The notion that “Falsehood flies, and the truth comes limping after it,” penned by Jonathan Swift in 1710, is present in today’s pervasiveness of social media, fake news, fearmongering and pseudoscience.
The U.S. Centers for Disease Control and Prevention, the World Health Organization, the American Academy of Family Practitioners and other institutions have poured money, research and education into debunking the supposed link between childhood vaccines and autism. Despite pleas from public health officials, a small but vocal minority of anti-vaxxers persists, choosing not to vaccinate their children for a variety of reasons and sometimes to the detriment of their community.
The U.S. in recent months experienced the largest outbreak of confirmed measles cases since 1992 even though the virus was considered eliminated nationally in 2000. This year, the World Health Organization listed “vaccine hesitancy” as one of the top threats to global health, estimating that 1.5 million deaths a year could be avoided if vaccine compliance improved.
When Clients Object
So, what does all of this have to do with the veterinary business? Veterinarians and their teams are called upon to be the trusted voices of unbiased best practices for animal health. When we fail to deliver factual information in an accessible, sensitive and timely fashion, our clients are left to the mercy of the internet and friends.
I recommend that you boldly get ahead of the vaccination debate by doing research, forming a cohesive team and providing community education.
Let’s start with three questions.
1. Does the anti-vaxxer movement translate to pet vaccines?
Possibly. Anecdotal commentary from various veterinarians suggests that the subset of the pet-owning population who have concerns about animal vaccine risks is growing. Proof of client hesitancy regarding vaccine chemical components, frequency of administration, immune responses, cancer risk, efficacy and necessity can be found online. At least a few of your clients and colleagues are probably in that group.
2. Is everyone in the veterinary industry on the same page?
No. A wide range of vaccine protocols exists and is complicated by off-label but manufacturer-guaranteed duration extensions and a variety of lifestyle and health considerations. On the practice level, everyone who discusses vaccine protocols with clients must be broadly educated. They need to agree with the hospital’s plan of care for the typical patient, deliver consistent information to clients and, when straying from the norm, make readily accessible and comprehensive notes on patient charts.
Rightfully, a client hearing mixed messages from one veterinarian to the next will start to question the validity of medical recommendations. Take time to meet as a group to openly and respectfully discuss new research and points of contention, humbly reevaluate standards to ensure they are appropriate, and conclude with a plan that everyone can and will comply with.
3. How should we respond to a questioning client?
Graciously. Clients questioning or balking at a medical recommendation — vaccines or otherwise — should be treated in a similar fashion as a disgruntled or complaining pet owner. Let them talk, confirm you are listening and validate their emotions. Educate with facts and provide resources. Admit when you are unsure of something, especially if it has not been formally researched. Give your best advice and allow the client to make the final decision.
Your side of a conversation about pet vaccines could sound something like this:
“I hear you are worried about potential side effects and question the necessity of giving a DAP vaccine today. The unknown associated with stimulating the immune system in patients can feel scary, and I understand your hesitancy.
“We follow the American Animal Hospital Association’s vaccination guidelines of boostering the DAP vaccine every three years for adult dogs. This is a core vaccine for all dogs regardless of lifestyle and is required by local boarding and grooming facilities in order to participate in their services. The vast majority of our patients, including my own pets, follow this immunization schedule without any known complications.
“While there is certainly more research to be done on vaccines, in my opinion the benefits of protection against these viruses for your healthy pet outweigh the known and unknown potential side effects. I recommend boostering this vaccine today if you are comfortable in proceeding.”
Other Considerations
Far more can be said about vaccines, of course. Let’s briefly examine titer tests, herd immunity and rabies.
1. Titering, a lab test that measures antibodies, could be offered to adult patients in lieu of a booster vaccine if the results are sufficient. The 2017 AAHA Canine Vaccination Guidelines include antibody testing as a reasonable assessment of protective immunity and offer suggestions for how to respond to a negative titer test. Note that controversy over titer tests continues in the veterinary community and that many pet businesses do not accept titers in place of vaccination.
2. Herd immunity, or resistance to the spread of disease, is an interesting topic and important for the protection of immunocompromised pets. Research-backed statistics are difficult to ascertain, but one study found that a 70% vaccination rate provided sufficient herd immunity against the distemper virus.
Daniel Island Animal Hospital, the sole veterinary practice in my community, has a strong vaccine protocol and high compliance rate. We have not seen a single case of parvovirus in 15 years of practice (knock on wood). You should remind clients that joining their neighbors in vaccinating pets helps lower the risk of disease in the entire community.
3. Rabies is another conversation altogether and a non-starter in our practice. Most states by law require pets to be vaccinated against rabies, and my team believes it is our responsibility to follow South Carolina’s requirements. Additionally, we are unwilling to put our teammates at unnecessary risk when they handle patients.
Bites from animals with a lapsed or unknown rabies vaccine history, of which we have had several in the past couple of years, generate a list of unsettling action items for team members. Working with a pet owner who refuses to vaccinate for rabies is a risk we are not willing to take. That relationship is promptly ended.
Gaining and Preserving Trust
I urge you to gather unbiased third-party articles and statistics backing your protocols and have them ready to text, email or hand to clients who need more than your word about best practices.
Ultimately, one role of a veterinary practice is to earn client trust and respect through honesty, integrity and communication. When we create a protocol emphasizing best patient care, we can confidently relay and defend our recommendations and protect all of our community’s pets.