Is non-surgical sterilization the best use for $75 million?

From ANIMAL PEOPLE, October 2008:
(Actual publication date 11-5-08.)

CHICAGO Anxiety tempered enthusiasm as 325 delegates to the Spay USA conference in Chicago on October 17, 2008 applauded the Found Animal Foundation pledge to invest $75 million in the quest to develop a non-surgical method of sterilizing dogs and cats. Almost everyone had questions with no quick answers.
First and easiest were questions about who Found Animal Foundation founder Gary K. Michelson is, and whether his commitment is genuine. Michelson has until now been barely known to animal advocates even in the Los Angeles area, where he lives and where the Found Animal Foundation is based.
Found Animal Foundation executive director Aimee Gilbreath and Alliance for Contraception in Cats & Dogs executive director Joyce Briggs and outreach director Karen Green repeatedly reassured Spay USA delegates that the $75 million is real money.

Some Spay USA conference attendees wondered whether they could entice their veterinarians or friendly scientists in their communities to start projects that would qualify them to apply for some of the money. But, except for a few vets who had already experimented with non-surgical sterilization methods, most had little idea where to begin.
Many conference attendees asked if Found Animal Foundation money might also be available to help sustain struggling surgical sterilization programs. Funding for low-cost and free dog and cat sterilization has diminished with the resources of donors hit by the collapses of the stock and mortgage markets. At the same time, sterilization programs from all over the U.S. and around the world report increased demand for their services.
Personnel at both the Pets Are Worth Saving and Anti-Cruelty Society sterilization clinics in Chicago mentioned to tour groups from the Spay USA conference that some of the increased demand comes from former generous donors who have fallen on hard times.
Several Spay USA attendees, after spending heavily on equipment and facilities to do high-volume, low-cost surgical sterilization, expressed concern that a move to non-surgical sterilization might leave them without a revenue stream to pay off their investment.
Some veterinary surgeons worried that they might be working to perfect and teach soon-to-be-obsolete skills.
But as Gilbreath told ANIMAL PEOPLE, perfecting a non-surgical sterilization method that qualifies for the Michelson prize will not be accomplished overnight. Neither does Michelson expect a non-surgical method to replace sterilization surgery, Gilbreath explained, although a non-surgical method that achieved the same benefits in preventing aggressive behavior and protecting the health of pets would be welcome.
The main purpose of developing a non-surgical sterilization method, Gilbreath emphasized, is extending the reach of dog and cat sterilization methods to the people, places, and animals who are still not served.
Currently, 73% of the U.S. pet dog population and 86% of the pet cat population are sterilized, according to marketing research by the American Association of Pet Product Manufacturers. Most of the U.S. has not had street dogs in visible numbers in several decades. The feral cat population appears to have dropped by 75% or more within ten years of the introduction of neuter/return cat control to the U.S. in 1991-1992.
However, the rapid progress in reducing animal shelter admissions and killing of homeless animals achieved during the 1980s and 1990s has tapered off in the present decade. Drops of a million shelter deaths per year were accomplished then, mostly by persuading average pet keepers to sterilize their animals, and helping them to do it affordably and conveniently.
Now that the total volume of animals coming to shelters is less than half of the number who were killed in shelters 25 years ago, achieving further reductions requires reaching the hard cases: the poorest, most remote, and/or most ignorant of pet keepers, and in the case of cats, the ferals who are hardest to trap.
The Found Animal Foundation hopes that a non-surgical sterilization method will ease and expedite handling the hard cases. In particular, the Found Animal Foundation hopes to prevent the estimated 50% of dog litters and 75% of cat litters that are not planned, about 80% of them born to mothers who are sterilized later.
The classic dilemma of too many dogs and cats being born to fill the niches in available homes has shifted in the U.S. to the point that almost all dogs entering shelters, and many cats, once had homes, but for various reasons lost them. The problem now centers on reducing dog and cat births to where dogs and cats are no longer easily available to pet keepers who fail to keep the animals from roaming, neglect them, or easily abandon them if they become inconvenient.
In developing nations the shape of the issue is considerably different, and the potential for using non-surgical sterilization appears to be far greater. In most of the developing world, fewer than half of all dogs and cats have ever had homes. Though many are fed, as community pets, most do not have primary caretakers who can be persuaded to take them to a clinic even a free clinic for sterilization surgery. Animal control typically consists of poisoning dogs and cats rather than impounding them.
Surgical sterilization is already officially the animal control method of choice in much of the developing world, though often not actually done, and is mandated in India, Turkey, and Costa Rica.
On October 3, 2008 the Veterinary Department of Serbia became the most recent of dozens of national public health agencies to endorse dog and cat sterilization in concept, in place of impounding and killing homeless animals.
But as Serbian animal advocate Slavica Mazak Beslic pointed out after the announcement ceremony, the Serbian recommendation did not come with any funding and still does not have the force of law. Beslic told ANIMAL PEOPLE that what she wants to see is a mandate that redirects funding from paying garbage collectors to catch and kill dogs and cats, to paying veterinarians to sterilize dogs and cats.
This should be coordinated, Beslic said, with a campaign now underway to eradicate rabies by distributing oral vaccine baits to wild foxes. Vaccinating dogs and cats, and sterilizing them to prevent births of unvaccinated offspring, would reinforce the fox vaccination effort.
For now, in Serbia as elsewhere, actually obtaining surgical sterilization service adequate to replace killing animals has proved much more difficult than winning endorsements from governments.
Even when governments put significant money into surgical sterilization, the funding tends to fall far short of the need.
The Blue Cross of India demonstrated surgical sterilization as a method of controlling the street dog population in Chennai in 1964, but the Animal Welfare Board of India did not recommend funding the Animal Birth Control program to the national government until December 1997. Eleven years later, after a decade of federal funding partially matched by municipal governments, the Indian ABC program still reaches only some major Indian cities, with no presence in most rural districts.
Other bottlenecks in India include an acute lack of veterinarians trained to operate on dogs and cats. A lack of veterinary technicians often means that Indian veterinarians cannot make efficient use of their time.
But the most pervasive problem among Indian ABC programs may be that the vets and vet techs they have tend to use obsolete surgical methods. Trained to operate on cattle rather than small mammals, many make large rather than minimal surgical incisions; use multiple sutures to close the unnecessarily large surgical wounds; fail to maintain strict surgical ascepsis; rely on antibiotics rather than ascepsis to prevent post-surgical infection, and hold animals for three to five days after surgery sometimes longer to ensure that sutures do not open and wounds do not become infected.
Long post-surgical holding times tend to overload shelter clinics. The central Tamil city of Salem in October 2008 tried to solve that problem by housing about 40 sterilized dogs in the unused former communicable disease ward of a city hospital serving a low-income neighborhood called Ammapet. The hospital mainly provides obstetric service to the indigent.
The dogs are kept in the most unhygienic environment, and the entire area is stinking, alleged The Hindu. Their barking and howling all through the day and night have not only disturbed the patients but also the health staff of the hospital.
A source described by The Hindu as a resident added that the dogs were not fed regularly and properly, and were not treated for post-operative complications, even though this was why they were kept.
Trained by Bali Street Dog Project surgeons from Indo-nesia, Animal Help Ahmedabad founder Rahul Sehgal in 2005 introduced U.S.-style high volume, same-day-release dog sterilization to India. The Animal Help team sterilized 45,000 dogs in 2006, but ran into unforseen problems.
The first was opposition to same-day release by much of the Indian humane community, including People for Animals founder and former federal minister for animal welfare Maneka Gandhi. Ms. Gandhi maintained from the beginning that same-day release could not be safely practiced in India.
A second problem came when delays in obtaining payment from the Ahmedabad city government obliged Sehgal to lay off veterinarians. Some who had not yet completed training in the Animal Help methods were hired to do ABC work in other cities, Sehgal told ANIMAL PEOPLE, and botched it. Their failures fueled the humane opposition.
Encountering continuing difficulty in getting paid in Ahmedabad, Sehgal in 2007 took his best vets to work in the suburbs of Bangalore and Hyderabad. While the Ahmedabad ABC program was interrupted, the unsterilized part of the dog population bred back up to the carrying capacity of the habitat, a city dog census found. Animal Help has continued to work in Bangalore.
Turkey mandated surgical sterilization instead of poisoning street dogs in 2004, but has never federally funded sterilization programs. Some city dog sterilization efforts have allegedly become conduits for routing public funds to supporters of the politicians in authority. Others have run afoul of officials who just want to get rid of the dogs, have no patience with methods that will take longer than a term of office to produce results, and resent the unfunded sterilization mandate.
In May 2008 more than 5,000 dead dogs were reportedly found in 20-odd mass graves in the Antalya suburbs of Kepez, Konyaalti, and Muratpasa. Hundreds of puppies had been buried alive. Many of the adult dogs had plastic ear tags confirming that they had been sterilized and vaccinated by veterinarians using the same methods as Friends of Fethiye Animals, whose success in reducing the Fethiye dog population through sterilization inspired the national mandate to sterilize dogs instead of killing them.
Prominently exposed and denounced by news media, the killings shocked much of Turkey, not least because Antalya, just 200 kilometers from Fethiye, is among the most affluent cities in the nation, frequented by European tourists. Interior minister Besir Atalay convened a hearing into the dog massacres. No one was criminally charged.
Meanwhile, with the Antalya case still in the headlines, similar killings came to light in Karabuk, about 200 kilometers north of Ankara, the Turkish capital, and in Kars, 100 kilometers west of the Armenian border.
Surgical sterilization has succeeded in almost eliminating animal control killing in Costa Rica, but Costa Rica likewises lacks a nationally funded sterilization program. Instead, sterilization surgery is made accessible nationwide through a variety of charities, whose work is endorsed but not funded by the Veterinary Licensing Board of Costa Rica.
The largest of these charities is the McKee Project, which has expanded to encourage similar programs throughout Central America and as far away as Argentina.
I believe McKee has created a change that will be lasting, founder Christine Crawford told ANIMAL PEOPLE, expressing particular optimism about progress in Guatemala. The only veterinary school in Guatemala is now training vet students in the McKee surgery method, Crawford said.   Unlike in Costa Rica, where McKee met political opposition from time to time, Guatemala has thanked McKee for showing them practical humane solutions without having to commit big mistakes to get there.
Starting in 1998 with three veterinarians trained by Spay USA, funded initially by a bequest from California activist Mary Ann McKee and several grants from the North Shore Animal League, McKee has in turn trained in the area of 500 vets, Crawford says, in Mexico, Nicaragua, and Panama, as well as Costa Rica and Guatemala. McKee has also trained U.S. and Canadian veterinarians who visited Costa Rica to learn techniques suitable for use in remote locations.
But successful as the McKee Project is, getting the surgeons to the animals or bringing animals to the surgeons remains a bottleneck, in a region where mountains, rivers, and swamps tend to magnify the effects of bad roads and distance.
Using an injectible immunocontraceptive or chemosterilant to sterilize dogs and cats would require only a fraction of the equipment and facilities needed to do conventional sterilization surgery. Mobile clinics could fly from place to place.
Would-be developers have tried to perfect an injectible dog and cat sterilization method for more than 50 years. Though aware of the need for non-surgical sterilization in remote and low-income communities, where full-service vet clinics are few and far between, most of the researchers have hoped to pay off the development costs by finding a method suitable for commercial as well as nonprofit use.
As hormonal contraceptive pioneer Wolfgang Jochle pointed out to the 2004 ACCD conference in Breckenridge, Colorado, commercial considerations have complicated the development process.
One is that a commercially successful non-surgical sterilization method might sell best if it was reversable, unlike conventional neutering surgery, so that a breeder could use it to limit breeding, rather than altogether preventing it. Another is that a non-surgical sterilization product used in pets must be safe for many times the usual lifespan of street dogs and feral cats.
Nonsurgical dog and cat contraceptive methods have often appeared to be almost ready for the veterinary marketplace, and several methods have actually been briefly marketed, but unforseen complications each time caused the products to be withdrawn.
The effect of withdrawing products from the commercial market in developed nations has often been to send the message to the developing world that the products are categorically unsafe and unsuitable. Continuing to investigate refinements of these products in developing world laboratories could be done for a fraction of the cost of doing further research in the U.S. and Europe, but except for the development of zinc-based chemosterilants similar to Neutersol in India, Brazil, and Thailand, little has been pursued.
Meanwhile, advances in surgical sterilization technique have enabled the most skilled dog and cat sterilization specialists to castrate male animals in as little as four minutes, and spay females in as little as six minutes. At that rate of speed, the difference in veterinary time expended between surgery and injection is slight, and surgery has advantages in altering the behavior and improving the longevity of animals that injectible methods so far have not conveyed.
One of the long-sought advantages anticipated from injectible sterilants was that animals could be sterilized at any age. Since 1993, however, when early-age surgical sterilization was endorsed by most leading veterinary organizations and humane societies, early-age sterilization surgery has become the norm rather than the exception at U.S. clinics, and is beginning to catch on worldwide but not without resistance.
ANIMAL PEOPLE recently visited the Bali Street Dog Foundation and Bali Animal Welfare Association clinics in Indonesia.
Founded in 1998 by Balinese vet Listriani Wistawan and U.S. expatriate Sherry Grant, a longtime Bali resident, the Bali Street Dog Foundation originally operated under the umbrella of the Yudisthira Swarga Foundation, named in honor of a Hindu king who refused to enter heaven without a street dog who had been loyal to him.
The foundation has taught high-volume, same-day-release dog and cat sterilization throughout southern Asia, including in Sri Lanka and Banda Aceh after the Indian Ocean tsunami.
BAWA, founded by American expatriate Janice Girardi, a 30-year resident of Bali, handles the eastern side of the most populated part of Bali. Working in temples and community halls, the BAWA mobile clinic sterilizes about 40 dogs per day. Members of the BAWA demonstrated safe dog-netting during the 2008 Asia for Animals conference.
Most of the BAWA veterinarians were trained by the Bali Street Dog Foundation but BAWA does not do early-age sterilization surgery, even though Girardi acknowledges that the biggest obstacle they face in trying to reduce the local dog population is that most of the dogs manage to have a litter before they can be caught and sterilized.
Veterinarians who practice early-age sterilization have almost unanimously emphasized to ANIMAL PEOPLE for more than 15 years that young animals are easier to operate on because their reproductive organs are not yet injured, diseased, or misplaced, and that they recover from surgery more rapidly, with less risk of infection. Yet the BAWA veterinarians, including visiting veterinary advisors from Australia, insisted to ANIMAL PEOPLE that early-age sterilization remained beyond their ability.
Back in the U.S., early-age sterilization practitioners who were told about the BAWA perspective just shrugged. Similar arguments used to be heard in the U.S., too.
Another long-anticipated advantage of using an injectible sterilant was avoiding complications of surgery, thereby enabling clinics to hold animals for shorter post-surgical observation and recovery intervals. The introduction of gas anesthesia, however, has almost eliminated complications of anesthesia after sterilization surgery. Even where gas anesthesia is not used, the advent of early-age sterilization has given surgeons daily practice at operating with minimal incisions, requiring much less suturing and presenting far less risk of becoming infected.
Early high-volume sterilization clinics reported surgical complication rates of up to 4%. Same-day release of altered male animals was rare; same-day release of female animals was unheard of.
Today, same-day release of all animals is not only the norm but almost mandatory at many major U.S. clinics, with high surcharges for leaving an animal at a clinic overnight. Post-surgical complications have become so rare at clinics that practice small-incision surgery with strict asepsis that the Foundation Against Companion-animal Euthanasia, in Indianapolis, did 14,000 surgeries before losing an animal an older cat who had respiratory trouble under anesthesia and has now maintained a comparable record through more than 100,000 surgeries since mid-1998.
Emulating the FACE approach, with a former FACE vet as chief sterilization surgeon, the Chicago Anti-Cruelty Society did more than 13,000 sterilization surgeries in 2007 with only four post-surgical complications. The Anti-Cruelty Society has sterilized more than 75,000 animals under their adapted version of the FACE protocol since 1999. The Anti-Cruelty Society fee of $50 for holding an animal overnight is as high or higher than the cost of surgery, in part because keeping animals at the clinic inhibits efficiency in doing the overnight cleaning and maintenance that enables it to work at high speed again the next day.
Both FACE, headquartered in a former heavy equipment garage, and the Anti-Cruelty Society, whose clinic was built in 1933, demonstrate that technique rather than fancy surroundings make the difference. What they do could be done anywhere, with comparable emphasis on cleanliness and economy of motion.
Yet another advantage of injectible sterilization is that it could presumably be done efficiently in remote locations. But remote location surgery has also come a long way since the first Spay USA conference back in 1993 featured veterinarians Jeff Young and Peggy Larson explaining how they respectively converted an old school bus and an old van into mobile clinics.
Young, of Planned Pethood Plus in Denver, visited Native American reservations throughout the Rocky Mountains region, eventually deciding that using a vehicle to haul supplies to stock temporary clinics set up in community halls or tents was more efficient than trying to operate inside the vehicle.
Larson, in northern Vermont, found that having volunteers deliver animals to her fixed-site clinic made far better use of her time than trying to go to where the animals were.
Soon after the first Spay USA clinic, Philadelphia-area vet tech Liz Jones converted a mobile home into a mobile sterilization clinic. Jones learned that mobile homes are not built to take the stresses that a high-volume sterilization clinic must. Currently planning to start a dog and cat sterilization program in Tanzania, Jones is weighing the options among mobile and fixed-site approaches.
Sean Hawkins, who in 1993 was just beginning the Houston-based Spay-Neuter Assistance Program under auspices of the Fund for Animals, invested nearly 10 times as much on his first mobile clinic as Young, Larson, and Jones had. Hawkins then-controversial decision to put the clinic into a large heavy-duty truck turned out to be the right choice among the available options.
These days a mobile sterilization clinic can be ordered ready to go from at least half a dozen makers of veterinary and animal control vehicles. Discussion of mobile sterilization at the 2008 Spay USA conference consisted of a few brief resumes of issues to consider in deciding what kind of vehicle to order, chiefly from Gregory Castle of the Best Friends Animal Society s No More Homeless Pets in Utah cmpaign, as prelude to much talk by Castle and others about how to do the promotion and community organization that is necessary to make a mobile sterilization campaign succeed.
Personifying the transition from a focus on technical issues to recognition of the importance of community organizing might be Oklahoma Spay Network coordinator Ruth Steinberger, of Bristow, Oklahoma, who spoke three times at Spay USA 2008. Steinberger, neither a vet nor a vet tech, has only been involved in animal work for a little more than a decade. Her background is organizing for social justice.
Known first on Native American reservations for investigative exposés of miscarriages of justice, published in Native Times and Lakota Journal, Steinberger remains active on behalf of human rights but animal work now takes most of her time.
Steinberger helps to facilitate more than 22,000 low-cost or free sterilization surgeries per year for dogs and cats in the less affluent parts of her own state, and assists similar programs in other western states. In appreciation of her work Steinberger received the 2006 Henry Bergh Award from the American SPCA.
What Steinberger does, and teaches, is the groundwork needed to make any public health campaign succeed, whether the subjects are animal or human. If the groundwork is done, Steinberger demonstrates, medical or veterinary time can be used most effectively. If the groundwork is not done adequately, a campaign will not succeed, regardless of what medical or veterinary techniques are used.
Steinberger worries that in times and places where funding is scarce, dog and cat sterilization programs will cut back on organizing and outreach, to focus on providing services while overlooking the necessity of getting people to bring animals to use them. The best way to make the most efficient possible use of veterinarians and technicians, Steinberger emphasized, is to make sure that the people and animals are lined up waiting when the vets and vet techs arrive.
Steinberger displayed slides of long lines of Native American reservation residents with their animals. Many had traveled for hours before dawn to reach her clinics, and would travel long into the night to get home.