Editor's choice November

VetScript THE OFFICIAL MAGAZINE OF THE NEW ZEALAND VETERINARY ASSOCIATION

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NEED FOR SPEED: Slow broadband, slow business GOING ORGANIC: Veterinarians’ role ONE HEALTH: Spreading the message

In the face of

DANGER

Dog ownership responsibility

ONE HEALTH

Meeting at the

intersection With One Health Day falling on 3 November, Bette Flagler talks to veterinarians and medical doctors who are working at the intersection of animals, humans and the environment.

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ONE HEALTH

PIPPA SCOTT IS the first veterinarian to be hired as an academic at the University of Otago School of Medicine, Christchurch. Scott, who grew up in New Zealand and received her BVSc from Queensland, her MSc in epidemiology from the London School of Hygiene and Tropical Medicine and her PhD on childhood vaccines from the University of Bern in Switzerland, is currently working on a post-doc, with funding from the Health Research Council (HRC).

Through her project, she is looking at the transmission of zoonotic diseases in New Zealand rural communities.

In particular, she’s looking at Shiga

toxin-producing E. coli (STEC) and Staphylococcus aureus. Her goal is to identify interventions to control the transmission of the pathogens from dairy cattle to humans.

Hers is a One Health life, smack dab in the middle of the intersection of animals, humans and the environment.

It’s just natural for Pippa Scott.

“I don’t feel like I’ve ‘crossed over to the other side’. I just really don’t see the boundary between humans and animals and the environment. It’s important not to think of vets and medics and health professionals as separate groups that can’t work together and that don’t

interact,” she adds. “It’s quite important to see that we’re all effectively doing the same thing and that we can, actually, really cut down some of those barriers, those ‘oh you do human species and we do other species’.

“We can start looking at what everyone is trying to achieve [towards] the same goals of having healthy animal and human populations.”

That a veterinarian is interested in looking across boundaries is no surprise to David Murdoch, the dean of the medical school that employs Scott.

He is convinced that veterinarians are well ahead of their counterparts

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ONE HEALTH

Pippa Scott has combined a global research career with two years in private mixed practice in Queensland and three years in companion animal practice in the UK.

in human medicine when it comes to One Health. In fact, he says, most in his profession aren’t even aware of One Health, despite the majority of public health organisations around the world supporting it.

“I suspect veterinary practice by nature is a bit more outward looking,” he says. “I don’t think the same can be said for the other side. In human health we tend to be a bit focused on humans. I think it’s very clear: my profession is following the veterinary profession. As a concept, One Health does resonate and when people hear about it, they say, ‘Well, yes, that just makes sense.’”

In terms of day-to-day practice, he thinks a good example of One Health in action is related to antibiotic resistance.

“It’s clearly a growing problem, and it’s been recognised and there’s a lot of concern about it. The vet profession has received a lot of flak, related to the agricultural use of large quantities of antibiotics, but the NZVA is leading the

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“I DON’T FEEL LIKE I’VE ‘CROSSED TO THE OTHER SIDE’. I JUST REALLY DON’T SEE THE BOUNDARY BETWEEN HUMANS AND ANIMALS AND THE ENVIRONMENT.”

way with its visionary statements about minimising use.”

On the other hand, Murdoch says, with New Zealand previously lagging the rest of the world in terms of the appearance of AMR, those in human health have been a bit complacent. But recent data shows resistance in New Zealand.

“We have a situation where previously the agricultural use of

antibiotics got all the criticism, but that’s being addressed. Whereas in human health, we’re not as good as we thought we were and we actually need to focus on that.”

Murdoch spoke about the veterinary profession leading the way earlier this year when he delivered a series of lectures about One Health. One lecture was at Parliament.

“At my talk in Parliament, there was a group of vets that came up to me afterwards and said, ‘To have a human health person praising vets, we’ve never heard that before.’ That surprised me! I thought, ‘Oh my gosh, that’s terrible.’”

To be fair, there are other medical doctors who are aware of One Health and who are looking not only at humans, but at the animal and environmental sides of the triad. Take a recent situation in Taranaki.

Claire Richardson comes from a dairy farm in Tataraimaka. She’s currently a fourth-year medical student at Otago University in Wellington. Home for

PHOTOS: LOUIS TRERISE

ONE HEALTH

the last summer holidays, she needed a project and spoke with Jonathan Jarman, the Taranaki District Health Board medical officer of health.

Jarman knew all too well the devastating effects of STEC on children.

Between 2006 and 2015, 39 of the 67 cases in Taranaki were in children aged between one and four, and 29 of those had been exposed to farms or farm animals during the week before becoming ill. Nearly half of those infected were admitted to hospital and five, he says, had kidney complications and needed dialysis and treatment at Starship Hospital.

“STEC doesn't cause disease in animals, but is a farming-related disease.

"In Taranaki [it] is more common than lepto and makes little children very sick.

But most of the farmers we have spoken to have never heard of STEC.” Researching the problem was a great experience for Richardson. “I was able to combine two of my interests for my

summer job. Not only that, I was able to produce a project that will hopefully help improve the health of our rural community. To be honest, when I first began this project I didn’t know much about STEC. I was given an outline to do the epidemiology to see the who, what, when, why and how of STEC in Taranaki over the past 10 years. I was surprised with the results, as I didn’t expect there to be such a strong link to the rural community.”

When you look at the causal pathway for STEC infections in humans, there are a number of intervention points in humans, animals and the environment.

There is a lot to learn about this bug, says Jarman, noting that it was first detected in New Zealand in 1993. “It is becoming more common in Taranaki and we want to turn the curve.”

One way to do that would be to reduce STEC in the environment. Jarman points to work done by veterinarian

“‘TO HAVE A HUMAN HEALTH PERSON PRAISING VETS, WE’VE NEVER HEARD THAT BEFORE.’ THAT SURPRISED ME! I THOUGHT, ‘OH MY GOSH, THAT’S TERRIBLE.’”

Springer Browne at Massey that has shown STEC being common in dairy calves in New Zealand.

Which leads him to the obvious question: “How can we reduce STEC carriage in animals? This is an animal health issue rather than a human health one. It is obvious that it is

“What tends to happen with One Health,” says David Murdoch, “is that the environmental side is overlooked. That’s something we’re aware of and actively working on.”

VetScript November 2016 – 31

ONE HEALTH

very important that farming families know about STEC and know about our key message: ‘Make sure that farm children wash their hands, particularly after helping out on the farm or after touching animals’. Vets have a key role in spreading the message and increasing awareness about STEC.” Nigel French, Professor of Food Safety and Veterinary Public Health at Massey University, couldn’t agree more. “In Taranaki we have an issue of children getting infected from calves.

The medical people got on top of that, but I think it would be a good idea to have greater communication between veterinary and medical practitioners. I don’t know exactly how you do that, but

who alerted us to neurotoxic shellfish poisoning in the early 1990s. He had heard about sick animals after they had been fed shellfish so he contacted us.

That’s when we discovered all of the human cases.”

French thinks there is quite a lack of understanding in the general public around zoonoses. “What’s surprising me is the public saying, ‘We don’t know what the risks are.’ That, for me, is really sad, because we’re doing all this research, but obviously we’re not communicating it well enough to the public for them to make good decisions.

That’s where I think we, as a profession working with the medical profession, have a really crucial role to play.”

working with human health issues and the relationship between animals and people. There’s a big initiative run by the Ministry of Health and MPI around developing a national guideline for controlling AMR in people and animals.

This is the first time it’s really been considered jointly, so this will involve a number of areas from surveillance, to better stewardship and use of antibiotics. So there’s a real drive now to get the medical and veterinary fields together to achieve the common goal.”

AMR is a big cab to get off the collaborative rank, but Murdoch and French both see infectious disease (which happens to be their areas of study) as the one with the most obvious

“THE LAST THING WE WANT TO DO IS TO GIVE THE IMPRESSION THAT WE’RE TRYING TO ‘NANNY STATE’ PEOPLE OR WRAP THEM IN COTTON WOOL.”

I think vets could play more of a role in providing advice to the general public about preventing infection.”

One of his Massey colleagues is making a start. Epidemiologist Jackie Benschop recently worked with the Canterbury DHB on a pamphlet called ‘Best friends shouldn’t share anything’.

“It’s a quick guide to staying healthy around your pet,” she says, explaining that the DHB didn’t have anything for pet owners and is considering distributing the pamphlet through pet stores and veterinary clinics as well as at the DHB facilities.

That’s just the kind of thing that needs to happen. But there’s room for more. It’s definitely a two-way street, and one that Jarman has travelled successfully before. He arrived in Taranaki after 20 years in Northland.

“At the time, Hugh Black was the vet for AgriQuality in Whangarei. I always let him know about human bovine TB cases, as Northland at that time was a TB-free zone. Hugh was the person

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French and Murdoch work together through One Health Aotearoa to try and raise awareness and conduct research at the interface of human, animal and environmental health.

It’s crucial, says French, to bring together the professions to tackle these issues using a common framework and not a siloed one. The One Health Aotearoa alliance is very much about creating situations for that kind of interaction, adds Murdoch. One of the most effective ways that’s happened is through conferences. So far there have been two and Murdoch says he has been “blown away” by the response.

“Nearly 200 people from more than 40 institutions have come along and have been totally engaged. The comments have been, ‘Gosh, I just didn’t know those people before, or I hadn’t really thought about that.’”

More and more are coming on board, according to French, who says that there is a lot going on at the moment.

“At the veterinary school we are

benefiting from collaboration – just think of Pippa Scott in Christchurch and Claire Richardson in Taranaki.

“We manage to transfer infection between each other at a regular rate, so why aren’t we doing more about this?” asks French. “Why isn’t there a greater awareness? Why isn’t the public aware of the risk?

“The last thing we want to do is to give the impression that we’re trying to ‘nanny state’ people or wrap them in cotton wool. It’s up to people to make their own decisions about what they eat and what they do to their bodies and what they drink. But we’re in a really strong position to at least tell them what the risks are. Then it’s up to them to decide what they want to do.

“Whether it’s consuming raw milk or not treating your water or not washing your hands after handling livestock, it’s up to you whether you want to do it.

But if you don’t know that what you’re doing could kill your child, then you bloody well should know about it.”

DANGEROUS DOGS

In the face of

DANGER By now you will have received the NZVA’s new position description on dangerous dogs, sent out in October. Matt Philp explores the thinking behind the scenes.

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DANGEROUS DOGS

VetScript November 2016 – 35

DANGEROUS DOGS

“TARGETING A SPECIFIC BREED IS A GROSS OVERSIMPLIFICATION OF A COMPLEX ISSUE.”

WHEN A DOG bites someone in the street or at home, at which end of the leash does responsibility lie? With the animal, or its owner? Rochelle Ferguson thought she knew the answer to that question, that some dog breeds are just innately dangerous.

“We’re all conditioned to think that, because of the way the media reports it,” says the Operations Manager for the NZVA’s Companion Animal Veterinarians branch. “But, really, the aggressive behaviour of a dog is more a reflection of the owner’s behaviour.”

Her mind was changed as a result of in-depth research to formulate the NZVA’s new dangerous dogs position description, sparked by a spate of serious dog attacks earlier this year.

When the media came calling for comment, the association’s former position statement seemed too thin and unconvincing to address what was clearly a significant public health issue.

“We thought we’d start right back

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at the beginning, and draw on the experience and knowledge we have in the veterinary community to develop something more comprehensive than just a position statement.”

In other words, they went back to the science. Working with others, Ferguson studied literature reviews on aggressive dogs put together by the likes of the American Veterinary Medical Association and work on the same issue by the Australian Veterinary Association (AVA). The overseas examples suggested that the breedbanning approach adopted in many territories isn’t supported by the facts.

“Dog breed is not the biggest contributing factor to a dog bite incident, based on the studies. The dog bite stats aren’t true stats, because they’re skewed by the popularity of the breed or type of dog. And people don’t accurately identify dogs, either.”

In fact, in some overseas jurisdictions, breed bans are starting to be overturned

for lack of evidence, according to Ferguson, who cites Germany and some US states as examples.

“Targeting a specific breed is a gross oversimplification of a complex issue.

It scores political points, but it’s failing to capture large numbers of potentially dangerous dogs, and it gives everyone a false sense of security. Also, it doesn’t promote a responsible attitude of dog ownership.”

Conversely, places that stress owner responsibility and the importance of licensing and education are enjoying some success. Calgary, for instance, whose animal control programme is considered among the most effective in North America, shifted to a ‘responsible pet owner’ model in 2000, and has been rewarded by a steep decline in the number of aggressive incidents.

The new NZVA position description on dangerous dogs reflects this approach, stressing the need for dogs to be classified according to their actions rather than their breed, and for the context of these actions to be considered.

Under the proposed model, which draws significantly on the AVA’s framework, there would be an emphasis on identifying potentially dangerous dogs before they became a serious problem. So, for example, a dog that exhibits unacceptable aggression without actually biting, or inflicts a single (not serious) bite wound in a situation where provocation of the dog has been established as a significant causal factor, would be classified as potentially dangerous.

A dangerous dog, meanwhile, would be classified on the basis of causing serious injury to a person or domestic animal or inflicting multiple bite wounds without provocation, among other criteria.

All dog owners would be licensed, and anyone wanting to keep a potentially dangerous or dangerous dog would require a special endorsement based on criteria such as being aged 18-plus, passing a criminal background check

DANGEROUS DOGS

The sector responds THE GOVERNMENT CLEARLY stated its view about dangerous dogs when Louise Upston, Associate Minister for Local Government, announced a national action plan in September to reduce risk and prevent harm from dog attacks.

This plan includes initiatives on education, support for enforcement of dog control laws, dog population control and improved data collection. It also has tough new laws that will be applied to dogs who, based solely on their appearance, are classified as ‘menacing’.

As well, animal shelters will be prevented from rehoming ‘menacing’ dogs. This effectively means that many dogs face being euthanised based solely on their appearance.

While the NZVA is supportive of the initiatives and intention of the government announcement, it is strongly against the breed-specific approach.

Rochelle Ferguson, spokesperson for the Companion Animal Veterinarians branch of the NZVA, argues that overseas experience shows such laws don’t work.

“It’s a huge step backwards for dog control in New Zealand to further enhance breed-specific legislation,” she says.

“Other countries are moving away from this type of approach as it has no scientific basis and has not been effective in reducing dog bites. Moreover, it essentially sentences hundreds of dogs to die based on how they look. Performing euthanasia for this reason alone does not align with the NZVA’s values.”

The NZVA was among the groups that presented to the Government on the issue of dangerous dogs. The NZVA advice stressed the importance of supporting a cultural change in the way dog ownership is viewed by instigating owner licensing. This focuses the responsibility for dog aggression firmly on the dog owner, and allows for control over who is legally able to own a high-risk dog.

Great gains in reducing dog aggression and stray dogs have been made in countries that have implemented owner licensing. “Dog breeds that feature highly in dog bite statistics are not there because they are inherently more aggressive; they feature because they are more popular among irresponsible dog owners.”

Until the focus is put firmly on these owners, we are unlikely to effectively address the problem.

ELSA FLINT VETERINARIAN AND VETERINARY BEHAVIOURIST On the NZVA’s new dangerous dogs position description: “I support it. I think the idea of owner licensing will be useful, because it puts more responsibility on people and gives some ability for them to be prevented from owning dogs … There’s the potential for more control that way. At the moment, the dog control laws are reasonably robust but quite hard to implement.

“And I like that it offers some recourse to rehabilitation or restorative justice, an option for a dog to be worked with rather than [euthanised]. There are situations currently where a dog might be reacting as you’d expect any dog to react, and they’re not given any chance. I think it’s important that we look at the [particular context] in which an incident occurs.

“It’s important that owners are educated on how to train and manage dogs … And people also need to take responsibility for how they behave around dogs. A lot of people behave in ways that can provoke dogs, so that needs addressing, particularly among people in jobs where they have to go onto properties.”

KEVIN STAFFORD PROFESSOR OF ANIMAL WELFARE, MASSEY On the NZVA’s new position: “It’s an improvement on the previous policy in that there’s some emphasis on strong enforcement for those who choose not to comply with the legislation, and an expectation that owners of dogs classified as potentially dangerous need to rehabilitate those dogs through a process of training.”

On the Government’s crackdown on dangerous breeds: “I think the Government has no choice; it has to go for breeds and types considered by the public as dangerous. We have to wait to see how it pans out.

Enforcement is really important and, if as an outcome of the Government’s discussions and amendments to the regulations, enforcement is more enthusiastically carried out, we may get some very positive outcomes.”

ARNJA DALE CHIEF SCIENTIFIC OFFICER, SPCA On the thrust of the new NZVA position: “The key thing is that any dog has the ability to bite. It is about education of dog owners and non-owners: how to interact safely, and how to train a dog with positive reinforcement, how to socialise it and meet its physical health and behavioural needs.”

On the Government’s recent announcement: “We firmly believe we need evidence-based recommendations that we know are going to make a difference in reducing dog bites. We will not support the tightening of breed-specific legislation, including rehoming breeds deemed to be menacing from any shelter … absolutely if a dog has been shown to have a propensity, we have no issue that that dog shouldn’t be homed.

“However, breed alone is no indicator of aggression. And we know from international and New Zealand research that we cannot accurately assess breed from visual appearance. Around the world, dogs deemed as Pit Bulls are being euthanised when they’ve got no Pit Bull in them.”

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DANGEROUS DOGS

“IT’S ABOUT CHANGING HOW PEOPLE VIEW OWNING A DOG AND THE RESPONSIBILITIES THAT COME WITH THAT.”

and demonstrating the mental and physical ability to handle the dog safely.

In addition, their property would have to be secured to allow the dog to be restricted, and display warning signage.

Ferguson stresses that the new position is by no means a softening on dangerous dogs. If anything, she says, the goal is to have tighter and tougher restrictions applied, including mandatory behaviour testing and rehabilitation training for dogs identified as potentially dangerous.

“We’d suggest that current restrictions would be more effective and keep society safer if they were supported by a more sensible classification framework.”

Another key recommendation is that dog control officers be given greater resources and support to more effectively apply their powers under the Dog Control Act. But the essence of the position description is that the problem of

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dangerous dogs will only be solved by change at the other end of that leash. A societal shift is required, says Ferguson.

“We’re looking at it in the same way as changing attitudes to drink driving and smoking. It’s about changing how people view owning a dog and the responsibilities that come with that.”

Education is critical. “This is where the veterinary profession kicks in, with our ability to educate our dog owners.

We’re in a fortunate position because we have such a close relationship with new puppy owners particularly.

“And we know that there are many reasons dogs bite, including some health-related – for example, if they’re sore or arthritic. So veterinarians have a big role to play in identifying dogs that could use some assistance and pointing people in the right direction.”

Encouraging responsible dog ownership also requires addressing the problem of stray and roaming dogs.

“If it gets too restrictive to own a

particular dog, people will just give it up and get a new one,” she observes. “So we have got to get on top of this endless supply of puppies. Owning a dog should be considered a privilege not a right,” she observes.

“Having an endless supply of unwanted puppies and dogs does not support this. When we looked overseas, places like Sweden and Switzerland that have rigorously applied breeding and ownership licensing don’t have shelters overflowing with unwanted dogs.

“Instead, dogs there are seen as part of the family. If we can move attitudes in New Zealand in that direction we’ll go a long way towards [people] training and looking after their dogs.”

The final plank of the new approach is a call for better data collection, standardised nationally.

“Part of the issue is that stats are collected by each territorial authority in whatever way they choose. It makes it very difficult to do comparisons nationwide.

“We have the ACC statistics, but they don’t account for the context [of dog bite incidents], so it’s difficult to gain useful knowledge from them.

“That’s part of the problem: it’s all hearsay, and so you get knee-jerk political reactions. It’s imperative to know what’s really happening.”

If anything, her research has opened her eyes to the complexity of the dangerous dogs issue, and the need for a comprehensive solution.

“I hadn’t quite appreciated just how tightly integrated all these concepts were. If you just did one thing in isolation, like you sorted out the classification system but didn’t also tackle education or stray dogs, then we wouldn’t get there.”

And it’s important we get this right, she adds. “I love seeing dogs around and the benefits they bring us. But if we’re going to have dogs welcomed in society then we’re going to have to manage some of the adverse effects, or people will want to ban them. That’s not going to be good for anybody.”

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