Research, strategic approach creates balance for proposed vaccine protocol changes

Dr. Michael Merrithew doesn't think he'll be quick to make any changes to his vaccine protocols despite a recent report from the American Animal Hospital Association (AAHA) that calls for reduction in vaccinating dogs.

Merrithew, a small animal veterinarian in Grand Blanc, Mich., has been practicing for 30 years and says there is little evidence to convince him to change.

"There are some things about being old that you've seen circle the world a couple of times," he says. "Particularly in human medicine, things come and go."

During the last few months, Merrithew has tried to educate himself on whether he should revise his vaccine protocols. He attended two meetings sponsored by Fort Dodge Animal Health and Merial on the issue. He also has attempted to track down research on vaccines but has had little success in finding any new material.

"I'm not cantankerous and old," he says. "You just have to show it to me."

He is concerned that the younger generation of the profession is just accepting the AAHA vaccine guidelines as edict and not going the extra mile to do their own research and form their own opinions based on practice experience and confirmed studies.

"You could just see by the looks on their faces that they were sucking this stuff up like it was the gospel," Merrithew recalls after he attended a recent meeting on the vaccine debate.

"As a profession and as scientists, we need to see more concrete proof before we're so quick to make changes in what we're doing. The proof just isn't there for me yet."

Merrithew says he has not seen any new studies or information printed in veterinary journals to justify change. He realizes that it is expensive and timely to conduct immunity challenge studies on vaccines. He hopes that vaccine manufacturers would be more forthcoming with their own information to help provide the profession with the much-needed data.

"I think this would help us make some better and more informed decisions," he says.

"Everyone is telling us that each veterinarian should adjust his or her vaccination schedule accordingly," Merrithew says. "According to what? There is no data telling us that we need to adjust our vaccine schedules."

The AAHA guidelines include unpublished research studies by Dr. Ronald Schultz that focus on the duration of immunity of vaccines. Schultz hopes to publish his more than 20 years of his research later this summer.

Still up in the air

The jury is still out for Merrithew as he wrestles with the dilemma of whether to switch his existing protocols based on the new AAHA guidelines.

He is not alone.

While other practitioners have decided they will make revisions to their vaccine protocols, they struggle with exactly how to develop and implement their own protocols without disrupting their daily practice and the relationship they have with their clients.

With the recent article on veterinary care in the July issue of Consumer Reports and the proposed changes with vaccinations, veterinarians will be walking a tightrope with their clients when it comes to credibility. The Consumer Reports article paints veterinarians as money-hungry individuals who offer unnecessary services to their clients to enhance their bottom line (See DVM Newsmagazine, July 2003, p. 1).

"These problems are nothing new," says Marsha Heinke, DVM, CPA, EA CVPM, DABFA. "Veterinarians need to stay up to date, they need to focus their responses in accord with scientific literature and keeping up to date with the knowledge as it changes and they need to have consensus among their staff to what their position will be and what type of message will be given to the client."

Heinke also says she doesn't think the profession should take a defensive stance with their clients when they decide to make changes in their vaccine protocols or in response to the Consumer Reports article.

"The profession has traditionally acted in the best interest of animals and really is a noble profession in terms of people trying to do the right thing," she says. "Unfortunately, in this day and age, there is increased scrutiny of everyone and everything. I think if people do the right thing, stay up to date, are honest with their clients and straightforward with their recommendations, that they'll come out fine."

Be prepared

The AAHA guidelines for canine vaccines along with the feline vaccines guidelines released by the American Association of Feline Practitioners (AAFP) in 1998 are the veterinary profession's first attempt to develop standards for vaccinating pets. Although the American Veterinary Medical Association did release a position statement last fall regarding vaccinations, the organization did not go into as much detail as the other two associations.

Dr. Michael Paul, who served as chair for the AAHA task force and a member of the AAFP task force, says the guidelines were developed to provide veterinarians with information to help them adopt the approach that, in fact, there is no one protocol but rather that each individual animal should be vaccinated with consideration of only medical concerns.

But that creates a monumental challenge for the practicing veterinarian. Many practitioners say they have more questions and answers and don't know where to begin.

The need to update the vaccine protocols may serve as a springboard to revising other standards of care for any veterinary practice. For any effective change to occur, it is essential to thoroughly evaluate the need for the changes and exactly how it will impact the entire practice, says Dr. Thomas Cantazaro, MHA, FACHE, Dipl. ACHE, a practice management consultant.

"Modern companion animal veterinary practices have a choice of fighting the trends and being left behind, or embracing the changes and modify their health care delivery modality to team-based systems which embrace the cutting edge of technology while maintaining the high touch caring which clients desire," he says. " The choice is an individual practice decision."