Case Study

Ebola Reston in the Philippines: Achieving

Commitment to Its Detection, Control and Elimination

16 Administrative 16 Administrative RegionsRegions

The PHILIPPINESThe PHILIPPINES

No. of Provinces 81No. of Cities 132No. of Municipalities 1,505No. of Barangays 45,888

3 Island Groups3 Island GroupsLuzon (north)Luzon (north)

VisayasVisayas (central)(central)Mindanao (south)Mindanao (south)

LUZON

MINDANAO

VISAYAS

PangasinanPangasinan

BulacanBulacan

Two Provinces with Ebola Reston Cases

THE VIRUSRNA VirusFamily: FiloviridaeGenus: Ebola virusAsian originEbola Virus Sub-Types1. Zaire (1976)2. Sudan (1976)3. Reston (1989)4. Côte d’Ivoire or Ivory Coast (1994)5. Bundibugyo (2007)

What was the purpose of providing research support to policy

Investigate the occurrence of Ebola Reston in the two pig farms Detect any viral circulation in the affected farm Assess the risk of Ebola Reston among animals and humans Find basis for quarantine and stamping out policies on the 2 farmsConduct surveillance in other parts of the country

and understand the epidemiology of Ebola Reston Virus. Protect the health of the general public especially those who are at high risk

Department of Agriculture

Bureau of Animal Industry DA Regional

Field Units (17)

Local Government Units Veterinary Schools

Int’l Organizations: FAO, WHO, OIE

NAC-ADCENAC-ADCERAC-ADCE

Philippine Veterinary Services

Department of Health

Processes by Which Decisions were Made and Actions Taken

Academe is represented in the Regional Advisory Committee for Animal Disease Control and Emergency (RAC-ADCE)RAC-ADCE submits policy recommendations

to National Advisory Committee (NAC-ADCE)NAC-ADCE transmits the policy recommendations to the Bureau of Animal Industry and then to the Secretary of Department of Agriculture

Policy Models Applicable in the Organizational Set-Up

Bounded-Rationality ModelRational Comprehensive ModelStages ModelPolicy Networks ModelMultiple StreamsPunctuated Equilibrium

Scoping

In Policy-MakingDepartment of Health- National Epidemiology Center, RITM, etcDepartment of Agriculture-Bureau of Animal IndustryInternational Organizations (WHO, FAO, OIE)Local government authorities

In Knowledge SynthesisAll relevant Stakeholders visitedAll relevant disciplines included

Boundary Setting

InInternational Organization’s supportGovernment supportLimited time for the investigation of Ebola occurrenceHuman resources Stakeholders

OutWildlife Experts

Problem Framing

Taking Values Into Account

International Organization – to protect international trade by avoiding spread of disease in other parts of the world. Department of Health – to promote welfare and reduce suffering of humansDepartment of Agriculture – to promote health and welfare of animals and promote farmer’s welfare

Harnessing & Managing Differences

Good DifferencesResearchers and policy makers working together to come up with policy on farm quarantine and Ebola controlContribution of media attention

Bad DifferencesDifferent timelines for researchers and policy makers

Who was intended to benefit?

Animals in the surrounding farms in the provinceThe farm workersThe slaughterhouse workersPeople coming in direct contact with the

exposed workers (e.g. family members, friends)The general public especially those at high risk in case of an epidemic

How, by Whom & When

HowI provided the research information

on Ebola investigation I engaged with the policy makers to discuss the best and rational/logical approach to decision making. I enlightened the media on Ebola

situation

Joint FAO/WHO/OIE Mission on Ebola Reston in pigs (6-15 January 2009)

ERV Mission Team

How, by Whom & When

Whom (Who was responsible)I served as a Member of the Ebola Reston Virus (ERV) Mission Team in Jan 2009Media was instrumental in provoking policy makers to make quick and rational decision.

Media Attention

How, by Whom & When

WhenAll throughout the research, discussion

with the policy makers happened. As vital information come in, policy recommendations are discussed. Guidance for future research and policy directions were deliberated upon.

Discussion with Policymakers

Over-All Contextual Factors

There was no policy history for ERV prior to investigation. Thus, the research influenced the decision.The initial decision was based on a bounded rationality model (precautionary approach).Policy makers were open to research for future guidance.

Openness to Research

Test for REBOV ELISA Ag

Representative samples

Antigen test

No further action

Negative

Positive

Test for REBOV ELISA Ag

Representative samples from

the farm

Antigen test

Identification and Quarantine of the

farm

Further epidemiologic

study

Positive

Negative

Continue quarantine until antigen negative Continue quarantine

until antigen negative

Lifting of Quarantine

Repeat blood collection (on same animals)

within one month

Legitimacy

Department of Agriculture and Department of Health (policy makers) co-funded and endorsed the research investigationKey People of good reputation in the Dept of Agriculture and Dept of Health were involved along with people from International Organization (WHO, FAO, OIE).I was taken as National Epidemiologistfrom the Academe. Also representing FAO Philippines.

Organizational Facilitators

Evidence-based research was able to influence the policy makersThe national and international interest on the issue and the urgency of the situation enabled research to influence the policy. The possible impact of political decision on public health safety (especially those at high risk), economy and political situation made the research output influential to policy making process.

What happened in terms of Policy Changes

Evidence-based policy on Ebola using bounded rationality model was designed. More evidences are coming in and a more appropriate rational comprehensive model is now being used. Bridge between research and policy

What did not Happen

Conclusive evidence on fruits bats as reservoir. More testing on bats have to be done. Wildlife experts were not part of the initial research investigation (Boundary Setting). Conclusive evidence on Ebola Reston transmission pathways. More research & policy must be done.

Reservoir???

?

Human to pig???

Human to human ???

Pig to human

ER

TRANSMISSION

x

x

Were Actions Successful?Successful in Engaging Policy Makers and Enlightening the MediaSuccessful in enforcing a precautionary measure that led to the stamping out of 6,000 pigs Successful in demonstrating Research and Policy in Disease (RAPID) Investigation

Thank You for Your

Attention!