‘Change is happening, no matter what’

The delay – an extended delay, at that – to the introduction of veterinary prescriptions for anti-parasitics is coming to an end, as Ireland must soon implement new veterinary medicines regulations (EU Regulation 2019/6) that came into effect back in 2022. To summarise, these anti-parasitics, currently available over the counter (as licensed merchant products [LM]), will soon be prescription-only medicines (POM)because the Health Products Regulatory Authority (HPRA) found that they no longer met the conditions to be exempt from prescription. In other words, the HPRA found an increase in resistance to such products by parasites.

The anti-parasitics issue is one of several that are causing concern – as well as consternation – for vets, pharmacists, licensed retailers, co-ops, and, importantly, farmers. The consternation stretches to whether some vaccines – classed as 'prescription-only medicine - exempt', or POM(E) – which were previously available from a farmer's own vet or a pharmacist, would now be made available over the counter in retail outlets.

What vaccines are involved?

Hazell explains that there are three types of vaccines on the market. Licensed merchant, or LM, which are over-the-counter retail products such as clostridia and leptospirosis vaccines.

The POM(E) vaccines, which can be sold by a veterinary practitioner, pharmacist, or for certain specific products, by a responsible person from a LM. These include a lot of respiratory vaccines such as IBR, PI3 and RSV, as well as the salmonella vaccine.

And the prescription-only medicines, or POM, vaccines would include scour vaccines, the live BVD vaccine, Bovilis, Rotavec and Footvax. These require a prescription and currently LMs and co-ops can supply these on foot of said prescription. But they cannot stock POM(E) vaccines, Hazell explains, unless they have a pharmacist on site.

A Statutory Instrument (SI), to be signed by the Minister for Agriculture, Food and the Marine could determine if POM(E) products could be dispensed by LMs. This SI, still in draft format, has been the subject of much debate by all sides and was the focus of a recent meeting between the minister and Veterinary Ireland.

Meeting

Hazell explains: “We highlighted to the minister the need to preserve the integrity of prudent prescribing of these medications,” she said. “Vaccines have now become part of this SI, particularly POM(E) vaccines, and that they would become available over the counter for sale in retail outlets.” Herein lies a big problem, as she, and Veterinary Ireland, see it.

“These are vaccines that are [currently] dispensed by a vet to a client, or by a pharmacy on foot of advice straight to the farmer. They are medicinal products that should not be used inappropriately on a farm, and professional advice is paramount," she says.

“The other side of it is the proper-assessment protocol that is being proposed, which would mean that a vet could prescribe without having a client-practice-patient relationship,” she says. This, according to Hazell, would lead to a two-tier prescribing system: one delivered by vets in general practice who are required to provide out-of-hours and weekend services, 24/7; and one that would just offer an out-of-hours clinical service for the product prescribed. This, she says, will threaten the viability of general veterinary practice.

“It would also go against the 12 principles of certification as stated in our Veterinary Code of Conduct, set out by the Veterinary Council of Ireland (VCI), which is our regulatory body.

The vet, as proposed in the current SI, would not have a relationship with the farmer and that contradicts what the VCI sets out in the code. That code is there for a reason.

“In relation to the anti-parastitics, our main focus is that they are prescribed prudently by a vet who knows the farmer and knows farming system. Then, that prescription can be taken to wherever the farmer wants to fill that prescription.”

‘Scaremongered’

On the back of that meeting, a joint statement was released from the Irish Co-operative Organisation Society (ICOS), Independent Licensed Merchants Association (ILMA) and Acorn Independent Merchants who were highly critical of the handling of this issue. They maintain that, if the SI favours the demands of the veterinary profession, it will ‘effectively legislate all licensed merchants out of business’. The statement read: “After one fractious meeting with the veterinary profession – who have scaremongered inaccurately about the potential impact on private veterinary practitioners – the statutory instrument has drastically changed.”

Farmers and farming organisations, too, have been voicing their concerns and expressing annoyance at their lack of involvement in the debate. The Irish Farmers’ Association (IFA) said the SI had the potential to severely limit competition in the supply of veterinary medicines for farmers if not framed correctly in a practical, reasonable and fair manner.

Chair of the IFA's Animal Health Comittee, TJ Maher said: “Access to competitively priced vaccines is a key component of reducing the necessity to use antibiotics on farms and, where possible, easier access to these important tools for farmers must be provided."

Addressing some of the comments, Hazell says vets have no issue with these medicines being available to buy in all the places they are currently available. But VI wants farmers' own vets to be the first port of call when a prescription is required for such products.

“It is not the sale, it is the prescribing of these medicines that is the issue,” she said.

“We are trying to prudently prescribe and protect the medicines that we have. This is why we are campaigning for the SI to be changed. That, and for the future of vets in practice because this SI is moving away from vets that are practising and we are trying to protect that service,” she said.

Does she think farmers will be negatively impacted by the demands of VI? “Anti-parasitics are going POM, so they are going to involve a vet’s advice anyway. So, do we [farmers] want advice that is tailored specifically to our farm, or not? In the long term, it is going to be more beneficial to have your own vet involved, the vet who has knowledge of the farm. The farmer can get the prescription from that vet, but can fill it wherever the farmer wants. It means the right product will be given at the right time in the right dose.”

I question Hazell on whether the veterinary profession is using the out-of-hours and weekend service as leverage to steer the minister in their favour? She responds: “There  is a real risk that if this SI is signed [as it is], it will impact our ability to provide an out-of-hours service the way we do now, and there may be job losses. Out-of-hours isn’t a money-making service so it is already hard to provide that service as it is," Hazell says.

This debate was still very much live at the time of print and, while it is looking like a new minister will be in the hot seat when a decision is made on this SI, there may well be a new VI president in the hot seat too.

A busy year

Just a few months after her appointment as president of VI in November 2023, Hazell made a significant career move, leaving her job as a large-animal vet in Kildare, and returning home to Cork for two main reasons: to go into partnership with her father on their dairy and dairy-to-beef enterprise; and to set up her own locuming business.

“I just decided to that it was time to come home go into partnership with dad and get more actively involved in the farm. The farm has always been such a big part of my life that I just felt like if I if I didn’t do it now, then I would regret it. So, I felt like we just needed to take a leap of faith.

“I also realised that I really missed being a vet, being out and about meeting farmers. I was probably in more of a management role in Kildare before I left, and I knew I wanted to keep my skills up. So, I looked into setting up a locuming company, and that is what I did. I contacted a few local practises and luckily I have been doing a lot of locuming for some practises in north Cork and Mitchelstown,” she says. There were personal reasons, too, for the move; having gotten married in 2023, she and her husband decided to put down roots and build a house closer to home this year.

Balancing act

Life is very busy, but in a good way, Hazell explains: “I love it. I just love the fact that I can balance farming and veterinary. I don’t really work as a vet in spring. I might do the odd Saturday if I’m needed for cover but generally, I’m on the farm full-time in spring and then, come the end of April, I’m back out TB testing, on call, and I have a factory shift every now and again, too.”

She is also a weekly contributor to the Irish Examiner, which keep the creative side of her brain ticking over. “It makes me think about the cases I’m seeing; it makes me do the research and helps to get the right information out there to the public and to farmers.

With a lot of strings to her bow, is it challenging to carve out time for everything, and have some left over for herself too? “Having spring off definitely helps because at least I don’t have any commitments to be anywhere else. It works quite well on the off season then because my dad and my uncle are on the farm so generally, I’m around in the morning to milk the cows and generally I’m back in the evening.

“It works well that that middle block of the day is where I do a lot of my locuming, and writing my article. It is a team effort on the farm, though. I was able to go on a lovely holiday for a week to Greece and the place was still standing when I got back.” 
But she has to remind her father to do the same. “Normally I book the holiday for them,” she says.

Farmer or vet first?

The question of whether she is a vet or a farmer first, provides some food for thought: “If you were to meet me on the street, I would probably say I am a vet and a dairy farmer. But that may change in the next 10 years. I’ve been a large-animal vet for 11 years, it’s just what I know, and I love it. But I’m very much a 'green' farmer and I’m learning a lot from my dad,” she says.

“The animal-health side of the farm is pretty covered because I can look after that, but I have a lot to learn about grassland management and fertiliser, even down to what silage fields to close off – these are all the things that come naturally to farmers because they have been doing it for so long. I’m really trying to figure out all these things, whereas my dad just knows,” she says.

She is very interested in the breeding side of the farm, she says: “Our fields are a little bit more colourful than they were two years ago. We have Speckle Parks there now and other breeds. I love the breeding side of it and this year now is the first time that I was put in charge of the breeding – what cows got what straws, the EBI – that really excites me.”

As a vet, Hazell sees the progress that is being made by farmers embracing technology: “I am really impressed by how farmers have grasped the breeding technologies, how they are making the breeding season more effective and efficient, and using the vet much more now in the breeding season, because a good breeding season sets you up for the whole year, whether you are beef or dairy.”

She says she is finding that farmers are far more concerned and up to date with preventative healthcare, and technology is really playing a role here, for the vet, too. Collars and robots and technology have been really helpful for vets: “There is more information there now for the vet to look at. Sometimes I might get called out to cows that don’t look sick, but the collar will have picked up that high temperature before the clinical signs have kicked in and that is super, to get on the farm before it becomes a bigger issue for the animal and animals.”

Using the example of a left displaced abdomen (LDA) diagnosis, she says, the farmer can send live information to her from the animal’s wearable technology that allows her to monitor the progress. “I had a case before where after an LDA diagnosis, I could see [through the wearable technology] that she went up for a day and then dramatically dropped, and I went out to her to find that she had a bleeding ulcer. The tech picked it up so quickly and it was that live information to the farmer and onto us that made the difference.” There is a strong chain of information there, so it is important that it gets used properly, she says.