the virus and do not pose a risk to U.S. livestock. However, some level of risk is inherent in international trade and travel, and no set of measures can ever completely eliminate the possibility that FMD will enter the country. Moreover, because FMD is a hardy virus and the level of inspection resources cannot keep pace with the increasing volume and magnitude of cargo and passengers, both legal and illegal, that continue to enter the country, the United States remains vulnerable to an outbreak. The FMD virus could enter the United States through a number of key pathways: live animal imports, imports of animal and other products, international passengers and their luggage, garbage from international carriers, international mail, and military personnel and equipment returning from overseas. For each of these pathways, USDA has developed and implemented specific preventive measures described below. Live animal imports. The United States allows imported livestock, such as swine, cattle, and sheep, only from preapproved countries that USDA judges to be free of FMD and other diseases of concern. For example, in April 2002, USDA recognized 49 countries or geographical regions as free of FMD. (See app. I.) Generally, live animals can be imported only through designated ports of entry, the majority of which are located along U.S. borders shared with Canada and Mexico, and three others located on the east and west coasts. Most live cattle imports into the United States originate from Canada and Mexico; live hog imports, from Canada; and live lamb imports, from Australia and New Zealand. Livestock exported to the United States must be accompanied by a U.S. import permit and a health certificate from an official government veterinarian in the country of origin. The health certificate states that the animals have been in the exporting country for at least 60 days prior to shipment and are free of other diseases of concern. Generally, animals arriving from countries other than Canada and Mexico may be quarantined. Zoological ruminants and swine from FMD-affected countries are permitted into the United States but must be processed through USDA’s New York Animal Import Center. Animal and other product imports. Thousands of animal and other products that could be contaminated with the FMD virus could potentially enter the United States during the course of normal international trade. These products include animal products meant for human consumption, such as meat and dairy products; nonfood animal products, such as hides, skins, casings, and animal extracts; as well as nonanimal products, such as farm equipment, hay, and straw. USDA regulates the importation of this diverse range of products to help minimize the risk of introducing FMD into the United States. USDA implements different import rules for FMD-free and FMD-affected countries. Generally, for countries free of FMD and other diseases of concern, USDA imposes few restrictions on animal product imports. For FMD-affected countries, USDA prohibits the importation of all susceptible products shipped 3 weeks prior to the date of official notification of the outbreak. This prohibition remains in effect until USDA reassesses the disease status of the affected country and determines the level of trade that can resume. USDA allows imports of animal and other products from FMD-affected countries only if they meet certain requirements. These requirements vary for different kinds of products, as follows: Animal products meant for human consumption. Generally fresh, chilled, or frozen meat from cattle, sheep, and pigs, and fresh milk are prohibited from FMD-affected countries. However, processed meat and dairy products are allowed from FMD-affected countries if they meet certain requirements. For example, meat products can be imported from FMD-affected countries only if (1) the country and meat processing plants have been deemed eligible to export meat products to the United States by FSIS and (2) the processing plants also meet APHIS’s meat-processing standards. The APHIS standards ensure that meat products from these countries are not contaminated with the FMD virus, and require that the products be processed in a manner that will inactivate the virus. For example, they must be fully cooked, dry cured, or canned and shelf-stable, with all bones removed. Moreover, a U.S. import permit and an official veterinary health certificate from the country of origin must accompany certain meat shipments. Similarly, most dairy products from FMD-affected countries must meet APHIS’s requirements to ensure that they do not pose a risk of FMD’s introduction. For example, milk products that are in a concentrated liquid form and are shelf-stable without refrigeration are allowed from FMD-affected countries. Some dairy products, such as condensed milk require a U.S. import permit, while others, such as yogurt and butter are unrestricted and do not require a permit. Nonfood animal products. A variety of nonfood animal products are allowed from FMD-affected countries if they have been properly treated to inactivate the virus; however, a U.S. import permit may be required. For example, tanned hides, leather, and fully finished mounted animal trophies can be imported into the United States from FMD-affected countries. Other products. USDA does not allow imports of grass, hay, or straw used for feeding, bedding, or other purposes from FMD-affected countries. However, used farm equipment is allowed with a certificate from the exporting country stating that the equipment has been steam cleaned. APHIS officials inspect farm equipment at U.S. ports of entry to ensure that it is free from dirt and soil. If dirt and soil are found, then inspectors will determine whether they can be adequately washed with detergent and disinfected at an appropriate location before granting approval for entry into the United States. All animal and other products arriving at U.S. ports of entry, whether from FMD-free or FMD-affected countries, are subject to inspection by U.S. federal inspectors. Customs officials, who review the documents accompanying the shipments, either electronically or on paper, provide the first level of inspection for these shipments. On the basis of this review, Customs is authorized to either release the shipments into commerce or hold them for USDA inspection. USDA provides Customs with a list of products to be flagged for inspection by APHIS. APHIS inspectors ensure that all the necessary documents accompanying the shipment, such as import permits and official health certificates, are complete and ensure that the shipments match their manifest. In some instances, APHIS inspectors will inspect the shipping containers to check their contents. After APHIS completes its inspection, the shipment may proceed to FSIS and/or the Food and Drug Administration for further inspection, depending on which agency regulates the safety of these products for human health issues, or may proceed to Customs for release into commerce. According to USDA, FSIS inspectors at ports of entry visually examine all shipments of products under FSIS’s jurisdiction and randomly select some for more in-depth examination. In commenting on a draft of this report, USDA noted that it has primary inspection responsibility for agricultural cargo and manifests at those ports staffed with USDA inspectors. To ensure that these shipments continue to be referred to USDA for inspection, the department said that it is working with Customs and other federal agencies to develop an automated targeting system, which will serve as an electronic interface among federal agencies to identify and automatically segregate high-risk plant cargo and track imported animals and animal products. International passengers. International passengers who may have been in contact with the FMD virus, either through contact with infected animals or materials such as soil and manure, or who bring potentially contaminated products into the country may also transmit the virus to the United States. USDA provides the following FMD-prevention information and types of scrutiny for international passengers in an effort to reduce the risk associated with this pathway: USDA requests airlines to make in-flight announcements on international flights; at ports of entry, it places warning signs and it plays prerecorded announcements about how international passengers can assist in keeping FMD out of the United States. International passengers must fill out a U.S. Customs declaration form that asks if they are bringing any animal or plant products into the country and if, while traveling abroad, they visited a farm or were in contact with animals. Passengers responding affirmatively to these questions are sent by Customs officials to a USDA inspection area at the port of entry for further processing. USDA officials may x-ray and inspect the contents of the passengers’ baggage; ask them additional questions; confiscate any prohibited items, such as meat and dairy products; and clean and disinfect their shoes. USDA’s Beagle Brigade and inspectors generally rove the baggage claim areas at major ports of entry to help identify passengers and their luggage that may be carrying prohibited food items. USDA inspectors look not only for suspicious packages, such as bulky, misshapen, and leaking containers, but also question passengers about their travels to determine whether they present a greater risk of disease transmission. If the dogs or the inspectors identify such passengers, these passengers are referred to the USDA inspection area for further processing. After the 2001 FMD outbreak in the United Kingdom, according to the international passengers we surveyed, some of these measures were not consistently implemented. For example, some passengers told us that the airlines they traveled on did not make any in-flight announcements about FMD. Other passengers told us that even though their Customs declaration form indicated that they had been in contact with animals or visited a farm while in the United Kingdom, they were not referred by officials to the USDA inspection area at the airport for further processing or they had to request USDA personnel at the airports to examine and disinfect the shoes that they wore while they were in FMD-affected areas in the United Kingdom. Garbage from international carriers. Garbage from international carriers, such as airplanes and ships, can also transmit the FMD virus into the United States if the garbage contains food items contaminated with the virus. Therefore, USDA has developed guidelines to ensure that garbage from international carriers is properly handled and disposed of so that it does not present a risk to U.S. livestock. For example, USDA inspectors supervise the removal of all international garbage from airplanes and ships. This garbage must be transported in leak-proof containers and must be disposed of properly, such as by incineration or sterilization, and subsequent burial at a landfill. USDA has compliance agreements with catering firms and cleaners that outline the proper handling and approved disposal methods for international garbage. Before a compliance agreement is signed, APHIS officials will, among other things, review the application; visit the handling, processing, or disposal facilities; observe the operation of any equipment to determine its adequacy for handling garbage; and certify and approve the garbage cookers and sterilizers to be used to process international garbage. USDA also monitors firms operating under these compliance agreements to ensure that they abide by the conditions stated in the agreement. International mail. Prohibited animal products that could transmit the FMD virus may also be sent through international mail and courier services to U.S. residents. As a result, international mail packages entering the United States are subject to inspection by Customs and USDA officials. Customs generally reviews the declaration form on the packages and either visually inspects or x-rays them as part of its responsibility to screen international mail for illegal and prohibited items, such as contraband and drugs. At USDA’s request, Customs can also screen international packages for prohibited animal products, such as meat and dairy products from FMD-affected countries. Customs sets aside packages that appear to contain such items for USDA’s inspection. USDA officials will review the declaration forms and may x-ray or open these packages for physical inspection. If the item in the package is a permissible product, the officials will reseal the package and release it for delivery; otherwise it will be confiscated and destroyed. In commenting on a draft of this report, USDA noted that mail from high-risk countries is more thoroughly scrutinized on the basis of pathway analysis. Military personnel and equipment. Because U.S. military forces are deployed throughout the world, troops and military equipment returning to the United States could introduce FMD and other diseases into the country. As a result, USDA provides support for the military and helps oversee the reentry of military cargo, personnel, equipment, and personal property to reduce the risk of introducing diseases into the United States. For example, military personnel must declare all agricultural items they are bringing back to the United States and identify whether they have been on farms or in contact with animals while abroad. Their clothing and gear should also be cleaned and washed before reentering the country. Similarly, all military rolling stock, such as humvees, trucks, weapons systems, and tanks, as well as other used military gear, such as canvas tents, must be thoroughly cleaned before reentry. Pallets, wooden crates, and other military equipment must be free of soil, manure, and debris. Military equipment used to eradicate animal diseases overseas, such as FMD, is not allowed reentry. For small-scale operations, the military must notify USDA at least 7 days in advance of arrival at a U.S. port of entry. USDA will determine if appropriate cleaning facilities are available at the first port of entry, and all items will be held at this port for inspection. If approved cleaning facilities are not available or if the equipment is contaminated to an extent that prevents cleaning, USDA will refuse to allow reentry. Large-scale operations require a 30-day notification. The United States has not had an outbreak of FMD since 1929, and some USDA officials and animal health experts believe that this healthy condition of U.S. livestock is directly related to the effectiveness of U.S. measures to prevent the incursion of the disease. However, these and other experts agree that the nation remains vulnerable to an FMD outbreak for the following reasons: FMD is a highly contagious and hardy virus that remains viable for long periods of time. FMD can be carried and transmitted by a variety of animate and inanimate items. Although the key pathways described earlier pose varying levels of risk to U.S. livestock, according to USDA, it could take only one contaminated product to come into contact with one susceptible U.S. animal to start a nationwide outbreak. The magnitude and volume of international passengers, mail, and products entering the United States creates an enormous challenge for USDA and other federal inspection agencies. As a result, most inspections at ports of entry are restricted to paper reviews of manifests supported by a limited number of judgmentally selected samples for physical inspection. For example, in fiscal year 2001, over 470 million international passengers and pedestrians arrived at U.S. ports of entry; of these, USDA inspected about 102 million. According to APHIS officials, about 30 percent of the items seized from passengers at airports were prohibited animal products or by-products. Table 3 provides information on the volume/numbers of passengers, vehicles, and cargo entering the United States and the level of APHIS’s inspections for fiscal year 2001. Similarly, the volume of international mail entering the United States makes it difficult for APHIS and Customs to adequately screen incoming parcels for FMD-susceptible products. For example, APHIS inspectors at the international mail facility in Elizabeth, New Jersey, told us that about 30,000 international parcels pass through their check point every day. This volume of mail provides the inspectors approximately 3 seconds per parcel to judge whether the package might contain FMD-susceptible products. Moreover, mail is processed at the facility during the day and night to keep up with the volume of international mail arriving daily. However, APHIS inspectors are present only during the day shifts and detector dogs are available for only 1 to 2 days per week. Although Customs’ inspectors screen packages for FMD-susceptible products during the time when APHIS inspectors are not available, both APHIS and Customs inspectors told us that the process is less effective than having an APHIS inspector on site. Nonetheless, according to APHIS’s Assistant Director for Port Operations, even doubling or tripling the agency’s inspection resources would not significantly reduce the FMD risk from overseas entries because the percentage of passengers, vehicles, and cargo receiving a physical inspection is likely to continue to be relatively low. Moreover, most U.S. preventive measures are not designed to intercept illegal entries of products or passengers that may harbor the FMD virus. According to USDA, the volume of illegal agricultural products entering the United States is growing, and contraband meat products entering the country is the single most important risk for the introduction of FMD. In addition, illegal shipments of products from countries other than the stated point of origin and illegal immigrants also pose significant risks. USDA and Customs annually confiscate thousands of contraband and prohibited products at U.S. ports of entry. For example, in fiscal year 2001, USDA seized 313,231 shipments of prohibited meat/poultry and animal by-products. According to USDA officials, these seizures are only a small portion of the contraband entering the United States. To respond to the growing threat from illegal entries, USDA recently created the Smuggling Interdiction and Trade Compliance program. Program officials collaborate with several federal, state, and private organizations to ensure compliance with U.S. agriculture import laws at ports of entry. U.S. preventive measures for FMD are comparable to the measures used by Canada, Mexico, and the United Kingdom for four key pathways included in this review: livestock imports, animal product imports, international mail, and garbage from international carriers. The pathway that presented the most significant area of difference concerned the measures used to process international passengers entering these countries. (Detailed information on the preventive measures used by Canada, Mexico, and the United Kingdom are provided in appendixes II through IV of this report.) Generally, U.S. preventive measures were similar to those used by the other three countries for the following four pathways: Imported livestock. The three countries allow imports of livestock only from approved countries that are FMD-free. Generally, these live animals must be imported through predetermined inspection ports that have adequate facilities available to quarantine the animals, if necessary. In addition, the countries require import permits and health certificates to accompany the livestock shipments unless the animals are imported directly for slaughter. Of the three countries, Mexico requires an official government veterinarian to (1) preinspect animals imported from countries other than the United States in their country of origin before they are loaded for transport to Mexico and (2) accompany the shipment and monitor the health status of the animals while they are in transit. Imported animal products. The countries generally allow animal product imports only from countries that they consider FMD-free and that meet their specific animal health and food safety standards. The countries also allow certain animal product imports from FMD-affected countries if they originate from a preapproved establishment and are processed in a manner that would inactivate the virus. For example, meat products that are fully cooked and canned and are shelf-stable can be imported from FMD-affected countries, but unprocessed products, such as fresh, chilled, or frozen meat, and untreated milk, are not allowed. In addition, all imported animal product shipments are subject to review and may be selected for physical inspection when they arrive at the port of entry in each of the countries. International mail. The countries handle international mail in a similar manner, which includes a review of the documentation detailing the sender, country of origin, and contents of the package. Only packages considered suspect, for example, because they do not include required information, are from high-risk countries, or have been sent by repeat offenders, are selected and opened for further inspection. Canada uses x-ray technology to help identify packages containing prohibited items, and Mexican officials told us that all international packages arriving from FMD-affected countries are opened and inspected for prohibited items. Garbage from international carriers. The countries’ federal agencies responsible for protecting animal health supervise the containment, transportation, and processing of garbage from international carriers. They generally dispose of international garbage by incineration or under certain conditions by burial at federally approved sites. For example, in Canada, international garbage can be buried at approved sites located at least half a kilometer from any premise with livestock and/or poultry and must be immediately covered by 1.8 meters (approx. 5.5 feet) of local refuse and/or other standard covering material. At the time of our review, none of the countries allowed domestic animals to be fed international garbage from airlines or ships. In commenting on a draft of this report, USDA noted that the United Kingdom faces greater risk than the United States because it is a member of the European Union, which includes, and provides for trade among, countries that are FMD-free as well as some that are not. The United States differed from Canada and Mexico in the measures used to prevent FMD from entering the country via international passengers. Specifically, we noted the following three areas of difference: Use of signs at ports of entry. While Canada, Mexico, and the United States all posted special signs at ports of entry to alert international passengers to the dangers of FMD, the U.S. signs were smaller and less visible in comparison with the signs used by the other two countries. For example, the Canadian signs were over 6 feet tall and warned passengers in large, bold letters in both English and French about FMD. Similarly, in Mexico the signs were also over 6 feet tall, included pictures, and colored text in English or Spanish. In contrast, the first U.S. signs were 1-by-1 foot and included relatively small-sized text on a white background that was difficult to read and did not easily convey the importance of the message. According to USDA officials, these signs were subsequently replaced with larger signs (3-by-3 feet) that included a colored graphic and larger-sized text. While larger, we observed at one U.S. international airport that the new signs were placed at a considerable distance from arriving passengers. These signs were placed on easels on top of the baggage carousels and therefore were several feet above eye level. In contrast, we observed that the signs in Canada and Mexico were placed in more easily visible locations that were in greater proximity to the passengers. According to agriculture officials in all three countries, they are limited in their ability to place signs at ports of entry because they have to negotiate the size and placement with the port authorities. As a result, they are not always able to use the most effective signs or locations. Figures 3 and 4 show the signs that were used in the United States and Canada and Mexico. Modified declaration forms. In 2001, both Canada and Mexico made changes to the declaration forms they use to process international passengers upon arrival. For example, after the U.K. outbreak in 2001, Canada reworded its declaration form to provide examples of food products of concern, such as dairy products. Similarly, Mexico developed a separate form that passengers coming from FMD-affected countries must complete, and it asks clear, detailed agriculture-related questions. In contrast, the United States did not make any changes to its declaration form in 2001, and some of the international passengers we contacted considered the agriculture-related question on the form ineffective and unclear. A senior APHIS official told us that USDA was aware that the question on the form was confusing and ambiguous to travelers. This official said that most of the confusion arises because the question on the form consolidates three questions into one. In commenting on a draft of this report, USDA stated that it has recently worked with Customs to revise the agricultural question on the Customs declaration form. The form now includes two agriculture- related questions that USDA believes will be more easily understood by travelers and will yield better information to the department to help focus its inspection efforts. The new form is currently being distributed throughout the country. Because USDA’s actions address our concerns, we have deleted our recommendation on this issue from this report. (See table 4 for a comparison of the agriculture-related questions on the prior and revised U.S. declaration forms.) Use of disinfectant mats. As a precaution, both Canada and Mexico developed guidelines requiring all international passengers arriving at airports and seaports to walk over disinfectant mats when entering the country. However, according to USDA officials, the United States chose not to use disinfectant mats because USDA research found that the disinfectant in the mat would become ineffective after a certain number of uses and may begin to harbor the virus, thus contaminating shoes that were otherwise clean. The United States has had significant success in keeping the nation’s livestock FMD-free since 1929. To some extent, the success of this effort is directly related to the effectiveness of U.S. preventive measures both abroad and at the nation’s borders. However, because of the extensive presence of FMD worldwide and because the magnitude and volume of international cargo and travel continue to expand, the nation’s vulnerability to an introduction of FMD remains high. The steps that other nations have taken to reduce the risk of FMD—such as signs to alert international passengers—could help improve USDA’s efforts to protect U.S. livestock. While we recognize that there is an additional cost to preparing new, larger, and more noticeable signs, we believe that, given the significant economic costs of an FMD outbreak to the nation, these costs are justified if they can help improve our preventive measures. To help improve the effectiveness of U.S. measures to prevent the introduction of FMD by international passengers, we recommend that the Secretary of Agriculture direct the Administrator, APHIS, to develop more effective signage about FMD for ports of entry. In its comments on a draft of this report, USDA stated that it is in the process of developing new signage for ports of entry that will be larger and more mobile than the ones that we observed during the course of our work. If FMD enters the United States despite USDA’s preventive measures, the nation’s ability to identify, control, contain, and eradicate the disease quickly and effectively becomes paramount. Recognizing the importance of an effective response and the necessity to prepare before an outbreak occurs, USDA and most states have developed emergency response plans that establish a framework for the key elements necessary for a rapid and successful U.S. response and eradication program. Many of these plans have, to some extent, been tested by federal and state agencies to determine their effectiveness. However, planning and testing exercises have also identified several challenges that could ultimately impede an effective and timely U.S. response if they are not resolved before an FMD outbreak occurs. Planning for a coordinated response to emergencies, including outbreaks of animal disease, is occurring at both the federal and state levels. Furthermore, both the federal government and many states have tested and revised their plans in response to the results of these tests. At the federal level, 26 federal agencies and the American Red Cross signed the federal response plan in April 1999, which is intended to guide the federal response to national emergencies and augment state response efforts. Under this plan, the Federal Emergency Management Agency (FEMA) is designated as the coordinating agency and is responsible for providing expertise in emergency communications, command and control, and public affairs. In the event of an FMD outbreak, FEMA would designate USDA as the lead agency and work closely with the department to coordinate the support of other federal agencies to respond to the outbreak. For example, under the plan, Customs would “lock down” ports of entry; the Department of Defense would provide personnel, equipment, and transport; the Environmental Protection Agency would provide technical support on the disposal of animal carcasses; the National Park Service would guide the response if wildlife become infected; and other agencies would provide additional support. To supplement the federal response plan and provide specific guidelines for an animal disease emergency, such as implementing quarantines of infected premises and disposing of animal carcasses, APHIS, USDA’s Homeland Security Council, and FEMA are taking the lead in developing a federal plan specifically for responding to an FMD or other highly contagious outbreak of an animal disease. The draft plan calls for the involvement of more than 20 agencies and describes the authorities, policies, situations, planning assumptions, concept of operations, and federal agency resources that will provide the framework for an integrated local, state, and federal response. At the state level, many states have developed an animal disease component for their state’s emergency management plans. According to the National Animal Health Emergency Management System (NAHEMS), in January 2000, only about half the states and U.S. territories had developed animal health emergency response plans. At that time, NAHEMS recommended that each state develop a plan for responding to animal health emergencies that links to their state’s emergency management plan and includes information on the following key elements: Animal health surveillance and detection systems. Control and eradication procedures. Communication between key partners. Involvement of emergency management officials. Collaboration between state and federal emergency responders. Involvement of state and federal animal health officials in responding to natural disasters. According to NAHEMS, in its 2001 annual report dated March 2002, the number of states and U.S. territories with animal disease emergency plans had increased to 46, of which 45 had included the plan as part of their state’s emergency management plan, and 30 indicated that their plan included all of the elements listed above. To ensure the efficacy and completeness of their plans, the federal government and many of the states have conducted “tabletop” and functional exercises. Tabletop exercises bring together key decision makers in a relatively stress-free setting to discuss the contingencies and logistics of a hypothetical disease evaluate plans, policies, and procedures; and resolve questions of coordination and responsibility. The setting is relatively stress-free because there is no time limit to resolve the hypothetical outbreak. In contrast, functional exercises simulate an emergency in the most realistic way possible, without moving people or equipment. It is a stressful, real-time exercise in which people apply emergency response functions to a hypothetical scenario. According to one APHIS official, functional exercises are best described as “dress rehearsals” for actual emergencies. The federal government has held both tabletop and functional exercises, as described below: To ensure that the federal FMD emergency response plan is comprehensive and well coordinated, USDA conducted a tabletop exercise in 2001. In this exercise, USDA developed a scenario involving a modest, limited FMD outbreak in the United States and obtained the views of 21 federal agencies and the American Red Cross on how they could support the federal response to an FMD outbreak. USDA used this information to revise its draft national FMD response plan. The federal government held a functional exercise in 2000—the Tripartite Exercise 2000—to test the plans, policies, and procedures that would guide the emergency response to a multifocal FMD outbreak in North America. The test focused on communication between the various entities involved in an outbreak and the use of vaccines by Canada, Mexico, and the United States. The test resulted in many recommendations to improve the three countries’ abilities to (1) communicate effectively, (2) provide program support, and (3) use vaccines. According to the final report, the recommendations, if implemented, will improve North America’s overall response capacity. The three countries have established working groups tasked with responding to these recommendations. Similarly, as of 2001, about 26 states had periodically conducted various kinds of exercises to test state responses to an FMD or other animal disease outbreak, according to NAHEMS. For example, in June 2001, the Texas Animal Health Commission, in conjunction with the Texas Division of Emergency Management within the Texas Department of Public Safety, conducted a 4-day modified functional exercise of the state’s draft FMD response plan and engaged 23 federal, state, academic, and private entities in the exercise. The exercise was designed to test participants’ abilities to control the simulated outbreak, find and deliver indemnity funds, and streamline the decision-making processes. Overall, the exercise determined that better communication and coordination could improve the speed and effectiveness of the state’s response. It also identified areas of ambiguity in the plan that left participants without clear directions at crucial times during the exercise. According to state officials, the plan was revised as a result of the exercise, and according to the Executive Director of the Texas Animal Health Commission, more exercises are necessary to continuously improve the plan. However, the state veterinarian also said that he does not believe that adequate resources are available either at the federal or state level for such activities. As the U.K. experience has demonstrated, responding to an FMD outbreak can tax a nation’s fiscal, scientific, and human resources. If a similar outbreak were to occur in the United States, the nation would face a wide spectrum of challenges that can hamper an effective and rapid response: (1) the need for rapid disease identification and reporting; (2) effective communication, coordination, and cooperation between federal, state, and local responders; (3) an adequate response infrastructure, including equipment, personnel, and laboratory capacity; and (4) clear animal identification, indemnification, and disposal policies. While USDA has made some progress in addressing some of these issues, significant work remains. The rapid identification and reporting of an FMD incident is key to mounting a timely response. However, a timely response depends on livestock producers’ and private veterinarians’ quickly identifying and reporting suspicious symptoms to state and federal officials. If they do not do so, FMD could become out of control before the federal and state governments could initiate any action. For example, within the first few days of the outbreak in the United Kingdom, before the first reports of FMD reached British officials, infected animals were criss-crossing the country in hundreds of separate movements, putting other livestock at risk. The main geographical spread of the disease occurred before any suspicion that the disease was present in the country. In contrast, in France, county officials quickly identified diseased animals from the United Kingdom, and were able to slaughter them quickly and avoid a large-scale outbreak. As a result, France sustained minimal animal losses and was declared FMD-free within months, while it took the United Kingdom almost a year to eradicate the disease and regain its FMD-free status. Several federal and state animal health officials with whom we spoke were concerned about how quickly disease identification and reporting would actually occur in the United States. They told us that livestock producers or veterinarians may not readily identify FMD because (1) the disease presents symptoms that are similar to other less-serious diseases, (2) FMD and other foreign animal diseases are not usually included in veterinary school curricula, and (3) many veterinarians may never have seen FMD- infected animals. Furthermore, livestock producers and veterinarians may not report the disease because they are not aware of the reporting process or may not realize the criticality of prompt reporting. According to USDA officials, the U.K. outbreak helped raise general awareness among state officials, private veterinarians, and livestock producers about the risks and potential of an FMD outbreak in the United States. An indication of this increased awareness is the doubling of foreign animal disease investigations from about 400 in 2000 to more than 800 in 2001. In addition, federal and state officials told us that the U.K. outbreak led to greater awareness of the need to have trained diagnosticians for foreign animal diseases in the field. In recent years, more field veterinarians have attended foreign animal disease training at USDA’s Plum Island facility. Nevertheless, as described in chapter 2, USDA intensified its efforts to increase public and industry awareness about FMD after the U.K. outbreak in 2001. As part of these efforts, USDA also addressed industry and animal health associations, and sponsored workshops, conferences, and informational telecasts for federal, state, and local officials, and others. In addition, the state governments also supported and supplemented USDA’s informational efforts. Despite USDA and state efforts to flood the livestock industry with information about the risks of FMD during 2001, the challenge to USDA will be to maintain this heightened awareness about FMD, now that the immediate risk from the U.K. outbreak has subsided. Cooperation, coordination, and communication between federal, state, and local agencies, private veterinarians, and livestock producers are essential for an effective FMD response. Recent planning efforts and test exercises have helped start the process of establishing greater coordination and improving the level of cooperation and communication between all levels. According to a USDA official, for example, USDA’s recent planning efforts to develop a national FMD response plan brought together officials from a variety of federal agencies to consider the implications of an FMD outbreak to their areas of responsibility and helped them develop ways in which they could support a federal response. Moreover, efforts to improve communication, cooperation, and coordination are beginning to transcend state boundaries. In 2001, 26 U.S. states/territories reported to NAHEMS that they were part of a group of states that had agreed to support each other in preparing for and responding to animal health emergencies. For example, according to Midwestern state officials, they are now beginning to address regional coordination and cooperation issues. In May 2002, seven Midwestern states met in Iowa for a planning conference to discuss a coordinated response plan for the region. While these planning and testing efforts have improved the level of communication, coordination, and cooperation, they have also identified areas that need considerable attention. For example, although the Tripartite Exercise of 2000 identified generally good communication and cooperation between government and industry participants, it also identified the need for the following actions: Improve the technology used to ensure an uninterrupted flow of information. Develop written agreements between national animal health and industry officials to ensure a continued high level of communication even when players change. Have federal and state counterparts work together to develop collaborative relationships that will improve communications during an actual outbreak. We also found that cooperation and communication between federal and state officials varied by state. For example, while some state officials indicated that they had excellent working relationships with their federal counterpart located in the state, others told us that cooperation and communication were limited. According to one APHIS field veterinarian, the level of cooperation and communication depends to a large extent on the personalities of the people involved and therefore such variance is to be expected. While the development of written agreements as suggested by the Tripartite exercise report and NAHEMS could help alleviate this problem, as of 2001, only about 32 U.S. states/territories had such agreements or other documents that detailed the respective roles of federal and state officials. To help improve cooperation, coordination, and communication, USDA officials told us that they are working with organizations such as the National Emergency Management Association to help states with their animal-emergency-planning efforts. In addition, USDA awarded 38 grants totaling $1.8 million in 2001 to state agencies, tribal nations, and emergency management organizations. According to USDA, this funding was to be used for training, equipment, and emergency-preparedness exercises. In commenting on a draft of this report, USDA stated that in late May 2002, it announced that it would be making more than $43 million available as grants to the states for strengthening homeland security preparedness. Of this $43 million, $14 million is to help states meet the national standards of emergency preparedness established by NAHEMS. Moreover, USDA stated that it is working with FEMA to develop a framework for a comprehensive communications plan to address a foreign animal disease outbreak. The plan will help better ensure the timely dissemination of information to critical audiences, including federal agencies, states, and industries. An effective response to an FMD outbreak requires an effective infrastructure, including a national emergency management control and command center, technical and other personnel, transportation and disposal equipment, and laboratory facilities and testing capacity. To ensure that a U.S. response to an FMD outbreak is properly coordinated and adequately controlled, USDA has established an Emergency Management Operations Center at its Riverdale, Maryland, location. In the event of an outbreak, USDA will activate this center to coordinate day-to- day activities during an FMD response and notify U.S. trading partners of the status of the outbreak. According to USDA’s draft FMD response plan, APHIS will set up the Joint Information Center—collocated with the Emergency Management Operations Center—to serve as the primary source of public information about the response and will coordinate with other federal and state information centers. In addition, as the U.K. outbreak illustrated, responding to an FMD outbreak requires extensive personnel resources. These include persons who can provide (1) specialized animal disease support for testing and diagnosis, epidemiology, vaccination, slaughter, and carcass disposal; (2) biohazard response support for controlling animals’ movement and decontaminating infected and exposed premises, equipment, and personnel; and (3) general logistics support for sheltering and feeding responders; the transportation, movement, and positioning of equipment and supplies; and general law enforcement. During the 2001 outbreak, the U.K. government had to request specialized animal disease support from several countries, including the United States, Canada, Australia, and New Zealand; hire thousands of private contractors to provide slaughter and decontamination support; and use military personnel to provide general logistical support. According to a U.K. government working paper issued in March 2002, during the peak of the outbreak, more than 7,000 civil servants, 2,000 veterinarians, and 2,000 armed forces personnel were involved in the response—making it a bigger and more complex logistical exercise than the United Kingdom’s involvement in the Gulf War. A recent test exercise in Iowa indicates that the personnel requirements to respond to an FMD outbreak in the United States would also be enormous—approaching 50,000 people to support a response. More specifically, according to APHIS estimates, the United States would be at least 1,200 veterinarians short of the required 2,000 to 3,000 specially trained veterinarians needed to respond to an animal health emergency. APHIS officials told us that while state and private veterinarians could help make up some of this difference, without appropriate training, their help would be of limited use. To address the personnel challenges posed by an FMD outbreak, USDA has undertaken several efforts. By partnering with FEMA and other emergency management organizations, USDA will be able to leverage these agencies’ resources to help provide many of the general logistical support activities. Similarly, USDA has established a memorandum of understanding with the Department of Defense to provide military personnel and equipment to support a response effort. In addition, APHIS has implemented an Emergency Veterinarian Officer Program to increase the number of veterinarians available to assist in an animal health emergency. The program trains federal, state, and private veterinarians to handle emergency situations. As of December 2001, APHIS had trained 276 emergency veterinarian officers, 145 of whom participated in responding to the U.K. outbreak. Moreover, USDA has trained 520 veterinarians across the country as foreign animal disease diagnosticians, and they may be called upon to provide specialized animal health support in the event of an outbreak. Finally, according to APHIS officials, USDA has informal arrangements with the United Kingdom and other countries to provide the United States with veterinary support. More formally, Australia, Canada, New Zealand, the United States, and the United Kingdom are currently drafting a memorandum of understanding that would allow the five countries to share veterinary resources in the event of an animal health emergency. In commenting on a draft of this report, USDA also indicated that it has created a National Animal Health Reserve Corps, composed of private veterinarians from around the country who would be willing to assist APHIS veterinarians in field and laboratory operations during a foreign animal disease situation. According to USDA, to date, more than 275 private veterinarians have signed on to this corps and the department is continuing its efforts to recruit more members. This corps will supplement the personnel drawn from states, and other federal agencies and organizations. A response infrastructure also requires a diagnostic laboratory system that is capable of handling the volume of testing and analysis necessary in the event of an outbreak. For example, from February through December 2001, the United Kingdom’s Pirbright Laboratory, that country’s primary reference laboratory, tested 15,000 samples for the presence of the FMD virus and performed 1 million monitoring tests to ensure that the disease had been eradicated. Nationwide, a total of 2.75 million samples were tested as part of the response to the outbreak. Despite this level of testing, according to U.S. veterinarians returning from the United Kingdom, the United Kingdom had unmet needs for laboratory assistance. In the United States, USDA’s Plum Island facility—the primary laboratory in the United States that is authorized to test suspected FMD samples—would be quickly overwhelmed in the event of an FMD outbreak, according to many federal and state officials with whom we spoke. Recognizing this potential problem, the National Association of State Departments of Agriculture recently recommended that the United States develop a national strategy for animal health diagnostic laboratory services that would include USDA’s Plum Island facility and its National Veterinary Services Laboratories at Ames, Iowa, as well as state and university laboratories. Currently, state diagnostic laboratories have no formal role in a foreign animal disease response. In addition, the Director of the Plum Island facility stated that the nation needs to look beyond Plum Island for laboratory support in the event of a large-scale FMD outbreak. He suggested that off-site noncentralized testing, using noninfectious material (tests that do not use the live virus), should be considered with backup testing support provided by Plum Island. APHIS officials told us that while the idea of a regional laboratory structure has merit, several issues would have to be addressed before such a structure could be implemented. For example, laboratory personnel would have to undergo continuous training and certification, and facilities would have to be renovated and maintained to provide state of the art capabilities. This would require a significant commitment of resources. In commenting on a draft of this report, USDA stated that as part of its efforts to strengthen homeland security preparedness, it is providing state and university cooperators with $20.6 million to establish a network of diagnostic laboratories dispersed strategically throughout the country. This network will permit the rapid and accurate diagnosis of animal disease threats. Moreover, USDA stated that earlier this year it allocated $177 million to make improvements at key locations, including its diagnostic and research facilities in Ames, Iowa, and Plum Island, and that $15.3 million was allocated to USDA’s Agricultural Research Service to improve rapid detection technology for FMD as well as other animal diseases. The effectiveness of a U.S. response to an FMD outbreak will require an animal identification and tracking system to allow responders to identify, control, and slaughter infected and exposed animals as well as clear animal disposal and indemnification policies. The 2002 farm bill, addresses animal disposal and indemnification issues by providing the Secretary of Agriculture with broad authority to hold, seize, treat, or destroy any animal, as well as to limit interstate livestock movement as part of USDA’s efforts to prevent the spread of any livestock disease or pest. The Secretary may also take measures to detect, control, or eradicate any pest or disease of livestock, as needed. In addition, the farm bill requires the Secretary to compensate owners on the basis of the fair market value of destroyed animals and related materials. USDA is currently trying to develop specific guidance on how these authorities will be implemented. Many epidemiologists believe that in the event of an FMD outbreak, successfully tracing affected animal movements within 24 hours is essential if the response is to be effective. However, the United States generally does not require animal identification, nor does it have a system for tracking animal movements. As a result, according to a USDA official, in the event of an FMD outbreak, USDA would likely have to rely on sales records to track animal movements, which could take days, or weeks, depending on the accuracy of record-keeping and producer/seller cooperation. The longer it takes to identify animals and track their movements from premise to premise, the more difficult it becomes to contain the outbreak. USDA officials told us that, depending on where the outbreak is first identified, it may be relatively easy or extremely difficult to trace. For example, if only one farm were infected and animals had not recently been moved on or off the premises, no tracing of live animals would be necessary. However, if the outbreak first appeared in a major market or feedlot where hundreds of animals move in and out on almost a daily basis, tracing would be very difficult and time-consuming. Recognizing the importance of an animal identification and tracking system, USDA began planning such a system 3 years ago, according to the Director of the National Animal Identification initiative. However, the industry resisted the concept because of the costs involved and the potential for the unauthorized disclosure of proprietary information. The Director noted that the events of September 11, 2001, as well as technological advances appear to be reducing the level of industry opposition to a national animal identification system. For example, this official told us that the National Cattlemen’s Beef Association recently indicated some support for such a system. However, the following issues will need to be resolved before a national system can be developed and implemented: The responsibility for funding the system. The type of technology that should be employed—strictly visual, electronic, or some combination. The amount of information that should be included on each animal’s identification tag or electronic-tracking device. The persons able to access this information. The information that should be shared with other federal departments and agencies. At what point on the farm-to-table continuum should identification end? In addition, during an FMD outbreak in the United States, the disposal of carcasses could become a significant challenge because of the potential number of animals that may have to be slaughtered. For example, during the U.K. outbreak, over 4 million animals, primarily sheep, were slaughtered for controlling the disease. According to USDA estimates, if the United States had an outbreak of comparable magnitude (affecting about 8 percent of the livestock population), over 13 million animals would be affected, and most of them would be cattle and hogs. Generally, disposal can occur by burial, incineration, or rendering. In the United States, according to USDA’s draft FMD response plan, burial would be the preferred method of disposal when conditions make it practical. The plan states that burial is the fastest, easiest, and most economical method of disposal. When burial is not feasible, the plan recommends incineration as the alternative means of disposal even though USDA recognizes that incineration is both difficult and expensive. According to a USDA veterinarian who helped during the U.K. outbreak, a 200-meter funeral pyre was used to incinerate 400 cows or 1,200 sheep or 1,600 pigs. Such a pyre required 1,000 railway ties, 8 tons of kindling, 400 wooden pallets, 4 tons of straw, 200 tons of coal, and 1,000 liters of diesel fuel. In addition, heavy equipment, such as bulldozers and a team of about 18 to 20 people, was needed to construct the pyre. Figures 5 and 6 show burial pits and incineration pyres used in the United Kingdom to dispose of slaughtered animals. According to the federal and state officials we spoke with, each of these disposal methods presents significant implementation challenges that have not yet been fully considered. For example, burial poses such challenges as the potential to contaminate groundwater, the need to identify burial sites and obtain appropriate federal and state permits and clearances in advance, and the potential to spread the disease if animals have to be transported to an off-farm burial site. For incineration, the incineration site has to be accessible to large equipment, and yet has to be sufficiently away from public view to minimize negative public reaction to the sight of large burning pyres. In addition, incineration could not only affect air quality but also may be ineffective because if not constructed properly, the pyres may not generate sufficient temperatures to completely incinerate the carcasses. According to a USDA veterinarian, in the United Kingdom the pyres generally burned for about 9 to 10 days before all of the carcasses were incinerated. Similarly, rendering poses challenges because transporting carcasses to rendering plants increases the risk of spreading the disease, and additional cleaning and disinfecting procedures would be needed at the rendering facility. Some U.S. veterinarians returning from the United Kingdom told us that during the outbreak, the United Kingdom faced many of these disposal challenges and they were concerned that the United States might not have devoted enough attention to deciding how it would address these or similar disposal issues. According to APHIS officials, USDA is currently creating digital maps of the whole country to help identify appropriate burial and incineration locations. In addition, USDA is trying to determine alternative uses of carcasses, such as safely converting the meat into food, and using vaccinations to limit the number of animals slaughtered and thus requiring disposal. Finally, clear indemnification and compensation criteria are needed to ensure producer cooperation to slaughter and dispose of infected and exposed livestock during an outbreak. During the U.K. outbreak, the government agency responsible for responding to the outbreak experienced delays in slaughtering animals because of farmers’ resistance and legal challenges. According to state and livestock association officials, indemnification would be a significant issue—one that could hamper a rapid response in the United States. USDA published a proposed rule on May 1, 2002, amending the indemnity provisions for its FMD-related regulations. This proposed rule clarifies how USDA will determine the value of animals and materials affected by an FMD outbreak and how indemnity payments will be made to claimants. USDA developed this proposed rule because it was concerned that potential delays to an FMD eradication program in the United States might occur because of producers’ perceptions that they might not be adequately compensated for the fair market value of destroyed animals, products, and materials as well as cleaning and disinfecting costs. Under the proposed rule, the federal government would pay 100 percent of the costs for the purchase, destruction, and disposition of animals if they become infected with FMD, as well as for materials contaminated with FMD and the cleaning and disinfection of affected premises, according to USDA. In commenting on a draft of this report, USDA agreed that animal identification, carcass disposal, and indemnity are all absolutely vital areas that have to be addressed before any major outbreak of disease. In this regard, USDA stated that it is working closely with the agricultural industries to provide forums for a national dialogue on the issue of a national identification plan for American livestock. The ultimate objective is to establish a national identification plan that provides the essential elements to improve emergency response and meet future needs. USDA further stated that it is investing in other options for disposing of carcasses on a large scale. Finally, USDA stated that it has extended the comment period from July 1 to July 31, 2002, for its proposed regulations that address how decisions regarding indemnity payments will be made in the event of an FMD outbreak. If an outbreak of FMD in the United States rages out of control, it could ultimately cost tens of billions of dollars and the destruction of millions of animals. To avoid such catastrophic consequences, the disease must be stamped out quickly. Although the federal government and state governments have made significant progress in developing and testing emergency response plans for an animal disease outbreak, such as FMD, significant issues remain unresolved. These unresolved issues could present major impediments to an effective and timely response if not addressed before an outbreak occurs. While USDA currently has several ongoing efforts to resolve many of these issues, the department has not established specific time frames for the completion of these efforts. We believe it is critical that adequate management attention and resources be made available to ensure that these issues are resolved expeditiously. To ensure that the United States is well positioned to respond effectively to an animal disease outbreak such as FMD, we recommend that the Secretary of Agriculture direct the Administrator of APHIS to develop a plan, which should include interim milestones and completion dates, for addressing the various unresolved issues that could challenge an effective U.S. response.

Summary: The 2001 outbreak of foot and mouth disease (FMD) in the United Kingdom decisively illustrated the devastation that this highly contagious animal disease can cause to a nation's economy. By the time the disease was eradicated, the United Kingdom had slaughtered more than 4 million animals and sustained losses of $5 billion in the food and agricultural sectors, as well as comparable losses to its tourism industry. Before 2001, the United Kingdom had been FMD-free for almost 34 years. Following the outbreak, the country was generally barred from participating in the international trade of live animals and animal products that could transmit the virus. The United States has adequate processes for obtaining information on foreign FMD outbreaks and providing the Department of Agriculture (USDA) and others with this information, but it lacks adequate processes for sharing this information with the Customs Service. The United States receives information on FMD outbreaks from USDA officials stationed abroad, international agricultural and animal health organizations, and foreign governments. These officials collect a wide array of agricultural and animal health information about the countries and regions in which they are stationed, which ensures that the United States has timely access to information on foreign FMD outbreaks. However, USDA's processes for disseminating information on foreign FMD outbreaks are uneven. U.S. measures to prevent the introduction of FMD are comparable to those used by other countries and have kept the United States free of the the disease for 75 years. Nevertheless, because of the nature of the disease and the risk inherent in the ever-increasing volume of international travel and trade, U.S. livestock remains vulnerable to the disease. USDA has a two-pronged approach to prevent FMD from reaching U.S. livestock. USDA tries to keep FMD as far as possible from U.S. borders by helping other countries control and eradicate the disease. USDA has developed and implemented specific preventive measures at ports of entry to ensure that international cargo, animals, passengers, and mail do not bring the disease into the United States. In the event of an FMD outbreak, the United States will face several challenges in mounting an effective and quick response, although USDA and many states have developed and tested emergency animal disease response plans.