Citizens' juries give verdict on whether private practice veterinarians should attend unvaccinated Hendra virus suspect horses

Abstract

Background Hendra virus (HeV) is endemic in Australian flying foxes, posing a threat to equine and human health. Equine vaccination remains the most effective risk mitigation strategy. Many horses remain unvaccinated – even in higher‐risk regions. Debate surrounding the vaccine's use is characterised by conflicting perspectives, misunderstanding and mistrust. Private veterinary practitioners are critical to early identification of public health risk through recognition, sampling and management of suspect‐equine‐HeV‐cases. However, managing such cases can be burdensome, with some veterinarians opting not to attend unvaccinated horses or to abandon equine practice because of risk posed by HeV disease and liability. Objective Ascertain the perspectives of informed citizens on what obligations (if any) private veterinarians have to attend unvaccinated horses with HeV or HeV‐like disease. Methods Three citizens' juries were tasked with considering approaches to managing HeV risk in Australia, including (reported here) roles and obligations of private veterinarians in responding to HeV‐suspect‐cases. Results Jurors acknowledged that HeV management posed an important challenge for private veterinarians. A clear majority (27 of 31 jurors) voted that veterinarians should not be obliged to attend unvaccinated horses. All recognised that greater support for veterinarians should be a priority. Conclusions When informed of HeV risks and strategies for control and management, citizens appreciated the need to support veterinarians performing this critical ‘One Health’ role for public benefit. The current governance framework within which zoonotic disease recognition and response operates limits the contingency and scope for increasing support and efficacy of these important veterinary public health practices.

‘It's our job’: Constraints to investigation of atypical disease events—Opinions of Australian veterinarians

“…Some practitioners referred to funding assistance available through the National Significant Disease Investigation Program; however, the remit of this programme is predominantly focused on livestock and wildlife diseases, extending to companion animals in only some state jurisdictions (Animal Health Australia [AHA], 2019; Annand et al., 2020). The lack of structured assistance available to small animal practitioners—in particular access to free or subsidized pathology testing through government laboratories—has real potential to heighten vulnerability to an emerging disease outbreak.…”

“…This often related to concerns about the possible risk of infection to themselves and others, along with unfamiliarity with appropriate procedures and support available from government veterinarians. Such concerns could be driven by experiences with Hendra virus, which resulted in veterinarians leaving equine practice due to personal health concerns, as well as work health and safety responsibilities and threat of litigation when managing potential and confirmed Hendra virus cases in horses (Annand et al., 2020; Mendez et al., 2017). These findings need to be considered in light of a recent study showing a high prevalence of imposter syndrome, the tendency to doubt one's abilities despite positive evidence to the contrary, amongst veterinarians (Kogan et al., 2020).…”

Hendra virus: to vaccinate or not to vaccinate? What is the alternative?

“…Citizen juries have been used to elicit the views of well-informed people on various control measures for reducing the risks associated with HeV infection. 15,16 Three juries reported that, although ecological strategies should be included in HeV risk management strategies, currently recommended interventions, including vaccination and changing horse husbandry practices, must remain a high priority. 16 Jurors acknowledged that HeV management posed an important challenge for private veterinarians, but the majority of jurors believed that veterinarians should not be obliged to attend unvaccinated horses.…”

“…16 Jurors acknowledged that HeV management posed an important challenge for private veterinarians, but the majority of jurors believed that veterinarians should not be obliged to attend unvaccinated horses. 15 One of the major difficulties facing vets is that the communication of the risks associated with HeV infection and the consequences of not vaccinating horses against this virus needs to be carried out in advance of the horse becoming sick. Although many vets have ready access to information for clients, and the majority inform clients about HeV-related risks when a horse appears sick, 17 by the time a vet is called to attend a sick horse, it is too late to discuss whether the horse should be vaccinated against Hendra.…”

“…In general, the public understands the risks associated with HeV infection and the role of vaccination in alleviating that risk. Citizen juries have been used to elicit the views of well‐informed people on various control measures for reducing the risks associated with HeV infection 15,16 . Three juries reported that, although ecological strategies should be included in HeV risk management strategies, currently recommended interventions, including vaccination and changing horse husbandry practices, must remain a high priority 16 .…”