Words by Ingrid Nilsson / BSc (Hons) in Biomedicine & Molecular Biology
Coming up on tonight’s show… Is the Hendra vaccine a cash cow for manufacturer, Zoetis? Are the vets pushing Zoetis’ barrow? Will the vets pushing Zoetis’ barrow that is carrying the cash cow be able to take their hands off the barrow and put down their grim reapers’ scythes for long enough to wipe the sweat off their hazard suit visors and treat your horse for colic?
Let’s find out. Joining us on THM Q&A is…Dr Deborah Middleton BVSc, MVSc, PhD (DM), veterinary pathologist and leader of the prize-winning, vaccine-creating CSIRO team; Equestrian Australia CEO Grant Baldock (GB); outspoken equine vet and endurance enthusiast Dr Matthew Walker BVSc (MW); Dr Nathan Anthony BVSc(Hons), MANZCVS (NA), President of the Equine Veterinarians Association (EVA); Assoc.Professor in Equine Medicine at Charles Sturt University – Dr Sharanne Raidal BVSc, MVSt, PhD, GradDipEd, FANZCVSc(SR); Pakenham equine vet Dr David Clemence BVSc (DC), and a spokesperson for pharmaceutical company, Zoetis (Z).
THE BY-LAW
THM: Why create and then revoke the Hendra Vaccination By-law?
Grant Baldock: 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 ‘high risk’ 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 – especially exports, other industry policies and adverse reactions. There will be opportunities to review the panel’s findings when published later this year.
THE VACCINE
THM: Deb Middleton – how did you come to be involved with Hendra?
DM: I was one of the few vets internationally working with animals at Biosafety Level 4 (BSL-4 ) (we are talking Ebola level, here – 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.
THM: Why were so few horses tested – some people say the vaccine is only now ‘Being trialled on my horse’?
DM: This perception may be due to the horse industry’s unfamiliarity with the licensing process. I don’t 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 – and we cannot safely hold horses at BSL-4 for longer periods. This approach is scientifically sound and peer-reviewed.
THM: Do Australians have an attitude of ‘It won’t happen to me’? Our isolation has protected us from many disease outbreaks affecting the rest of the world.
DM: I too have wondered about the cultural element, but I’m 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’s no peak industry body to act as a single communication vehicle. These days communication is rapid, easy and uncontrolled – 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.
RISK
THM: What is the true risk of Hendra to the horse community?
DM: With Hendra infection we have the most difficult of all risk management scenarios – a low likelihood/high consequence event. If horses and people were being infected weekly, we would not be having this conversation.
Dr Matthew Walker: The highest priority in this debate is perceived vs actual risk of Hendra. There’s more risk in putting a saddle on a horse. I’d love for the EVA or FEI to publicise figures of horse and human injuries/deaths associated with their sport! I’ve attended an ODE where the ambulance couldn’t 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 ‘disease of vets’, not of the general public.
THM: Panellists, do you agree that Hendra is a “disease of vets” – not a public health concern?
Dr Sharanne Raidal: Vets, owners, trainers and ‘in-contact’ horses have all been infected, hence I think Hendra is a public health concern. We don’t 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!
DM: I think that the transmission case from horse to vet nurse, is commonly overlooked. I’m not sure that even if Hendra was a “disease of vets”, that makes it OK not to support a key control measure that will avoid putting such people in harm’s way.
Dr Nathan Anthony: There’s absolutely no reason any person in contact with a sick, unvaccinated horse couldn’t 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).
THM: Why can’t vets just wear Personal Protective Equipment (PPE)?
NA: Some say we should just “toughen up”. 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.
MW: Vets are slack when it comes to PPE. And it’s not rocket science. If I came across a crook horse up back of Murwillumbah, I’d say “Look, your horse is suspicious. Put the dog on the chain, don’t touch the horse, we’ll test it, leave it overnight and see what happens.” If I came across a horse that died suddenly overnight, I’d think “OK, might be Hendra.” If the horse was half dead, “Still might be Hendra.” I’d 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.
THM: Are vets really trying to ‘push this vaccine down our throats at the expense of our horses’ welfare’, in order to make money?
DM: Actually, I haven’t seen this kind of behaviour from vets. I’ve observed animal welfare and duty of care. Hendra mimics just about every other common equine disorder. When people are handling Hendra-infected horses, they’re unlikely to know until it’s too late.
SR: As a registered ‘vaccinator’ I’ve not appreciated any pressure or push from Zoetis. Most vets are resistant to company attempts to sway our practice – we’re 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 – making a living isn’t at the cost of compromised patient care or betrayal of clients’ trust.
Dr David Clemence: One man’s fear is another’s marketing. I’ve had numerous discussions with Zoetis – they will push hard to sell a product. When my clients ask, I just say ‘Well I don’t vaccinate my own horses.’
THM: Is it reasonable for a vet to refuse to attend an unvaccinated horse?
MW: Hendra is the horse version of those HIV-AIDS grim reaper ads. Hendra can’t 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’s blackmail.
NA: It’s not blackmail, it’s simply best practice risk mitigation. Any unvaccinated horse with colic could have Hendra, we’re just playing Russian Roulette. Vets have to protect all their patients and clients, and many practices just wouldn’t survive financially any lengthy quarantine periods.
DM: 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.
SR: 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.
TARGETED VACCINATION
THM: Why should this be a federal By-law when all cases have been in Qld/NSW?
GB: Horses from Qld/NSW travel Australia-wide to attend EA events. We don’t want to pre-empt the review panel outcomes, but it’s fair to say that any future policy requires a flexible approach.
NA: Hendra has an incubation period of more than 2 weeks – a horse can travel from a high risk to low risk area in this time.
DC: It makes sense for Qld/NSW vets to vaccinate – would give me great peace of mind, there. But as I explained to Zoetis, it’s a very big ask to convince Victoria and the other states.
SR: 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’s impossible to guarantee horses outside NSW/Qld are not at risk – targeted vaccination chances missing new cases.
MW: 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 ‘Australian rabies’ virus – are as prevalent in bats as Hendra, horses and people have died from it – but where’s the vaccination push? It’s a double standard. Another double standard – why hasn’t Australia’s biggest horse industry, the TB industry, been asked to vaccinate? Because no-one wants a $300,000 racehorse to experience an adverse reaction!
SR: 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’t horse- to-horse. Over 80 horses, as well as humans and dogs, have caught Hendra virus from horses. Secondly, there’s an effective human lyssa vaccine – it’s not a double standard, it’s just irrational to vaccinate horses for lyssa.
ADVERSE EFFECTS
THM: At least 7 or 8 horse deaths have been officially acknowledged as Hendra vaccine-related. I’ve heard from several distressed horse owners who trusted the vaccine, had a bad outcome, and feel they were just fobbed off. Are you concerned?
DM: If I were confident the reactions – particularly the deaths – were from the vaccine, then of course I would be concerned. Unfortunately the reporting situation’s become so clouded that it’s difficult to see how we’ll be able to get a handle on the “true” 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’s 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’s no additional value to continue vaccinating after this. However, my opinion is not what governs the licensing process.
MW: I think the vaccine itself is fantastic – but I do believe there are many adverse effects and not enough reporting to the AVPMA. I’ve heard of vets advising clients ‘not to bother’.
Zoetis spokesperson: 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’s 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’ll collect more 12m DOI data for APVMA and make a further application in the future.
DM: Possibly, APVMA guidelines don’t 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’s to our great credit that we’ve 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 – we need include this in our decision-making.
I’LL TAKE THAT AS A COMMENT
Views from the Horse Community
Horses do die suddenly, but since this vaccine, it happens a little too often. I think some people don’t want to connect it – they want to know they have done the best thing, that their vet is right. – J. Millward, NSW (‘Say No to Hendra Vaccine’ Admin)
We’d 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. – M. Williams, QLD (‘Hendra Virus Info Group’ Admin)
I believed the hype. My vet pressured me to vaccinate my 35yo gelding, who became very sick and eventually died. He said: “You can’t prove it”. I feel I betrayed my horse terribly with this decision. – S. Middleton, NSW
My horses have had 5 Hendra vaccinations each and are happy and healthy – including a cremello who’s usually sensitive to everything. Sure, I’d 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.
– A. Brockhurst, QLD
I refused to keep vaccinating after my horses reacted to the 2nd shot – and was stood down by my employer for insubordination. Zoetis is turning the equine world upside-down.
– R.Abbott, QLD
Our current vet was Alister Roger’s offsider, and she too, is a great vet. No pressure to vaccinate and she knows better than most what happened.
– S.Cunningham, QLD
I will approach lawyers for a pro-bono case when I have the numbers and more info. I’m hoping to implement a holistic change – the current system is clearly broken. – M.Buljan, NSW
Vets are taking responsibility for their own lives – that’s why they don’t want to treat unvaccinated horses. I’ve got no stake in the vaccine other than I like the idea that horses and people don’t suffer and die. Really works for me. Crazy, huh? – M. Jones, NSW
If you have horses and (even invisible) flying foxes – don’t for one moment think that it can’t happen to you. Because guess what, it’s happened to others and I know they didn’t think it could happen to them either. I saw the fear in their eyes. – L. Zupanc, QLD
When I wrote the book “Spillover”, 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. – J.Crane, QLD
CLOSING REMARKS
THM: If you could send just one message to THM readers?
GB: Member and horse welfare is at the centre of all EA decision making – we will continue to listen to our members.
NA: There are now over 110,000 vaccinated horses and comparatively few – but vocal – critics. Please talk with your vet – they’re the best person to provide you with facts and answer your questions.
MW: 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 – owners deserve an informed choice.
DC: Hendra is distracting from the bigger picture – fencing! I’ve seen every permutation possible of leg injuries caused by wire. Just don’t expose your horses to it!
Z: In the last 2 years, 12 unvaccinated horses have died preventable deaths from Hendra. The benefits far outweigh the risks.
SR: 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.
DM: Everyone is challenged by Hendra – the horse industry, vets, APVMA and Zoetis. I’d 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.
You have been watching THM Q&A. I’m not Tony Jones. Goodnight.
This article originally appeared in the June 2015 edition of The Horse Magazine
For over 5 years since the tragic loss of human life, professionals have known the risks associated with the virus and the need for ppe in order to preserve life. Yet vets happlity continued to treat horses displaying symptoms similar to those known to be displayed by infected horses, without ppe. So why all of a sudden, or since the introduction of the vaccine, are vets either refusing to treat unvaccinated horses or only now donning on ppe.
Surely hendras hendra, & they should of areal been wearing ppe for the past 5 years. Funny that….
Well done THM as we have come to expect – probing reporting and a fair presentation. Berni Saunders
As A breeder of Warmblood horses, the co-owner of Bellara Park Equestrian Centre and a member of the EA and Pony Club Qld I have been severely affected by the impact that mandatory vaccination has had on the industry. I have observed friendships disintergrate, pony clubs & Show Societies lose memberships and generally a decline in the number of competitors. Personnally I have stopped breeding horses and have heard ppl say they will not buy horses from Qld. This has hit me financially. I have seen a reaction of a horse to the vaccine (belonging to a friend) I no longer can call a vet to my horses in times of need as I cannot afford to vaccinate. I can no longer compete at the Ekka. I have watched a young horse (vaccinated and belonging to a friend who believed it the right thing to do) die of colic (I believe a lot of vaccinated horses get colic). I know a local who had a horse get sick on his property and was involved in a quarantine situation. I believe in vaccination but I believe there is something grossly wrong with this vaccine and I believe that it should be the owner’s right to vaccinate or not to vaccinate a horse. it is not the right of the vets or the
drug company or the government to order the horse owner to do it when the vaccine is dodgey. I had a horse once who was allergic to penicillin. After the first reaction my vet told me never to inject that horse with penicillin again. That horse lived till she was thirty-five. As owners and breeders and competitors of horses we deserve to have the right to compete and to enjoy our horses every bit as much as the vet has the right to attend or not attend an unvaccinated horse. no one wishes any one to be infected with a deadly virus but this blackmail & panicked decision making attitude has to be replaced with informed and workable plan that everyone use. I am very fastidious in stable management & hygiene at my place.There are many other illnesses and problems that horses suffer from that we as owners have to have good hygiene and stable management in order to avoid being infected. Vets have to clean up their act. The drug company has to get the vaccine down to a manageable price and make it safer to use. Even the drug company will not guarantee their product. The government has to make sure that the ppl are protected and that everyone’s rights are preserved as well as the vets & drug companies. That might mean making some money available for more research and management of bats. Somehow I think the government is avoiding paying anything because the horse industry refused to pay for EI. NO ONE wants to pay! Imagine a way of removing the virus from bats altogether. Something like the way Chemo destroys cancer. Someone out there must have the answer.
The vaccine is a quick fix but it is not the real answer.
I have spoken to a lot of ppl who vaccinate and don’t believe their horse is affected in any way. But I also speak to a lot of ppl who are not convinced. A lot of things don’t add up and this is what is making us all uncomfortable. I believe the government has to start doing more research into the disease and its spread. Someone has to start putting the data through a computer until it discovers a cure or a prevention . In the mean time ppl are doing everything possible to make sure their horses are protected as well as their children. If dogs are infected too why aren’.t they being vaccinated too. And what about cats? Why aren’t the vets refusing to treat them? This hysteria has to stop and ppl have to start thinking rationally to find a solution. I was at the UQ recently for a talk on founder & feeding rationale. I had to walk under trees the were filled with bats and walk on scat and bat droppings all over the ground to get to the auditorium. There were students everywhere. & ppl walking their dogs! In the middle of the “Hendra Season” Why isn’t something being done about that? These are the oddities that make us feel that we are being duped and lied to for the sake of the drug companies and vets. Instead of wielding sticks and ordering ppl to make morally incorrect decisions, Let’s just get together and find a workable solution so we can all get on with our lives!
I am not an anti-vaccer. Certainly far from it.
I did the right thing and had 5 horses vaccinated for the hendra virus.
One had local swelling, and stiffness in his neck- normal reaction and nothing a little bute and a higher hay net couldn’t resolve.
But my two precious Clydesdales suffered.
On their 3rd shot, they became lethargic, itchy, moody, and listless. The itchiness turned into an obsession. Where these two would mutually groom until blood appeared. When not mutually grooming, they were rubbing themselves frantically against trees, posts, anything they could.
They removed their long flowing forelocks and manes, parts of their tails, skin along their backs. One mare rubbed her ear so badly it tuned into a haematoma. That didn’t stop her from itching even further (mind you- she was covered in a face/hood/neck/body and belly rug). She burst the haematoma and opened it to infection. She was on antibiotics for 3-4 weeks. Cost me nearly $2000 for the vets.
Under vets advice, we treated for everything that could possibly cause the itching- Lice, mites, neck threadworm, pinworm, ticks, and finally the vet said it must be qld itch that is now here to stay with her! These horses were completely healthy and shiny with no illnesses before this vaccine. It was the only change whatsoever.
Then we tested with 2nd daily cortisone injections to stop the itching. All this did was make her depressed, sweaty and no change to the itching.
Zoetis/APVMA said it was an unknown reaction! Pfft!!! Other horses have experienced the exact same thing as mine have post vaccination. How is that a coincidence?
Now I have two ugly hairless horses,lost value, who are sensitive to everything, and my mare has a permanently floppy ear due to the damaged cartilage from the infection.
No longer my prized show winning mare.
Also, I have no other option but to keep vaccinating my horses as these bloody vets are refusing to treat them if I don’t inject them with this poison again!!!! This will just lead to more owners having to do home vet work. Come on. Hasn’t this vaccine done enough damage? Ever heard of vaccinosis?? Because that is real and that is what is happening everywhere!
Not happy at all!!!!!!!