Misinformation and a “me first” attitude could unravel response to horse disease incursions

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Prevention during 'peacetime' was not second nature, and, as such, both participants and their clients struggled to change their habits for no convincing reason, researchers say.
Exotic disease prevention during ‘peacetime’ was not second nature, and, as such, both participants and their clients struggled to change their habits for no convincing reason, researchers say. Image by fb2013

Britain’s horse owners may prove to be their own worst enemy when it comes to preventing the spread of exotic diseases across the nation.

Veterinarians interviewed for a study aired concerns that owners did not have a sense of their horse belonging to a national herd, often sought advice from everyone except their vet — including “strange people on the internet” — and were pessimistic over whether riders would “give up” their everyday activities to protect others.

Improvements are required in Britain to achieve an optimal level of preparedness for the incursion of exotic horse diseases, the authors concluded.

The study team, writing in the Equine Veterinary Journal, recommended additional support for frontline veterinarians, such as skills-based training, and accessible and trusted emergency support networks. They also said the responsibilities and expectations of veterinarians in a disease incursion should be clearly laid out.

Kelsey Spence and her fellow researchers said outbreaks of exotic diseases occur infrequently, but can cause significant health and economic consequences.

In preparation for such an outbreak, each country in the United Kingdom produces a contingency plan that outlines stakeholders’ roles and responsibilities for animal disease emergencies.

It has been shown that primary care veterinarians are critical in mobilising an effective outbreak response alongside government authorities.

“Given their training, expertise and established relationships with animal owners, primary care veterinarians are well placed to advise both their clients and other stakeholders in the event of a disease emergency,” they said. Indeed, they share responsibility for maintaining freedom from pathogens that cause exotic diseases. However, little is known about the current state of exotic disease preparedness within the British horse industry.

The authors noted that Britain’s horse industry has experienced sporadic outbreaks of exotic diseases in the past several years, including equine infectious anaemia in 2012 and equine viral arteritis (EVA) in 2019. In each instance, the investigation was prompted after primary care veterinarians performed diagnostic testing on horses imported into the country, or had gathered with international horses several years earlier.

A systematic review of pathogen incursions following international horse movements identified that most transmission events involved horses that had not shown any clinical signs at the time of import, allowing them to enter the general population and subsequently spread infection.

“In the event that exotic diseases escape border control, primary care veterinarians are likely to be the first line of defence to detect and report these pathogens.”

While contingency planning focuses on coordinating the response to an exotic disease, preventing pathogen incursions in the first instance is central to effective preparedness.

Primary care veterinarians have many roles and responsibilities when responding to an exotic disease outbreak, the researchers said. “However, guidance on how to improve preparedness is less clear.”

Specialised training is available, but there is no research exploring what primary care veterinarians need for succeeding in this role and a lack of guidance on how they should follow current preparedness advice.

In their study, the researchers set out to explore experiences of, and attitudes towards, equine exotic disease preparedness amongst Britain’s frontline veterinarians.

Fourteen primary care equine veterinarians were interviewed, purposively selected to include perspectives across varying levels of experience, clientele and location.

All interviews were recorded, transcribed and analysed.

The study team said three themes emerged: One around the participants’ self-concept of their role as primary care veterinarians; another centred on working within their bounds of influence, encompassing their perceived inability to influence their clients’ knowledge and behaviours; and the effects of a fragmented horse industry, illustrating the wider culture in which vets worked.

The authors said the veterinarians’ self-concepts of their role in primary care practice shaped how they approached exotic disease preparedness.

“Participants,” they said, “often found themselves working to the ‘firefighter’ model of medicine, responding to ill-health instead of proactively providing wellness services. This ingrained reactive approach meant that participants struggled to shift into a preventive mindset in the absence of an imminent threat.”

Participants acknowledged they could not reasonably be an expert in all areas of veterinary medicine. Over time, their expertise became targeted towards common conditions, moving them further away from specialist topics such as exotic diseases.

One vet commented: “On a day-to-day basis, I’m being paid to go and fix the eye or the heart or something and you can’t just spiral off into worrying [the client] about West Nile virus.”

Prevention during ‘peacetime’ was not second nature, and, as such, both participants and their clients struggled to change their habits for no convincing reason. For clients, this meant that the norm was often an absence of biosecurity until an outbreak occurred.

The vets acknowledged that they and their clients needed to develop habitual baseline biosecurity behaviours, even when there was no particular infectious threat. It was anticipated that this shift to a preventive mindset would take some time for both parties.

The study team found that the vets generally struggled with a perceived inability to influence their clients’ knowledge and behaviours toward improving biosecurity.

“Some participants viewed their role as information providers, or educators, and experienced frustration when clients did not follow their advice. The need to be influential stemmed from an assumption that the client lacked sufficient knowledge.

“By acting as an educator, participants aimed to change their clients’ behaviours through providing more knowledge. Participants perceived a greater level of influence when a positive client relationship was established,” they said.

However, good veterinarian-client relationships were sometimes undermined by more accessible information sources, such as other horse owners on social media.

“The increased availability and accessibility of competing influences was an added challenge to the veterinarian’s ability to influence positive change.”

The vets acknowledged that while they could provide clients with more information, they were not in a position to ensure it was actually acted upon.

Some vets felt their lack of influence extended beyond client relationships. Some had highlighted shortcomings in existing policies, such as the passport system, to the governing bodies, but their concerns had been ignored.

Veterinarians felt they were viewed as only one of many options for clients, and in many instances, as the last choice for advice.

One commented: “They always listen to the farrier, dentist, back person, the woman that comes and talks to their horse and the horse talks back, before they listen to the vet.”

Clients frequently accessed a wealth of information, including misinformation, before consulting their veterinarian. The rise of social media, online forums, and Google searches was a particular frustration, given the potential for bad advice.

One vet wryly remarked: “They go, ‘I read something here’, and you go, ‘Stop reading those forums because they’re just strange people on the internet giving out information’.”

Concerns were aired about the fragmented nature of the horse industry.

An effective response to an equine infectious disease outbreak would rely on action at the population level. However, the culture of the wider horse industry was characterised by a lack of cohesion among members. There were issues with co-ordination across sectors, and unbalanced resources between racing and non-racing horses, reflected a siloed industry structure.

The veterinarians perceived that owners, in general, did not have a sense of their horse belonging to a national herd.

In the event of an outbreak, eterinarians were pessimistic about the likelihood that horse owners would 'give up' their everyday activities in order to protect others.
In the event of an outbreak, eterinarians were pessimistic about the likelihood that horse owners would ‘give up’ their everyday activities in order to protect others. Image by TheOtherKev

The overarching structure of the horse industry was described by the veterinarians as disparate and disjointed, with different sectors — racing and non-racing — operating by their own rules within their own contexts.

In particular, the racing sector had more resources and support than other sectors and could therefore prepare and facilitate a more coherent response to outbreaks. This was largely driven by the economic value of racehorses.

The racing sector was guided by recommended biosecurity protocols created by regulatory and statutory bodies. In contrast, the wide variety of activities encompassed by the non-racing sector allowed for more lenience and discretion in biosecurity-related decisions.

Contextual differences between racing and non-racing sectors meant that the guidelines created for racing were not perceived as applicable to other types of horses. Several participants suggested that existing guidelines could be modified for the non-racing sector.

“Participants perceived a greater tendency towards individualism in the horse industry compared with other livestock sectors,” the researchers said.

“When biosecurity precautions were undertaken by participants, horse owners assumed it was related to their individual horse (eg, that the veterinarian was implying their horse was unhealthy). However, livestock farmers viewed biosecurity as a routine precaution to protect their herd.

“Participants perceived that horse owners primarily looked out for themselves, despite keeping their horses in a shared environment. In the event of a yard outbreak, this attitude was perpetuated by the tendency for owners to blame others for introducing the pathogen.”

One vet commented: “It’s a very emotive issue. Everyone gets very upset and starts pointing fingers at one another about who brought a disease onto the yard — there’s a lot of politicking involved.”

This tendency for horse owners to ostracise those with horses affected by disease made it challenging for participants to promote preparedness, a practice that relies on altruism. Preventing the spread of infectious diseases requires clients to make sacrifices, such as restricting horse movements.

When horse ownership was tied to clients’ livelihood, such as for those in the racing industry, it was more difficult for participants to convince them to be altruistic.

In the event of an outbreak, the veterinarians were pessimistic about the likelihood that horse owners would ‘give up’ their everyday activities in order to protect others.

One vet observed: “It will entirely depend on their perception of their moral and ethical boundaries about what’s more important, their show at the weekend or the wider health of the country’s populations of equines as a whole.”

The study team said their findings highlighted several challenges to preparedness, including the mismatch between the nature of primary care practice and the required awareness of exotic diseases, the lack of influence on clients’ general horse management behaviours, and the fragmented nature of the equine industry.

In the absence of an imminent threat, participants did not prioritise exotic disease preparedness because of more immediate concerns.

“An individualistic culture within the British horse industry appears to pose a key threat to effective exotic disease preparedness overall,” the authors said.

The findings suggest that improvements are required before an optimal level of preparedness can be achieved, they said.

“Further research into the culture of the horse industry and how the overarching structure might facilitate or prevent effective disease preparedness is required.”

The study team comprised Kelsey Spence and Jacqueline Cardwell, with Britain’s Royal Veterinary College; Sarah Rosanowski, with Equine Veterinary Consultants Ltd in Hong Kong; and Josh Slater, with the University of Melbourne in Australia.

Challenges to exotic disease preparedness in Great Britain: The frontline veterinarian’s perspective
Kelsey L. Spence, Sarah M. Rosanowski, Josh Slater, Jacqueline M. Cardwell
Equine Veterinary Journal, 27 May 2021 https://doi.org/10.1111/evj.13469

The study, published under a Creative Commons License, can be read here.

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