By Don Vaughan

After more than a year on social lockdown due to the coronavirus pandemic, the United States is finally starting to see a return to normalcy. Three effective vaccines helped get us there, but also sowed division as a significant percentage of Americans declined to become vaccinated for various reasons.

Perhaps unsurprisingly, some veterinary practitioners are now reporting an uptick in vaccine hesitancy among their clients, which can leave pets at risk of contracting serious diseases. The question: How should veterinarians and staff respond to better educate reluctant pet owners?

The reasons pet owners give for not getting their pets vaccinated are varied, and often deeply personal. Some refuse because of a general antipathy toward vaccines, often supported by misinformation gleaned from nonmedical sources.

"I personally have experienced numerous occasions where clients have not wanted to vaccinate their pets due to their views about vaccines in people," reports Kathy Kallay, DVM, owner of Four Paws Animal Hospital & Wellness Center in Fredericksburg, Va. "Even with COVID, I still run into these people."

Dr. Kallay recalls one client who burst into tears and stated she would never have her pets vaccinated again because she believed vaccines had caused autism in her grandson. "Due to the strength of her emotional response, I knew there was no way I was going to be able to change her mind, so I didn't even try," Kallay says. 

Decades-long issue

Negative attitudes toward vaccines grew substantially following a 1998 report, published in the British journal, The Lancet, which erroneously suggested a link between autism and the measles, mumps, and rubella (MMR) vaccine. The article was retracted in 2010, but the damage had already been done, says Kelli Ferris, DVM, assistant clinical professor at the North Carolina State University College of Veterinary Medicine in Raleigh.

"Despite the retraction of the article due to fraudulent data, vaccine hesitancy continued to pick up momentum; California saw a doubling of non-medical exemptions from 2007-2014," Dr. Ferris reports.¹ "And by 2014, many communities had over 20 percent of kids without adequate vaccinations. If anything, COVID-19 just added fuel to this already smoldering fire."

Other common reasons for vaccine hesitancy among pet owners include cost, the breeder instructed the client not to have the animal vaccinated, a fear of too many vaccines being given at once, the pet goes outside only to eliminate, the yard is treated for pests, and the yard is fenced so the pet can never escape, says Mechelle Regester, VMD, MS, co-owner of Strasburg Veterinary Health in Strasburg, Pa.

Such views can be frustrating to veterinarians and staff. "For the patient, vaccines are about the prevention of disease," notes Amy Snyder, DVM, MBA, associate clinical professor at the North Carolina State University College of Veterinary Medicine. "For the community, the value of vaccines is they mitigate the spread of zoonotic diseases. As a veterinarian, I see my role as bridging the two. I provide vaccines that protect the patients, which in turn helps to protect the community from the spread of zoonotic diseases. Vaccine hesitancy has the power to impact both the individual patient and
the community."

Animal vaccines are divided into two categories: core and noncore. Core vaccines are recommended for all animals regardless of their environment and exposure to risk, while noncore vaccines are more commonly tailored to an individual animal's lifestyle and risk factors, says Snyder. Core vaccines include canine distemper, canine parvovirus, leptospirosis, and adenovirus
for dogs; herpesvirus, calicivirus and panleukopenia for cats; and rabies for both species. Detailed vaccine guidelines are available from the American Animal Hospital Association (AAHA) and other organizations. 

Client education challenges

Educating hesitant clients regarding the importance of animal vaccines can be challenging. "The thing we tend to forget is most of the 'anti-vaxxers' are making emotional decisions, and we need to speak their language," says Kallay. "As medical personnel, our default is to present evidence, while often we can get farther with this group by asking them to share their concerns. I admit even now, I struggle with these kinds of conversations because they feel unnatural and unproductive. I have to keep reminding myself this is the most likely way I will get this group of people to trust me and
my recommendations."

During such conversations, it is vital clients are not made to feel stupid or foolish regarding their vaccine beliefs, no matter how bizarre. "I think it's important we acknowledge and recognize their fears and concerns," says Ferris. "I take those concerns seriously and I address them in a really serious and hopefully nonjudgmental way when people bring them up."

To facilitate an effective conversation with clients, Ferris suggests replacing the phrase "vaccine compliance" with "vaccine adherence."

"Compliance is me telling the client what they need to do, and they are not really part of the conversation," she explains. "Vaccine adherence is something we discuss together for the health of the patient. If the client is part of that decision-making, they are more likely to keep to the vaccine schedule for their pets."

At Kallay's practice, the discussion about vaccines begins with the nursing staff, then Kallay reiterates. "I think hearing it from two different people helps," Kallay says. "It also gives the client a little time to think about it between the conversations. We use written materials, usually brochures provided by the vaccine manufacturers, to send home with clients who are undecided."

"I talk the science," says Dr. Regester of the conversations she holds with reluctant clients. "I discuss the risk of the long-term effects of the illnesses vaccines help prevent. If they decline, they must sign an Against Medical Advice form. This usually catches the client's attention and lets them know we are truly passionate in our recommendation of the vaccine." 

Exploring client hesitancy

Snyder finds it helpful to dig deep into why clients are reluctant to have their pets vaccinated. "I need to understand where their hesitation is coming from," she says. "Often it's a matter of identifying misinformation and providing clients with reliable sources of information regarding the efficacy and safety of vaccines."

Vaccines are essential to an animal's health, but they also are an income generator for veterinary practices, though not to the degree they were in the past. According to a survey conducted by Live Oak Bank, the majority of practices surveyed derived 10 percent or less of annual revenue from providing vaccinations. But there can be other perks. "I would argue the opportunity is worth more than the vaccine," Ferris says. "It's also the interaction with the client, which can generate a better relationship."

Unfortunately, cost is one of the most common reasons why clients decline vaccines for their pets, which can place a practice in a difficult position. Some practices offer vaccines at no cost to clients who are truly indigent, while others offer a payment plan option.

To save money, more and more pet owners are getting core vaccines at low-cost community clinics, returning to their veterinarians for other healthcare needs. "Our assumption is this trend will continue as more and more low-cost clinics appear in places like Walmart," says Kallay. "Our long-term strategy/goal is to shift our emphasis to sick medical care, hospitalizations, and non-routine surgeries." 

Tools to educate

Veterinarians come to the issue of vaccine education with a variety of effective tools. "It's a combination of excellent conversation skills and an understanding of the importance of core and noncore vaccines in my geographic area," says Ferris. "It's also providing clients with good information at a level targeted to the individual. We want to include the pet owner as part of the healthcare team for their pet. Their opinions and concerns matter."

Kallay agrees, noting, "The more you can personalize the interaction with each client, the more open they are to listening to what you have to say. By understanding their and their pets' individual needs, I think we gain their trust. I believe most clients can sense when they are getting a canned speech and are less likely to listen to what you have to say."

Don Vaughan is an award-winning writer who frequently writes about veterinary-related topics.

Reference

1. Vaccine Hesitancy: More than a movement. David Calender. Human Vaccines & Immunotherapeutics. 2016; vol. 12, issue 9. https://bit.ly/3hVspVN