Canine and feline core vaccinations: US veterinarians’ concerns and perceived impact of COVID-19 antivaccination views on veterinary medicine

Lori R. Kogan College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO

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Mark Rishniw Veterinary Information Network, Davis, CA

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Abstract

OBJECTIVE

Assess US veterinarians’ perceptions regarding vaccine concerns (their own and owners’) and the association between owners’ vaccine concerns and COVID-19 antivaccination sentiments.

SAMPLE

Members of the Veterinary Information Network.

PROCEDURES

An electronic survey distributed via the Veterinary Information Network data collection portal.

RESULTS

1,341 US veterinarians completed the survey. Top veterinarian concerns for vaccinating a healthy adult dog were anaphylaxis, soreness at injection site, and lethargy; for cats, these concerns included vaccine-associated sarcoma, lethargy, and soreness at injection site. Veterinarians reported that the most common concerns mentioned by owners included that the pet does not go outside, that vaccinations are unnecessary, that vaccinations can lead to chronic or severe illness, and cost. Veterinarians reported an increased number of dog and cat owners reluctant about or resistant to the idea of rabies vaccines and core vaccines since the time that COVID-19 vaccines became widely available. There was an association between veterinarians’ perceptions of local COVID-19 antivaccination sentiments and the increase in the number of vaccine-resistant or -concerned clients.

CLINICAL RELEVANCE

There appears to be little overlap between veterinarians’ primary concerns related to vaccinations and their perception of dog and cat owners’ primary concerns. The fact that the number of resistant clients is positively associated with the presence of veterinarians’ perceptions of a local COVID-19 antivaccination sentiment suggests that human antivaccination sentiments impact pet owners’ views of companion animal vaccinations. A better understanding of the cognitive biases that impact owners’ vaccine decisions can help veterinarians better communicate with vaccine-reluctant clients and increase vaccination compliance rates.

Abstract

OBJECTIVE

Assess US veterinarians’ perceptions regarding vaccine concerns (their own and owners’) and the association between owners’ vaccine concerns and COVID-19 antivaccination sentiments.

SAMPLE

Members of the Veterinary Information Network.

PROCEDURES

An electronic survey distributed via the Veterinary Information Network data collection portal.

RESULTS

1,341 US veterinarians completed the survey. Top veterinarian concerns for vaccinating a healthy adult dog were anaphylaxis, soreness at injection site, and lethargy; for cats, these concerns included vaccine-associated sarcoma, lethargy, and soreness at injection site. Veterinarians reported that the most common concerns mentioned by owners included that the pet does not go outside, that vaccinations are unnecessary, that vaccinations can lead to chronic or severe illness, and cost. Veterinarians reported an increased number of dog and cat owners reluctant about or resistant to the idea of rabies vaccines and core vaccines since the time that COVID-19 vaccines became widely available. There was an association between veterinarians’ perceptions of local COVID-19 antivaccination sentiments and the increase in the number of vaccine-resistant or -concerned clients.

CLINICAL RELEVANCE

There appears to be little overlap between veterinarians’ primary concerns related to vaccinations and their perception of dog and cat owners’ primary concerns. The fact that the number of resistant clients is positively associated with the presence of veterinarians’ perceptions of a local COVID-19 antivaccination sentiment suggests that human antivaccination sentiments impact pet owners’ views of companion animal vaccinations. A better understanding of the cognitive biases that impact owners’ vaccine decisions can help veterinarians better communicate with vaccine-reluctant clients and increase vaccination compliance rates.

Introduction

Vaccine hesitancy, identified in 2019 as one of the top 10 threats to global health by the World Health Organization,1 can be defined as a delay in acceptance or refusal of vaccination despite availability of vaccination services. Reasons for vaccine hesitancy are complex and context specific.2 Research pertaining to vaccines suggests that vaccine hesitancy is driven by individual factors (eg, emotions, values, risk perceptions, knowledge, or belief) as well as social, cultural, political, and historical factors.3,4 The increase in vaccine hesitancy threatens to reverse the significant progress that has been made in the prevention of vaccine-preventable diseases.57

Feelings and perceptions about vaccines became especially salient with the onset of COVID-19. Despite the widespread availability of a COVID-19 vaccine throughout the US, several states only have approximately 60% of their population fully vaccinated.8 Major barriers to vaccine uptake have been broadly classified as logistical (time, transportation, cost, location) and attitudinal. Attitudinal barriers, including beliefs and fears about communicable diseases and vaccines and distrust of health-care and governmental agencies,9 result in a reduction in the willingness to obtain a vaccine.

A study conducted by The American Academy of Family Physicians Science Fellows in 2021 suggests positive attitudes about vaccines have remained stable or decreased since the availability of the COVID-19 vaccine. This study also finds that the percentage of people who report using the media (television, internet, and social media) as their primary vaccine information source increased by 17% when compared with the time before COVID-19.10 In fact, 48% of Americans report getting some (30%) or a lot (18%) of their news and information about COVID-19 vaccines from social media.11 The media, and social media in particular, have been blamed for spreading misinformation about vaccines and conspiracy theories.12 These beliefs are not without impact, as these individuals are less likely to get a vaccine even if it is free and widely available.13,14 In one study,13 conspiracy theories about COVID-19 were endorsed by a third of the study’s participants, and those who believed at least one of these conspiracies were 4 times less likely to get a COVID-19 vaccine. Furthermore, these beliefs appear to be stable across time and generalizable across situations.14 One recent study by Roberts et al15 found many common traits among antivaccination attitudes in general and feelings about the COVID-19 vaccine.

Vaccinations are also a vital component in companion animal health.16,17 The core vaccinatable diseases for dogs include canine distemper, canine parvovirosis, infectious canine hepatitis, and rabies.18 The core vaccinatable diseases for cats include feline (panleukopenia) parvovirus, feline calicivirus, feline herpes virus-1, and rabies.19 Similar to human health, canine and feline vaccines are considered safe, cost-effective ways to prevent infectious diseases.20 Yet there has been increasing concern expressed by veterinarians around the world that vaccine compliance rates are decreasing.21 A study22 in the US found wide variability in companion animal vaccination rates between states and even veterinary clinics, suggesting several elements play a role in vaccination decisions, including erroneous beliefs, lack of awareness and knowledge, and the veterinarian-client relationship.

While it appears there is an association between antivaccination sentiments regarding childhood diseases and companion animal vaccine compliance,23 it is unknown whether attitudes about the COVID-19 vaccine impact pet owners’ views about feline and canine vaccinations. This study was designed to explore veterinarians’ perceptions of the possible relationship between COVID-19 antivaccination sentiments and perceived trends in vaccination compliance rates for dogs and cats. Additionally, we examined and compared veterinarians’ concerns about vaccinating healthy dogs and cats with their perceptions of clients’ concerns.

Materials and Methods

An anonymous online survey was created in collaboration with Veterinary Information Network (VIN), an online veterinary community, to evaluate US veterinarians’ views regarding rabies and other core vaccinations for dogs and cats. Because rabies vaccines are mandated by law in most states, we assessed rabies vaccines separately from other core vaccines. For the purpose of clarity, vaccines in this study are referred to as rabies and other core vaccines. The survey, modeled after our previous study,23 consisted of 26 questions, primarily Likert scale, with free-text boxes provided for participants to enter brief alternative answers when none of the listed options applied to them. The questions included demographic items (ie, state of residence, year graduated from veterinary school, local anti–COVID-19 vaccination sentiments), vaccination beliefs about dogs and cats (eg, dogs should be regularly vaccinated with core vaccines), and vaccination concerns for dogs and cats. The survey also included questions about their experiences and perceptions related to clients’ concerns or refusal of vaccines. A final question at the end of the survey allowed for free-text entry for any comments participants chose to make about the impact of the anti–COVID-19 vaccination movement on veterinary preventative health medicine. The survey was voluntary, and participants could choose to stop at any point. They could also choose to skip any questions they did not wish to answer. No incentives were offered for participation, and the estimated time for survey completion was less than 10 minutes.

Similar to our previous study, a link to the survey was distributed via an email invitation to eligible VIN members (n = approx 43,000), with access made available from January 14, 2022, through February 2, 2022. A follow-up message was sent 2 weeks after the initial invitation. The survey was administered directly through the VIN data collection portal with branching logic used to display only relevant questions to each participant. Only data from US respondents who stated they work in a veterinary practice where they routinely vaccinate client-owned dogs or cats were included in the analyses. The study was categorized as exempt by Colorado State University’s Institutional Review Board. Descriptive statistics and χ2 tests were used to analyze the results. Statistical significance was set at P < 0.05.

Results

A total of 1,341 respondents from all 50 United States (and the District of Columbia) indicated they routinely vaccinate only dogs (10 [0.7%]), only cats (26 [1.9%]), or both dogs and cats (1,305 [97.3%]). The states with the largest percentage of participants included California (164 [12.2%]), Texas (100 [7.5%]), Florida (74 [5.5%]), New York (62 [4.6%]), Pennsylvania (59 [4.4%]), Washington (52 [3.9%]), and Massachusetts (47 [3.5%]). Only 67 (5.0%]) participants reported graduating veterinary school prior to 1980; the remaining participants graduated between 1980 and 1989 (280 [20.9%]), between 1990 and 1999 (367 [27.4%]), between 2000 and 2009 (320 [23.9%]), and after 2009 (307 [22.9%]).

When asked whether rabies vaccinations are required by law where they practice, most indicated a statewide mandate for both dogs and cats (1,013 [75.5%]), followed by for dogs only (266 [19.8%]). A few claimed that the law differs from region to region within their area of practice (45 [3.4%]), that no mandate exists (14 [1.0%]), or that they didn’t know (3 [0.2%]). Almost all participants indicated they support regular (not necessarily annual) vaccines for canine rabies (1,293 [98.7%]), canine core (1,268 [96.6%]), feline rabies (1,280 [96.5%]), and feline core (1,252 [94.1%]).

Respondents were presented with a series of possible risks associated with vaccinating a healthy adult dog with no prior vaccination history to assess their general concerns about vaccination reactions. The top concerns included anaphylaxis, soreness at injection site for several days, and lethargy for several days after vaccination (Table 1). Respondents could also write in additional concerns; the most common additional concerns included immune-mediated disease (n = 46) and allergic reaction (9). Similarly, veterinarians were asked to indicate their concerns when vaccinating a healthy adult cat with no prior vaccination history. The top concerns were vaccine-associated sarcoma, anaphylaxis, and abscess formation at injection site (Table 2). The most common additional write-in concerns noted by participants included immune-mediated disease (n = 12), exposure risk (11) and gastrointestinal signs (9).

Table 1

Veterinarians’ concern level with several potential issues that may arise when vaccinating a healthy adult dog that has no prior vaccination history.

Canine Quite a bit Some None/minimal
Anaphylaxis (n = 1,310) 107 (8.2%) 461 (35.2%) 742 (56.6%)
Vaccine-associated sarcoma (n = 1,310) 72 (5.5%) 174 (13.3%) 1,064 (81.2%)
Abscess formation at injection site (n = 1,307) 68 (5.2%) 56 (4.3%) 1,183 (90.5%)
Inappetence for several days after vaccination (n = 1,309) 44 (3.4%) 212 (16.2%) 1,053 (80.4%)
Lethargy for several days after vaccination (n = 1,309) 29 (2.2%) 443 (33.8%) 837 (63.9%)
Soreness at injection site for several days (n = 1,307) 22 (1.7%) 539 (41.2%) 746 (57.1%)
Pain on injection (n = 1,309) 15 (1.1%) 298 (22.8%) 996 (76.1%)
Cost to the client (n = 1,306) 13 (1.0%) 317 (24.3%) 976 (74.7%)
Bleeding from injection site (n = 1,307) 6 (0.5%) 47 (3.6%) 1,254 (95.9%)
Table 2

Veterinarians’ concern level with several potential issues that may arise when vaccinating a healthy adult cat that has no prior vaccination history.

Feline Quite a bit Some None/minimal
Vaccine-associated sarcoma (n = 1,289) 153 (11.9%) 707 (54.8%) 429 (33.3%)
Anaphylaxis (n = 1,285) 89 (6.9%) 315 (24.5%) 881 (68.6%)
Abscess formation at injection site (n = 1,287) 60 (4.7%) 72 (5.6%) 1,155 (89.7%)
Inappetence for several days after vaccination (n = 1,287) 47 (3.7%) 352 (27.4%) 888 (69.0%)
Lethargy for several days after vaccination (n = 1,287) 34 (2.6%) 523 (40.6%) 730 (56.7%)
Pain on injection (n = 1,286) 31 (2.4%) 383 (29.8%) 872 (67.8%)
Soreness at injection site for several days (n = 1,287) 27 (2.1%) 452 (35.1%) 808 (62.8%)
Cost to the client (n = 1,272) 14 (1.1%) 302 (23.7%) 956 (75.2%)
Bleeding from injection site (n = 1,285) 7 (0.5%) 48 (3.7%) 1,230 (95.7%)

In addition to their own concerns, veterinarians were asked to indicate, from a given list, how frequently vaccine-hesitant or -resistant dog and cat owners mention specific vaccine-related concerns. The most common concerns or issues mentioned by both dog and cat vaccine-hesitant or -resistant owners include that the dog or cat does not go outside, that the owner feels vaccinations are unnecessary, that vaccinations can lead to chronic or severe illness, and vaccine cost (Tables 3 and 4).

Table 3

Veterinarians’ reported perceptions of clients’ concern level with several potential issues that may arise when vaccinating a healthy adult dog that has no prior vaccination history.

Issues of potential concern Often/very often Sometimes Never/rarely
Dog never goes outside, so never exposed (n = 244) 143 (58.6%) 85 (34.8%) 16 (6.6%)
A belief that vaccinations are unnecessary (n = 245) 123 (50.2%) 97 (39.6%) 25 (10.2%)
A belief that vaccinations can lead to chronic or severe illness (n = 244) 76 (31.1%) 96 (39.3%) 72 (29.5%)
Cost (n = 244) 70 (28.7%) 101 (41.4%) 73 (29.9%)
Soreness at injection site for several days (n = 243) 31 (12.8%) 95 (39.1%) 117 (48.1%)
Lethargy for several days after vaccination (n = 244) 26 (10.7%) 109 (44.7%) 109 (44.7%)
Religious or philosophical beliefs (n = 244) 24 (9.8%) 56 (23.0%) 164 (67.2%)
Anaphylaxis (n = 244) 23 (9.4%) 77 (31.6%) 144 (59.0%)
Political objections (being required to vaccinate against rabies; n = 245) 18 (7.3%) 45 (18.4%) 182 (74.3%)
Inappetence for several days after vaccination (n = 243) 16 (6.6%) 76 (31.3%) 151 (62.1%)
Pain on injection (n = 244) 11 (4.5%) 62 (25.4%) 171 (70.1%)
Vaccine-associated sarcoma (n = 244) 4 (1.6%) 23 (9.4%) 217 (88.9%)
Abscess formation at injection site (n = 242) 1 (0.4%) 3 (1.2%) 238 (98.3%)
Bleeding from injection site (n = 244) 0 1 (0.4%) 243 (99.6%)
Table 4

Veterinarians’ reported perceptions of clients’ concern level with several potential issues that may arise when vaccinating a healthy adult cat that has no prior vaccination history.

Issues of potential concern Often/very often Sometimes Never/rarely
Cat never goes outside, so never exposed (n = 262) 213 (81.3%) 43 (16.4%) 6 (2.3%)
A belief that vaccinations are unnecessary (n = 264) 155 (58.7%) 86 (32.6%) 23 (8.7%)
A belief that vaccinations can lead to chronic or severe illness (n = 262) 86 (32.8%) 82 (31.3%) 94 (35.9%)
Cost (n = 26) 70 (26.7%) 100 (38.2%) 92 (35.1%)
Vaccine-associated sarcoma (n = 2,602) 31 (11.8%) 84 (32.1%) 147 (56.1%)
Lethargy for several days after vaccination (n = 262) 24 (9.2%) 111 (42.4%) 127 (48.5%)
Religious or philosophical beliefs (n = 263) 23 (8.7%) 49 (18.6%) 191 (72.6%)
Political objections (being required to vaccinate against rabies; n = 261) 21 (8.0%) 42 (16.1%) 198 (75.9%)
Soreness at injection site for several days (n = 261) 21 (8.0%) 87 (33.3%) 153 (58.6%)
Inappetence for several days after vaccination (n = 260) 20 (7.7%) 184 (32.3%) 156 (60.0%)
Pain on injection (n = 260) 12 (4.6%) 66 (25.4%) 182 (70.0%)
Anaphylaxis (n = 261) 10 (3.8%) 56 (21.5%) 195 (74.7%)
Bleeding from injection site (n = 260) 1 (0.4%) 3 (1.2%) 256 (98.5%)
Abscess formation at injection site (n = 260) 0 10 (3.8%) 250 (96.2%)

Trends in clients hesitant or resistant to vaccines

Respondents who reported that they had clients who expressed concerns or refused to vaccinate their dog or cat since COVID-19 vaccines became widely available were asked if they felt the number of vaccine-hesitant or -resistant clients has decreased, increased, or remained constant. Between 30% and 40% of veterinarians (depending on the specific vaccine) reported the number of hesitant or resistant clients had increased. Participants were asked if they felt there is a COVID-19 antivaccination sentiment in their community (n = 1,271), to which 915 (72%) said yes, 214 (17%) said no, and 142 (11%) indicated they did not know. For those who reported a local COVID-19 antivaccination sentiment, they were asked to indicate its prevalence (n = 878). The majority reported some (551 [63%]), followed by a great deal (317 [36%]) and minimal (10 [1%]). When asked whether they felt that the COVID-19 antivaccination sentiment has impacted their clients’ feelings and/or behaviors related to vaccinating their dogs or cats, 831 (65%) said “no”; 188 (15%) said “yes,” and 256 (20%) said “don’t know/had not thought about it.” Veterinarians who responded “yes” were asked to report on the nature of the impact: whether the numbers of clients declining vaccines has decreased, increased, or remained the same. The majority reported that the COVID-19 antivaccination sentiment has led to more hesitant or resistant clients as well as increased numbers of clients who want to discuss vaccines (Table 5). When asked how frequently vaccine-hesitant or -resistant clients reference COVID-19 antivaccination sentiments (using a 3-point Likert scale including never/rarely, sometimes, and often), nearly one-third reported both dog- and cat-owning clients reference COVID-19 antivaccination sentiments sometimes (canine = 84 [30%]; feline = 85 [30%]), and about 10% reported they reference it often (canine = 32 [11%]; feline = 26 [9%]).

Table 5

Veterinarians’ views of the impact anti–COVID-19 vaccination sentiments have on the number of owners who decline or express concern about rabies and core vaccinations.

Issues of potential concern Fewer owners declining or expressing concern about rabies and core vaccinations Same number of owners declining or expressing concern about rabies and core vaccinations More owners declining or expressing concern about rabies and core vaccinations Don’t know
Declining rabies or core vaccinations
 Rabies (n = 183) 8 (4.4%) 99 (54.1%) 66 (36.1%) 10 (5.5%)
 Core vaccines (n = 184) 6 (3.3%) 60 (32.6%) 112 (60.9%) 6 (3.3%)
Expressing concerns about rabies and core vaccinations
  Rabies (n = 183) 6 (3.3%) 82 (44.8%) 90 (49.2%) 5 (2.7%)
  Core vaccines (n = 185) 5 (2.7%) 47 (25.4%) 129 (69.7%) 4 (2.2%)
Want to discuss vaccinations (n = 187) 6 (3.2%) 25 (13.4%) 155 (82.9%) 1 (0.5%)

Participants were asked how successful they feel they are in changing the minds of vaccine-hesitant or -resistant clients. Veterinarians report the highest success in changing clients’ minds about rabies vaccines for dogs (132 [62%]), followed by rabies vaccines for cats (112 [51%]). They reported less success for other core vaccines for dogs (99 [37%]) and cats (71 [26%]).

χ2 Tests were conducted to assess the relationship between a local COVID-19 antivaccination sentiment and having vaccine-hesitant or -resistant clients. We found that the presence of a COVID-19 antivaccination sentiment was associated with higher numbers of vaccine-hesitant or -resistant clients (Table 6). Similarly, significant associations were found between the presence of a local COVID-19 antivaccination sentiment and the trend in numbers of vaccine-hesitant or -resistant pet owners. The presence of a local COVID-19 antivaccination sentiment was associated with a perceived increase in vaccine-hesitant or -resistant dog and cat owners (canine rabies vaccine: n = 135, χ2 = 12.26 [4], and P = 0.016; canine core vaccine: 239, χ2 = 11.21 [4], and P = 0.024; feline rabies vaccine: 215, χ2 = 11.6 [4], and P = 0.026; and feline core vaccine: 253, χ2 = 14.09 [4], and P = 0.007).

Table 6

Local anti–COVID-19 vaccination sentiment and whether participants have had clients who have expressed concerns or refused to vaccinate their dog or cat for rabies or core vaccines against recommendations since the COVID vaccine became available.

Canine Feline
Rabies Core Rabies Core
Have had clients who have expressed concerns or refused to vaccinate their dog or cat for rabies or core vaccines against recommendations
Issues of potential concern No Yes No Yes No Yes No Yes
No anti–COVID-19 vaccination sentiment 194 (94.6%) 11 (5.4%) 195 (93.8%) 13 (6.3%) 192 (91.4%) 18 (8.6%) 194 (91.1%) 19 (8.9%)
Anti–COVID-19 vaccination sentiment 775 (87.0%) 116 (13.0%) 690 (76.6%) 211 (23.4%) 711 (79.4%) 185 (20.6%) 685 (75.4%) 223 (24.6%)
Don’t know if anti–COVID-19 vaccination sentiment 129 (94.2%) 8 (5.8%) 122 (89.1%) 15 (10.9%) 130 (91.5%) 12 (8.5%) 131 (92.3%) 11 (7.7%)
Canine Feline
Rabies Core Rabies Core
Presence of COVID-19 antivaccination sentiment association with higher levels of vaccine-hesitant or -resistant clients n = 1,233; χ2 = 14.14 (2); P < 0.001 n = 1,246; χ2 = 38.86 (2); P < 0.001 n = 1,248; χ2 = 26.05 (2); P < 0.001 n = 1,263; χ2 = 41.42 (2); P < 0.001

Discussion

This study explored several issues pertinent to canine and feline vaccinations, a critical component in helping prevent infectious diseases.24 First, we sought to determine whether the primary concerns veterinarians have about vaccinating healthy dogs and cats, and their perceptions of clients’ concerns, have changed since the COVID-19 pandemic.23 We found that the primary areas of concern for veterinarians when vaccinating a healthy adult dog include anaphylaxis, soreness at the injection site, and lethargy. For cats, the main concerns are vaccine-associated sarcoma, lethargy, and soreness at the injection site. In contrast, veterinarians’ perceptions of owners’ primary concerns include feeling that vaccinations are unnecessary, concerns that vaccinations can lead to chronic or severe illness, feeling no need because their dog or cat does not go outside, and cost. These concerns expressed and perceived by veterinarians are similar to those found in our previous study,23 conducted prior to the COVID-19 pandemic.

Furthermore, we found an association between local anti–COVID-19 vaccination sentiment and increased numbers of vaccine-hesitant or -resistant clients for both canine and feline rabies and other core vaccines. These results mirror the association found between antivaccination sentiments regarding childhood diseases and pet vaccinations in our earlier study.23 Unfortunately, in both studies, veterinarians reported an ability to change owners’ minds about rabies vaccines only half the time and even less frequently for other core vaccines.23

For both human and animal health, vaccines are vitally important health advances, saving countless lives and dramatically reducing the occurrences of vaccine-preventable diseases.25 Yet, despite these benefits, there are a considerable number of people who are hesitant or resistant to vaccinate themselves, their children, and their pets. The COVID-19 pandemic has increased awareness of the importance of vaccines, yet studies suggest that approximately 25% of adults living in high-income countries are undecided or do not plan to obtain the COVID-19 vaccination.26 This figure is similar to the proportion of people who report reluctance in obtaining routine vaccines.26

One common theory for the increase in antivaccine sentiments is that vaccination programs have been so successful that many vaccine-preventable diseases are now quite uncommon in many wealthier countries, leading to complacency about infectious diseases and questions regarding the need for continued immunization. Additionally, with the diseases so rare, people may begin fearing potential adverse effects of vaccines more than the diseases they prevent.26 Similarly, many animal owners are hesitant about vaccinating their pets and doubt the necessity of vaccinations.27,28 This is resulting in a disturbing decrease in vaccinations.29

The reasons pet owners give for not getting their pets vaccinated are varied and often deeply personal. Studies in the US, Australia, and UK pertaining to the most common reasons for vaccine refusal or reluctance mirror the results found in this study. These reasons include feeling vaccines are not necessary, that the owner’s animal does not encounter other animals or go outside, worry that vaccinations can lead to chronic or severe illness, and cost.23,30,31 Educating hesitant or resistant clients regarding the importance of core (including rabies) vaccines can be challenging.28 Yet several studies24,32,33 suggest that pet owners look to their veterinarians for medical advice; Filipe et al,24 for example, found that 97% of owners cite veterinarians as their most useful source of information about vaccines.

When trying to convince people to obtain vaccines themselves, the standard medical approach is to provide patients with information and scientific evidence. When these efforts are not successful, many times health professionals react by providing even more information rather than changing communication methods.34 Similarly, when talking to vaccine-reluctant clients, veterinarians often begin, appropriately, by discussing the facts and scientific support for vaccines. While important to disseminate accurate information, focusing entirely on facts might not always be the best technique for modifying client behavior.28,30,32

Similar to other areas involving risk judgment and decision-making, several factors influence people’s views35 on vaccines, including cognitive distortions—biases in thinking or processing information that predictably result in identifiable errors in thinking and can negatively impact important decisions.36 Although, ideally, people would make risk decisions based on rational thought, research pertaining to other forms of risk mitigation suggests otherwise.37

Some of the cognitive biases that may impact pet owners’ vaccine decisions include minimization, magnification, myopia, and fear-based emotional reasoning. The minimization bias is the tendency to discount or minimize the importance of things (eg, their dog acquiring an infectious disease), while magnification pertains to people’s propensity to exaggerate the importance or consequence of something (eg, vaccine risks).36,38 Myopia is the tendency to focus on the short term or present moment when assessing the costs and benefits of a decision such as whether to vaccinate. For people who think myopically, it can be hard for them to envision the benefits of protective measures, such as vaccines, until it is too late.38 Another cognitive error that can play a role in vaccine decisions is the tendency to base decisions on a “gut” feeling. People who “trust their gut” often assume (erroneously) that their emotions accurately reflect reality.39 This distortion in thinking can impact their ability to make educated, informed vaccine decisions.

A better understanding of the underlying reasons that people make irrational decisions can help veterinarians deliver more effective messages regarding vaccines. For example, it might be helpful to encourage owners to think about what they would do if their pet acquired a disease that could have been prevented by a vaccine. How would they feel? How would they afford the expensive treatment? The key to mitigating several of these cognitive biases is to help people realize that they can make the future potentially less turbulent if they make small sacrifices and take small risks in the current moment. Studies40,41 pertaining to human vaccines have found that direct communication between health-care providers and patients reduces vaccine concerns and improves overall uptake. Veterinarians who are able to listen to their clients with the goal of understanding their fears and errors in thinking and provide a positive, supportive partnering relationship can be pivotal in helping change owners’ behaviors.34

One final reason that people may make irrational decisions worthy of attention is herd behavior, or the tendency to make decisions based on the actions and choices of others.42 When unsure, people tend to look to the behaviors of others to help them decide on the right course of action. Social media, with its ability to reach large audiences quickly, has taken herd behavior to a new level. In contrast to traditional media, social media content is often anonymous, does not undergo editorial oversight or fact checking, and typically offers some combination of facts and personal opinion.4345 Studies have found that exposure to antivaccination sentiments online negatively impacts readers’ intention to vaccinate,46 and in fact, the spread of negative or inaccurate information online about vaccines has been identified as the leading cause of vaccine hesitancy.47 One way to use herd mentality to improve vaccination rates is to obtain vaccine endorsements by celebrities,45 an effective strategy for numerous human health-care decisions.48 Veterinary clinics can use this approach by showcasing celebrities (local or national) as well as model owners who have chosen to vaccinate regularly.

Limitations to this study are those inherent in an online survey. Our sample consisted of US VIN members, so caution is suggested when generalizing to other veterinarians. Another limitation, given the small number of responses from all those eligible, is response bias.

Additionally, some of the questions pertained to participants’ perceptions of clients’ concerns regarding vaccinations rather than reports from the clients themselves. As these are veterinarians’ perceptions, they have the potential to be biased and subject to recall bias. Further research pertaining to the impact of antivaccine sentiments on veterinary medicine, including successful strategies veterinarians employ to convince clients to get their pets vaccinated, is needed to better understand this dynamic relationship.

In summary, addressing resistance to vaccines, whether it involves humans or companion animals, involves working with people to build trusting relationships, listening to their concerns and fears, and providing education to combat misinformation and help them make informed decisions.9,45,49 Pet owners turn to their veterinarians more than any other source (including the internet and social media) for pet health information.24,33,50 By better understanding why some owners are hesitant or resistant to canine and feline core vaccines, veterinarians can adapt their vaccine messages to positively impact vaccine compliance.

Acknowledgments

No external funding was used in this study. The authors declare that there were no conflicts of interest.

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