BSE and variant CJD: Emerging science, public pressure and the vagaries of policy-making

Classical bovine spongiform encephalopathy (BSE) was first recognized in 1987 in the United Kingdom and ultimately spread to cattle across Europe and to the Middle East, North America and Japan through the movement of infected animals and contaminated meat and bone meal. The human expression of BSE, variant Creutzfeldt-Jakob Disease (vCJD), likewise was first identified in the UK and now has been observed in many countries due to human exposure to BSE contaminated products or to vCJD contaminated human tissues through transplantation and injection. BSE provides an example of an emerging infectious disease that demonstrates the challenges of policy-making in the face of rapidly changing science and public outrage pushing for action. Lessons learned through the BSE epidemic include: (1) beware of facts as new science continues to emerge; (2) complex issues rarely have simple solutions; (3) evaluate epidemics from a macro-epidemiologic perspective to understand their complexity and devise effective risk management strategies; (4) options always exist for prevention/control; (5) risk communications play a vital role before and during an emerging disease epidemic; and (6) risk management progress involves both science and politics. Adoption of One Health approaches involving systems thinking and shared leadership hold the most promise for effectively managing complex emergency global health issues like BSE.