As bird flu spreads among U.S. cattle, veterinarians find themselves in a familiar position: the frontlines

When, in April, the federal government began requiring some cows to be tested for a strain of avian flu before their herds could be moved across state lines, it seemed like an obvious step to try to track and slow the virus that had started spreading among U.S. dairy cattle.

But Joe Armstrong, a veterinarian at the University of Minnesota extension school, feared the U.S. Department of Agriculture rule could lead to potential problems for his colleagues, who were in effect being deputized to implement it.

“I am 100% expecting this to result in many arguments with clients,” he said on a podcast then, deploying the term veterinarians use for the farmers who hire them. “Whether or not the practicing vet is the one who’s handed down the rule, they are now enforcing it, and there are going to be clients lost over this situation. That amount of stress and pressure from two directions — USDA from the top, clients from the other side — puts practicing veterinarians in a very stressful day-to-day.”

Armstrong’s remarks highlighted both the crucial role that veterinarians are playing in efforts to try to stop the H5N1 outbreak and the sometimes difficult position that doing so has put them in.

Since the outbreak in cattle was discovered earlier this year — by veterinarians themselves, as it happens — dairy veterinarians have been on the frontlines of the response. They’re testing cows. They’re teaming with farmers and dairy workers to prevent additional infections, both bovine and human. They’re using their on-the-ground experience to trace how the virus is transmitting.

They’re the ones, as Tera Barnhardt, a veterinarian in southwest Kansas, put it, “with shit on their boots.”

But they’re also having to navigate the concerns of the farmers who pay them, which are sometimes at odds with the campaign to contain the virus. Some farmers have been reluctant to test their herds, because of restrictions on movement of infected cattle and on milk sales. Before the government started covering testing costs, they also didn’t want to shell out thousands of dollars for tests themselves.

In an interview last week, Armstrong told STAT he knew of veterinarians who had lost clients over disputes over whether to test.

“I didn’t want to be right,” he said about the prediction he made on his podcast.

But knowing where the virus is is vital if its spread is going to be stopped. Already, the virus has spread to at least 140 herds in a dozen states, setting off alarm bells about the impact on cows and the possible implications for human health, if things take a turn for the worse.

“It makes it really challenging to be that veterinarian and say, I know there’s flu on this farm, but the owner won’t approve testing,” said Keith Poulsen, a veterinarian who now spends most of his time running the Wisconsin Veterinary Diagnostic Laboratory. “That makes a pretty big ethical dilemma for veterinarians.”

Public health agencies are also turning to dairy veterinarians to serve as lookouts for human cases, and to be liaisons to a world they don’t have access to. It was a veterinarian who brought a Texas dairy worker with conjunctivitis to the state health department’s attention, a man who ultimately became the first human H5N1 infection tied to the cattle outbreak. Anecdotes from veterinarians about other sick dairy workers have raised concerns about missed human cases.

“We’ve tried working with dairy industry groups in Texas but dairies are concerned about biosecurity and have not allowed public health on to the farms,” a spokesperson for the state health department told STAT at the time. “Most of our outreach to the dairy farms has been through their veterinarians.”

The outbreak has shone a light on how vital veterinarians are in the business of farms, the safety of our food supply, and monitoring for human health threats. But the demands on them are adding more weight to a profession that’s faced workforce shortages going back decades and that practitioners say have only grown more acute.

Only some 8% of veterinarians focus on food animals or have mixed animal practices, according to the American Veterinary Medical Association, compared to roughly 70% who focus on pets, or in the field’s vernacular, “companion animals.” And while the ranks of those clinicians are steadily growing, the shortage of rural veterinarians has persisted, with ongoing impacts for farms.

“We are losing animals because we just have no one to come to the farm in time to save them,” Sen. Cindy Hyde-Smith (R-Miss.) said at a hearing in December 2022, adding that the workforce problems “threaten the long-term viability of our livestock industries.”

The reasons are many, those in the field say. It is physically grueling work, dealing with large animals in all sorts of weather. Rural veterinarians are not only the regular caretakers, but also the ones farmers call in the middle of the night in an emergency. They don’t make as much money as their counterparts in cities (though some of that is due to cost-of-living differences), which is a major consideration for graduates of veterinary schools carrying debt from their $200,000 education.

Then come the hurdles that rural communities are facing generally. Can you find day care for your kid? Can your spouse find a job?

“Every young person I talk to who’s interested in animal science, I beg them, I literally beg and plead with them, to look at large animals,” Chavonda Jacobs-Young, an undersecretary at USDA, said in response to Hyde-Smith’s questions at the hearing.

The federal government and different states have tuition repayment programs for veterinarians who work in underserved rural areas, and veterinary schools have increased their class sizes to build up the pipeline. Hyde-Smith and other lawmakers have been pushing to change the federal Veterinary Medicine Loan Repayment Program so that the funding is given tax-free.

But it’s not just an issue of attracting people to the field, but retaining them. Fred Gingrich, the executive director of the American Association of Bovine Practitioners, said that roughly half of veterinarians who start in food-animal medicine leave within a decade, with the long hours catching up to people, particularly when they start families. That indicates there need to be broader solutions.

“We need to fix ourselves, so the next generation of veterinarians wants to work here,” he said.

For rural veterinarians, addressing the H5N1 outbreak has posed particular challenges. While some farms have a small number of sick cows, some herds have had widespread infections. Even if only 10% to 20% of animals are showing signs of disease, that’s still a lot of animals to take care of when there are thousands of cows in a herd.

“It’s just a huge wave of infections coming within a 10- to 14-day period,” said Justin Kieffer, a former private practice veterinarian now at Ohio State University. “It’s just a mad scramble to try to maintain normal farm operations.”

When cows have H5N1, farmers generally provide supportive care, like giving fluids and making sure the animals eat. Most animals recover, though some seriously ill cows are euthanized, and those whose milk production doesn’t return to normal are sent to slaughter.

But in other respects, the influenza outbreak gets at much of what veterinarians already do, including trying to protect workers. There are a range of diseases that can be acquired from close contact with farm animals — from tuberculosis and salmonella to cryptosporidiosis and brucellosis — so veterinarians already talk with workers about how to safeguard themselves from “spillover” events.

“Employee training is part of being a veterinarian,” said Nick Schneider, who practices in Colorado and Texas.

With H5N1, veterinarians and related specialists have been helping answer key questions about the outbreak. Jason Lombard, a veterinary epidemiologist formerly with USDA and now at Colorado State University, teamed up with old colleagues for an investigation in Michigan that determined, for example, that several infected herds hadn’t brought in cows from other locations, meaning there was some other way the virus was introduced.

Colorado farms have also been asking for Lombard’s help, a sign that some producers are eager to play a part in containing the outbreak.

“Some of these farms, the more recent ones, they knew the disease was already in the state, so they had incorporated some pretty good biosecurity practices, yet they still became infected,” Lombard said. “They want additional information about what more they could have to prevent disease. And can we determine how it actually came onto their farm?”

The spread of H5N1 to cows has underscored what experts call the “One Health” approach — the idea that human health is deeply connected to animal health. It calls for integrating the surveillance and prevention of animal diseases when considering human health risks, meaning that veterinarians need to be viewed as vital partners.

“You gotta have your hands on the animal, you gotta have your boots on the ground, you gotta see the challenges of the farm for what they are,” said veterinarian Barnhardt.

Megan Molteni contributed reporting.