The use of participatory modelling to inform management of endemic foot-and-mouth disease: A case study from Nusa Tenggara Barat, Indonesia

Management of infectious diseases such as foot-and-mouth disease (FMD) in the endemic situation in smallholder farming systems brings significant challenges. While spatially explicit agent-based models (ABMs) are useful to inform disease response decision-making, complementary methods are needed to more fully capture the influences of context on disease control and management, such as human behaviour and ecological factors which are of particular importance for endemic diseases. We describe the development of an integrated Participatory Modelling approach (PM) applied to the control of FMD within Nusa Tenggara Barat, Indonesia, wherein participatory epidemiology and causal loop diagrams (CLD) were used alongside an ABM of FMD transmission to inform recommendations and potential strategies for disease elimination. These techniques enabled greater focus on the impact of socio-economic and cultural factors for management and control of endemic FMD in Nusa Tenggara Barat. The PM framework facilitated integration and interaction of methodologies, where data collected using participatory epidemiology approaches to stakeholder engagement informed development of both the ABM and CLD. The CLD highlighted that cattle movements, as a major contributor of risk of FMD exposure and infection, were driven by the socioeconomic relationship between smallholder farmers and livestock collectors. Vaccination was also identified as critical for FMD control, with the CLD indicating this would require both effective vaccine delivery systems and farmer engagement and education, underpinned by partnership between provincial governments and animal health leadership. Adoption of PM in both epidemic and endemic animal disease management development allows contextual factors of 'how we can get things to happen' and 'what actions are feasible' to act as modifiers for quantitative recommendations of 'what can be done', promoting consensus and engagement with the many stakeholders required for effective disease control and management.