Professor Richard Squires, chairman of the WSAVA vaccinations guidelines group, examined the reasons for the growth in the numbers of clients expressing “vaccine hesitancy” and offered some advice to colleagues on how to persuade pet owners to accept their professional recommendations.
He believed that attitudes towards veterinary vaccines reflected a powerful trend in human medicine. Antivaccination campaigners have been around ever since the first mass inoculations against smallpox in the 1790s. But the numbers of people opposing vaccination for their children has increased enormously over the past decade. The term vaccine hesitancy only appeared for the first time in the medical literature in 2010 but by last year there were more than 350 papers addressing the issue.
Richard Squires from James Cook University in Queensland, Australia, highlighted the range of different factors behind this trend – such as the erosion in public respect for the professions, the growing popularity of alternative medicine and an explosion in the amount of misinformation found on the internet or circulated via social media.
The scale of the problem for veterinary practitioners is more difficult to judge because sceptical clients do not explain their concerns, they simply don’t book vaccination appointments – “they are invisible to us,” he warned.
However, one vital source of information on vaccination trends is the PDSA’s annual PAW report, which demonstrated a drop in the numbers of puppies receiving inoculations from 88 percent to 72 percent between 2016 and 2019. This “very frightening” trend could spark a re-emergence of distemper in dogs, he said.
He presented the results of an informal study of more than 2,500 practitioners on six continents which showed that the problem is not unique to the UK. Certainly, more vets responding to the English language questionnaire reported an increase in clients voicing opposition to their treatment recommendations, but similar attitudes were apparent to those practitioners completing the survey in other languages, such as Russian, Japanese and Spanish. “It could well be that they are on the same trajectory, but at a different stage in the process,” he suggested.
The main reason for clients refusing to have their pets vaccinated was cost, mentioned by 58 percent of respondents to the survey, followed by concerns over safety and efficacy (54 percent) and a belief that animals were being “overvaccinated” (43 percent). On the potential for vaccines producing adverse reactions, it was noted that the issue with feline injection site sarcomas in the 1990s was a reminder that no medical procedure is risk-free. But a large proportion of vaccine sceptics appear to link treatment for their dogs with the widely discredited theory that childhood inoculations cause autism in humans. Richard highlighted that “the link between vaccination and autism in humans has been completely debunked [and] autism isn’t an identified illness in dogs and cats”, and so this concern is completely irrelevant in terms of veterinary treatment.
Yet despite this apparent shift in public opinion about the benefits of routine treatment for common infectious diseases, Professor Richard Squires said that there is no reason to believe that the future for animal health is bleak. He cited a study last year in the US journal PLoS One by Simone Eschle and colleagues from Ludwig-Maximilians University in Munich. It concluded that most German dog owners are still amenable to accepting veterinary advice on the need for an annual vaccination to maintain protection against leptospirosis (Eschle et al., 2020).
He felt that veterinary practitioners need to be more focussed in communicating the science behind vaccination to their clients. It was clear that some owners are confused by the complexity of messages about core and non-core vaccinations and on which diseases require regular booster vaccinations.
Meanwhile, other clients may be asking for more complexity in the guidance provided by their veterinary advisors. He said the current WSAVA guidelines on vaccination strategies recognise that a major cause of dissatisfaction among pet-owners was the belief that their views do not receive sufficient respect from veterinary staff. These clients will often respond well to a more collaborative approach and the offer of a tailored treatment programme geared to their pet’s particular environment and lifestyle. This could be agreed during the consultation at the time of the pup’s first annual health check, he suggested.
However, Prof Squires felt that the emergence of vaccine hesitancy was a symptom of a broader issue that veterinary staff need to play their part in addressing. Suspicion about the safety of routine inoculations is associated with both an erosion of public trust in scientific opinion and a growing readiness to accept misinformation.
So, practitioners will need to put more effort into understanding their clients’ opinions on vaccines and putting the case for the contribution that these products make to protecting the health of companion animals.
Others are also looking at ways to constrain the growth in unscientific nonsense. He commended the work of a team at the University of Cambridge which has worked with Dutch colleagues to create an online game which encourages people to look more critically at the information they see in social media. “This game will vaccinate the minds of the people who play it against gullibility,” he said.