First Questionnaire-based Survey on the Uptake and Use of FMD-HS Combined Oil Adjuvant Vaccine in India

Since the 16^th century vaccines have been used in veterinary sciences (Mcvey and Shi, 2010) to control and eradicate disease for livestock health and welfare, as demonstrated by the global eradication of rinderpest (Normile, 2008). Vaccination is considered to be the best strategy for disease control and for minimising economic losses due to diseases, but diffusion and adoption of vaccination technology at field level is very low (Rathod et al., 2016).

Foot-and-Mouth disease (FMD) and Haemorrhagic Septicaemia (HS) are two diseases transmitted through contact of the susceptible animal with the infected ones, causing heavy economic losses to the livestock industry. These are endemic in many countries of the world including India. FMD is a viral disease causing direct losses in the form of productivity and indirect losses in the form of restriction on international trade of livestock and their products including germplasm (Sunder et al., 2015). HS is an acute septicaemic disease and sporadic outbreaks occur every year in the state affecting mainly buffalo and to lesser extent cattle (Cuevas et al., 2020).

Recently, Government of India has allowed the State of Haryana to go for the 27^th round of FMD and HS Combined Oil Adjuvant Vaccine for mass vaccination of eligible bovine population, at a six-monthly interval under FMD-CP. This was the second phase of the combined vaccination. Haryana is the only state in India where a single FMD-HS vaccine was used in bovines as a pilot project for protection against two most economically important diseases i.e., HS and FMD. The FMD-HS vaccine would increase the number of animals vaccinated against FMD and HS (Chabra et al., 2004).

Therefore, this study was planned to analyse the uptake and usage of dual vaccine amongst the livestock owners for the first time ever. This study at field level will provide us with valuable feedback and statistical information from livestock owners for further future studies and references.

Questionnaire
 
A paper version of the questionnaire was developed extensively covering information regarding respondents and questions relating to use of dual vaccination in their animals. The questionnaire contained a total of 15 questions, out of which 07 questions were related to the respondents and 08 questions were related to the dual vaccine and their effects on animals. A survey was conducted amongst farmers between November, 2019 to January, 2020. It took approximately 07 minutes to complete the survey. Pretesting of the questionnaire was carried out with four veterinarians, eight veterinary students. Minor corrections were made and paper copies for piloting were sent to 40 farmers. The questionnaire received from pilot participants, was finalised for distribution among the respondents. The data was collected on paper copies via direct contact at farm level and telephone lines. Other necessary information was also gained through secondary sources such as departmental records, reports etc.
 
Distribution
 
The target population was randomly selected livestock farmers from the 6 Districts of Haryana State namely Karnal, Panipat, Kurukshetra, Ambala, Panchkula and Yamunanagar, who owned or worked with cattle. The survey was conducted during the period of November, 2019 to January, 2020 in which farmers were selected through random sampling. The purpose of the survey was explained to the farmers prior to the distribution or filling of the questionnaire. Livestock owners were contacted either directly at their farm or house level or through telephone, via contact establishment from respective districts. Responses collected from farmers were physically filled in paper copies of survey questionnaires.
 
Statistical analysis
 
A datasheet was created using Microsoft Excel (2010) and questionnaire responses were manually entered. Ten percent of the questionnaires were checked to detect data entry errors; no errors were observed. Where appropriate, answers to open questions were categorised into themes using thematic analysis methodology (Attride-Stirling, 2001). The questions, for which it was possible to select more than one answer; in those cases, the cumulative proportions could exceed 100 per cent. The data collected from sample respondents were coded, analysed and presented in the form of tables. The data were analysed using the chi square test.

Respondent demographics
 
The questionnaire was completed by 973 respondents between November, 2019 and January, 2020 (Table 1). Respondents were contacted in the study period when the vaccination process was just completed. The response rate for the paper based questionnaire was estimated at 97.3 per cent (n=973/1000). Non respondents were not further investigated.


 
Vaccine uptake
 
Specific questions were asked about uptake of the vaccine and 96.81 per cent (n=942/973) of respondents indicated that they got their animals vaccinated (Table 2). 3.19 per cent (n=31/973) of respondents excluded certain animals from vaccination (Table 2). When prompted for further information, animals which were most frequently excluded from vaccination were pregnant (58.06%, 18/31) and lactating (16.12%, 5/31) animals, with no significant differences observed in relation to vaccination status of cattle and buffalo (Table 3). In a similar study Rathod et al., (2016), also found that nearly 86.4% of respondents believed that livestock vaccination was relevant to local production practices. Scott and Gunn, (2008) also stated that improved immunity through vaccination can reduce the risk of losses at farm.

​

​
 
Vaccine usage
 
Specific questions were asked to the respondents regarding the vaccine usage they were familiar with. Respondents indicated multiple motivations for getting their animals vaccinated including disease control (88.85%, n=837/942), losses (87.79%, n=827/942) in terms of money and production, veterinary advice (79.62%, n=750/942), Disease testing/monitoring (23.78%, n=224/942) and requirement for sales (26.86%, n=253/942) (Table 4). Datasheets of Dual Vaccine recommended that unhealthy animals should be excluded from vaccination, as vaccinating immune-compromised animals may lead to ineffective protection. In this survey, farmers excluded sick (n=2), pregnant (n=18) and lactating (n=5) (Table 3). Respondents stated they excluded pregnant animals from being vaccinated for fear of abortion. However, the number of excluded pregnant animals was far lower. This may be due to farmers being unaware or not being advised of the risks of vaccinating pregnant animals. Other reasons for not excluding animals could be that a whole herd approach is being taken for management purposes and all animals are being vaccinated, rather than selecting animals individually for adequate disease control. In a similar study Cresswell et al., (2014) reported that in their survey nearly 33 percent of respondents excluded certain animals from vaccination, out of which 6 percent excluded pregnant animals from vaccination.

​

While the most frequent reason/motivation for not getting their animals vaccinated was that they did not perceive there to be a problem that required vaccination (n=18/31, 58.06%) (Table 2). Cresswell et al., (2014) also found in their survey that farmers who did not vaccinate their animals did not perceive there to be any problem. Economic factors as more than half the respondents had discussed decrease in production and stress associated with vaccination after administering the dose. Rathod et al., (2016) also found in their survey that there was a significant difference (p<0.001) among the farmers of different states of the country as compared to Haryana and Punjab states which might be related to the socio-economic condition of farmers. Whereas, Lal, (2000), in his study found that the majority of farmers were not familiar with the vaccination process and not aware that vaccinations were being carried out for certain diseases. Habiyaremye et al., (2017), in their survey observed that the majority of famers (86%) believed in the importance of vaccination. As per Rathod et al., (2016), the adoption of vaccination is poor at field level. Rathod et al., (2013) mentioned that the states should also undertake extensive livestock extension activities to educate farmers about the benefits of vaccination. In a study conducted by Hesterberg et al., (2007), reported that 84.8% of smallholder livestock farmers vaccinated their cattle.

Majority of farmers (n=839/942, 89.07%) vaccinated their animal through the intramuscular route which is the most preferred route of vaccine administration. However, 3.18% (n=30/942) of farmers vaccinated their animals via subcutaneous route and merely 0.32% (n=2/942) of farmers informed about intravenous administration and 7.54% of farmers had no information regarding the route of administration (Table 4). Most farmers vaccinate their animals via intramuscular route as the majority of vaccination is done under guidelines and supervision of field veterinarians and staff, which explains the correct administration route of vaccine. Whereas, some farmers might not have access to the veterinary services, they may have contacted some untrained practitioner or supplier, who would have injected the vaccine via the least preferred route. In a study on other veterinary medicines, such as ivermectin and ceftiofur sodium depicted no difference in the efficacy of the drug, regardless of the route of administration, using intramuscular versus subcutaneous (Lifschitz et al., 1999).

Vaccination drive was mostly carried out by veterinarians (n=438/942, 46.5%), VLDAs (n=311/942, 33.01%) and staff workers (18.58%) of the GVH/GVD. Only 4.56 per cent (n=43/942) of respondents indicated that they or somebody else vaccinated their animals. Generally, no specific qualifications are required to be a Para-veterinary or Gopal worker; it may be that some of them carried out vaccination with no formal training. Further work to confirm the effect of training for vaccine efficacy may help to focus future activities. Habiyaremye et al., (2017) also found that 85% of the farmers prefer a vaccine that can be used to treat multiple diseases.

In the study, veterinarians are valued by respondents as important discussion partners (88.03%) regarding post vaccination management in animals, who shared with them their expertise in addition to supplying vaccines (Table 4). It highlights the potential opportunity for the veterinarian to combine their role as administrator with their role as advisor about vaccination. In a study conducted by Habiyaremye et al., (2017) it was revealed that most respondents (94 per cent) sourced information regarding vaccinating cattle from their veterinarian, with the majority of respondents preferring face-to-face communication. Hall and Wapenaar (2012) have also found veterinarians to be most valued by farmers as important discussion partners in the field of animal health.

Nearly 68.15 per cent (n=642/942) of respondents indicated decrease in productivity on vaccine administration. Stress, Hyperthermia, Anorexia/Inappetance/Swelling/Pain and Lameness was indicated by 53.72 per cent (n=506/942), 18.68 per cent (n=176/942), 28.87 per cent (272/942) and 4.14 per cent (39/942) respondents, respectively. Stress, anorexia/inappetance/swelling/pain, decrease in productivity and Lameness was indicated significantly higher in cattle (63.31, 33.57, 73.62 and 6.24%) as compared to buffaloes (46.10, 25.14, 63.81 and 2.48%) which were significantly higher in cattle as compares to buffaloes, which may be due to species difference (Table 4). These results may attribute towards the low acceptance of vaccine among farmers citing the above constraints which may be addressed by extensive awareness programmes and other extension approaches. Rathod et al., (2016) also referred to such constraints linked to vaccination of animals.
 
Knowledge transfer
 
Most respondents (n=836, 85.92%) sourced information regarding vaccinating cattle from the veterinary hospital of their area. Whereas, 23.02% (n=224) and 17.99% (n=175) of respondents preferred to receive information about vaccination from a newspaper and internet, respectively. Face to face communication was preferred over other virtual means (Table 2). For the successful implementation of the vaccine programme in the state the existing veterinary services must be intensified by strengthening/upgrading institutions to achieve preventive veterinary care through door step services. Rathod et al., (2013) emphasised on applying hotline approach from field hospitals to the state epidemiologist and necessary inputs should be made available (Table 2).
 
Constraints of the study
 
In this study, the proportion of farmers not getting their animals vaccinated was likely to be underestimated. Bias due to convenience sampling is probable; it is likely that farmers who got their animals vaccinated and were interested in vaccination were more inclined to participate in the survey than those who did not have any interest in vaccination. Another limitation of the study was that information provided by respondents may have differed from reality, particularly when answered from memory or recall basis. Therefore, incorrect answers may have been provided by respondents.

The sample size of 973 respondents limited the power of this study; increasing the number and area of study to consolidate our findings would further support the study results. However, the area and population in the state of Haryana is known to be challenging to engage in survey based research and increasing sample size/area will take considerable effort.

As the current published body of work in the field of uptake and usage of cattle vaccines is scarce, the findings of this study are important to describe current usage strategies on vaccination. In conclusion, uptake of dual vaccines in India was generally good. It may also be concluded that the veterinarian is the main administrator and main source of knowledge for farmers in the dual vaccination programme and, therefore, remains crucial to its success. In general, the use of dual FMD-HS vaccine in place of single vaccines is better in order to immunize large number of dairy animals at a faster rate, as earlier, animals had to be vaccinated four times in a year, which was not only tedious for veterinary workers and farmers, but was also extremely stressful to the animals.

All authors declare that they have no conflict of interest.