238 P. Livingstone and N. Hancox
dynamics and be able to modify operations or
policies in order to ensure strategic milestones
are met within budget. As well as being account-
able to direct funders and key stakeholders, pro-
gramme managers will also need to be responsive
to wider public concerns relating to wildlife
disease control measures. Managers will need
access to ecological and wildlife management
expertise alongside veterinary and epidemiologi-
cal capability, and programme delivery will
need to be supported by ongoing effective
communications.
15.4 Options for Managing M. bovis
and its Transmission in Low to
Medium–High GNI Economies15.4.1 BackgroundIn 2016, countries in the low to medium–high
GNI economies contained 84% of the estimated
7.4 billion world population (Worldometers,
2016). Low to medium–high GNI populations
tend to be young, poorly educated, rural dwell-
ing and employed in agriculture (The World
Bank, 2016b). Randolph et al. (2007) consider
livestock to be an essential household asset in
rural and peri-urban parts of the low to
medium–high GNI economies. Livestock provide
nourishment, traction power, manure, fuel and
social status, and may even serve as banks.
Nevertheless, because of factors such as close
contact (often with shared housing), poor sani-
tation and consumption of raw milk, meat and
blood from animals (Mfinanga et al., 2003), peo-
ple living in these economies are exposed to
a disproportionately high share of zoonoses
( Randolph et al., 2007), including TB (Cosivi
et al., 1998; Mfinanga et al., 2003). This can
undermine the value of livestock as a means of
reducing poverty.
The need and ability to manage zoonotic
diseases such as TB is directly affected by health
priorities and availability of local and interna-
tional funding and resources. Over the last few
decades, low to medium–high GNI economy
countries have faced resource constraints and
declines in funding. Under such circumstances,
the type of veterinary and public health services
otherwise used to manage zoonotic diseases in
livestock in high GNI countries are not sustain-
able (Randolph et al., 2007). Furthermore,
because of migratory lifestyles, illiteracy, fragile
social contexts and remoteness, critical health-
care, veterinary services and information are
often unavailable to rural populations ( Randolph
et al., 2007; The World Bank, 2016b).
Despite these obstacles, livestock ownership
can offer pathways to alleviate poverty in low
to medium–high GNI economies. Perry et al.
(2002) provided a framework describing how
livestock could contribute to poverty reduction
by reducing the vulnerability of the household
livestock asset base, and by improving both pro-
ductivity and access to markets for produce.
Using this framework, Perry and Grace (2009)
forecast a reduction in livestock disease, and
improved availability of food and marketable
livestock products. They also identified that
value-adding and selling produce from small-
scale producers provided employment opportu-
nities, especially in a vertically integrated
system, all of which would assist in poverty
reduction.
Perry and Grace (2009) strongly supported
the reduction of zoonotic diseases, but noted
that the role of zoonoses and their impact on
poverty had not been investigated or evaluated
in poorer countries. Given that disease impacts
can be measured, this provides a means of deter-
mining the feasibility and costs of some form of
disease control. Perry and Grace (2009) caution
that the form of disease control must be socially
acceptable to the livestock-keeping community,
not impede farming systems and ideally be able
to be implemented from within the community.
They further identify Ecohealth as a trans-
disciplinary system to approach disease issues
that ‘aims to integrate human, livestock, wildlife
and ecosystem health, exploring their interde-
pendence’. Ecohealth appears very similar to the
current One Health concept that recognizes that
the health of humans and animals is interde-
pendent with one another and the ecosystem
they live in (OIE, 2016c). Positive and meaning-
ful collaboration between ecologists, sociolo-
gists, physicians, veterinarians, epidemiologists
and microbiologists under a One Health pro-
gramme provides the best chance of under-
standing and then controlling infectious
zoonotic diseases such as TB in low to medium–
high GNI economies.