The recent publication of the new canine guidelines by the American Animal Hospital Association (AAHA) is creating some debate
throughout the veterinary profession and has hit a little closer to home for even more practitioners.
Last year, the Journal of the American Veterinary Medical Association (JAVMA) published research showing feline sarcomas occurred
about once in 32,000 immunizations, rather than the 1 in 10,000 previously reported by the initial anecdotal researchers (I
say "anecdotal" because of the small "n" used in their research colonies). For the first time in my professional career, our
associations have caved in to the public power curve, and have issued guidelines and positions that are not based on solid
scientific research.
The new reality is that the AAHA Canine Vaccination Task Force has written abundant guidelines for the vaccinations of our
canine patients, and even shared the "estimated titers" reflecting the "estimated minimum duration of immunity (DOI)"; the
kicker is in the article's summary section. During the last few years, some university researchers have published skip-year
vaccine protocols, but the respective veterinary college deans have refused to adopt them as solid research or "policy". Missouri
is not changing its immunization protocols from the United States of Department Agriculture-approved vaccine inserts, since
there is no liability protection if they do. There has not yet been anyone or any company to come forward and state they are
willing to support the individual practitioner or practice when the skip-year vaccine case goes to court; you are on the limb
all by yourself.
Figure 1.
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The AAHA Canine Vaccine Task Force had 14 members, 12 are diplomates, yet that will not help your case when the court reads
the guideline summary statements. The complete AAHA Canine Vaccine Task Force report is available from www.aahanet.org. The
AAHA guidelines show the practice just what material is being made public, and it will be the proactive practice that minimizes
the client response (not coming in for annual vaccines). The AAHA Task Force also stated, "...informed consent...is an ethical
and legal requirement of biological use...Vaccine decisions must be approached like any other medical decision."
We have seen a few practice alternatives already effectively working with alternating-year vaccines:
- Some practices refuse to deviate from the biological label until someone is willing to officially share the liability; some
vaccine manufactures say they will support skip-year vaccines, but nothing has been provided yet in writing.
- A few practices have started to give vaccines away, to remove the cost of the vaccines from the client's excuse/claim process
(and they have concurrently ensured the consultation fee is adequate to cover the vaccine cost).
- Some practices are already staggering vaccines so only one vaccine is given at a time, and only one three-year vaccine is
given each year.
We have encouraged practices to make an annual examination a requirement for receiving vaccines, then determine if the animal
will be shifted to a skip-year protocol.
We also recommend practices see an animal three to six times a year. A majority of these visits are for wellness examinations
so a technician can see the patient.
In human health care, many doctor visits are scheduled with the skilled nursing staff. If we adopt this "annual doctor-client-patient
relationship" as a requirement, then the practice's programs for multiple visits and wellness care visits are less expensive;
we save the client the doctor's consultation if the animal is healthy, and we allow the doctors to see the cases which really
need their diagnostic expertise (providing higher net).
Consider the spin-off needs when you are planning a year of care, and then seeing the companion animal three to six times
during the subsequent 12 months:
- Better follow-up on master problem list entries
- Pediatric needs
- Immunizations
- Heartworm testing
- Parasite and fecal screens
- Nutritional issues
- Skin surveillance
- Dental hygiene
- More than 40 surveillance programs.
- Genetic predispositions (e.g., www.upei/cidd/intro.htm).
- Senior programs
- Chronic condition surveillance.
We actually prefer the health care delivery system where the annual visit is scheduled four to six months before or after
the last vaccine, so the visit can be a true "planned" consultation to discuss travel, lifestyles, age factors, genetic predispositions,
and changes in the home environment, and also be a visit where nothing invasive is done. By having this "annual life-cycle
consultation", they qualify for preferred client/patient status, which means lower cost nursing appointments are now available
to them.
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