The Godfray Review into England's 25-year bovine tuberculosis (bTB) strategy came at a great time for the British Veterinary Association (BVA). Our existing bTB position had been developed in 2014 and was largely focused on the then-pressing issue of badger culling. However, it overlooked many of the other complex issues behind the spread of infection. And of course, since then, both the science and the political environment had evolved.
By 2018, when the Review was published, we felt the timing was right to update our position through a comprehensive review of UK-wide TB policies and scientific evidence. We coordinated a working group comprising veterinary practitioners, representatives from BVA specialist divisions including the British Cattle Veterinary Association and the British Veterinary Zoological Association, and experts from the world of government veterinary surgeons and wildlife groups, among others
A fresh approach to our TB position
In updating our position, we recognised a number of things. First, that as a representative body for veterinary surgeons throughout the UK, we wanted to be able to consider how TB in cattle affected all areas of the UK. To this end, a whole day was dedicated to meeting with devolved government representatives, seeing what we could learn from each other, and how we might seek to promote alignment between each jurisdiction.
Second, we recognised that the old and polarised debate about badgers was exactly that — old and polarised. BVA has long supported the badger cull when it is done humanely, effectively and in the right area with evidence that the disease level in wildlife may pose a risk to cattle and other farmed species. We have not moved away from this position in our updated paper. What is new is that this is now one chapter in five in our comprehensive document.
Third, we recognised that we needed to help guide the veterinary profession into a position of being more engaged with TB in cattle in the same way that we are with bovine viral diarrhoea (BVD), Johne's, infectious bovine rhinotracheitis or any other infectious disease on farm. Unifying the team of farmer, private veterinary surgeon, state veterinary surgeon and government is essential if we are to all take the unified steps which we see as necessary to finally push TB away as a health and economic drain on our cattle industry. Recent Department for Environment, Food and Rural Affairs (Defra) statistics highlighted that the average cost of a breakdown to a farmer is £6600, but that it rises to over £18 000 if you are a farm of 300 animals or more. We have been paying the price of business as usual for too long. Together, we need to implement changes to reduce the frequency, duration and severity of breakdowns.
As well as recognising that if we are to reduce the risk of TB in cattle on farms, we need to be holistic in terms of wildlife controls, we also recognised the risk posed by other farmed species. We have drawn attention to this in our document and asked for more research to be able to sensibly test for and control disease in these species groups, most particularly the camelids, but also goats, sheep, farmed deer and pigs.
All of this requires a change in mindset from veterinary surgeons and farmers on the ground too. I have spent many years working with farmers who have felt helpless in the face of a disease outbreak which is creeping across their county, apparently randomly choosing which farm to pick out next for its particularly cruel attention (Figure 1). As veterinary surgeons I also believe we have to recognise that while we have all ensured that our testing has improved and is maintained at an excellent standard, no disease was ever eradicated by testing alone. BVA is calling in this document for greater autonomy on farm for the people who know the needs and farming practices of that farm the best — the livestock keeper and their veterinary surgeon — to make decisions about what they might do to reduce the disease risk, over and above the statutory requirements to undertake surveillance testing.
This might be about using novel tests which may highlight animals at risk of developing disease. It might be about identifying high risks of entry or spread of disease — biosecurity and biocontainment risks — and taking proportionate action to reduce those risks. It might be about educating others on the farm that simply heading out to market for a ‘good deal’ as part of a sociable day out may not be the best thing to do in terms of biosecurity generally, and in this case, for reducing the risk of buying TB specifically.
Across the high risk and edge areas of England, and through Wales, there have been some excellent initiatives to identify the risks and appropriate mitigation factors which may be undertaken on a farm-by-farm basis. I am talking about the TB Advisory Service (TBAS) and Cymorth TB. Both of these initiatives aim to work with farmers who are keen to reduce the risks of TB on their farms, to understand those risks, and to offer sensible, practical and achievable solutions to reducing them. The uptake has been lower than we might have hoped, although satisfaction for those who have received a visit remains very high. I can understand the hesitation.
Importance of data sharing and evidence gathering
We have no empiric evidence of what difference a particular measure will make to the overall disease risk on a farm. This makes demonstrating the worth of any intervention to a farmer very challenging. From a human behaviour point of view, it is more difficult for a farmer to feel the benefit of an investment which, if successful, leads to the continued absence of disease. To clarify, if you invest £1000, and do not have TB in your cattle this year or next, then was it a good investment? It is impossible to prove that you would or would not have had TB anyway without making the investment!
There are data out there that could provide this information to farmers — it is just not shared with the right people. This is why we are calling for a greater connection between the data held by different bodies. That TBAS can know what interventions have been made on farm but not share that data with Animal and Plant Health Agency (APHA), while APHA know which farms have had breakdowns in a unit time but are unable to share the data with TBAS, is a lost opportunity to gain useful in-sights into the effectiveness of the advice being given. Again, breaking out of the ‘farmer’, ‘veterinary surgeon’ and ‘state’ silos and working collaboratively would feel to be an important step towards making this a reality.
Government have expressed a desire to see a move away from licensing new badger culls over the next few years. As already stated, BVA supports the culling of badgers in a humane and effective way where there is evidence of disease spread to cattle. We do not see that this process will end any time soon, but it is sensible to consider how we might evolve into a ‘post-culling world’. While there is excellent evidence that vaccinating badgers helps to reduce the risk of disease in other badgers, and indeed may have a benefit which spreads to the next badger generation, there is as yet insufficient evidence in either direction for the impact on cattle. One report which even the authors cautioned against over-interpreting is not enough for us to fully understand this picture.
We remain delighted to hear that both cattle vaccination, and a test which will enable its use, the so-called DIVA (distinguishing infected from vaccinated animals) test, are likely to be brought to market in the next few years. There are no platinum bullets when it comes to controlling TB, no single measures which, if implemented, would mean we could forget about all the others; rather, there are a series of steps that we must take to push the R value for TB in cattle below 1. BVA looks forward to seeing the evidence on the impact of vaccinating cattle on the spread of the disease to other cattle, both through increased resilience of those uninfected animals, and reduced shedding of those infected. It is quite reasonable to hope that this may become another very helpful tool in the armoury of the veterinary surgeon and farmer, working together to identify the best solution for each herd. Again, think of BVD — as veterinary surgeons we do not automatically advise vaccinating; we risk assess, discuss options, identify alternative routes to reduce risk and, ultimately, present a balanced argument to our clients so that they are able to take an informed view on whether to invest in that vaccine.
Placing this alongside enabling farmers and veterinary surgeons to make greater choices on tests at both a herd and individual level, over and above the statutory minimum, again gives more control back to those who are best placed to implement it. Choosing to select a more sensitive test for a post movement test, for example, may give more confidence in the result when introducing a valuable bull into a herd. While some of these options already exist, there is capacity to increase both availability of, and awareness of, the numerous options.
Key research asks
BVA has made five clear calls for evidence in our document, some of which we have covered already. We seek to understand better the cost of a disease outbreak. As highlighted above, the cold financial cost has been detailed in a recent Defra report, but there is more to consider. How does the fear of TB impact on people's farming strategy? What purchasing choices are made by those suffering from or fearful of an outbreak? What is the emotional impact of TB on farming practice? At a time when mental health and wellbeing are so much in focus in our society, we believe that it is important to understand that losing livestock, or even the fear of losing livestock, carries with it a great burden of stress which stands outside the financial impact on the farm. This impact is felt most acutely, of course, by the animal keeper. As a practitioner, I can tell you that it is also felt keenly by the veterinary surgeon who is emotionally and professionally invested into that herd.
Since Mycobacterium bovis exists in faeces, then it is reasonable to wish to better understand the risk of the bacteria in cattle faeces to the spread of this disease within herds. There has been much anecdotal evidence on both sides of this discussion, and we ask now for research to conclude the size of that risk. After all, if it is found to be a problem, then we can begin to ask for solutions, putting yet more pressure on that R value, and reducing the cost of the disease to our farms. It might be that this is part of the story in terms of repeat breakdowns. With so many farms, even in the high risk areas of the country, never having experienced a TB outbreak, while others seem to be in and out of restrictions so often, we would like to see research to be better able to understand these differences. Simply being a dairy cow on a larger farm does not feel like the whole story, and even if it is, we would hope that it would be possible to get underneath the bonnet of this headline and understand how those larger dairy farms can help themselves to reduce risk.
Moving forward together
In summary, we believe that we can be successful as a country in eradicating TB in cattle. To do this will take a commitment from farmers, private veterinary surgeons, state veterinary surgeons and government to keep moving to utilise the most up-to-date evidence on what are the most sensible measures to put in place for each cattle holding in the country. These measures may involve wildlife control, changes to the ways we manage our cattle, alterations in how and when we purchase cattle, and may in-volve controls about how we deal with faeces. Together, when we face TB as any other disease, we can and will bring it under control. The goal of achieving a life without fear of TB must surely be worth the uncomfortable realisation that many of us can do more.