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ORIGINAL ARTICLE
Citizens’juries give verdict on whether private practice veterinarians
should attend unvaccinated Hendra virus suspect horses
EJ Annand,
a,b,c,d
* PA Reid,
e
J Johnson,
b,f,g
GL Gilbert,
b,f
M Taylor,
g
M Walsh,
b,f
MP Ward,
a,b
A Wilson
h
and C Degeling
i
Background Hendra virus (HeV) is endemic in Australian flying
foxes, posing a threat to equine and human health. Equine vacci-
nation 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 per-
spectives, misunderstanding and mistrust. Private veterinary prac-
titioners 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 burden-
some, 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 con-
trol 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.
Keywords community-based participatory research; Hendra
virus; One health; syndromic surveillance; vaccines; Zoonoses
Aust Vet J 2020 doi: 10.1111/avj.12957
Hendra virus (HeV) infection is endemic in Australian fly-
ing fox populations. Since first identified in 1994, HeV is
known to have infected horses on 62 occasions resulting in
104 horse fatalities and zoonotic transmission resulting in four
human fatalities. Three of the four human deaths resulted from
occupational exposure. Horse-husbandry and infection control prac-
tices that aim to reduce equine risk exposure have been promoted
since 1995. However, the efficacy of these practices is unknown, and
many owners and veterinarians find the recommended changes diffi-
cult and expensive to implement.
1,2
An equine vaccine against HeV
has proven 100% effective in preventing infection and more than
150,000 horses have been vaccinated since its release in November
2012. Despite equine veterinarians, animal biosecurity agencies and
Workplace Health and Safety (WHS) regulators continually
emphasising that vaccination of horses is the most effective HeV risk
mitigation strategy, many owners choose not to vaccinate –even in
areas assessed to be at relatively high risk of infection. Reasons cited
by these owners include perceived low likelihood of HeV disease,
vaccine cost (Veterinary administration required at approximately
$100 AUD/dose with annual boosters required after an initial course
of two doses between 3 and 6 weeks apart and a booster at 6-
months), potential adverse reactions or compromised sporting per-
formance and risk of export and international travel restrictions for
vaccinated horses to some countries.
3–5
Horse owners, equine organisations and veterinarians all have obli-
gations to mitigate and manage HeV risks as best as is reasonably
practicable.
6–8
Given the potentially catastrophic impact of HeV
infection in humans, strict personal protective equipment (PPE) and
biosecurity protocols are essential when managing potentially
infected horses. Both the Work Health and Safety Act 2011 (WHS
Act) and Biosecurity Act 2015 (2014 Qld/2015 NSW) legislations,
interpreted at the state level, place a shared obligation on horse
owners and veterinarians to prevent or minimize HeV disease
risks.
7,8
Both Acts support a ‘shared approach’to managing the
work, health and safety (WHS) obligations of people and organisa-
tions so that the economy, the environment and the community are
protected.
6
As is consistent for zoonotic disease occurring in all nonproduction
animal species in Australia, equine HeV disease recognition and
sampling is most often carried out by private veterinarians. The costs
*Corresponding author.
a
The University of Sydney, School of Veterinary Science, Sydney, New South Wales,
Australia; ed.annand@sydney.edu.au
b
The University of Sydney, Marie Bashir Institute for Infectious Diseases and
Biosecurity, Sydney, New South Wales, Australia
c
CSIRO, Health and Biosecurity, Canberra, Australian Capital Territory, Australia
d
Equine Veterinary and Epidemiology Services, EquiEpiVet, Berrima, New South
Wales, Australia
e
Private Equine Veterinary Practice, Brisbane, Queensland, Australia
f
The University of Sydney, Sydney Health Ethics, Sydney, New South Wales, Austral ia
g
Department of Psychology, Macquarie University, Sydney, New South Wales,
Australia
h
The University of Sydney, Menzies Centre for Health Policy, Sydney, New South
Wales, Australia
i
University of Wollongong, Australian Centre for Health Engagement, Evidence and
Values, Wollongong, New South Wales, Australia
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AUSTRALIA’S
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© 2020 Australian Veterinary Association Australian Veterinary Journal 1
of molecular and serology testing of potential HeV cases are covered
by the State Government Departments of Agriculture (as for other
notifiable diseases). Government veterinarians are obliged to investi-
gate cases where there is a genuine suspicion of a notifiable disease
and yet, as in many countries, Australian government veterinary ser-
vices are insufficiently resourced to undertake this activity across all
species and regions, particularly for nonproduction species such as
horses. New South Wales (NSW) has the most effective coverage of
government veterinarians through the Local Land Services (LLS) vet-
erinary service (funded by the NSW Government, the federal gov-
ernment National Landcare Program and rural ratepayers). While
many HeV investigations are carried out by LLS veterinarians, their
animal health service priority is on production animal species.
9
State
Government Departments acknowledge that attending HeV suspect
cases is optional rather than an obligation for private veterinarians
but that private equine practitioners remain highly suitable and
important first responders to suspect HeV cases. Australian veteri-
nary graduates are obliged to uphold an ethical code comparable to
those of human medical practitioners, ‘to practice veterinary science
ethically and conscientiously for the benefit of animal welfare; ani-
mal and human health; users of veterinary services; and, the commu-
nity’. However, as for human medicine, these are not binding or
enforceable agreements and have not been consistent between gradu-
ating cohorts over time or between institutions.
10,11
Horses infected with HeV experience a usually fatal acute disease
mediated by an endothelial vasculitis.
12
Infected horses usually show
respiratory and/or neurological signs with a rapid clinical disease
progression, although signs can be variable and even discreet.
12
The
potential for infectious virus to be shed before the recognition of
clinical disease adds to the difficulty in managing risk in
unvaccinated horses. Veterinarians most experienced in clinical
equine practice remain the most capable for the recognition of sus-
pect cases via pathogenesis-orientated consideration of disease
presentation.
12
Veterinarians in private practice who attend sick, unvaccinated
horses are performing a public health role. Some private practi-
tioners find themselves ‘between a rock and a hard place’due to the
burdens and stressors involved in managing HeV risk in
unvaccinated horses. If they do not attend suspected equine HeV
cases, members of the public are potentially at risk of exposure, and
prompt case recognition and prevention of potentially fatal human
disease is jeopardized. If veterinarians do attend, they are confronted
by substantial health and financial risks, as well as WHS and
Biosecurity legislative obligations. They also face indemnity liability
obligations in a context in which they have limited control of the
actions of others and restricted treatment options. In HeV endemic
regions, many veterinarians have felt the need to restrict their con-
sultation to vaccinated horses, while others have stopped attending
horses altogether or moved to practice in lower risk regions.
13–15
A
Queensland Parliamentary Inquiry into the vaccine and its use by
veterinarians (which included consideration of the WHS prosecu-
tions of three private veterinarians) highlighted the challenges that
veterinarians face.
15,16
The rise of One Health approaches to managing HeV disease in Aus-
tralia has increased awareness of zoonotic emerging infectious
diseases and augmented effective disease surveillance and response
networks between human and animal health sectors. However, this
increased awareness of previously underappreciated zoonotic disease
has highlighted the limitations and barriers to effective ‘One Health’
detection and response under the current Australian policy and gov-
ernance framework. Internationally the differing aims and institu-
tional separation of human and animal health disciplines are
recognized as problematic,
17–19
leading to countries such as the US
and Denmark establishing specific One Health interagency structures
to better co-ordinate human, animal and environmental agency
responses to zoonotic risks.
20,21
In Australia, the Queensland (QLD)
Government formed an unfunded Hendra Virus Interagency Techni-
cal Working Group in 2011, which included animal health and
human health experts, with the aim of identifying best practice for
the prevention of human infection. The group published technical
advice online in 2014.
22
The Tripartite alliance of the World Organi-
sation for Animal Health (OIE), World Health Organisation (WHO)
and the Food and Agricultural Organisation of the United Nations
(FAO) has recently published guidelines for countries for responding
to and managing zoonotic disease that highlight ways in which the
different sectors could best work together.
23
It is against this background that we present findings from three citi-
zens juries convened between August 2017 and March 2018 to con-
sider issues surrounding how Australia should manage the risks of
HeV spillover, including the obligations of veterinarians. After out-
lining these findings, we discuss the current framework within which
One Health zoonotic disease surveillance and response operates
within Australia, and the challenges this framework poses for
improving the management of endemic zoonotic diseases.
Materials and Methods
A citizens’jury is a process in which a broadly representative group
of citizens are brought together to be educated about and deliberate
on a specific issue.
24
What distinguishes such deliberative methods,
from other research methodologies for eliciting public views, is the
structured and constructive process of information exchange, and
the opportunities for developing knowledge between experts and
members of the public towards informing policy.
25
The method
assumes that people can think rationally and change their views
should the evidence warrant it.
26
Citizen jury processes aim to pro-
vide citizens with the conditions for their making informed decisions
that reflect their authentic preferences. Citizens’juries are a delibera-
tive method with these general characteristics:
1A group of citizens is convened for 1–3 days;
2They are asked to consider a specific issue;
3They hear evidence (sometimes conflicting) from a range of rele-
vant experts, to whom they are then given the opportunity to ask
questions;
They are given time for deliberation and to arrive at reasoned con-
clusions, all of which are documented. A small sample size is consid-
ered necessary for high-quality deliberation. Citizens’juries
convened to consider issues surrounding infectious disease control
and prevention have been greatly informative in Australia and
internationally.
27,28
Australian Veterinary Journal © 2020 Australian Veterinary Association
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Study setting
In this study, citizens’juries were convened in Rockhampton (QLD),
Lismore and Sydney (NSW) to elicit views of well-informed members
of the public on (1) the permissibility and perceived legitimacy of using
ecological approaches to manage the risks of HeV spillover, and (2) the
social and ethical obligations veterinarians might have when requested
to attend horses considered potentially infected with HeV. Jurors had
the option to vote for or against each proposal and provide a set of rec-
ommendations in response to the questions. Rockhampton and Lismore
are both regional centres in rural areas on the eastern seaboard of Aus-
tralia; both have been affected by local HeV outbreaks. The capital of
NSW, Sydney is a coastal metropolis located further south than the
other study settings. Home to a large racing and recreational horse pop-
ulation, Sydney has around 20 permanent flying-fox camps located
across the metropolitan region
29
Sydney is yet to be affected by a case
of HeV disease but in June 2019 a case was identified, which caused
fatal disease in an unvaccinated horse in the Upper Hunter Valley
region north-west of Sydney.
30
HeV has previously been identified by
molecular testing of bat urine collected from under flying fox roosts in
Sydney.
31
The risk of a spillover event occurring further south because
of the altered range of the flying fox reservoir hosts is hypothesised as
being in response to clearing of native food source forests and the
effects of climate change.
32,33
Citizens jury processes
Adult participants (n = 31), of varied backgrounds, genders and ages,
were recruited by an independent professional research service by
random-digit-dialling and a social media advertising campaign
targeting horse owners. Participants were then selected purposively
from the resulting pool to promote sociodemographic diversity
within each group, and to make sure that each jury included partici-
pants who either owned or worked with horses (Table 1).
Each jury commenced with an orientation session to introduce the
process, the questions for consideration and obtain consent. To
ensure that participants were informed about the issue under consid-
eration, each jury was presented with balanced factual evidence
supporting different expert perspectives on the feasibility, benefits
and potential cost of different strategies for managing HeV risk, and
given opportunities to ask questions of experts. Jury Day 1 focused
on understanding: basic HeV biology; the socio-economic impact of
HeV emergence; different interventions to manage infection risks;
common clinical and practical issues associated with these strategies
and with management of potentially HeV-infected horses; and the
epidemiological evidence for the drivers of HeV emergence (Table 2).
Testimony from four experts was prerecorded and shown to jurors
as video presentations. Experts were selected on the basis of their
institutional roles, experience and expertise, to provide balanced and
factual information supporting different expert perspectives on the
feasibility, benefits and potential cost of different strategies for man-
aging HeV risk (equine vaccination; adopting low-risk horse hus-
bandry practices; and ecological approaches). Each presentation ran
for approximately 30 minutes. Prerecording ensured the format of
the evidence presented was standardized across juries.
Expert witness biographies and copies of their presentations are
available online.
34
After each video presentation, the expert was
available by teleconference call or in person for jurors to ask ques-
tions. These question and answer sessions, facilitated by a researcher,
allowed jurors to clarify or question the evidence and opinions pres-
ented. Facilitation focused on promoting constructive dialogue and
fair interaction amongst jurors. Our impression when running the
juries was that constructive dialogue and fair interaction between
jurors continued during unfacilitated sessions –a view, which was
later confirmed through a review of the transcripts of jury
proceedings.
For the first hour of Jury Day 2, jurors reflected on, discussed and
debated the evidence, aided by a researcher acting as facilitator.
Juries then deliberated for an hour, without researchers being pre-
sent, to reach a verdict on the questions posed. The verdicts, justify-
ing reasoning and dissenting views, were reported to the research
team in a final facilitated feedback session. Our research and
reporting processes for these citizens’juries were crosschecked
against the accepted checklist and standards.
35
Jurors were then asked to deliberate and vote on two questions. In
PART A they were asked to consider the acceptability of ecological
approaches to managing the risk of HeV infections. The juries’ver-
dicts in response to this question, their reasoning, and a detailed
report on the conduct, content and analysis of each of these delibera-
tive events are reported elsewhere.
36
In this paper we report on the
response of each jury to PART B, which addressed the following
question:
Given the risk of human infection from HeV diseased horses,
should veterinarians and other first responders be obliged to
attend unvaccinated horses that have clinical signs consistent
with HeV infection?
Table 1. Participants of three citizens’juries convened between August 2017 and March 2018 in Rockhampton (QLD), Lismore and Sydney (NSW) to
consider issues surrounding how Australia should manage the risks of HeV spillover, including the obligations of veterinarians and their verdicts
summarised
Should private vets be obliged to attend unvaccinated horses?
Community jury participant characteristics Final verdict
(n) Owns or works with horses Does not own or work with horses Yes No
Rockhampton 12 6 6 2 10
Lismore 9 5 4 2 7
Sydney 10 3 7 0 10
© 2020 Australian Veterinary Association Australian Veterinary Journal 3
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Data collection and analysis
The verdict provided by each of the juries together with the reasons
for their decision are the key outcomes of citizens’jury processes.
24,25
Each of the three deliberative groups (juries) acted as a unit of analy-
sis in this study. During the final session of each jury, a researcher
recorded the verdict and justifications on a flipchart. Each point was
reviewed by the jury for accuracy. All jury deliberations (facilitated
and un-facilitated) and expert question and answer sessions were
audio-recorded and transcribed to allow for verification and analysis.
Transcripts were reviewed to identify and clarify jurors’reasoning.
We present a summary of jurors’descriptions of the rationale and
reasoning that led to their responses to the questions asked of them.
This study was approved by the Human Research Ethics Committee
at The University of Sydney (215/009).
Results
All juries recorded a majority verdict that private practice veterinar-
ians should not be obliged or pressured to attend unvaccinated
horses. They justified their views by considering that the conse-
quences of owners’decisions not to vaccinate (despite availability
and risk management advice) should not be borne by others. Jurors
who voted this way argued that owners would likely have made a
choice not to provide the best protection for their horses and the
consequent risks and burdens of this decision should not be placed
on veterinarians. The jurors’key concern was that veterinarians
should be able to determine the conditions under which they work
on a case-by-case basis (including minimising personal health risks
to which they are exposed). Veterinarians might have a duty-of-care
Table 2. Description of the four experts, perspectives and topics that addressed each of three citizens’juries convened between August 2017 and
March 2018 in Rockhampton (QLD), Lismore and Sydney (NSW) to consider issues surrounding how Australia should manage the risks of HeV
spillover
Expert testimony provided to the community juries
Expertise Expert area Data provided
1 Epidemiology and analytical methods Professor of veterinary public health –
zoonotic disease control and prevention.
•The basic science around Hendra virus (e.
g. what it is, the species it impacts, how
the virus spreads, how vaccination
functions);
•The threat Hendra poses to human and
animal health; the socio-economic
impacts of Hendra virus emergence
•Measures to prevent and manage disease
incidence and spread;
•The multifaceted nature of the
enhancing current Hendra ‘spillover’
prevention strategies
2 Equine veterinary practice and
epidemiology
Specialised in equine veterinary surgery,
reproduction and emerging infectious
disease
•The difficulties in diagnosing Hendra
virus infections in horses;
•What vaccination of horses involves (cost,
effectiveness and longevity of the
vaccine);
•The risks to veterinarians (and other first
responders) of treating unvaccinated
horses;
•The potential impact on industry of an
outbreak of Hendra;
3 Occupational health and psychology Occupational psychology and risk
minimisation in horse husbandry
•The content, mechanisms and nature of
behaviour interventions to control
Hendra virus in its ecological context;
•The strengths, weaknesses and broader
politics of the different strategies to
prevent and manage the risk of Hendra
virus spillovers –changing how people
work with horses, fencing of fruit trees
and covering water troughs, and the
uptake of equine vaccination
4 Landscape epidemiology, wildlife ecology,
emerging infectious disease
Hendra virus ecology, flying-fox population
dynamics
•Hendra virus in its ecological context;
•The strengths and weaknesses of the
following strategies to prevent and
manage outbreaks of Hendra –relocation
of bat colonies, bat culling, and habitat
preservation/restoration
Australian Veterinary Journal © 2020 Australian Veterinary Association
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for the animal welfare issues associated with not providing care to
sick horses, but it was reasonable for their concerns for their own
personal safety to over-ride this. Some jurors who held this view,
considered the potential that more owners might be convinced to
vaccinate should private veterinarians apply surcharges for attending
HeV suspect cases and/or restrict or decline providing veterinary ser-
vices for unvaccinated horses. They felt awareness of the extra finan-
cial costs of biosecurity management and protocols for veterinarians
and the potential impacts on animal welfare (delayed treatment
whilst waiting for HeV exclusion test results) should encourage
owners to vaccinate their horses against HeV.
Jurors explored and held a range of positions during their delibera-
tions (Table S1). However, when the verdict was reported in Rock-
hampton and Lismore –areas that have substantial HeV infection
risks –a minority of jurors (Table 1) still held the view that veteri-
narians, trained in the use of PPE, should attend unvaccinated HeV
suspect horses because they are best placed to manage the public
health implications. The four jurors who voted that veterinarians
should attend also expressed an overriding concern about the animal
welfare issues associated with not providing care to sick horses. Most
jurors, including those who voted against placing any obligation on
vets, considered that responding to zoonotic disease risks to be a vet-
erinary professional duty and an important public health role that
veterinarians should occupy. During each group’s deliberations,
jurors drew comparisons to firefighters and paramedics –profes-
sional groups who regularly expose themselves to controlled risks in
order to protect individuals and the community. Mandating equine
vaccination was discussed at each event but was ultimately rejected
because of ethical and pragmatic concerns about making a vaccine
compulsory. Independent of how they voted, all jurors agreed that
veterinarians who responded to potential HeV cases should not have
to bear the associated biosecurity costs such as PPE, sampling and
shipping consumables, procedural, management and training costs.
Establishing effective government subsidy to compensate and sup-
port private veterinarians who respond to potential cases of zoonotic
disease of public health relevance was strongly supported.
Discussion
After the 2 days of information and deliberation, a substantial
majority of jurors at each event voted that veterinarians in private
practice should not be obliged to attend unvaccinated horses. Many
of the jurors reported finding this a very hard question to answer,
given the potential catastrophic consequences of exposure to HeV
for owners and public that come into contact with an infected horse,
while also considering those in other professions and occupations
who often put themselves at risk of harm while performing their
roles. Jurors appreciated the welfare compromises experienced by
unvaccinated ill horses that are subject to delays and restriction of
veterinary treatment until HeV testing had been performed.
37
They
took the position that while veterinarians might have a duty-of-care
for the welfare of sick horses, it is a duty that should be shared by
horse-owners. Private veterinary attendance of potential HeV
infected horses was unanimously appreciated as constituting a criti-
cal and unique benefit to public health, and that this important role
should be optimally supported so that individual veterinarians are
not left carrying the substantial associated financial, WHS and per-
sonal burdens. Jurors’discussions around considering the obligations
of veterinarians in attending HeV suspect horses focused on what
veterinarians were owed if they chose to accept responsibility for
managing these challenging cases. On this basis, they concluded that
current systems to manage occupational risks associated with equine
HeV cases are inadequate and that additional government support is
needed. Nurses and firefighters perform their roles supported by
large, robust and trusted organisational systems that minimise the
risk of occupation-related harm. Several jurors proposed that mini-
mum support measures, such as a government supplied PPE and a
yearly stipend for veterinary first responders, should be implemented
to ensure continued and optimised private veterinary involvement in
a public health role of responding to potential cases of zoonotic
disease.
Against this background, the policy framework that governs how
veterinarians respond to suspect zoonotic disease events is complex
and potentially restrictive to meaningful change. In Australia, as for
many countries, challenges include both differing priorities and limi-
tations to prompt data sharing and thus the opportunity for timely
‘One Health’interpretation of disease data. Despite the widespread
endorsement of One Health across both animal and human health
agencies in Australia,
38
scope for meaningfully interagency support
of zoonotic disease investigation in animals is limited unless there is
a laboratory-confirmed notifiable diagnosis.
18
On a disease-by-dis-
ease and state-by-state basis ‘One Health’discussion is carried out
between sectors and in many instances has resulted in improvements
in zoonotic disease operations.
39–42
The National Significant Diseases
Investigation Program (NSDIP) provides limited funds for regis-
tered, nongovernment veterinarians to investigate significant disease
events, defined as those exhibiting high morbidity and mortality,
rapid spread, effect on public health, trade or production or where
initial investigation has failed to establish a diagnosis.
43,44
While
NSDIP is not intended to support the investigation of established
notifiable diseases such as HeV in horses, it does include clinically
similar diseases or diseases showing increasing incidence or an
expanding geographic or host range.
43
It is a promising national ini-
tiative, arguably currently underutilised, promoted mainly for wild-
life and livestock disease with varied support interpretation and
promotion, between jurisdictions. It is unlikely that NSDIP has suffi-
cient contingency and resource allocation to bridge the gap required
to adequately support private veterinarians in investigation of poten-
tial zoonotic disease in nonproduction domestic and companion ani-
mal species. As noted above, Government veterinarians are obliged
to investigate suspect notifiable disease cases and yet remain under-
resourced to meet this demand across the extensive geography of
Australia, especially if the requirement is for them to attend every
unvaccinated horse with an HeV suspect illness.
Increased support for private-practitioner-first-responders per-
forming zoonotic disease investigation and risk management within
an optimised ‘One Health’operational framework of animal, human
and environmental health agencies seems warranted and is strongly
supported by informed citizen opinion. This might best be achieved
by developing specific zoonotic disease capacity with veterinary
© 2020 Australian Veterinary Association Australian Veterinary Journal 5
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representation within the human health sector to assess, support,
manage and fund zoonotic disease investigation and management. A
good example of the benefit of zoonotic disease consideration
embedded in human health was the parallel consideration of human
and equine cases of West Nile virus in 2002 in Texas, USA, by the
Zoonoses Control Branch of the Texas Department of State Health
Services.
45,46
Failing such optimal change for broad benefit, our find-
ings highlight potential public support for other more specific mea-
sures such as zoonotic disease investigation reimbursement for
attending veterinarians met by government, industry or both.
A limitation to this study, inherent to participatory deliberative
research methods such as citizens’juries, is that despite significant
effort to collate diverse and representative participants, the necessar-
ily small groups of ‘engaged citizens’views may not represent those
of the target population –in this case the wider general public. It is,
however, noteworthy that three juries in different settings came to
similar conclusions. Another limitation was that, due to limitations
in the volume of information that could effectively be conveyed,
jurors were not presented extensive comprehensive details of rele-
vant national legislative framework such as the WHS Act and the
Biosecurity Act in which owners and veterinarians are interpreted as
managing risks as a shared responsibility (at the time of publication).
They were, however, made aware of the ‘shared responsibility’inter-
pretation of the WHS Act prompted by the Queensland Parliamen-
tary Inquiry of 2016. Jurors were explicitly told that there are no
national legislative obligations for private veterinarians to attend and
investigate suspected HeV cases, however, at the time of the juries,
clarity on how noncommercial horse carers utilising veterinary
ambulatory care may be defined under the definition of a PCBU (A
Person Conducting a Business or Undertaking) under the WHS Act
was only recently been available and not widely understood. Jurors’
deliberations focused on what it is reasonable to expect of veterinar-
ians beyond and regardless of interpretations of the legislative
framework.
Conclusion
Our findings highlight that, when informed of relevant legislative
framework and processes surrounding suspected equine HeV cases,
members of the public recognise the challenges faced by private vet-
erinary practitioners in responding to and managing HeV like illness
in horses. Members of the public appreciate the importance of the
private veterinarian’s roles towards optimising public health and ani-
mal welfare outcomes and the need for improved support for them
by continuing this crucial role.
The structure of policy and governance relating to ‘One Health’zoo-
notic disease investigation, response and management, in Australia,
currently limits the contingency, permanence and adaptability of
meaningful support for private veterinarians undertaking their cru-
cial role. This jury study reports that informed citizens in three sepa-
rate regions, affected by varying HeV disease risk, strongly advocate
that private equine practitioners receive increased support for their
investigation and management of potential zoonotic disease. This
support is likely to be optimised through establishing a specific sec-
tor, which includes veterinary and ecological representation within
Health Departments at multiple levels (national/ state and local) that
considers, prioritises and funds zoonotic disease operations from a
necessary ‘One Health’perspective.
Failing such optimal changes, there is potential for other more spe-
cific interim supportive measures such as zoonotic disease investiga-
tion reimbursement for attending veterinarians met by Government,
industry or both.
Acknowledgments
This work was supported by a Project Grant (APP1083079) from the
National Health and Medical Research Council of Australia to CD,
GLG, MPW and AW. The funder provided support in the form of
salaries for authors CD and JJ, but did not have any role in the study
design, data collection and analysis, decision to publish, or prepara-
tion of the manuscript.
Conflicts of interest and sources of funding
The authors declare no conflicts of interest or sources of funding for
the work presented here.
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Supporting information
Additional Supporting Information may be found in the online ver-
sion of this article at the publisher’s web-site: http://onlinelibrary.
wiley.com/doi/10.1111/avj.12957/suppinfo.
Table S1. Comments and statements made by jurors during their
deliberations
(Accepted for publication 17 April 2020)
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