How I deal with antivaxxers in my practice

Jeff Werber, DVM

Dr. Jeff Werber is staff veterinarian at Value Vet in Los Angeles. He is also an award-winning veterinary journalist and co-creator and chief veterinary officer of Airvet Telehealth.

As a veterinarian practicing in the Los Angeles area—where there are more vegans per capita than any city other than Portland—I see my share of pet owners who are interested in alternative and nontraditional veterinary care. Naturally, many of these clients are also skeptical of the value of vaccinations. It's a reality many of us in veterinary medicine have to deal with, since the antivaxxer movement shows no sign of fading anytime soon, even in the age of COVID.

Of course, while immunizations are essential in protecting pet health, I don't believe in overvaccination either. I'm very careful with my clients about what vaccines I consider essential, or core, and which ones are necessary based on lifestyle. Here in LA, do I vaccinate every patient for Lyme? Hell, no! Leptospirosis? Only if the pet is around water or wildlife. I sit down and talk to every client about what their lifestyle is before we decide on a vaccination protocol.

An antivaxxer walks into a clinic...

If a client comes to me insisting that they don't want a single vaccination for their pet, I first ask them what they're basing their opinion on. Where did they get their information? I hear them out, then I say, "Well, that's not how I understand it, and here are my sources, which I probably trust more than your sources."

If they're still resistant, I tell them the only vaccination I have to do by law for an adult dog in California is rabies every three years. If they ask me to write a note that I'm opposed to giving a rabies vaccine to their dog, I won't do it. I've had people come in with an older dog, and we do a blood test and everything is fine. But they want me to say the dog is too old for rabies.

I tell them that if that dog can take a walk outside, as far as the state of California is concerned, it's not too old. It's a legal issue, and I'm not going to jeopardize my license. Now, if the dog literally can't move, if it's in lateral recumbency at home—basically in hospice—then I can sign that dog off on rabies.

If they don't want to do another vaccine, one I would consider core for Los Angeles, I tell them, "Look, the vaccine is your choice. Distemper and parvo are not required by law, so you can do what you want. But if you take Muffy to the dog park, or you go running with her on the beach, or you go anyplace where you could meet other dogs, your pet is at risk. I'm just letting you know. But if you don't want to vaccinate, I'm OK with that."

Simply put, I can't force them. But I at least want it to be at their risk, not mine. After the conversation, I put a note in the patient file that says, "Discussed and recommended vaccines; owner declined." Then I'm safe. I think it's very important to at least make note of the conversation. That way if a client ever says, "No, doctor, you didn't tell me that," I can pull up my notes on the conversation. It's very important to cover your butt.

"Simply put, I can't force them. But I at least want it to be at their risk, not mine."

Always learning

Of course, as veterinarians we're always discovering new things. While I've never liked giving a zillion vaccines in a day, I used to say it was because I didn't want to overload the patient's system with antigens. But I had a discussion once with a human immunologist who told me it's not the number of antigens that's the problem—the immune system can deal with thousands of antigens at any given time. Instead, it's the preservatives and the adjuvant in the vaccine that cause reactions.

So our bivalent, trivalent or quadrivalent vaccines—which stimulate an immune response against multiple antigens using a single dose of adjuvant and preservatives—are actually minimizing risk while maximizing protection. So I had to change my explanation to my clients. It reminds me of what my mentor said when I was a smartass vet student. She said, "Sure, Jeff, you know your stuff, but don't forget: Every five years, half of what you know is going to be obsolete."

The referral option

In conventional medicine, our attenuated—or modified live virus (MLV)—vaccines involve a pathogen that's been passed through another species, like the rabbit or the pig, for multiple generations to the point that it's no longer infective to the original host. It still has the effect of a live virus, and it's antigenically similar enough to mount an immune response, but it's not enough to cause disease in the dog or other original host.

"If a client refuses vaccination but is interested in doing something to protect their pet against infectious disease, I'll refer them to my friend who's a homeopathic vet."

Now, there's an alternative that homeopaths and naturopaths use called a "nosode," which is a microdose of the actual pathogen. It's too small to actually cause disease, but the naturopaths feel that it's enough to mount an immune response. If a client refuses vaccination but is interested in doing something to protect their pet against infectious disease, I'll refer them to my friend who's a homeopathic vet. He went to Cornell, so he's a trained veterinarian, but his path was alternative medicine. He's a really smart guy and I like him a lot, so I don't mind referring to him if my clients want that kind of approach.

Another alternative

Some of my clients have had their pets vaccinated early in life and simply don't want to subject them to repeated immunizations every year if their pets don't need them. That's where titer testing comes in. In these situations I'll say something like, "I would feel terrible knowing your dog got parvo because it went to the park and played with a puppy. I just want to make sure our antibody is adequate, for your peace of mind and mine, so I recommend we check with a titer test."

Here's what really seals the deal: If the results come back indicating that the animal is not immune, I'll do the vaccine for free. They love that and almost always comply.

Can't we get along?

Really, there's so much animosity between the "science is king" crowd and the "vaccines are evil" bunch—between alternative and traditional approaches to veterinary medicine. The best we can do to build understanding and bridge the tension is try to educate about what we know and what we don't know. Certainly the Eastern and Western medical communities are very different. But with Eastern medicine... Well, it's hard to argue with something that's been working for 5,000 years. So I'm OK with it. I say, "Just so you know, I would recommend..." and I leave it at that.

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