Quantifying cost of disease in livestock: a new metric for the Global Burden of Animal Diseases.

BACKGROUND: Increasing awareness of the environmental and public health impacts of expanding and intensifying animal-based food and farming systems creates discord, with the reliance of much of the world's population on animals for livelihoods and essential nutrition. Increasing the efficiency of food production through improved animal health has been identified as a step towards minimising these negative effects without compromising global food security. The Global Burden of Animal Diseases (GBADs) programme aims to provide data and analytical methods to support positive change in animal health across all livestock and aquaculture animal populations. METHODS: In this study, we present a metric that begins the process of disease burden estimation by converting the physical consequences of disease on animal performance to farm-level costs of disease, and calculates a metric termed the Animal Health Loss Envelope (AHLE) via comparison between the status quo and a disease-free ideal. An example calculation of the AHLE metric for meat production from broiler chickens is provided. FINDINGS: The AHLE presents the direct financial costs of disease at farm-level for all causes by estimating losses and expenditure in a given farming system. The general specification of the model measures productivity change at farm-level and provides an upper bound on productivity change in the absence of disease. On its own, it gives an indication of the scale of total disease cost at farm-level. INTERPRETATION: The AHLE is an essential stepping stone within the GBADs programme because it connects the physical performance of animals in farming systems under different environmental and management conditions and different health states to farm economics. Moving forward, AHLE results will be an important step in calculating the wider monetary consequences of changes in animal health as part of the GBADs programme. FUNDING: Bill & Melinda Gates Foundation, the UK Foreign, Commonwealth and Development Office, EU Horizon 2020 Research and Innovation Programme.

Global losses due to dairy cattle diseases: A comorbidity-adjusted economic analysis.

An economic simulation was carried out over 183 milk-producing countries to estimate the global economic impacts of 12 dairy cattle diseases and health conditions: mastitis (subclinical and clinical), lameness, paratuberculosis (Johne's disease), displaced abomasum, dystocia, metritis, milk fever, ovarian cysts, retained placenta, and ketosis (subclinical and clinical). Estimates of disease impacts on milk yield, fertility, and culling were collected from the literature, standardized, meta-analyzed using a variety of methods ranging from simple averaging to random-effects models, and adjusted for comorbidities to prevent overestimation. These comorbidity-adjusted disease impacts were then combined with a set of country-level lactational incidence and/or prevalence estimates, herd characteristics, and price estimates within a series of Monte Carlo simulations that estimated and valued the economic losses due to these diseases. It was estimated that total annual global losses are USD 65 billion (B). Subclinical ketosis, clinical mastitis, and subclinical mastitis were the costliest diseases modeled, resulting in mean annual global losses of approximately USD 18B, USD 13B, and USD 9B, respectively. Estimated global annual losses due to clinical ketosis, displaced abomasum, dystocia, lameness, metritis, milk fever, ovarian cysts, paratuberculosis, and retained placenta were estimated to be USD 0.2B, 0.6B, 0.6B, 6B, 5B, 0.6B, 4B, 4B, and 3B, respectively. Without adjustment for comorbidities, when statistical associations between diseases were disregarded, mean aggregate global losses would have been overestimated by 45%. Although annual losses were greatest in India (USD 12B), the USA (USD 8B), and China (USD 5B), depending on the measure of losses used (losses as a percent of GDP, losses per capita, losses as a percent of gross milk revenue), the relative economic burden of these dairy cattle diseases across countries varied markedly.

Population, distribution, biomass, and economic value of Equids in Ethiopia.

BACKGROUND: Equids play a crucial role in the Ethiopian economy, transporting agricultural inputs and outputs in the dominant subsistence agricultural systems and the critical link for value chains throughout the country. However, these species are often neglected in policies and interventions, which reflects the data and information gaps, particularly the contribution of working equids to Ethiopia. OBJECTIVE: To assess population dynamics, distribution, biomass, and economic value of equids in Ethiopia. MATERIALS AND METHODS: Equine population data were obtained from the Ethiopian Central Statistics Agency (CSA) annual national agriculture surveys published yearbooks from 2004 to 2020. Parameters such as the number of effective service days and daily rental value were obtained from interviews and literature to estimate the stock monetary and service value of equids. Descriptive statistics were used to assess population dynamics and the geographical distribution was mapped. RESULTS: The estimated total Ethiopian equid population increased by more than doubled (by 131%) between 2004 and 2020 from 5.7 (4.9-6.6) million to 13.3 (11.6-15) million with 2.1 million horses, 10.7 million donkeys, and 380 thousand mules. Similarly, the number of households owning a working equid has increased. Equine populations are unevenly distributed across Ethiopia, although data were lacking in some districts of the country. The per human-capita equine population ranged from 0-0.52, 0-0.13, and 0-0.02 for donkeys, horses, and mules, respectively. The equid biomass was 7.4 (6.3-8.4) million Tropical livestock unit (TLU) (250 kg liveweight), 10% of total livestock biomass of the country. The stock monetary value of equids was USD 1,229 (651-1,908) million, accounting for 3.1% of total livestock monetary value and the services value of equids was USD 1,198 (825-1,516) million, which is 1.2% of Ethiopian 2021 expected GDP. CONCLUSION: The Ethiopian equine population has grown steadily over the last two decades. Equids play a central role in transportation and subsistence agriculture in Ethiopia and contribute significantly to the national economy. This pivotal role is insufficiently recognized in national livestock investments.

European soybean to benefit people and the environment.

Europe imports large amounts of soybean that are predominantly used for livestock feed, mainly sourced from Brazil, USA and Argentina. In addition, the demand for GM-free soybean for human consumption is project to increase. Soybean has higher protein quality and digestibility than other legumes, along with high concentrations of isoflavones, phytosterols and minerals that enhance the nutritional value as a human food ingredient. Here, we examine the potential to increase soybean production across Europe for livestock feed and direct human consumption, and review possible effects on the environment and human health. Simulations and field data indicate rainfed soybean yields of 3.1 ± 1.2 t ha-1 from southern UK through to southern Europe (compared to a 3.5 t ha-1 average from North America). Drought-prone southern regions and cooler northern regions require breeding to incorporate stress-tolerance traits. Literature synthesized in this work evidenced soybean properties important to human nutrition, health, and traits related to food processing compared to alternative protein sources. While acknowledging the uncertainties inherent in any modelling exercise, our findings suggest that further integrating soybean into European agriculture could reduce GHG emissions by 37-291 Mt CO2e year-1 and fertiliser N use by 0.6-1.2 Mt year-1, concurrently improving human health and nutrition.

Economic assessment of an intervention strategy to reduce antimicrobial usage in small-scale chicken farms in Vietnam.

Antimicrobials are a core aspect of most livestock production systems, especially in low-and middle-income countries. They underpin the efficient use of scarce feed resources and stabilize returns on capital and labor inputs. Antimicrobial use (AMU) contributes to the production of healthy animals, yet AMU in livestock is linked to antimicrobial resistance (AMR) in animals, humans and the environment. The Vietnamese Platform for Antimicrobial Reduction in Chicken Production was implemented during 2016-2019 and was one of Southeast Asia's first interventions focused on AMU reductions in livestock production. The project targeted small-scale commercial poultry farms in the Mekong Delta region of Vietnam using a "randomized before-and-after controlled" study design. It provided farmers with a locally adapted support service (farmer training plan, advisory visits, biosecurity, and antimicrobial replacement products) to help them reduce their reliance on antimicrobials. A partial budget analysis was performed comparing the control group (status-quo) and intervention group (alternative). The median net farm-level benefit of the intervention strategies with the project's support was VND 6.78 million (interquartile range (IR) VND -71.9-89 million) per farm. Without project support the benefit was reduced to VND 5.1 million (IR VND -69.1-87.2 million) to VND 5.3 million (IR -VND 68.9-87.5 million) depending on the antimicrobial alternative product used. At the project level with a focus on AMU and its reduction, subsequently influence on the resistance reduction, our results showed that achieving resistance reduction benefits with the current knowledge and technologies required investment of at least VND 9.1 million (US$ 395.10) per farm during the project's lifetime. The results highlight the positive net profit for the majority of enrolled farms and a reasonable investments from the project. The recommendation focuses on the implementation of policies on financial support, legislation, and information as potential solutions to facilitate the application of intervention strategies to reduce AMU in poultry production.

Current and potential use of animal disease data by stakeholders in the global south and north.

What cannot be measured will not be managed. The Global Burden of Animal Diseases (GBADs) will generate information on animal disease burdens by species, production system, type and gender of farmer and consumer, geographical region, and time period. To understand the demand for burden of animal disease (BAD) data and how end-users might benefit from this, we reviewed the literature on animal diseases prioritisation processes (ADPP) and conducted a survey of BAD information users. The survey covered their current use of data and prioritizations as well as their needs for different, more, and better information. We identified representative (geography, sector, species) BAD experts from the authors' networks and publicly available documents and e-mailed 1485 experts. Of 791 experts successfully contacted, 271 responded (34% response rate), and 185 complete and valid responses were obtained. Most respondents came from the public sector followed by academia/research, and most were affiliated to institutions in low- and middle-income countries (LMICs). Of the six ADPPs commonly featured in literature, only three were recognised by more than 40% of experts. An additional 23 ADPPs were used. Awareness of ADDPs varied significantly by respondents. Respondents ranked animal disease priorities. We used exploded logit to combine first, second and third disease priorities to better understand prioritzation and their determinants. Expert priorities differed significantly from priorities identified by the ADDPs, and also from the priorities stated veterinary services as reported in a survey for a World Organisation of Animal Health (WOAH) technical item. Respondents identified 15 different uses of BAD data. The most common use was presenting evidence (publications, official reports, followed by disease management, policy development and proposal writing). Few used disease data for prioritzation or resource allocation, fewer routinely used economic data for decision making, and less than half were aware of the use of decision support tools (DSTs). Nearly all respondents considered current BAD metrics inadequate, most considered animal health information insufficiently available and not evidence-based, and most expressed concerns that decision-making processes related to animal health lacked transparency and fairness. Cluster analysis suggested three clusters of BAD users and will inform DSTs to help them better meet their specific objectives. We conclude that there is a lack of satisfaction with current BAD information, and with existing ADDPs, contributing to sub-optimal decision making. Improved BAD data would have multiple uses by different stakeholders leading to better evidenced decisions and policies; moreover, clients will need support (including DSTs) to optimally use BAD information.

Rationalising development of classification systems describing livestock production systems for disease burden analysis within the Global Burden of Animal Diseases programme.

The heterogeneity that exists across the global spectrum of livestock production means that livestock productivity, efficiency, health expenditure and health outcomes vary across production systems. To ensure that burden of disease estimates are specific to the represented livestock population and people reliant upon them, livestock populations need to be systematically classified into different types of production system, reflective of the heterogeneity across production systems. This paper explores the data currently available of livestock production system classifications and animal health through a scoping review as a foundation for the development of a framework that facilitates more specific estimates of livestock disease burdens. A top-down framework to classification is outlined based on a systematic review of existing classification methods and provides a basis for simple grouping of livestock at global scale. The proposed top-down classification framework, which is dominated by commodity focus of production along with intensity of resource use, may have less relevance at the sub-national level in some jurisdictions and will need to be informed and adapted with information on how countries themselves categorize livestock and their production systems. The findings in this study provide a foundation for analysing animal health burdens across a broad level of production systems. The developed framework will fill a major gap in how livestock production and health are currently approached and analysed.

Strategies to reduce antimicrobials in livestock and aquaculture, and their impact under field conditions: a structured scoping literature review.

Antimicrobial resistance is a pandemic problem, causing substantial health and economic burdens. Antimicrobials are extensively used in livestock and aquaculture, exacerbating this global threat. Fostering the prudent use of antimicrobials will safeguard animal and human health. A lack of knowledge about alternatives to replace antimicrobials, and their effectiveness under field conditions, hampers changes in farming practices. This work aimed to understand the impact of strategies to reduce antimicrobial usage (AMU) in livestock and aquaculture, under field conditions, using a structured scoping literature review. The Extension for Scoping Reviews of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA-ScR) were followed and the Patient, Intervention, Comparison, Outcome, Time and Setting (PICOTS) framework used. Articles were identified from CAB Abstracts, MEDLINE and Scopus. A total of 7505 unique research articles were identified, 926 of which were eligible for full-text assessment; 203 articles were included in data extraction. Given heterogeneity across articles in the way alternatives to antimicrobials or interventions against their usage were described, there was a need to standardize these by grouping them in categories. There were differences in the impacts of the strategies between and within species; this highlights the absence of a 'one-size-fits-all' solution. Nevertheless, some options seem more promising than others, as their impacts were consistently equivalent or positive when compared with animal performance using antimicrobials. This was particularly the case for bioactive protein and peptides, and feed/water management. The outcomes of this work provide data to inform cost-effectiveness assessments of strategies to reduce AMU.

Approximating the global economic (market) value of farmed animals.

Understanding the global economic importance of farmed animals to society is essential as a baseline for decision making about future food systems. We estimated the annual global economic (market) value of live animals and primary production outputs, e.g., meat, eggs, milk, from terrestrial and aquatic farmed animal systems. The results suggest that the total global market value of farmed animals ranges between 1.61 and 3.3 trillion USD (2018) and is expected to be similar in absolute terms to the market value of crop outputs (2.57 trillion USD). The cattle sector dominates the market value of farmed animals. The study highlights the need to consider other values of farmed animals to society, e.g., finance/insurance value and cultural value, in decisions about the sector's future.

Attributing Ethiopian animal health losses to high-level causes using expert elicitation.

The Global Burden of Animal Diseases programme is currently working to estimate the burden of animal health loss in Ethiopia. As part of this work, structured expert elicitation has been trialled to attribute the proportion of animal health losses due to three independent and exhaustive high-level causes (infectious, non-infectious, and external). Separate in-person workshops were conducted with eight cattle, nine small ruminant, and eight chicken experts. Following the Investigate-Discuss-Estimate-Aggregate protocol for structured expert elicitation, estimates were obtained for the proportion of animal health loss due to high-level causes in different combinations of health loss, species, age-sex class, and production system. Three-point questions were used to inform beta-pert distributions and capture uncertainty in estimates. Individual expert estimates were aggregated by quantile mean to produce average distributions. Random samples from these average distributions estimated that infectious causes inflict the highest proportion of health loss in Ethiopia, with at least 40 % of health losses estimated to be due to infectious causes in all categories. This study provides a rapid, simple, and engaging method to attribute the burden of animal health loss at a high-level. Results are informative, however will become increasingly useful once they can be compared with results from more sophisticated, data-driven models.

Approaches for disease prioritization and decision-making in animal health, 2000-2021: a structured scoping review.

This scoping review identifies and describes the methods used to prioritize diseases for resource allocation across disease control, surveillance, and research and the methods used generally in decision-making on animal health policy. Three electronic databases (Medline/PubMed, Embase, and CAB Abstracts) were searched for articles from 2000 to 2021. Searches identified 6, 395 articles after de-duplication, with an additional 64 articles added manually. A total of 6, 460 articles were imported to online document review management software (sysrev.com) for screening. Based on inclusion and exclusion criteria, 532 articles passed the first screening, and after a second round of screening, 336 articles were recommended for full review. A total of 40 articles were removed after data extraction. Another 11 articles were added, having been obtained from cross-citations of already identified articles, providing a total of 307 articles to be considered in the scoping review. The results show that the main methods used for disease prioritization were based on economic analysis, multi-criteria evaluation, risk assessment, simple ranking, spatial risk mapping, and simulation modeling. Disease prioritization was performed to aid in decision-making related to various categories: (1) disease control, prevention, or eradication strategies, (2) general organizational strategy, (3) identification of high-risk areas or populations, (4) assessment of risk of disease introduction or occurrence, (5) disease surveillance, and (6) research priority setting. Of the articles included in data extraction, 50.5% had a national focus, 12.3% were local, 11.9% were regional, 6.5% were sub-national, and 3.9% were global. In 15.2% of the articles, the geographic focus was not specified. The scoping review revealed the lack of comprehensive, integrated, and mutually compatible approaches to disease prioritization and decision support tools for animal health. We recommend that future studies should focus on creating comprehensive and harmonized frameworks describing methods for disease prioritization and decision-making tools in animal health.

Livestock health and disease economics: a scoping review of selected literature.

Animal diseases in production and subsistence environments have the potential to negatively affect consumers, producers, and economies as a whole. A growing global demand for animal sourced food requires safe and efficient production systems. Understanding the burden of animal disease and the distribution of burden throughout a value chain informs policy that promotes safe consumption and efficient markets, as well as providing more effective pathways for investment. This paper surveys existing knowledge on the burden of animal disease across economic categories of production, prevention and treatment, animal welfare, and trade and regulation. Our scoping review covers 192 papers across peer-reviewed journals and reports published by organizations. We find there exists a gap in knowledge in evaluating what the global burdens of animal diseases are and how these burdens are distributed in value chains. We also point to a need for creating an analytical framework based on established methods that guides future evaluation of animal disease burden, which will provide improved access to information on animal health impacts.

The economic impact of endemic respiratory disease in pigs and related interventions - a systematic review.

BACKGROUND: Understanding the financial consequences of endemically prevalent pathogens within the porcine respiratory disease complex (PRDC) and the effects of interventions assists decision-making regarding disease prevention and control. The aim of this systematic review was to identify what economic studies have been carried out on infectious endemic respiratory disease in pigs, what methods are being used, and, when feasible, to identify the economic impacts of PRDC pathogens and the costs and benefits of interventions. RESULTS: By following the PRISMA method, a total of 58 studies were deemed eligible for the purpose of this systematic review. Twenty-six studies used data derived from European countries, 18 from the US, 6 from Asia, 4 from Oceania, and 4 from other countries, i.e., Canada, Mexico, and Brazil. Main findings from selected publications were: (1) The studies mainly considered endemic scenarios on commercial fattening farms; (2) The porcine reproductive and respiratory syndrome virus was by far the most studied pathogen, followed by Mycoplasma hyopneumoniae, but the absence or presence of other endemic respiratory pathogens was often not verified or accounted for; (3) Most studies calculated the economic impact using primary production data, whereas twelve studies modelled the impact using secondary data only; (4) Seven different economic methods were applied across studies; (5) A large variation exists in the cost and revenue components considered in calculations, with feed costs and reduced carcass value included the most often; (6) The reported median economic impact of one or several co-existing respiratory pathogen(s) ranged from €1.70 to €8.90 per nursery pig, €2.30 to €15.35 per fattening pig, and €100 to €323 per sow per year; and (7) Vaccination was the most studied intervention, and the outcomes of all but three intervention-focused studies were neutral or positive. CONCLUSION: The outcomes and discussion from this systematic review provide insight into the studies, their methods, the advantages and limitations of the existing research, and the reported impacts from the endemic respiratory disease complex for pig production systems worldwide. Future research should improve the consistency and comparability of economic assessments by ensuring the inclusion of high impact cost and revenue components and expressing results similarly.

Characterizing Ethiopian cattle production systems for disease burden analysis.

This paper addresses knowledge gaps in the biomass, productivity and value of livestock for the pastoral, mixed crop-livestock and specialized dairy systems in Ethiopia. Population size, reproductive performance, mortality, offtake and productivity of cattle were calculated from official statistics and a meta-analysis of data available in the published literature. This information was then used to estimate biomass and output value for 2020 using a herd dynamics model. The mixed-crop livestock system dominates the Ethiopian cattle sector, with 55 million cattle (78% total population) and contributing 8.52 billion USD to the economy through the provision of meat, milk, hides and draft power in 2021. By comparison, the pastoral (13.4 million head) and specialized dairy (1.8 million head) systems are much smaller. Productivity varied between different production systems, with differences in live body weight, productivity and prices from different sources. The estimated total cattle biomass was 14.8 billion kg in 2021, i.e., 11.3 billion kg in the mixed crop-livestock system, 2.60 billion kg in the pastoral system and 0.87 billion kg in the specialized dairy system. The total economic asset values of cattle in the mixed crop-livestock, pastoral and specialized dairy systems were estimated as 24.8, 5.28 and 1.37 billion USD, respectively. The total combined output value (e.g., beef, milk and draft power) of cattle production was 11.9 billion USD, which was 11.2% of the GDP in Ethiopia in 2021. This work quantifies the importance of cattle in the Ethiopian economy. These estimates of herd structure, reproductive performance, productivity, biomass, and economic value for cattle production systems in Ethiopia can be used to inform high-level policy, revealing under-performance and areas to prioritize and provide a basis for further technical analysis, such as disease burden.

The global burden of neglected zoonotic diseases: Current state of evidence.

The majority of emerging infectious diseases are zoonoses, most of which are classified as "neglected". By affecting both humans and animals, zoonoses pose a dual burden. The disability-adjusted life year (DALY) metric quantifies human health burden since it combines mortality and morbidity. This review aims to describe and analyze the current state of evidence on neglected zoonotic diseases (NZDs) burden and start a discussion on the current understanding of the global burden of NZDs. We identified 26 priority NZDs through consulting three international repositories for national prioritization exercises. A systematic review of global and national burden of disease (BoD) studies was conducted using pre-selected databases. Data on diseases, location and DALYs were extracted for each eligible study. A total of 1887 records were screened, resulting in 74 eligible studies. The highest number of BoD was found for non-typhoidal salmonellosis (23), whereas no estimates were found for West Nile, Marburg and Lassa fever. Geographically, the highest number of studies was performed in the Netherlands (11), China (5) and Iran (4). The number of BoD retrieved mismatched the perceived importance in national prioritization exercises. For example, anthrax was considered a priority NZD in 65 countries; however, only one national study estimating BoD was retrieved. By summing the available global estimates, the selected NZDs caused at least 21 million DALYs per year, a similar order of magnitude to (but less than) the burden due to foodborne disease (included in the Foodborne Disease Burden Epidemiology Reference Group). The global burden of disease landscape of NZDs remains scattered. There are several priority NZDs for which no burden estimates exist, and the number of BoD studies does not reflect national disease priorities. To have complete and consistent estimates of the global burden of NZDs, these diseases should be integrated in larger global burden of disease initiatives.

Animal sources of antimicrobial-resistant bacterial infections in humans: a systematic review.

Bacterial antimicrobial resistance (AMR) is among the leading global health challenges of the century. Animals and their products are known contributors to the human AMR burden, but the extent of this contribution is not clear. This systematic literature review aimed to identify studies investigating the direct impact of animal sources, defined as livestock, aquaculture, pets, and animal-based food, on human AMR. We searched four scientific databases and identified 31 relevant publications, including 12 risk assessments, 16 source attribution studies, and three other studies. Most studies were published between 2012 and 2022, and most came from Europe and North America, but we also identified five articles from South and South-East Asia. The studies differed in their methodologies, conceptual approaches (bottom-up, top-down, and complex), definitions of the AMR hazard and outcome, the number and type of sources they addressed, and the outcome measures they reported. The most frequently addressed animal source was chicken, followed by cattle and pigs. Most studies investigated bacteria-resistance combinations. Overall, studies on the direct contribution of animal sources of AMR are rare but increasing. More recent publications tailor their methodologies increasingly towards the AMR hazard as a whole, providing grounds for future research to build on.

The DECIDE project: from surveillance data to decision-support for farmers and veterinarians.

Farmers, veterinarians and other animal health managers in the livestock sector are currently missing sufficient information on prevalence and burden of contagious endemic animal diseases. They need adequate tools for risk assessment and prioritization of control measures for these diseases. The DECIDE project develops data-driven decision-support tools, which present (i) robust and early signals of disease emergence and options for diagnostic confirmation; and (ii) options for controlling the disease along with their implications in terms of disease spread, economic burden and animal welfare. DECIDE focuses on respiratory and gastro-intestinal syndromes in the three most important terrestrial livestock species (pigs, poultry, cattle) and on reduced growth and mortality in two of the most important aquaculture species (salmon and trout). For each of these, we (i) identify the stakeholder needs; (ii) determine the burden of disease and costs of control measures; (iii) develop data sharing frameworks based on federated data access and meta-information sharing; (iv) build multivariate and multi-level models for creating early warning systems; and (v) rank interventions based on multiple criteria. Together, all of this forms decision-support tools to be integrated in existing farm management systems wherever possible and to be evaluated in several pilot implementations in farms across Europe. The results of DECIDE lead to improved use of surveillance data and evidence-based decisions on disease control. Improved disease control is essential for a sustainable food chain in Europe with increased animal health and welfare and that protects human health.

Methodological choices in brucellosis burden of disease assessments: A systematic review.

BACKGROUND: Foodborne and zoonotic diseases such as brucellosis present many challenges to public health and economic welfare. Increasingly, researchers and public health institutes use disability-adjusted life years (DALYs) to generate a comprehensive comparison of the population health impact of these conditions. DALYs calculations, however, entail a number of methodological choices and assumptions, with data gaps and uncertainties to accommodate. Thisreview identifies existing brucellosis burden of disease studies and analyzes their methodological choices, assumptions, and uncertainties. It supports the Global Burden of Animal Diseases programme in the development of a systematic methodology to describe the impact of animal diseases on society, including human health. METHODS/PRINCIPAL FINDINGS: A systematic search for brucellosis burden of disease calculations was conducted in pre-selected international and grey literature databases. Using a standardized reporting framework, we evaluated each estimate on a variety of key methodological assumptions necessary to compute a DALY. Fourteen studies satisfied the inclusion criteria (human brucellosis and quantification of DALYs). One study reported estimates at the global level, the rest were national or subnational assessments. Data regarding different methodological choices were extracted, including detailed assessments of the adopted disease models. Most studies retrieved brucellosis epidemiological data from administrative registries. Incidence data were often estimated on the basis of laboratory-confirmed tests. Not all studies included mortality estimates (Years of Life Lost) in their assessments due to lack of data or the assumption that brucellosis is not a fatal disease. Only two studies used a model with variable health states and corresponding disability weights. The rest used a simplified singular health state approach. Wide variation was seen in the duration chosen for brucellosis, ranging from 2 weeks to 4.5 years, irrespective of the whether a chronic state was included. CONCLUSION: Available brucellosis burden of disease assessments vary widely in their methodology and assumptions. Further research is needed to better characterize the clinical course of brucellosis and to estimate case-fatality rates. Additionally, reporting of methodological choices should be improved to enhance transparency and comparability of estimates. These steps will increase the value of these estimates for policy makers.

Reporting on 16 years of laboratory capacity building while exploring the future of WOAH's Laboratory Twinning Programme.

Animal health laboratories are an increasingly important part of safeguarding animal and public health due to their role in surveillance and diagnostics of animal diseases, food safety, and in the development and production of medicinal products, vaccines, and diagnostic tools. Despite their importance, the global distribution of veterinary laboratory expertise is uneven, with greater concentration of reference laboratories in wealthier countries. To address this issue, the World Organization for Animal Health (WOAH, founded as OIE) created a Laboratory Twinning Programme in 2006. The paper will briefly review this Programme in the context of an increasingly populated global health security field, based on a literature review and on a combination of public and internal WOAH data and describe the implementation of the Programme in the past 16 years, noting the drivers for project implementation, its links with the global livestock biomass distribution and with the current distribution of veterinary laboratory expertise. There has been broad uptake and diversity in the focus of the twinning projects implemented in WOAH Member Countries. The Laboratory Twinning Programme would benefit from an evaluation that looks at its outcomes and quantifiable impact in beneficiary countries. A case is made for the development of a monitoring and evaluation system tailored to the Programme's specificities.