There is a great deal of literature including many books on the science behind risk/benefit analysis. I reviewed some of them
prior to writing this article, but try as I might, I could not incorporate much into the task at hand, namely doing a risk/benefit
analysis of vaccination in pets. One thing I did learn was that one can't just do a risk/benefit analysis: there must be a
purpose in mind, e.g. what is the most effective approach to the control and prevention of disease X, or, what is the safest
approach to the prevention of disease X? From the perspective of the pet owner, the purpose behind vaccination could be: what
vaccines are necessary for my pet, and are these vaccines safe for my pet? I will focus on these last two questions since
the decision belongs with the client, but the veterinarian, being the expert, is expected to advise the client as to what
is best for the pet.
The process leading to a vaccination decision for an individual pet involves the owner/owning family and the veterinarian.
The patient is the pet, and both the veterinarian and the owner presumably want to do what is best (safe and effective protection)
for the pet. The veterinarian is expected to be an advocate for the pet and not to have another agenda. The attitude of the
owner probably reflects the strength of the bond between owner and pet and the place of the pet within the family structure.
It also would be expected to reflect the personal risk acceptance profile of the owner, his or her knowledge and understanding
of vaccination, as well as the trust and confidence he or she has in the veterinarian.
A number of groups, including the American Veterinary Medical Association (AVMA), American Animal Hospital Association (AAHA)
and the vaccine manufacturers, advocate that a risk/benefit analysis be done on each pet to be vaccinated rather than instituting
species-specific vaccine protocols for all pets seen by the practice. This article examines that notion and explores what
such an approach would entail.
Factors in the veterinarian's decision-influencing role would probably include:
- Fundamental knowledge and understanding of the science of vaccinology;
- Practice philosophy/goals, e.g. evidence-based and high quality medicine;
- Standards adhered to: internally generated or externally driven, e.g. AAHA;
- Level of devotion to and understanding of the scientific process;
- Level of understanding of Aesculapian authority in pet practice, or the importance of being an advocate for the pet;
- Knowledge of the diseases and disease organisms in question and their local prevalences, mechanisms of spread, ease of diagnosis
and treatments.
- Knowledge of the likely level of exposure by the particular pet to diseases;
- Status of the pet's immune system;
- The efficacy of the vaccine as well as the incidence of adverse effects;
- Respect for the opinions and sensitivities of the client.
Factors in the owner's decision-making process:
- Trust in the advice received from the veterinary team, particularly the doctor;
- Level of risk the owner will tolerate;
- Financial priorities of the owner;
- Strength of the bond between owner pet. Is the pet a family member? Each of these factors can influence vaccination decisions.
Each of these factors can influence vaccination decisions.
Knowledge, understanding Veterinarians know that vaccination is the most cost-effective strategy for controlling infectious diseases in pet populations,
and most would agree that it is far better to prevent disease than to let it occur and then treat it. Vaccination is a medical
procedure that does not always induce immunity and can cause side effects, which in rare cases, may be severe. Veterinarians
also appreciate that vaccination is a population-based disease control strategy and understand that disease in individual
pets is a reflection of the level of disease threat, the level of immunity in the individual and in the local pet population
as well as the presence or absence of other modifying factors. It is important that clients also understand the limitations
of vaccination.
Practice goals, standards This will vary from practice to practice. Practices may establish their own standards or may follow the lead of organizations
such as veterinary schools, AAHA, and veterinary medical associations. At Banfield, we set our own standards. These reflect
our commitment to provide pets with the same care we want for ourselves. We are a bond-centered, evidence-based practice,
and we are committed to making life better for families. We believe that pets should not be a threat to other family members.
We are committed, therefore, to preventing diseases that pose a threat to people and to preventing diseases that pose a significant
threat to pets. As such, we recommend vaccination of pets against:
- All diseases of pets that are endemic to the United States and are associated with significant morbidity and mortality – especially
those for which there are no readily available diagnostic tests or effective therapy (e.g. distemper, parvovirus, panleukopenia,
FeLV, FIV, rabies);
- Chronic diseases or diseases with chronic sequelae that affect a pet's quality of life (e.g., Lyme disease, feline respiratory
disease).
- Diseases that are directly or indirectly transmissible from pets to the human members of the family (e.g. leptospirosis, giardiasis,
rabies). Practices that have a different philosophy will presumably recommend a different mix of vaccines, and practices with
a single location may well tailor their recommendations to only those diseases they encounter locally.
Regarding revaccination intervals, we, like many practices, take the position that this should be dictated by scientific evidence
that has been proven to be safe and effective in field studies. In cases where such evidence is lacking or deemed insufficient,
we will recommend vaccination protocols that have proven over time to provide excellent protection and minimal adverse events.
Other practices may choose to align with the recommendations of their local referral practice, school of veterinary medicine
or AAHA, while trusting that such groups know what they are doing.
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