Coming up on tonight\u2019s show… Is the Hendra vaccine a cash cow for manufacturer, Zoetis? Are the vets pushing Zoetis\u2019 barrow? Will the vets pushing Zoetis\u2019 barrow that is carrying the cash cow be able to take their hands off the barrow and put down their grim reapers\u2019 scythes for long enough to wipe the sweat off their hazard suit visors and treat your horse for colic?<\/strong><\/p>\n Let\u2019s find out. Joining us on THM Q&A is…Dr Deborah Middleton <\/strong>BVSc, MVSc, PhD (DM), veterinary pathologist and leader of the prize-winning, vaccine-creating CSIRO team; Equestrian Australia CEO Grant Baldock<\/strong> (GB); outspoken equine vet and endurance enthusiast Dr Matthew Walker<\/strong> BVSc (MW); Dr Nathan Anthony<\/strong> BVSc(Hons), MANZCVS (NA), President of the Equine Veterinarians Association (EVA); Assoc.Professor in Equine Medicine at Charles Sturt University – Dr Sharanne Raidal<\/strong> BVSc, MVSt, PhD, GradDipEd, FANZCVSc(SR); Pakenham equine vet Dr David Clemence <\/strong>BVSc (DC), and a spokesperson for pharmaceutical company, Zoetis <\/strong>(Z).<\/p>\n THE BY-LAW<\/strong><\/p>\n THM: Why create and then revoke the Hendra Vaccination By-law? <\/strong><\/p>\n Grant Baldock:<\/strong> Hendra was a biosecurity issue for EA long before the vaccine – protecting horse and human health was the driving force behind the 2014 By-law. For \u2018high risk\u2019 events, mandatory vaccination is the most practical way to reduce risk. However we recognise our members require more info, time, engagement. EA revoked the By-law in Feb 2015 in order to assess member concerns \u2013 especially exports, other industry policies and adverse reactions. There will be opportunities to review the panel\u2019s findings when published later this year.<\/p>\n THE VACCINE<\/strong><\/p>\n THM: Deb Middleton – how did you come to be involved with Hendra?<\/strong><\/p>\n DM:<\/strong> I was one of the few vets internationally working with animals at Biosafety Level 4 (BSL-4 ) (we are talking Ebola level, here \u2013 THM), so Hendra came under my responsibility at CSIRO. Our lab has been involved since this virus was discovered around 20 years ago. Labs in France, Canada and the USA have also researched Hendra and Nipah using cats, ferrets, hamsters and primates. But Redlands and Cawarral were a turning point, because I was involved in their field post-mortems. I knew from our lab work that it was comparatively easy (scientifically) to protect animals from Hendra by vaccination. When I saw the impact of those outbreaks on the people, their families and businesses, in a situation where science could actually help, it was clear that we needed to create the horse vaccine.<\/p>\n THM: Why were so few horses tested – some people say the vaccine is only now \u2018Being trialled on my horse\u2019?<\/strong> THM: Do Australians have an attitude of \u2018It won\u2019t happen to me\u2019? Our isolation has protected us from many disease outbreaks affecting the rest of the world. RISK<\/strong><\/p>\n THM: What is the true risk of Hendra to the horse community? <\/strong><\/p>\n DM:<\/strong> With Hendra infection we have the most difficult of all risk management scenarios \u2013 a low likelihood\/high consequence event. If horses and people were being infected weekly, we would not be having this conversation.<\/p>\n Dr Matthew Walker:<\/strong> The highest priority in this debate is perceived vs actual risk of Hendra. There\u2019s more risk in putting a saddle on a horse. I\u2019d love for the EVA or FEI to publicise figures of horse and human injuries\/deaths associated with their sport! I\u2019ve attended an ODE where the ambulance couldn\u2019t keep up with the falls. In my family, my grandad lost an eye to a horse, his brother was killed and my father broke a leg. Hendra is a \u2018disease of vets\u2019, not of the general public.<\/p>\n THM: Panellists, do you agree that Hendra is a \u201cdisease of vets\u201d – not a public health concern? <\/strong><\/p>\n Dr Sharanne Raidal:<\/strong> Vets, owners, trainers and \u2018in-contact\u2019 horses have all been infected, hence I think Hendra is a public health concern. We don\u2019t know the infectious dose of this organism. It would sadden me greatly if the implication was that the well-being of vets was somehow less important than that of horse owners or the wider public. Vets are people too!<\/p>\n DM: <\/strong>I think that the transmission case from horse to vet nurse, is commonly overlooked. I\u2019m not sure that even if Hendra was a \u201cdisease of vets\u201d, that makes it OK not to support a key control measure that will avoid putting such people in harm\u2019s way.<\/p>\n Dr Nathan Anthony:<\/strong> There\u2019s absolutely no reason any person in contact with a sick, unvaccinated horse couldn\u2019t be infected. I regularly find owners heavily contaminated with blood from a laceration, nasal discharge from a respiratory case, or saliva from a very sick horse with choke or colic. Last year alone, six people (none of them vets) who had high exposure to Hendra, needed experimental monoclonal antibody treatment (listen to Dr Geoffrey Playford talking about this in his ABC radio interview at http:\/\/www.abc.net.au\/radionational\/programs\/breakfast\/hendra-vaccine\/4165490-THM).<\/em><\/p>\n THM: Why can\u2019t vets just wear Personal Protective Equipment (PPE)?<\/strong><\/p>\n NA:<\/strong> Some say we should just \u201ctoughen up\u201d. May I remind them, this virus has killed our colleagues and friends. Others say all will be ok if we wear PPE. I can tell you that dressing up like a spaceman, and dressing owners up like spacepeople carries its own risk working with fractious horses in hot Queensland conditions. PPE greatly increases the chance of needle stick injury, heat exhaustion or injury.<\/p>\n MW:<\/strong> Vets are slack when it comes to PPE. And it\u2019s not rocket science. If I came across a crook horse up back of Murwillumbah, I\u2019d say \u201cLook, your horse is suspicious. Put the dog on the chain, don\u2019t touch the horse, we\u2019ll test it, leave it overnight and see what happens.\u201d If I came across a horse that died suddenly overnight, I\u2019d think \u201cOK, might be Hendra.\u201d If the horse was half dead, \u201cStill might be Hendra.\u201d I\u2019d buy a pair of paper overalls, goggles, booties, before attending. You can get this stuff from Bunnings for $100 tops. Someone would have to be severely lacking common sense to catch Hendra, given what we now know.<\/p>\n THM: Are vets really trying to \u2018push this vaccine down our throats at the expense of our horses\u2019 welfare\u2019, in order to make money?<\/strong><\/p>\n DM:<\/strong> Actually, I haven\u2019t seen this kind of behaviour from vets. I\u2019ve observed animal welfare and duty of care. Hendra mimics just about every other common equine disorder. When people are handling Hendra-infected horses, they\u2019re unlikely to know until it\u2019s too late.<\/p>\n SR:<\/strong> As a registered \u2018vaccinator\u2019 I\u2019ve not appreciated any pressure or push from Zoetis. Most vets are resistant to company attempts to sway our practice \u2013 we\u2019re highly trained to base our recommendations on best available scientific evidence. This vaccine is a triumph for scientific endeavour – government funding and industry combined to produce a stunningly effective vaccine very quickly. However it is costly, particularly for owners of multiple horses. Pharmaceutical companies must run to profit to cover R&D and remain viable – but it would be great to see lowered production\/distribution costs. Potentially, fewer boosters may further reduce costs. As for making money, many vets subsidise intensive care\/challenging cases by not charging adequately for their time \u2013 making a living isn\u2019t at the cost of compromised patient care or betrayal of clients\u2019 trust.<\/p>\n Dr David Clemence: <\/strong>One man\u2019s fear is another\u2019s marketing. I\u2019ve had numerous discussions with Zoetis \u2013 they will push hard to sell a product. When my clients ask, I just say \u2018Well I don\u2019t vaccinate my own horses.\u2019<\/p>\n THM: Is it reasonable for a vet to refuse to attend an unvaccinated horse?<\/strong><\/p>\n MW:<\/strong> Hendra is the horse version of those HIV-AIDS grim reaper ads. Hendra can\u2019t jump up fences or go down roads. Using fear and guilt and playing on ignorance is inappropriate for any vet or doctor. If vets refuse to attend an unvaccinated horse, well that\u2019s blackmail.<\/p>\n NA:<\/strong> It\u2019s not blackmail, it\u2019s simply best practice risk mitigation. Any unvaccinated horse with colic could have Hendra, we\u2019re just playing Russian Roulette. Vets have to protect all their patients and clients, and many practices just wouldn\u2019t survive financially any lengthy quarantine periods.<\/p>\n DM:<\/strong> In my view the encouragement by vets to vaccinate horses in areas of known infection risk is nothing more or less than best practice on their part.<\/p>\n SR:<\/strong> Like all things, it depends on context: location, practice type (ambulatory\/hospital). In general, yes – due to WHS considerations and possible litigation by other owners. Vets must act in the best interest of their staff, other patients, and their own health and well-being.<\/p>\n TARGETED VACCINATION<\/strong><\/p>\n THM: Why should this be a federal By-law when all cases have been in Qld\/NSW?<\/strong><\/p>\n GB:<\/strong> Horses from Qld\/NSW travel Australia-wide to attend EA events. We don\u2019t want to pre-empt the review panel outcomes, but it\u2019s fair to say that any future policy requires a flexible\u00a0approach.<\/p>\n NA: <\/strong> Hendra has an incubation period of more than 2 weeks \u2013 a horse can travel from a high risk to low risk area in this time.<\/p>\n DC:<\/strong> It makes sense for Qld\/NSW vets to vaccinate – would give me great peace of mind, there. But as I explained to Zoetis, it\u2019s a very big ask to convince Victoria and the other states.<\/p>\n SR:<\/strong> Hendra is an emerging disease: infection location, clinical presentation, outbreak timing – all have changed as we learn more. We have antibody-positive bats well outside the currently known spill-over areas, and it can be difficult to recognise smaller bat populations. Putting these together, it\u2019s impossible to guarantee horses outside NSW\/Qld are not at risk – targeted vaccination chances missing new cases.<\/p>\n MW: <\/strong>I agree with vaccinating horses in the risk zones. But vaccinating 1,800,000 East coast horses – no epidemiological sense and no compliance. Antibodies to Lyssa – the \u2018Australian rabies\u2019 virus – are as prevalent in bats as Hendra, horses and people have died from it \u2013 but where\u2019s the vaccination push? It\u2019s a double standard. Another double standard – why hasn\u2019t Australia\u2019s biggest horse industry, the TB industry, been asked to vaccinate? Because no-one wants a $300,000 racehorse to experience an adverse reaction!<\/p>\n SR:<\/strong> Firstly, only 2 known horses have died from Lyssavirus and to my knowledge – the transmission mode\/infection mechanism are unknown – but almost certainly it isn\u2019t horse- to-horse. Over 80 horses, as well as humans and dogs, have caught Hendra virus from horses. Secondly, there\u2019s an effective human lyssa vaccine –\u00a0\u00a0 it\u2019s not a double standard, it\u2019s just irrational to vaccinate horses for lyssa.<\/p>\n ADVERSE EFFECTS<\/strong><\/p>\n THM: At least 7 or 8 horse deaths have been officially acknowledged as Hendra vaccine-related. I\u2019ve heard from several distressed horse owners who trusted the vaccine, had a bad outcome, and feel they were just fobbed off. Are you concerned?<\/strong><\/p>\n DM: <\/strong>If I were confident the reactions \u2013 particularly the deaths – were from the vaccine, then of course I would be concerned. Unfortunately the reporting situation\u2019s become so clouded that it\u2019s difficult to see how we\u2019ll be able to get a handle on the \u201ctrue\u201d picture. Hendra vaccination may need to evolve into a more closely managed process; but we need to be having a different set of conversations for that to happen. My opinion, is there\u2019s ample evidence for the initial shot, the 21 day booster and the first 6 month booster setting up a good level of antibody persisting at least a further 12 months. There\u2019s no additional value to continue vaccinating after this. However, my opinion is not what governs the licensing process.<\/p>\n MW:<\/strong> I think the vaccine itself is fantastic \u2013 but I do believe there are many adverse effects and not enough reporting to the AVPMA. I\u2019ve heard of vets advising clients \u2018not to bother\u2019.<\/p>\n Zoetis spokesperson:<\/strong> This vaccine was introduced under an APVMA permit, so the adverse event reporting is more rigorous. Vets must report any suspected reaction, no matter how minor or unlikely that the vaccine was responsible. APVMA recently renewed the permit with some minor wording changes. There\u2019s been no change to the vaccine or its efficacy. No vaccinated horse has contracted or shed the virus. Zoetis submitted data to the APVMA supporting a change to annual boosters after the initial 3 doses. However, the regulator indicated its intention not to approve this submission, so we expect the vaccine will be registered this year under the current booster regimen. We\u2019ll collect more 12m DOI data for APVMA and make a further application in the future.<\/p>\n DM:<\/strong> Possibly, APVMA guidelines don\u2019t cater well to BSL-4 pathogen testing. Exposing vaccinated horses to live Hendra virus in the lab involves significant animal welfare\/human safety issues. It\u2019s to our great credit that we\u2019ve been able to generate the current efficacy data; we could so easily have none at all. Moreover, this data aligns strongly with that of other lab animals \u2013 we need include this in our decision-making.<\/p>\n I\u2019LL TAKE THAT AS A COMMENT<\/strong> Horses do die suddenly, but since this vaccine, it happens a little too often. I think some people don\u2019t want to connect it – they want to know they have done the best thing, that their vet is right. <\/em> – J. Millward, NSW (\u2018Say No to Hendra Vaccine\u2019 Admin)<\/strong><\/p>\n We\u2019d love more positive vaccine stories in the media. Many thousands of horse owners are competing, racing and breeding without any problems. It concerns us that some may become scared of vaccinating, which might result in the vaccine being taken off the market and also result in more human deaths.<\/em> – M. Williams, QLD (\u2018Hendra Virus Info Group\u2019 Admin) <\/strong><\/p>\n I believed the hype. My vet pressured me to vaccinate my 35yo gelding, who became very sick and eventually died. He said: \u201cYou can\u2019t prove it\u201d. I feel I betrayed my horse terribly with this decision.<\/em> – S. Middleton, NSW<\/strong><\/p>\n My horses have had 5 Hendra vaccinations each and are happy and healthy – including a cremello who\u2019s usually sensitive to everything. Sure, I\u2019d like it to be cheaper – but would rather my tax dollars go to people with real problems, like kids with cancer or drought-stricken farmers – not to my very expensive hobby. I refused to keep vaccinating after my horses reacted to the 2nd shot \u2013 and was stood down by my employer for insubordination. Zoetis is turning the equine world upside-down. Our current vet was Alister Roger\u2019s offsider, and she too, is a great vet. No pressure to vaccinate and she knows better than most what happened. I will approach lawyers for a pro-bono case when I have the numbers and more info. I\u2019m hoping to implement a holistic change – the current system is clearly broken. <\/em>– M.Buljan, NSW<\/strong><\/p>\n Vets are taking responsibility for their own lives – that\u2019s why they don\u2019t want to treat unvaccinated horses. I\u2019ve got no stake in the vaccine other than I like the idea that horses and people don\u2019t suffer and die. Really works for me. Crazy, huh? <\/em>– M. Jones, NSW<\/strong><\/p>\n If you have horses and (even invisible) flying foxes \u2013 don\u2019t for one moment think that it can\u2019t happen to you. Because guess what, it\u2019s happened to others and I know they didn\u2019t think it could happen to them either. I saw the fear in their eyes. <\/em>– L. Zupanc, QLD<\/strong><\/p>\n When I wrote the book \u201cSpillover\u201d, my aim was to increase awareness. As horse owners, we need to deal with this virus. My remaining horse is fully vaccinated. The threat and impact of this virus is still with me everyday, it will never leave. <\/em>– J.Crane, QLD<\/strong><\/p>\n CLOSING REMARKS<\/strong><\/p>\n THM: If you could send just one message to THM readers?<\/strong><\/p>\n GB:<\/strong> Member and horse welfare is at the centre of all EA decision making \u2013 we will continue to listen to our members.<\/p>\n NA:<\/strong> There are now over 110,000 vaccinated horses and comparatively few – but vocal – critics. Please talk with your vet – they\u2019re the best person to provide you with facts and answer your questions.<\/p>\n MW:<\/strong> Horse owners need to ask their vet about vaccination, and vets need to be more open in their risk assessment. We need balance and perspective \u2013 owners deserve an informed choice.<\/p>\n DC:<\/strong> Hendra is distracting from the bigger picture – fencing! I\u2019ve seen every permutation possible of leg injuries caused by wire. Just don\u2019t expose your horses to it!<\/p>\n Z:<\/strong> In the last 2 years, 12 unvaccinated horses have died preventable deaths from Hendra. The benefits far outweigh the risks.<\/p>\n SR:<\/strong> The vast majority of vets will work to the best of their ability (and then some) to ensure the best outcome for you and your horse.<\/p>\n DM:<\/strong> Everyone is challenged by Hendra \u2013 the horse industry, vets, APVMA and Zoetis. I\u2019d like to see a little more generosity of spirit in our conversations. No-one with whom I regularly communicate wants anything other than horses and people to be protected from Hendra.<\/p>\n You have been watching THM Q&A. I\u2019m not Tony Jones. Goodnight.<\/em><\/strong><\/p>\n This article originally appeared in the June 2015 edition of The Horse Magazine<\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" Coming up on tonight\u2019s show… Is the Hendra vaccine a cash cow for manufacturer, Zoetis? Are the vets pushing Zoetis\u2019 barrow?<\/p>\n","protected":false},"author":1,"featured_media":23057,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"nf_dc_page":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[37],"tags":[1121,1122],"class_list":["post-23056","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-horse-care-and-health","tag-hendra","tag-the-hendra-debate"],"acf":[],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/www.horsemagazine.com\/thm\/wp-json\/wp\/v2\/posts\/23056","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.horsemagazine.com\/thm\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.horsemagazine.com\/thm\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.horsemagazine.com\/thm\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.horsemagazine.com\/thm\/wp-json\/wp\/v2\/comments?post=23056"}],"version-history":[{"count":6,"href":"https:\/\/www.horsemagazine.com\/thm\/wp-json\/wp\/v2\/posts\/23056\/revisions"}],"predecessor-version":[{"id":32291,"href":"https:\/\/www.horsemagazine.com\/thm\/wp-json\/wp\/v2\/posts\/23056\/revisions\/32291"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.horsemagazine.com\/thm\/wp-json\/wp\/v2\/media\/23057"}],"wp:attachment":[{"href":"https:\/\/www.horsemagazine.com\/thm\/wp-json\/wp\/v2\/media?parent=23056"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.horsemagazine.com\/thm\/wp-json\/wp\/v2\/categories?post=23056"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.horsemagazine.com\/thm\/wp-json\/wp\/v2\/tags?post=23056"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
\nDM:<\/strong> This perception may be due to the horse industry\u2019s unfamiliarity with the licensing process. I don\u2019t think an equine vaccine has ever been rolled out in Australia before. The number of horses used to assess protection onset, and those used in safety studies by Zoetis, meets the specifications of APVMA. However, there is one key difference in the horse testing model – it requires euthanasia during the time of predicted acute disease \u2013 and we cannot safely hold horses at BSL-4 for longer periods. This approach is scientifically sound and peer-reviewed.<\/p>\n
\nDM:<\/strong> I too have wondered about the cultural element, but I\u2019m not sure we have any real parallels – Hendra has put us into uncharted territory from a global perspective. No other country has the problem of a BSL-4 pathogen infecting people via a domestic animal, on an ongoing basis, and has also attempted to introduce a long-term control measure. I think a key communication difficulty arises from the highly fragmented nature of the horse industry. There\u2019s no peak industry body to act as a single communication vehicle. These days communication is rapid, easy and uncontrolled \u2013 sometimes we forget that once a statement passes through several filters, it will inevitably have shifted slightly in ways which may or may not be important.<\/p>\n
\nViews from the Horse Community<\/strong><\/p>\n
\n<\/em>– A. Brockhurst, QLD<\/strong><\/p>\n
\n<\/em>– R.Abbott, QLD<\/strong><\/p>\n
\n<\/em>– S.Cunningham, QLD<\/strong><\/p>\n