Bovine tuberculosis

Perspectives on Global Bovine Tuberculosis Control 253

control options, such as culling, are constrained
by national legislation, this is more than a philo-
sophical question, and generates considerable
obstacles to the development and implementa-
tion of national disease control policies.
As was noted in Chapters 6 and 7, the
multi-host nature and environmental survival
of pathogenic mycobacteria generates complex-
ity in disease control. While there is much
research on the infection in different species and
even of multi-host epidemiology, the role played
by an environmental component is sometimes
ignored or over-simplified in its presentation.
More research is justified on the ability of myco-
bacteria to survive outside of an animal host
and the conditions that favour this. Greater
understanding in this area will help epidemio-
logical investigation, mathematic disease model-
ling, and ultimately which control options are
developed and employed.
As noted by Livingstone in Chapter 15, the
reality of managing M. bovis, wherever it is
found, is that it requires adequate resources.
These are either lacking or prioritized for other
needs and wants for large sections of the world.
To our knowledge there has been no systematic
review of the international funding picture for
M. bovis. This needs to differentiate between
investment from international bodies such as
the WHO and the proportion of gross national
income (GNI) spent on TB control. Expenditure
will need to be broken down into broad catego-
ries, such as surveillance, compensation or
research. This is a prerequisite for understand-
ing how impactful this expenditure is, or for con-
ducting retrospective or prospective benefit–cost
analyses. A major difficulty with TB benefit–cost
analyses is obtaining or deriving a monetary

value for the benefits. Gaining agreement as to

who is responsible for funding a TB strategy is a

major challenge for a sustained programme

with a long time frame.

Infection of humans with M. bovis within

countries of lower GNI is gaining greater recog-

nition as a ‘hidden zoonosis’. Beyond the ethical

imperative to address this, further work is needed

to understand the significance of the zoonosis as

a driver of poverty itself. What is feasible in terms

of TB control within low GNI countries will be

very different to what is feasible within higher

GNI countries, and must be developed as a col-

laboration between different disciplines and

community representatives with a clear appre-

ciation of what is socially acceptable and practi-

cal in each case. Effective communication and

knowledge sharing is crucial to success. At the

time of writing (August 2017) there were multi-

institutional efforts from WHO, OIE, FAO and

The Union to officially launch a ‘Road Map’ to

address the global challenges posed by zoonotic

tuberculosis.

16.6 Conclusion

In this book, leading researchers have provided

an update on our knowledge of bovine TB and

the many obstacles that remain to eradication of

this disease as a threat to humans and animals.

The goal of eradication can only be achieved

through a holistic approach that integrates cur-

rent thinking and translates it to novel modali-

ties for disease control. This is a substantial

challenge but inspired by the information con-

tained herein, one that we strive to achieve.

References

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