THIS series gives readers the opportunity to consider and contribute to discussion of some of the ethical dilemmas that can arise in veterinary practice. Each month, a case scenario is presented, followed by discussion of some of the issues involved.
In addition, a possible way forward is suggested; however, there is rarely a cut-and-dried answer in such cases, and readers may wish to suggest an alternative approach. This month's dilemma, ‘Changing established protocols’, was submitted and is discussed by Hanne Stabursvik. Readers with comments to contribute are invited to send them as soon as possible, so that they can be considered for publication in the next issue. Discussion of the dilemma ‘When in Rome . . . ’, which was published in the January issue of In Practice, appears on page 95.
The series is being coordinated by Steven McCulloch, a practising vet with a PhD in the ethics of veterinary policy. It is hoped it will provide a framework that will help practitioners find solutions when facing similar dilemmas.
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Hanne Stabursvik graduated from the Norwegian School of Veterinary Science in 1995 and became a member of the RCVS in 2000. She has a MSc in livestock health and production, and equine science. She is now a practice owner and practitioner covering Norway, the UK, Argentina and Israel.
Changing established protocols
One of your clients has questioned your practice vaccination protocol for their pet cat and dog. You have been to a CPD event recently where it was suggested that the most appropriate regimes include antibody monitoring and less frequent vaccination. You are not aware that this is commonly done in your area. How should you proceed?
Issues to consider
Our obligations as veterinary surgeons are to protect animal health and welfare as well as public health through the provision of evidence-based healthcare. When new scientific knowledge points to different ways of providing healthcare to the animals in our care, we have a duty to consider the best way forward. However, here the evidence available to practising vets is not completely clear as much of the available guidance on vaccination does not match the more progressive WSAVA guidance advocating antibody titre testing instead of vaccination for many infectious diseases (WSAVA 2016).
With a departure from the established vaccination protocol, and with the ongoing controversies regarding vaccinations in general, some companion animal owners may become complacent about the whole concept of preventive medical care. For others, it might raise questions about how trustworthy our professional advice really is if one of the cornerstones of veterinary care suddenly changed. All of this could potentially impact on owners' willingness to comply with annual health checks as well as result in reluctance to follow up with other prophylactic treatments, such as worming and flea treatments. If there was evidence that a rapid change in vaccination policy would have a negative impact on animal health and welfare, this would be a relevant factor when considering the best course of action.
There is no getting away from the fact that vaccinations continue to be the ‘bread and butter’ of every day veterinary practice. Vast resources have gone into educating our clients that annual vaccinations are key to animal health. Unless a carefully thought out communication strategy is implemented, any changes in core animal health services have the potential to severely impact on business, where loss in income from such a central service as vaccinations could drive up prices for other products and services offered at a clinic (for instance, critical care, or routine operations such as neutering). The worst case scenario is where a loss of income from vaccinations or health checks could affect business to the point of having to make staff redundant.
Although vets are ethically and professionally obliged to put animal health and welfare on top of their priorities, they are also ethically and professionally obliged to run their business in such a way that they can deliver strong, evidence-based advice to their clients. Vets also have a social obligation to manage their business affairs in such a manner that their employees can feel confident that they have a stable job for the foreseeable future. Lack of job security for staff is a well-known cause of demotivation and loss of productivity.
Possible way forward
With so much at stake, it could be argued that making such a dramatic change in the way we deliver prophylactic health care to animals in our care is not something that should be attempted in an ad-hoc way.
Consider if the profession were to move towards testing for antibody titres before vaccination. In this case, clients who question why we still give annual boosters would be the easiest to deal with. The challenge lies with those clients who are less informed about vaccines and how they work. There is arguably a significant proportion of clients that are influenced about the need for vaccination by controversies in human healthcare, such as the well publicised furore surrounding the MMR debate.
To successfully manage the transition from annual vaccination boosters to checking antibody titres and ‘top-up’ as needed, we need to see strong leadership from our professional bodies, which have the resources to develop educational material to be distributed among member practices. Educational material should also be made available on social media platforms. The pathology of infectious diseases, immunology and vaccinology are complex issues. Should we expect the general practitioner, alone, to successfully communicate, for instance, that their cat has antibodies against feline panleucopenia, but could in fact be infected by a canine strain of the same virus?⇓
Another problem that must be overcome is the lack of availability of monovalent vaccines. Today, almost all of the commonly used vaccines are polyvalent, a fact that would make the idea of only topping up on the vaccines that need topping up meaningless. Therefore, it is not enough that the veterinary profession alone embraces new science and the opportunities that follow. It is vital that the whole of the immunology industry, vaccine manufacturers as well as manufacturers of antibody kits, adapt to changes in this central aspect of animal health and welfare.
Perhaps, to avoid any negative consequences to animal welfare arising from mixed messages about vaccination policy, individual vets and practices should hold off making changes to their protocol until there is clear professional support. Clinicians can help drive this change by lobbying their professional organisations and even vaccine manufacturers – there are many channels available now in this multimedia world.
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