Thirteen Years of Hell in Paradise: An Account of the Caribbean Amblyomma Programme

Contents

PREFACE

EDITOR’S FOREWORD

PROLOGUE:

SOME HISTORICAL PERSPECTIVES

CHAPTER 1:

IN THE BEGINNING …

CHAPTER 2:

IMPLEMENTATION: 1994 – 1995

CHAPTER 3:

REVIEW OF PROGRAMME DOCUMENTS FOR THE ERADICATION OF AMBLYOMMA VARIEGATUM FROM THE CARIBBEAN

CHAPTER 4:

MID 1995 TO SEPTEMBER 1996

CHAPTER 5:

OCTOBER 1996 TO SEPTEMBER 1997

CHAPTER 6:

THE MTR DEBRIEFING MEETING

CHAPTER 7:

1997 - 1998

CHAPTER 8:

1999 IN THE PINE

CHAPTER 9:

2000

CHAPTER 10:

ADMINISTRATIVE ANARCHY

CHAPTER 11:

2001

CHAPTER 12:

2002

CHAPTER 13:

DATABASE DILEMMAS

CHAPTER 14:

2003 - THE LAST OF THE BIG TIME SPENDING

CHAPTER 15:

MONOTONOUS MOVES

CHAPTER 16:

2004 - THE LAST YEARS IN ANTIGUA

CHAPTER 17:

2005

CHAPTER 18:

2006

CHAPTER 19:

THE LINGERING DEATH! OCTOBER 2006 – MAY 2008

EPILOGUE:

CONCLUSIONS AND LESSONS LEARNED

ACKNOWLEDGEMENTS & CREDITS

TABLES AND ANNEXES

Endnotes

PREFACE

This book is an informal and unofficial documentary of the history and implementation of the Caribbean Amblyomma Programme, known as the CAP. The Programme aimed to eliminate the Amblyomma tick from the whole of the Caribbean region because of the immense damage that it causes to livestock and because it transmits some very important diseases. I became involved in the CAP in 1994 when I received a telephone call from Food and Agriculture Organization (FAO) headquarters informing me that I was being transferred from the FAO regional Africa tick and tick-borne disease programme based in Zimbabwe to lead the new Programme in the Caribbean. There was to be no discussion or negotiation on the issue - I should pack my bags and transfer to the Caribbean immediately.

During the previous year the African programme had become highly political and controversial, and I, as the Programme Coordinator, was often caught in the middle of a deadlocked dispute between donors, African national governments and international agencies, including my own employer, the FAO itself. I felt marginalized and it seemed that I was considered by some to be a suitable scapegoat for a potentially disastrous political, no one wins, scenario. Ironically, however, many expert observers outside the African programme regarded it as a great success.

I soon realized the true meaning of the expression Out of the Frying Pan into the Fire! To even the most sunnily-disposed observer, the CAP must appear to be one of the most controversial and ill-conceived animal health interventions ever embarked upon by an international community. Its conception and incubation period took 13 years and its implementation another 12. Contrary to all logic, after running for 12 years it was terminated when the topical bont tick (TBT) had been eliminated from four islands, and another four had attained a very low prevalence of the tick. Its final eradication would have been a relatively simple, inexpensive and short-term task for the team of proven field-workers engaged on it.

The idea of writing this book came early in 1995, only a year after I joined the Programme. Even at that early stage, serious difficulties with the organization and funding were already apparent. As a starting point to my first Annual Report I reviewed the13-year pre-start-up phase of the CAP. This revealed the totally chaotic, contradictory and the rather acrimonious basis of the whole operation. The volume of correspondence and reports was so large and convoluted that it was impossible to write a comprehensive review within a reasonable period. During the last five years of the Programme (2002-7), however, an improved state of equilibrium, and realism, emerged, which made the idea of presenting the long history of the CAP more feasible, and the prospect, ultimately, of its success might have made for a happy ending and a contented retirement for me. Then the plug was pulled, just as success, at last, seemed attainable.

So, as my retirement loomed, I could not just let go. I had to commit the whole sorry mess to paper. I do this partly out of bitterness, but mostly in the hope that it may be read by those planning future programmes. I hope that it may encourage them to apply more common sense and common humanity than did many of those who were involved in the CAP.

Who said "It is better to have tried and failed than not to have tried at all"? One might have seen immediately prior to its implementation that the Programme was destined to fail! In many ways, however, it has not been a total failure and many positive things have happened, even if the ultimate goal of tick eradication was attained only in some of the islands.

This book tries to describe objectively the players, the partners and their politics within the environment in which the Programme operated. I have tried to avoid an "I am right and you are wrong" approach, and to apply water logic rather than rock logic. In any case, due to the very dynamic nature of the CAP, there was always a need for some flexibility as well as continuity, during its implementation. This happened far too infrequently during the Programme’s life. So, I have tried to promote the idea of the use of common sense throughout this analysis.

The establishment of any programme is complex and difficult. The views and objectives of scientists, donors, implementing agencies, and the various governments, must all be considered and harmonized. The setting-up of a governing body, the Amblyomma Programme Council (the APC) was particularly complicated because of the number of governments and dependencies involved (in this case more than 20), the multiplicity and diversity of interested parties, and of course the lack of clarity about who would provide the funds, and manage them effectively. The implications of this complexity should have been quite obvious from the start in view of the long preparatory period. The planners, presumably, were aware of the complications, and therefore, surely ought to have settled these basics before going on to the details of implementation. Unfortunately, the APC was never given the authority necessary to do even this, let alone to have any autonomy. Considering some of the history, the involvement of the Americans, British and French, and so many directly-involved but equally culturally diverse island governments, was entirely unprecedented. Thus, even the most unenlightened Council should have foreseen that some choppiness might be expected. However, with almost total consistency, the planners failed abjectly to recognize, let alone deal with, the potential complications. Consequently, throughout the operational life of the Programme, we, the field workers, were faced with one crisis after another. As this Report will show, far too much of our time was taken up in dealing with these crises rather than getting on with the real substance of the Programme. Sadly, however, the ultimate loser was the whole Caribbean community that would have benefited so greatly, had the Programme achieved its key objective - the eradication of the Amblyomma tick.

One of my main conclusions was fairly obvious from the beginning: International collaboration is an essential tool in the implementation of multi-donor, multi-institutionally funded programmes. Nevertheless, rather than a multitude of individual, potentially incompatible agreements being made, a single multi-organizational agreement is essential to synchronize and harmonize operations under a single autonomous body such as the APC. The APC should of course have been empowered with some legally acceptable authority, but it wasn’t. In describing the preparation and implementation of US International Cooperative Agreements, Wyss (2000) makes a very pertinent observation, emphasizing the importance of interpersonal relations during execution: "Experience has shown that the best agreement with the wrong mixture of people may not work as well as a bad agreement with the right mixture of people". We shall see throughout this book, just how true this observation is, and how different the outcome might have been had we been blessed consistently with more of the right mixture of the right people.

I wrap up this book with some brief remarks on lessons learned and my feelings at the time of the Programme’s closure, after the 13 years involvement in its implementation. If any one is brave enough to have another go at eradicating the TBT from the Caribbean, then I hope this book is a useful springboard!

Rupert Pegram, Antigua 2010

EDITOR’S FOREWORD

This is the first book that Rupert Pegram has written and it is the first that I have edited. We are both biologists so it is not a literary masterpiece. However, we believe that the message that it seeks to deliver is so clear that it will survive our literary depredations.

Up to the mid-1990s there were many internationally funded Research and Development Projects operating in the farming sector in Africa, Asia, Latin America and the Middle East. Many of them were joint ventures with farmers, veterinarians, scientists and agriculturists in their host countries. Not all of them were successful, but overall their contribution was very positive and they established enduring relationships between workers in the host countries, their international staff and the funding donors. For the past 10 years, however, there have been almost no field based Projects, anywhere in the Developing World. Instead, Aid funds earmarked for animal health purposes are mostly spent on research projects in First World universities and research institutes, and in vast internationally staffed institutes located in Developing World countries. Little goes directly to the supposed beneficiaries of the Aid, the Developing World countries themselves. Rupert and I deplore this situation and we believe that this policy of the Aid administrators, donor fund managers and politicians, should be questioned.

This book relates the history of the Caribbean Amblyomma Programme (CAP), one of the last big field Projects, from the viewpoint of its Technical Manager, Rupert Pegram. It ran from 1994-2007. It’s objective was to eliminate a particularly troublesome tick from the Caribbean region. The CAP was established and managed by a large number of national and international Agencies and it was funded by a consortium of national and international donors. It cost almost $M50 and it failed to achieve its objective.

Project planning began in 1982 but the first technical staff were not deployed in the field until 1994. Yes, it took a group of supposedly professional managers and politicians twelve years to plan a Project with a single key objective and the Project that they designed and subsequently managed sank into failure.

Rupert supports every detail of this sad story with dates, documentary evidence and names. His interpretation of the facts might sometimes be queried, but the facts themselves are solid. The final chapter summarises the main reasons for the CAP’s failure, then makes insightful recommendations for the design and management of Projects that future planners (and donors) would surely do well to heed.

The book describes the initial technical successes of the Project, then its descent into confusion, acrimony, duplicity, evasiveness and failure. The profound incompetence, and even malice, of some of the Project’s administrators is scarcely believable. There are some heroes, and they are given their rightful recognition, but there are some villains who surely should be ashamed of the damage they did to the Project and, thereby, to the Caribbean nations that were so badly let down by the Project’s failure.

Ironically, the two most important factors in the CAP’s failure were embedded in its structure and planning. The planners, in effect, designed failure into the Project and they persisted with their discredited procedures to the dismal end. With a multiplicity of managing agencies, participating countries and donor bodies, the planners, surely, should have insisted on a simple and clear management structure, but they did not.

No doubt there were difficult legal and political considerations but the planner’s ranks included diplomats, lawyers, accountants and supposedly professional managers. A number of eminent scientists were involved too. Instead of producing a workable Project Plan, they accommodated every interest group in the Project’s structure and decision-making processes. They left important legal issues unresolved and the bulk of the funds were consumed in administration rather than field work. Rupert appears to have been responsible, simultaneously, to about five different managers. He and his staff were best qualified to make decisions on technical matters and on the recruitment of technical staff, but the management structure made it all but impossible for them to do this.

The second embedded failure was purely technical. The Project’s tick eradication strategy had two key elements. The first was the systematic application of acaricidal (tick-killing) chemicals to all livestock for long enough to kill all the ticks. The second was a surveillance programme involving the careful examination of a sample of treated livestock for long enough to confirm that the tick had, indeed, been eradicated. Computer models were commissioned to define and monitor each of these procedures. From the outset, the technical staff said that the proposed timelines for both procedures were too short to guarantee success and that the computer models were based on unsound premises. The Project’s senior managers rejected their views – even when clear evidence of failure was accumulating from the field. Of course, extension of the timelines would have meant an increase in Project costs, but the inevitable failure of the Project to achieve its objectives surely should have been a more important consideration. Thus, the refusal of the management team to accept the advice of its own technical experts must be added to the catalogue of their collective incompetence.

I knew little of the history of the CAP when Rupert told me that he intended to write a book about it. He suggested that we should meet to chat about our various experiences of working in the field in Africa and elsewhere, and particularly of working on Aid funded Projects. He had been involved in tick-associated Projects, mostly in Africa prior to the CAP, for almost 30 years. I worked in the pharmaceutical industry for most of my career, mainly on the discovery and development of drugs for the treatment of tick-transmitted diseases of farm livestock. I ran field trials to test candidate new products in about 20 countries, half of them in Africa. I lived and worked in Africa for more than 10 years.

I left the industry for five years in the mid-1990s to run a British Aid funded Project at Muguga in Kenya. Its objective was to develop a system of immunising cattle against East Coast fever (ECF), a tick-transmitted disease that kills more than 600,000 cattle each year in Eastern Africa. The vaccine was crude but it protected cattle against ECF very effectively. It was based on work originally carried out at Muguga 30 years previously by a multinational team managed by FAO and funded by various donors, but because of bungling, bloody-mindedness, and worse, by a whole raft of Aid administrators, it had never been made available to cattle owners.

The new Project’s team of very competent and dedicated Kenyan veterinarians and technologists was given the task of testing the vaccine in field trials, developing a process for its large-scale manufacture, and then making it available to farmers to protect their cattle. Apart from a few finishing touches, we achieved all of these objectives. An agreement was made for Muguga to sell the vaccine to a local pharmaceutical company at a modest profit, which would pay for continuing research at Muguga. The company would distribute the vaccine to veterinary practitioners, and they would immunise cattle throughout the country.

Despite these successes, the Project was terminated in 1997 for reasons that were not made clear. Perhaps British Aid thought that our live vaccine would be made obsolete by a molecular vaccine, whose development they were also funding elsewhere. But that was more than 12 years ago and there is still no sign of the molecular vaccine. Whatever the reasons for the cancellation, the Kenyan staff were left with almost no Aid funds and the Project’s achievements mostly ran into the sand. I returned to the pharmaceutical industry to manage R&D in a company with special interest in African and Middle Eastern countries, with products for the control of ticks and tick-transmitted diseases. I left that job and set up a small consultancy business in 2005.

Throughout this time I came across Rupert, in the field, at scientific conferences and elsewhere. I also read some of his many publications, mostly on tick ecology and biology, and tick control. I came to respect him as a scientist, for his ability to build and work within Project teams in Africa, and for his determination to see that the results of their work would be helpful to hard-pressed farmers. His attitude towards senior managers in the Aid industry was sometimes cavalier and occasionally quixotic, but always sincere, and I respected this too. His philosophy and mine are very similar.

We talked about our experiences and opinions, and particularly about Rupert’s CAP, my ECF Project and my time in the pharmaceutical industry. Our views on the causes of the ultimate failure of the two Projects were strikingly similar. We agreed that the most fundamental ones had been their hopelessly top-heavy, and in parts incompetent, management.

Each year the higher managers of the ECF Project, together with expert consultants of their choosing, would conduct a Project Review. They would listen to the Project team’s reports, opinions and plans, then they would make alternative proposals. These were usually closely allied to the research interests of the managers and consultants, and of the universities and institutes to which they were attached. They seemed largely to ignore the needs of the farmers, the supposed beneficiaries.

Rupert regarded the CAP’s review meetings more positively than this, perhaps because he was closely involved in their planning and agenda setting, and he had a major say in the choice of external consultants. This said, some of the CAP reviews turned out badly and some resulted in acrimony between the various supporting Agencies. Amazingly, the CAP’s management system appeared to have no mechanism to resolve, or even to address, such disputes.

Over the years, I had listened to many Aid Project team members, including Rupert, complaining about the pig-headedness of their senior managers. By contrast, they were usually very complimentary about the support and insight of senior officials and politicians in their host countries. It was good to be able to agree that my counterparts in Kenya had also been outstandingly positive and supportive. I admit that mostly I attributed the gripes about their managers from other Projects around Africa to the petty grievances that we all feel when our views and suggestions are ignored. It was only when I joined a Project myself that I recognised how different their management systems were, compared with those I had known in the pharmaceutical industry.

In industry, project management structures are simple and direct. An R&D team comprises the minimum number of staff in each of the disciplines that will be needed to achieve the Project’s goals. The required disciplines are likely to change over time so there is constant movement of staff into and away from individual projects. All Project Leaders report to a single senior manager. Projects are reviewed regularly and sometimes an external consultant attends. The consultant, and his work, is always known and respected by team members. Senior managers from areas such as Marketing and Manufacturing are involved as necessary, particularly at the more advanced stages of a Project. In a research project, they decide whether the lead has commercial potential and whether its manufacture is feasible and cost-effective. If it isn’t, the project is cancelled. With product development projects, senior Manufacturing and Marketing managers handle the transfer of the product from R&D to their own areas of responsibility.

On joining the ECF Project, I was amazed to find that there were four or five levels of management above me, the Technical Advisor, though I never fathomed the exact management structure. The system seemed to be a complex of checks and balances aimed principally at ensuring compliance with management procedures rather than the achievement of Project objectives. Rupert’s catalogue of administrative and funding-centred difficulties in the CAP suggests that priorities there were similar.

Management Consultants are often derided as figures of fun, but I suspect that even the most callow of them would have a field day if invited to investigate management structures and performance in the Aid industry. They would surely conclude that their structures are ludicrously complex, inefficient and even obstructive to the achievement of their professed goals.

I fancy that the management consultant would say that the systems were a recipe for under-employed managers to indulge in work creation, principally to justify their own positions. They could be expected to make time-wasting requests for detailed reports on every aspect of the work in order to give the impression that they were doing something useful. Internal wrangling over who had authority over the decision-making process would be inevitable, but this would be trivial compared with the scramble to avoid responsibility when things went wrong. They would also waste a lot of money. The remorseless stream of unhelpful decisions from the CAP’s managers suggests that this analysis would describe them rather well. Perhaps the Aid industry should engage a Management Consultant on every project, at least in the planning stages. This suggestion would surely be rejected out of hand, but it would be fun to observe the consternation that it would cause !

Rupert implies that the CAP’s failure, and probably the perceived failure of other Projects, including mine, played a major part in the almost total abandonment, from the mid-1990s, of field-based research and development Projects. I suspect that much of the disappointment that he clearly feels over the circumstances of the CAP’s demise stem from his belief that it was a betrayal of the Developing World. The CAP’s project concept was fine. Its failure was due primarily to inept planning and incompetent management. If the planners had listened to the concerns of the scientists and made the necessary strategic changes, the Amblyomma tick would probably have been eradicated from the Caribbean and the image of field-based Projects would have been enhanced.

Instead, it has become increasingly difficult to secure research funding for any work that does not involve laboratory-based molecular biology. Molecular biology was heralded, probably justifiably, as the most promising source of new vaccines, against ticks themselves and the diseases they transmit, of diagnostic tests, epidemiological tools and much more. However, predictions of the costs and timescales to convert these advances into products that would benefit real farmers were wildly optimistic. They have not succeeded yet, and it is my belief that they will not do so until further important advances have been made elsewhere in fundamental studies of cell biology, immunology and molecular genetics, and in related disease areas such as malaria, AIDS and cancer.

I do not doubt that the quality of molecular research in the tick and tick-borne disease area is very good. The issue, though, is not the quality, but the relative quantity, of this research. It may be massive as a proportion of the Aid budget for animal health but it is minute compared with the effort on malaria, AIDS and cancer. Therefore, the chance that the key fundamental advances will be made in our area is surely very small. In effect, therefore, Developing World countries are subsidising basic research in the Developed World.

Meanwhile, the scientific press is packed with publications describing potential vaccines, exquisitely sensitive diagnostic tests, and gene sequences that explain all manner of tick-borne disease-related phenomena, but none of this has had much effect beyond the laboratory in which it was discovered. Furthermore, it is difficult to see how these ideas could be introduced effectively into farming systems, particularly to subsistence-level farmers, when most cows are milked by hand, much of the land is cultivated by hoes, and veterinary practitioners and their support services are scarce and poorly resourced.

Surely in the meantime we should develop available methods and knowledge to deliver effective, affordable and easily understandable solutions that do not depend on expensive laboratory support. We need to apply the SWAN principle – Supply What’s Available Now. It seems to me that the enthusiasm to introduce molecular solutions to the problems of subsistence farmers is rather like trying to develop fusion reactors to generate electricity in an age of steam power.

The research areas in which Rupert and I worked, ticks and tick-transmitted diseases, are particularly important to Developing World farmers. They kill millions of livestock every year. Effective means of controlling all of them are already in use, and some have been for many years, but they are not affordable by everyone and they are not always used to their best effect. For example, the veterinarians on my Project were able to cure more than 90% of cases of ECF, mostly with a single injection of drug, but many veterinary practitioners achieve only a 60% cure rate. The main reason is that it is difficult to diagnose and treat the disease early enough, so the veterinarian is mostly asked to treat very sick animals. It is also hard to recognise mixed infections with more than one disease, each of which is potentially fatal and which requires different treatment.

Projects that help farmers and veterinarians to use existing acaricides and curative drugs more effectively are surely what are needed. Diagnostic aids that the veterinarian can use on the farm to give quick and accurate results, so that treatment with the correct drugs can be given immediately, would be particularly helpful. Molecular biology has produced laboratory-based tests that can identify a single parasite in a billion host cells but there is no test that can tell the veterinarian that the sick cow in front of him is being overwhelmed by a particular disease. Supportive treatments and good nursing care by the animal owners are particularly important in restoring treated animals to good health and productivity, and they can save the cost of repeated visits by the veterinarian. Projects to address simple issues such as these would be relatively inexpensive. They could use mostly local expertise and they would give immediate benefits.

To give an example of this principle in action, the ECF immunisation Project at Muguga needed to know the incidence of ECF in the areas in which we were going to conduct vaccine trials so that we could judge the success of the trials. Higher management, on the advice of their independent consultants, offered a molecular epidemiologist to tackle the problem. The study would take a year, and it would require the establishment of a specialised molecular biology laboratory at Muguga. It would have told us how many animals had experienced ECF in the past but little about the current disease situation. The Project team members suggested an alternative approach. We should offer to treat, with curative drugs, any animal in the area suffering from ECF, free of charge. In this way we should quickly learn the prevalence of the disease and the ability of farmers to recognise it.

The response of the cattle owners to this offer was excellent but we were surprised to find that they did not report their sick animals to us until, on average, four days after they first suspected ECF. Most of the cases were in dairy cows and by this time most of them were very sick and producing almost no milk. We managed to cure only about 60% of them. After a few months, however, most cases were being reported to us by the second day of symptoms when the disease was still relatively mild. Now we were able to cure more than 90% of them, and their milk production returned almost to pre-disease levels within about 10 days.

This simple and inexpensive enterprise taught us far more than just the incidence of ECF in the area. We learned that the cattle owners (or in many cases, their wives) were very good at recognising even the early symptoms of ECF because more than 90% of the animals presented to us did, indeed, have ECF. Most importantly, the cattle owners came to trust us and they were very keen to have their animals included in our vaccine trials. This seems to me to be a good example of basic field-craft and the use of local knowledge – of farmers and Project team members – in action.

It is ironical that many of the people now in positions to influence the direction of Aid funded research and development, and to allocate funds to practical research, spent much of their earlier careers working on Projects in the field. Some were excellent field researchers, strongly motivated to help Developing World farmers. However, on moving into the higher strata of the Aid industry, or on being engaged as expert consultants, they seem to have become dazzled by the promise of novel, laboratory-based, research.

Consequently, unless a new Project proposal has a strong molecular biological or molecular epidemiological content, it has little chance of being funded. When an element of fieldwork is included in a successful proposal, its principal objective appears to be to test new molecular epidemiological tools to study a problem, while doing little to resolve it. A cynic might believe that its real purpose is to substantiate patent claims or simply to generate publishable data to enhance the reputation of the researchers and of the institutions in which they work.

There seems to be an antipathy in the Aid establishment towards anything to do with curative drugs despite their being the only available way to save livestock once they have contracted a tick-borne disease. If there is a fear that more widespread awareness of their efficacy would prejudice funding for vaccine research, it is surely misplaced because the tick and tick-borne disease problem is so vast that acaricides, drugs and vaccines together would still struggle to contain it.

The result of all of this is that competent and motivated research workers in the disease-affected countries are starved of funds and experienced former employees on field-based Projects have had to look for alternative employment. The one glorious exception is a Belgian veterinarian. Seemingly frustrated by the inability of the Aid establishment to implement ECF immunisation anywhere, she has set up an extremely successful free-lance programme in Northern Tanzania, using the original vaccine developed at Muguga 40 years ago.

Perhaps the pharmaceutical industry has something else to teach us. When faced with decisions on how best to apply limited R&D funds, their primary concern is to choose projects that will recoup the cost of a product’s development as quickly as possible, and then generate a good profit, by maximising its sales. Technical Aid, one assumes, aims to use its funds to produce the greatest possible benefit to its recipient countries and communities by reducing the impact of identified problems, to the greatest possible degree, in the shortest possible time. In both cases the best course of action should be to pursue the strategy that will most effectively tackle the identified problem.

In reality, industry’s strategy and that of the Aid bodies and academia for the control of ticks and tick-transmitted diseases have been almost diametrically opposite. Recent Aid policy has been overwhelmingly to support open-ended research on molecular vaccines and diagnostics. Industry, conversely, has produced acaricides and curative drugs but it has ignored molecular approaches almost completely.

Only one or two drugs are available to cure each of the tick-transmitted diseases but the industry’s strategy has been to produce generic copies of these, not to try to produce new ones. This is partly explained by the high cost of new drug discovery and development, but it also reflects the view that the existing drugs are very effective and the chances of finding better or less expensive alternatives, at acceptable cost, are small. Similarly with acaricides; they are all developed from products whose principal markets are in more wealthy countries. These drugs and acaricides save millions of cattle affected by ticks and tick-borne diseases each year. The supposed objective of Aid is to solve problems in poor countries, but its molecular approach over the last 30 years has yet to save its first cow.

I estimate that if only 20% of the Aid funding had been spent on providing curative drugs and acaricides to livestock owners who otherwise could not afford them, about a million more cattle could have been saved each year. If a further 5% were spent on field-based Projects to help veterinarians to increase cure rates from the current 60% to an achievable 90%, the figure would be nearer 1.5 million.

Meanwhile, it is worrying that the most expensive Aid-funded tick control Project ever undertaken – the CAP, and the most expensive assault on the control of tick-transmitted diseases, with live and molecular vaccines against ECF, have both failed to meet their objectives. Is it a coincidence that the strategists and consultants behind these two programmes were largely the same people, and that many of them are still in charge of Aid strategy ?

………. which brings us back to Rupert Pegram’s biography of the CAP. It could be seen simply as a sad indictment of the establishment, management and decision-making processes of one very large, very costly, internationally funded undertaking that failed to achieve its objective. But it is far more than that. Throughout the book, Rupert explains the Project’s failures and he suggests how they could have been avoided. He has the courage to name the people he believes were most responsible (and he takes some of the blame himself) but he also praises those who performed well. His sadness, and at times anger, that the farmers of the Caribbean were so badly let down by the failure of the CAP, is clear. This book is his plea to those in a position to influence Aid policy to have the courage and humility to learn from past mistakes and to re-establish a vigorous field research-based ethic, designed and managed for success rather than for failure.

This book deserves to be read widely. Its message is important and it is to be hoped that those in positions of influence in the business of International Aid will accept the sincerity of its message and act accordingly.

Nick McHardy,

Co. Wicklow, Ireland, September 2009

PROLOGUE:

SOME HISTORICAL PERSPECTIVES

The adult tropical Bont tick (TBT), Amblyomma variegatum, is a large and brightly coloured parasite that infests primarily domestic animals and wild ruminants. Its preferred host is domestic cattle, but it also infests sheep, goats, horses, dogs and some wild animals, especially large mammals. Immature ticks also feed on smaller mammals such as the mongoose, various reptiles and birds, notably the cattle egret, Bulbucus ibis.

The many species of Amblyomma ticks are distributed worldwide but the TBT itself is of African origin. It was first introduced into the Caribbean in about 1750 when tick-infested cattle were imported into the island of Guadeloupe from Senegal. It spread quickly to a neighbouring island, Marie Galante. A second introduction of the tick to the Caribbean is reported on cattle bound for Antigua in about 1865, but other records suggest that those animals, or perhaps another consignment of cattle some years later, were trans-shipped on the island of St Kitts on their way to Antigua. There is some confusion because local names were given to the Amblyomma ticks on each island.

In Antigua the TBT is known most commonly as the Antigua Gold tick but also as the St Kitts tick because of the historical belief that the infested cattle came from St Kitts. This same confusion may also have been responsible for the apparently erroneous belief that St Kitts was first infested in about 1909. The TBT is also called the Sink-in tick in Antigua, probably because the mouth parts penetrate so deeply into the skin. On other islands the tick is variously called:

•   Tique Senegalese in the French West Indies.

•   Crop Over tick in Barbados, as it is prevalent during the August crop over that is carnival period.

•   Pretty tick in St Kitts and Nevis.

•   Rasta or Reggae tick in Dominica and St Lucia because of its striking colouration.

The tick spread to other Caribbean islands from these original foci during the 20th century, and it was still spreading as recently as 1990. Most of the more recent spread was associated with the migration between islands of cattle egrets, which first arrived on some southern Caribbean islands via South America, from Africa around the 1950’s. The egrets then migrated north and colonized various additional islands in the 1960’s. Inevitably, therefore, all the other islands of the Caribbean, and also the mainland countries of North, Central and South America, were thereby exposed to the risk of infestation by the ticks and the diseases that they transmit, a potentially catastrophic state of affairs for the enormous cattle populations in these areas.

The bites of the tick are severe, and frequently result in septic wounds and abscesses. This is particularly damaging when the ticks attach to the teats of cows, and they can also cause considerable damage to hides and skins. Possibly even more importantly, the tick is the main vector of the rickettsia organism, Ehrlichia ruminantium, and the cause of heartwater disease, which affects all types of domestic ruminants: cattle, sheep and goats, and which can produce very high mortality rates. The TBT is also associated with a dramatic increase in the prevalence and severity of acute dermatophilosis, a skin disease of cattle caused by the bacterium Dermatophilus congolensis. In the Caribbean, acute dermatophilosis is the major cause of economic loss resulting from the presence of the tick. In St Kitts and Nevis almost 90% of the cattle died from dermatophilosis within a few years of the introduction of TBT.

Perhaps surprisingly, but very fortunately, heartwater disease is relatively uncommon in the Caribbean. The reasons for this will be discussed later in this report.

The first attempt in the Caribbean to eradicate the ticks was in the US Virgin Island (USVI) of St. Croix in 1968-1969. The campaign was successful, but the ticks re-established themselves on the island soon afterwards. Since then, it has also been eliminated from Culebra, Vieques, and Puerto Rico, and again, in a second campaign, from St. Croix. St. Croix was re-infested in 1987, and again in 2000, and Puerto Rico was re-infested in 1992. The re-infesting ticks were probably carried between islands by cattle egrets, but the tick was believed to have been eradicated once more from these islands in 1993. This demonstrates the pivotally important point that eradication is possible, but if tick-free status is to be maintained, eradication must be on a regional basis to ensure that islands freed of the tick do not become re-infested from nearby islands.

The continued spread of the tick in the 1970’s and 1980’s, the confirmation of the first occurrence of heartwater in the Caribbean (in 1980 in Guadeloupe and in 1984 in Antigua), and the apparently favourable climatic conditions for the tick in south, central and north America, led to the realization that eradication was essential if these mainland areas were to be protected from infestation by the TBT and the diseases that it transmits. A feasibility study and an economic assessment carried out in 1986 demonstrated convincingly that eradication from all the Caribbean islands was possible. An outline strategy and an organizational structure were defined, based on this feasibility study and it became the primary framework for the subsequent CAP proposals and documents.

During the original formulation of the CAP in the late 1980’s and early 1990’s, the overall cost was estimated to be US$ 35.0 million. In the immediately following years, the proposed budget was reduced, for no apparently logical reasons, to US$ 13.4 m for the Tropical Bont Tick (TBT) eradication programme in CARICOM countries and US$ 17.1 m for the French West Indies - a reduction of US$ 5.0 m, or around 15%. In 1995, however, a critical analysis and review of the CARICOM programme budgets and work plans by the CAP staff indicated that the proposal grossly underestimated the costs of two major inputs: staff requirements and the acaricidal (i.e. tick-killing) chemical that is applied externally to livestock to kill ticks. This was in part because livestock numbers were grossly underestimated, but also, and most importantly, because the unique style of livestock management on the islands was not understood so the difficulty of ensuring that every animal would be treated with acaricide was not recognised.

The 1995 review, discussed in detail in chapter 3, also considered some more recent appraisals made by prospective donors of funds because the 1994 document revision gave inadequate consideration to the various earlier evaluations. The main concerns were expressed by representatives of the British Overseas Development Agency (ODA) at both the 1992 and the 1994 FAO donor meetings, and also in an independent European Union (EU) appraisal in 1994. These findings are summarized here to emphasize the weight of opinion that the Programme needed expert re-appraisal prior to its implementation. The single most important concern, noted by the British representative, was that all the Programme budgets were grossly underestimated. These included unrealistically low cost estimates for treatment teams, vehicles and acaricide, and the likely need to continue the treatment campaigns for four years, not two.

Other concerns included the following:

•   Lack of clarity over the status of the USAID/USDA pilot project to be implemented in Antigua.

•   Effects of the intensive use of acaricide on the enzootic stability of tick-borne diseases on the islands.

•   Animal identification and handling methods in relation to Landless Farmers.

•   Absence of a precise definition of Tick-free Status and the duration of the post-treatment surveillance period necessary to confirm it.

•   Aspects of the proposed programme management infrastructure and project servicing costs.

The 1995 internal CAP review also identified serious technical flaws in the proposed implementation strategy for the field programme. It was stated that the acaricide will be applied in appropriate handling facilities for livestock. According to the need, the animal handling facilities will be either permanent or mobile and will be distributed at strategic locations on each island. This proposal was clearly illogical because most of the livestock owners were landless and/or only part-time farmers. Thus:

•   Exactly who would construct the facilities? Where would they be sited?

•   How many of the farmers would be willing to bring their livestock to the facilities?

The British experiences on St Kitts should also have been seen as very relevant as it was reported that the dip tanks that were built for earlier tick control activities were grossly under utilized because animals could be neither herded nor transported to these facilities. Unfortunately, it appears that yet again the experiences of those on the ground were ignored and no changes were made to the planned strategy. Regarding the estimates for the cost of acaricide, in an early draft it was calculated that 27,500 litres were required, costing US$ 532,000. This was increased subsequently to US$ 964,000, but our own 1995 appraisal indicated that at least 50,000 litres, costing US$1.0 million, would be required, even for a minimal two year treatment period. Moreover, these figures contrasted significantly with those in 1991 correspondence that indicated over US$ 4.0 m for acaricide, albeit that this figure may have included requirements for the French West Indies, in addition to the CARICOM islands.

In 1995, based in part upon independent appraisals of the Programme by the EU and ODA, the technical strategy was revised and reformulated. The new approach envisaged tick control treatments to be carried out by the livestock owners themselves at an opportunity cost of about US$ 8.2 million. Government inputs were estimated at US$ 2.85 m, and donor funding requirements were established at US$ 10.0 m, although it was accepted that even this figure was grossly inadequate. The revised estimates were based on the assumption that all livestock in TBT-infested islands would have to be treated regularly and repeatedly if eradication was to be achieved. For example, in Barbados between 1990 and 1995, the TBT had spread from a single location into nine out of the 11 parishes on the island. Furthermore, revised livestock census data and the aforementioned assumptions necessitated an increased estimate for acaricide of about 90,000 litres costing almost US$ 2.0 m, even for the inadequate two year treatment cycle in the CARICOM islands alone. Extension to a more realistic 4-year period of treatment and inclusion of the French West Indies would triple this cost.

Thus, the Programme began on a foundation of invalid assumptions and census data, and unrealistically low cost estimates that would be the cause of almost continuous dispute, acrimony, disruption and confusion throughout its life. Fortunately, the enthusiasm, expertise and teamwork of the national field staff were able, in part at least, to compensate for this dilemma.

CHAPTER 1:

IN THE BEGINNING …

The Conception Period

The tropical Bont tick (TBT), Amblyomma variegatum, was first formally described in 1794 in Africa by Neumann, but it had already been introduced into Guadeloupe, in the mid - 1700s, and into Antigua about 100 years later. It spread to Marie Galante soon afterwards. It was restricted to these three islands until about 1948 when it was introduced into Martinique on cattle transported from Guadeloupe. Thereafter, in the 1970’s, the tick spread rapidly to other islands, coincident with the migration and expansion of the population of cattle egrets, Bubulcus ibis.

Amblyomma variegatum was first reported in St Croix, USVI in 1967. It was believed to have been eradicated from the island in 1970, but further outbreaks were reported in 1987, 1993 and again in 2000, apparently carried by egrets. It was discovered on Puerto Rico in 1974 and efforts were made to eradicate it, but the island was not considered free of the tick until 1989, some 15 years later. The island then became re-infested in 1992. During the overview period, 1967-1990, the TBT became established on 18 Caribbean islands. It was estimated that if the TBT, and its associated diseases, heartwater and dermatophilosis, were to become widely established throughout their potential range in the Americas, annual losses to the livestock industry would be at least US$ 762 million.

During the 1980’s there was a great deal of concern over the potential problems associated with the continued spread of the TBT in the Caribbean, and particularly by the confirmation of heartwater, in Guadeloupe and in Antigua. Undoubtedly though, heartwater had been described clinically several times in the 1900’s in Guadeloupe although there was no definitive, bacteriological, confirmation of this. A few years later, the relationship between A. variegatum and the epidemiology of dermatophilosis was demonstrated, which added greatly to the concerns.

Following confirmation of heartwater in the Caribbean in 1980, and the perceived risk of its spread to the mainland, a USDA team visited the region in July 1981 on a fact-finding mission. The concept of a regional programme to eradicate A. variegatum from the Caribbean was conceived as a result of its findings. Unfortunately, the consequent activities were generally not well coordinated and did not progress in any meaningful way until the 1990’s. New ideas and new players often appeared in the files but there was little coherence or follow-up. No clear plan emerged and no single agency appeared to be in control. In November 1983, FAO held their 3rd Expert Consultation on Research on Tick-borne Diseases and their Vectors, in Rome. This meeting recommended that FAO should urge Caribbean governments to cooperate with each other and provide material support to eradicate heartwater, but interestingly not the TBT specifically, from Guadeloupe and Antigua, the only two islands in which, at that time, heartwater was known to exist.

These developments led to a re-assessment, in 1985, of the distribution of TBT in the Caribbean. Startlingly, it was confirmed that in recent years up to 18 islands had become infested. Later that year the first meeting of the CARICOM Chief Veterinary Officers (CVOs), held in Kingston, Jamaica, recommended a regional approach to the eradication of the TBT and that countries should undertake a pilot project to test the feasibility of proposed eradication procedures. In the same year, the Standing Committee for Ministers responsible for Agriculture (SCMA) meeting in Guyana, and the Inter-American Committee for Animal Health (IACAH), meeting in Brazil, reaffirmed the need for urgent and co-ordinated action against the continued spread of the TBT.

The US Animal Health Association (USAHA) meeting held in Wisconsin, later in 1985, urged USAID and USDA to support and fund a project for the eradication of A. variegatum from the whole Caribbean region. Immediately following, in January 1986, the US National Cattlemen’s Association (USNCA) annual meeting, held Texas, recommended that USAID and USDA/APHIS develop a specific operational plan to do this, because of their fear that the TBT and its associated diseases could spread to the American mainland.

These recommendations led to a technical meeting on the feasibility of TBT eradication being held in Washington, DC, in May 1986. This meeting proposed the creation of an Amblyomma Programme Council to develop the TBT eradication Programme policy and to oversee its implementation. Further endorsements by the USAHA in Kentucky in November 1986 and the NCA meeting in Nevada in January 1987 contributed to the formation of the Researchers Study Group; comprised mainly of staff at the USDA and IICA, with additional technical expertise from FAO, EMVT, ODA, the University of Florida, and the University of Utrecht, all of whom supposedly had expertise on the epidemiology and control of TBT.

The following year, in March 1987, CARICOM convened a "Technical Workshop on Amblyomma variegatum eradication" in Barbados at which the former proposal for the establishment of an Amblyomma Steering Committee, the predecessor to the Amblyomma Council (APC), was endorsed. The feasibility study report, "Management of the Tropical Bont Tick (Amblyomma variegatum) and Associated Diseases in the Caribbean" was distributed to interested parties in March 1987, and presented to the CVOs of all affected islands. A special meeting of the Standing Committee of Ministers responsible for Agriculture (SCMA) then formally approved the formation of APC. Its terms of reference and functions were defined as:

•   Development of policies and guidelines for the coordination of Amblyomma control activities in the Caribbean.

•   Appointment of independent technical advisors and consultants to guide the Council and prepare appropriate technical reviews or submissions to evaluate progress.

•   Review and recommend budgetary requirements and identify sources of funds.

•   Review, monitor and evaluate the current status of A. variegatum in the Caribbean and adjacent territories.

At last, a proposal for inter-Agency cross-fertilization first appears in this document, but as we shall see, it was a choppy Caribbean sea in which to attempt to plan such technical, logistical and financial collaboration. There were already numerous examples of activities being planned and carried out unilaterally without reference to other partners and a lack of overall coordination amongst them. Even the principal US agencies could not agree on the most important issue facing the planners: which acaricidal chemical, in which formulation and by which method of its application to livestock should be used in the eradication effort.

An environmental assessment for a proposed pilot eradication project on Antigua, originally comparing the amidine chemical amitraz and the synthetic pyrethroid permethrin, formulated for use in dip-baths, was prepared for USAID. These products were known to be very effective for control of TBT in Africa. In November 1987, the USAHA meeting in Kentucky again recommended that USDA and USAID should cooperate fully with islands in the Caribbean, International Organizations, and interested Governments to implement the strategies outlined in the feasibility study proposal, including the proposed pilot eradication project. The National Cattlemen’s Association meeting in the following January further recommended that the USDA and USAID support the specific operational plan for eradication of A. variegatum from the Caribbean region as set forth in the feasibility proposal. As noted previously, the US livestock industry was concerned over the possible spread to North America.

USDA/APHIS recommended that a synthetic pyrethroid product, Bayticol® (Bayer), should be used in the pilot project in preference to amitraz. The two were known to be approximately equally effective as acaricides but Bayticol has the