Proactive Prevention

What can we do to increase vaccination compliance among hesitant pet owners?

Vaccines are the foundation of preventive veterinary medicine. They help protect pets from a host of infectious diseases, many of which can be life-threatening. The AVMA offers the following reasons:

1. Prevention of Disease: Vaccinations prevent numerous contagious and potentially deadly diseases, including rabies, distemper, parvovirus, and feline leukemia. These diseases can have severe health consequences for animals, and vaccines provide immunity against them.

2. Community Health: Vaccinating pets also contributes to public health. For example, rabies is a zoonotic disease, meaning it can be transmitted from animals to humans. Vaccination is essential in preventing the spread of such diseases.

3. Protection and Cost-Effectiveness: Vaccines are considered a cost-effective measure. The cost of vaccinating a pet is much less than the potential cost of treating a serious illness that could have been prevented with a vaccine.

So why aren’t more pet owners compliant with vaccines? And what can the veterinary community do to change their minds? In the following articles, several experts weigh in.

Counting the Cost

Do pet owners truly understand the risks involved in not properly vaccinating their dog or cat?

There is a legitimate, life-saving reason for every time a vaccination is recommended for dogs and cats. Most diseases that veterinarians want to vaccinate pets against are pretty bad, said Kristine Smith, DVM, DACZM, Global MBA, Senior Veterinary Medical Lead, Core Brands, Zoetis. They’re deadly. “Obviously the ultimate cost is the loss of your pet.”

But even if the pet recovers, simply treating the sick dog or cat can turn into a massive financial burden on the client. “Most of the things that we vaccinate against – distemper, parvovirus, leptospirosis, etc. – are very expensive to treat because they have significant mortality rates,” Dr. Green said.

A lot of these animals end up in intensive care in the hospital. How expensive the bill gets often depends on how extensive the pet owner is willing to go in treating the pet. For example, the survivability rate of leptospirosis can be 70% to 90% typically of dogs that get treated. But those dogs may be treated at a university specialty center where the pet owner could be walking away with thousands of dollars in medical bills.

Meanwhile, the cost to vaccinate for leptospirosis ranges from $15 to $45 depending on the location and veterinary practice.

“In pets, if we find it worth vaccinating for, then it’s because we’re trying to save lives, and the outcome is a lot more severe and more unlikely to save those pets without a significant cost to the owner.”

How much does it cost to treat the diseases that vaccines are designed to prevent? Vet-Advantage asked Trupanion for data that reflected the average cost of treatment over the last four years 2020 – 2023.

It’s important to note that the real cost of care is likely higher, perhaps significantly so, the pet insurer said. This is because there are a number of other factors not reflected. Also, costs may be higher or lower based on location and other considerations.

Potential cost of treatment

From education to recommendations

The annual visit is still the cornerstone of care where core vaccines, blood work and standard diagnostic tests are run. But Dr. Green said it’s important to educate the owner that the annual visit may not be the only time they need to come in to see the veterinarian for vaccines. Certain lifestyle events may warrant an additional checkup or vaccination.

For example, if the owner declines a kennel cough vaccine during the routine wellness visits but then wants to board their pet during a vacation, he or she should schedule an appointment to get the vaccination ahead of time. Or, if the pet owner is planning on traveling with the pet to an area with a greater risk of Lyme disease, they should come in for that and any other pertinent lifestyle vaccine.

“We need that pet owner to remember to check with their veterinarian and see if there’s anything else that they might need for their pet to keep them safe during these events,” she said.

Practices need to make a strong recommendation when they know that the risk exists, and not just put it on the pet owner to make the decision. For example, there’s only about 40% compliance rate with the leptospirosis vaccine in the U.S. Yet the ACVIM and AAHA now recommend that 100% of dogs be vaccinated for lepto (see sidebar). “The newest guidance is that it should be considered as core for all dogs, and we have 60% of dogs that aren’t, so that’s a big gap we need to work on, Dr. Green said. “We need to educate veterinarians to provide stronger recommendations, because lepto exists all over the country. It’s a risk for all pets, and it’s deadly.”

Pet owners have a lot of information to digest during a veterinary visit, so they won’t remember every detail or recommendation made. Dr. Green said it’s important to provide educational resources in more than one location and format. This can be in the form of take-home brochures, QR Codes in the exam room or front desk, or posters on the wall. “It’s nice to have those touch points to give pet owners other places they can go for information,” she said.

To overcome vaccine hesitancy, Dr. Green said clients need to feel like they are being heard, and that their concerns are respected, in order to have trust in the person they are receiving advice from. “Building a relationship can take time,” she said. But practices that take that extra effort to make sure they know the pet’s name and lifestyle, building that feeling in the client that you are there for them and their pet, you’re not just a business but a trusted resource, those things make a world of difference. “Pet owners feel like they’re in a safe space to make a good decision. So, whatever it takes to do that, I think it’s something to focus on as a practice if you want to have good compliance with your customers. Veterinarians do what they do because they love animals.”

Leptospirosis vaccine now designated a core vaccine

The AAHA 2023 Canine Vaccination Guidelines have now officially been updated to reflect a change in status of the leptospirosis vaccine from non-core to core, according to the American Animal Hospital Association (AAHA). This is following consensus statements from the American College of Veterinary Internal Medicine (ACVIM) and the World Small Animal Veterinary Association (WSAVA), and the recommendation of AAHA’s vaccine guidelines task force.

Ingrid Taylor, DVM, Director of Guidelines for AAHA, oversaw the expert task force that agreed the change was needed. “Any dog that goes outdoors, whether in an urban or a rural setting, can be exposed to leptospirosis,” she explained. “Over the years that AAHA has been publishing guidelines, we have seen a substantial increase in the prevalence of this disease. Because this disease is zoonotic, it is important to protect both dogs and people by encouraging widespread vaccination.”

Update: AAHA guidelines designate Leptospirosis vaccine as core – AAHA

An Avoidable Risk

Rabies cases have been up since the pandemic. What can the veterinary community do to convince skeptical pet owners about the importance of vaccination for this deadly disease?

Rabies is fatal, but preventable. A rabies vaccine has been available for more than 100 years. The veterinary community knows these facts inside and out. So why has been an alarming increase in rabies cases globally, and even in the United States, since the outbreak of the COVID-19 pandemic?

Tina Bearden, DVM, technical support manager for Boehringer Ingelheim said there are several reasons as to why we’ve seen an increase in rabies cases following the COVID-19 pandemic. “The pandemic-induced lockdown disrupted the handling of stray dogs, updating vaccinations, and population control activities, which certainly had an impact on many preventive health efforts, including rabies.”

But there are other reasons, too – in the U.S., states like Delaware, Texas, Minnesota, and Vermont have seen recent increases in rabies cases as a result of exposure to infected wildlife. “As exposure to rabies has risen, we’re also seeing more skepticism among pet owners about the importance of vaccination.”

A 2023 study revealed that over half of dog owners expressed doubts about the effectiveness of rabies and other pet vaccinations. The findings, published in the wake of the COVID-19 pandemic, indicate that pet owners who are skeptical of human vaccines are also more likely to question the value of vaccines for their pets. “COVID presented other factors that contributed to the difficulties in rabies management, too, including increased aggressiveness in dogs who experienced lockdown restrictions during their socialization period, an altered dog population, risky human-dog encounters, and an interruption in rabies surveillance efforts.”

Dr. Bearden said the increased hesitancy surrounding pet vaccines is a complex issue with several contributing factors. Online misinformation about vaccines, often spread through social media and unreliable sources, can lead pet owners to believe false claims about vaccine safety and efficacy. Additionally, some pet owners may focus on the rare vaccine side effects while underestimating the severity and prevalence of preventable diseases like rabies.

“Cost and access are important factors, too,” she said. “Vaccination costs and the time it takes to travel to a veterinarian for these vaccines can be barriers for some pet owners and might cause them to altogether disregard vaccination because they feel it is too costly or inconvenient.”

Health ramifications

But the cost not to vaccinate could be devastating for pets and their owners. Increased rabies cases in the pet population could have several serious implications. Rabies is a zoonotic disease, which means it can be transmitted from animals to humans. “Not only does rabies impact the health of pets, but increased rabies cases pose higher risk of human exposure through bites or scratches,” Dr. Bearden said. “While it is 100% preventable, rabies is almost always fatal once symptoms appear. Increased cases in pets could lead to more human deaths, especially in areas with limited access to post-exposure prophylaxis.

Additionally, treating rabies exposure is expensive and resource intensive. Increased cases would put a strain on healthcare systems, particularly in developing countries. The global cost of rabies is estimated to be around $8.6 billion per year including lost lives and livelihoods, medical care and associated costs, as well as uncalculated psychological trauma.

Overcoming hesitancy

One of the best things veterinarians can do with clients is to open the conversation. “It’s up to us to help build trust with pet owners and address some of their concerns,” Dr. Bearden said. “When we see a client and pet in the office, it’s an opportunity to start a conversation about preventive care and vaccination, and I think we can do that openly and candidly by acknowledging that vaccine hesitancy is a real issue, but also underscore the potential short and long-term risks of ignoring preventive measures. By actively listening to our clients’ fears, we can help facilitate an educational conversation.”

Taking an evidence-based approach can be helpful as well. “With so much misinformation on social media, we have a unique opportunity to present clear information about vaccination, and connect our clients with resources and educational materials to help them make a decision, including reminding them that – in many areas of the country – rabies vaccines are mandated by law.”

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