Vaccine hesitancy and the importance of client communication

After Matt Motta, PhD, and his sister Gabriella Motta, DVM, published their 2023 research on canine rabies vaccine hesitancy, their story made national news. The topic struck so much of a chord that it even made its way to Saturday Night Live’s Weekend Update feature, joking that dog owners were worried their dogs would develop “pawtism” from their vaccines.

While the made-up term was meant to be comedic, it referred to a very real concern among pet owners—that by vaccinating their pet, they could inadvertently be harming them. And unfortunately, that concern has not lessened over time.

Factors contributing to vaccine hesitancy

Matt Motta said that there are many reasons why pet owners may be hesitant to vaccinate their pets, and that recent current events have likely contributed to this hesitancy. The COVID-19 epidemic was one such event. Motta said his research has shown that people’s attitudes toward the COVID-19 vaccine shaped the way they felt about other types of vaccines for themselves, other humans, and their pets, which he refers to as a “spillover effect.”

“The way we feel about vaccines is often tightly associated with the way that we think about ourselves. That seems a very, very personal issue for a lot of people,” he said. “In fact, we’ve actually published research on what we call ‘anti vaccine social identity,’ the idea that some people see labeling themselves as an anti-vaxxer as central to their understanding of their sense of self.”

“You’re someone who came to hold negative views toward the COVID-19 vaccine. Odds are you hold more negative views toward vaccinating yourself against seasonal flu, towards vaccinating your kids against measles,” he said. And in the post-COVID years, those with negative views toward vaccines have also developed a growing distrust for scientific authorities and public health experts trying to get the word out about the benefit of vaccination for both humans and animals.

This sense of distrust has also been directed in some instances toward the vaccine manufacturers and, by extension, human and veterinary medical professionals who have been accused by some of being overly influenced and/or manipulated by “Big Pharma.”

State and federal concerns

While in many cases this distrust has only played out as hesitancy to vaccinate on the part of the individual, some government officials at both the state and federal levels have translated their opposition to vaccination and scientific research into proposed legislative and policy changes.

Motta pointed to an attempt by the New Hampshire state legislature to roll back requirements for pet owners to register their dogs with the state. While the bill did not pass, Motta worries that future efforts might be successful. “Part of registering your dog in New Hampshire means getting a rabies vaccine,” he explained. If registration were to no longer be required, “there would be no way to make sure that dogs were getting their rabies vaccine,” Motta said.

Additionally, he raised the concern that a law being passed in one state could have ripple effects in other states, either because other state legislatures decide to enact similar legislation, or because pet owners from the state with the new law travel to other states with their unvaccinated pets and increase the risk of disease spread.

The many sources of misinformation

Apart from cultural and political influences, pet owners express other reasons for being hesitant to vaccinate their pets in their discussions with veterinary professionals.

Cheryl Roth, DVM, DABVP (Canine/Feline), co-owner and medical director of Guardian Veterinary Care in Sherwood, Oregon, said that pet owners are sometimes exposed to misinformation about vaccine safety from a variety of sources including groomers, breeders, pet store employees, friends, or even strangers on the internet.

She gave the example of the leptospirosis vaccine and the fear some pet owners have toward it. “Whether it’s my breeder said don’t do this or oh, I heard this kills small dogs,” Roth said, some clients express serious concern about the perceived risk to their dog. “I get that,” she said, “Your breeder probably had that [negative experience with a vaccine] 20 years ago and said never again.”

Jordan Gagne, DVM, DABVP (Canine/Feline), DABVP (Feline), Director of Veterinary Medicine at the Salem Animal Rescue League, in Salem, New Hampshire, said that many of her clients are worried about over-vaccinating their pets.

“Sometimes that means hesitancy in vaccinating their pet for something they perceive the pet is low risk for and sometimes it is just a concern about the physical number of vaccines given at one time,” she said.

Additionally, Gagne is seeing that the efficacy of vaccines sometimes creates a false sense of security among pet owners. “Because the prevalence of canine parvovirus, feline panleukopenia virus, and rabies virus [infection] is so low in the pet population our region (due to widespread vaccination efforts over the years), owners perceive that the disease risk is low,” she said. “They worry that the risk of vaccination (potential for a reaction, pain caused to their pet at the site, financial cost) is greater than the risk of the disease.”

Reaching vaccine-hesitant clients

Finding yourself in a position where you need to repeat the science behind and necessity of certain vaccines to clients can be frustrating. However, it’s important for all members of the team who engage in those conversations to remember why these clients might be pushing back—and to remember it’s almost certainly not about you.

“Clients always state they are worried about causing potential harm,” said Gagne. Vaccine hesitancy among pet owners is “a huge concern,” both due to the risk for the individual pet and to public health. But she realizes not all pet owners see it that way. “It’s important to remind myself, when I have these conversations, that at the very core, vaccine hesitancy stems from caring about their pets.”

Being open to discussing the client’s concerns while remaining neutral and curious as she works to get to the root of the hesitancy has been the most successful approach for Gagne. She’ll share her sources (like the AAHA/Feline VMA Vaccination Guidelines), discuss core versus noncore vaccines, and go over the client’s specific concerns, taking the family’s history and lifestyle into account.

“If the client is concerned about the number of vaccines, we talk about ways to space vaccination schedules out; concerned about injection site sarcomas or vaccine reactions, we discuss the actual risk/prevalence in the literature and strategies veterinary medicine has developed over the years to lower those risks; concerned that the needle is painful, we discuss what a subcutaneous injection is and low-stress handling tools we plan to use; declining because they feel their pet is not ‘high risk,’ well then we discuss what that actually means and whether that is true or not for their pet,” she said. And, she added, “Spoiler: their pet is often not as low risk as they think.”

Successful conversations and individualized care

So what does that success rate look like?

“I find that 95% of the time, owners are receptive to receiving the information when it is approached in a truly educational way that puts their pet’s health first,” Gagne said. “They want individualized care and to know that my recommendation is not just one-size fits all; I have considered the evidence and tailored the recommendation to their specific dog or cat.”

On the other side of the country, Roth sees her fair share of vaccine hesitancy as well, and like Gagne, she aims to engage with these clients without putting them on the defensive.

“In our clinic, it’s all about the client relationship for us, so we respect where they’re coming from. We want to hear what their concerns are and then, ultimately, our goal is to put them in a comfortable place,” Roth said. “You are your pet’s hero in this story, and we’re your ally. It’s your job to make those decisions; we’re just here to provide that information.”

After all, she said, the client’s goal is to keep their pet healthy, as is the practice’s. Taking a nonadversarial approach to vaccine conversations helps to build that relationship, along with trust.

Such conversations might look like, “We’re on your side. It’s not about who wins in this argument. It’s not a debate,” she offered as an example. “I absolutely want what’s best for Max here, and here’s what we’re seeing. You know I work with a bunch of rescues and I see this disease in our area.”

Preparing for an uptick in vaccine hesitancy

In today’s post-COVID world,   the level of vaccine hesitancy among pet parents seems likely to continue to grow in coming years. Veterinary practices should prepare for that.

A recent “secret shopper” study involved contacting over 5000 veterinary practices in six states (California, Minnesota, Ohio, Pennsylvania, Texas, and Washington) to collect observational data on whether those practices required certain vaccines in order to see new patients. Simon Haeder, PhD, MPA, was a corresponding author on the study.

The study had a number of limitations and even more nuance, but it led to another important question: How many practices have thought through how they want to handle potential vaccine-hesitant clients? And how many have taken the time to train staff members to ensure they’re all on the same page when talking to vaccine-hesitant potential clients?

“Does the office have a policy in place to address this, or is the response driven by who sat at the front desk that day?” Haeder wondered. “That’s a question the study can’t answer, but it’s an interesting one.”

Creating an official policy, at least on the individual practice level (if not higher, in the case of corporate groups), is a wise move. Haeder is hopeful that his work on the topic will encourage more people in the profession to think through the concerns and implications.

“I think we’re better off if we start thinking about this now, instead of having individuals make decisions that maybe they’re uncomfortable with, or haven’t thought about enough, so they’re making decisions on a whim,” he said.

But don’t take that to mean he suggests a policy of turning people away if they express concerns about vaccines. Getting people in the door for an initial appointment so that the team can have the kinds of conversations mentioned by Gagne and Roth can be a powerful strategy. That strategy may need to change, though, for clients calling about things like nail trims or boarding, where the opportunity for that conversation might not present itself (and the potential for a bite can be higher).

Looking ahead

Even better than individual practice policies, Haeder said, would be for veterinary associations (and the veterinary professionals within them) to lead the charge on the issue.

“This is a big stakeholder discussion,” he said. “I think this is really an opportunity for veterinarians to use their status. If you look at most trusted professions in the United States, veterinarians are, historically, always right at the top.

“As a group that has a lot of respect in society, getting ahead of these issues, developing protocols, or having statements that they think are appropriate to lead the charge here and ensure that you know pet ownership is safe, pets are safe, public health is protected—I think it’s really the most pragmatic, but also the most forceful step for veterinarians as a as a group here.”

Motta also suggested that veterinary professionals will need to be more open to considering vaccine research that is funded by vaccine manufacturers and not automatically dismiss it as biased given that governmental sources of vaccine research funding are being “actively deprioritized.”

“We can’t rely on our government to fund the research that we do,” he explained. “We may have to go to the pharmaceutical industry if we want to be able to continue doing this research because they’re about to become the only funders in town.”

Photo credit: SeventyFour/iStock via Getty Images Plus

Disclaimer: Trends™ content is meant to inform, educate, and inspire by providing an array of diverse viewpoints. Any content published should not be viewed as an official stance, position, or endorsement by the American Animal Hospital Association (AAHA) or its Board of Directors.