The Marginal Gains of TB Testing - OV Procurement part 5

In writing these comments about OV procurement, it was suggested to me that OV procurement won't make much difference when it comes to managing/controlling/eradicating TB (thanks Dilwyn):

@GarethEnticott All this misses the point though. Need wholesale change in way to control #bovinetb. OV tendering won't make any differenceMon Oct 03 15:44:22 via webDilwyn Evans
whelfordian

This might by true: that the OV procurement exercise is no more than a miniscule part of managing bovine TB, that there are other more important things to be done. Im not sure the New Zealanders would agree with this: testing, the cost and the quality are a key battle front in their eradication plan. Sure, they're dropping 1080 from helicopters to poison possums, whilst wildlife control here has been forced underground (literally). But the reforms to TB testing in New Zealand were also accompanied by a shift in ownership: farmers pay for TB testing indirectly via a levy, but it also means that they have some say in how it operates. So there's no testing during the winter calving months for example, there's no ear tag reading and there are other examples of flexibility to suit the farmer too. What this means is that testing is not seen as a chore, something to resist. Of course it helps when disease is on the decline, but they all play into what determines the quality of testing. Quality is not simply about audit procedures, but it needs to be seen in the round.

Other people might see improving testing quality as a 'marginal gain' : in high performance systems, its often difficult to accurately say how much "such and such" affects quality, or any other dimension of performance, but "such and such" can make the difference between success or failure. Maybe when it comes to managing TB, trying to improve its quality is one such marginal gain - its worth doing something about it, and its worth doing properly.

Some "marginal gains" in action - picture BikeRadar

The term "marginal gains" has been popularised particularly in sport: when the Great British cycling team dominated the 2008 Olympic Games, their Director of Performance Dave Brailsford attributed the success to the ‘aggregation of marginal gains’. Its the little things that matter – and if you don’t pay attention to them or take them for granted, then you wont’t get anywhere. Much the same is true in agriculture and the veterinary profession. Some things can be measured and measured, but often its gut feeling and field level experimentation that works best (see this book). As Einstein once said:

"Not everything that can be counted counts, and not everything that counts can be counted"

In TB there are plenty of things like this. Take for instance attempts to put a figure on the cost of a TB breakdown. Its difficult, particularly for the farmer, because much of their loss is intangible - difficult to put a cost on. We can try - although the current cost-benefit analysis doesnt - to monetarise stress and emotional affects, but it might not make much sense either. We may be better off with some evidence, albeit less certain, less rigid or less quantitative.

Maybe TB testing is like that. Sure there are some problems with quality. But maybe we're better off living with them rather than reinventing a system, particularly if it doesnt resolve them. But learning to live with uncertainty is only easy (if ever it is easy) when those affected by it have some sort of say over which uncertainties they want. For TB, thats not so much about finding and using different or newer tests, but displacing power - handing the choice to others, like farmers.

Its also true in another way too. When other veterinary services were put to competitive tender, such as those required by the Meat Hygiene Service, just a few companies supplied vets to carry out this work. The danger for AHVLA is that contracting TB testing could result in the loss of those marginal gains that the current way of using local vets already provides, and worse. Vets will say they are best placed to do this: they are trusted by farmers, can keep an eye on other diseases, provide advice to farmers, and respond to other emergencies. Besides, no-one else is going to be prepared to turn up at short notice or at morning milking to start a TB test. Farmers can get some wider benefit from that visit too.

Marginal gains meet the badger:
Geraint Thomas & Bernard Hinault at the Tour 2011 (Source)

The trouble with this argument is that real evidence is needed to support it. It might be true - some quick polling by the BCVA in response to this threat showed that around 90% of vets said they were conducting passive surveillance and other work whilst TB testing. When I surveyed vets in Wales after the Health Check Wales, the figure was much lower with many vets saying they simply did not have time to do this. The real figure is likely to vary between farms and be dependent on the context and the relationship between the vet and the farmer.

But estimating the financial value of these benefits would be very difficult. That does not mean they do not exist or have no value. We should also be familiar with the effects of other examples of competitive tendering: when it was applied to school meals, for example, cheap rather than local food ended up in school dinners, contributing to public concern over the food we eat. Failure to appreciate the value of intangible benefits can have serious consequences.

Perhaps these benefits are worth losing if it saves money. Money saved could be reallocated to finding other ways of maintaining and promoting these forms of passive surveillance and veterinary capacity. I'd say thats unlikely given the way government finances are currently being managed. Perhaps a better answer though is to ask those people who are likely to gain from all of this: farmers. What sort of TB testing system do they want? Do they care about the marginal gains of their vet visiting? Do they want change, or low cost? They're the ones that need to be involved in this debate.