Strategies for the Global Eradication of Peste des Petits Ruminants: An Argument for the Use of Guerrilla Rather Than Trench Warfare.

Many historical disease eradication campaigns have been characterized by large-scale mobilization and long-term campaigns of mass vaccination. As the duration of a program increases, the total cost also increases, but the effectiveness and sustainability decrease, sometimes resulting in premature loss of stakeholder support, field team fatigue, and failure or major set-backs. In contrast to this trench warfare approach, this paper proposes an eradication strategy modeled on guerrilla tactics: use exceptionally good, locally relevant and timely intelligence; strike rapidly and effectively in small areas; achieve your goals; and keep moving. For peste des petits ruminants eradication, this means a shift away from long-term mass vaccination, focusing instead on addressing some of the challenges that have plagued previous eradication programs: ineffective surveillance and movement management. Recent developments in surveillance have shown that it is now feasible to capture information about almost all cases of disease, all movements and all control activities, from the entire population in real time. Developing powerful, effective and sustainable surveillance systems is an essential prerequisite for rapid, affordable PPR eradication. PPR can be rapidly eliminated from small populations by achieving very high levels of vaccination coverage for only a short period. The key challenge is then to prevent the re-introduction of disease as immunity wanes, and to respond rapidly and effectively in the case of further local outbreaks. A comprehensive understanding of movement patterns and their drivers will allow rapid progressive eradication to be implemented. The population can be divided into manageably small units, targeted sequentially for high-coverage short-duration vaccination, then moving to the next unit based on the distribution of disease and the direction of animal flow. This approach optimizes the use of available resources, and minimizes the challenge and disruption of managing retrograde movement from infected to uninfected areas. High levels of community engagement are required to achieve the quality of surveillance, movement management and rapid response necessary for success. Traditionally, long-term vaccination has been used to first eliminate the virus from a population, and then to protect it against re-introduction of the disease. Under the guerrilla strategy, continuous real-time information, not long-term vaccination, is the main tool for disease eradication.