Vaccines, why don’t we ask?

I’ve been wondering something. Why don’t people want to ask about vaccines? Why we do them? Which ones we choose? What those diseases are? With all of the controversy surrounding vaccines in the recent past, why don’t people ask? Is it just absolute trust in their veterinarian? Is it that they worry the information is too technical? Is it that we don’t really care? I don’t think that is the answer.

I’m not sure if it is a combination of these things or if I’m missing the mark completely. What I do know is that I’m guilty of it myself. There have been a few instances that started me wondering about this gap in communication. First, I recently presented about vaccines to our team at MPES during a staff meeting. I explained the way that I think about vaccination and the immune system. The way that I found to understand immunology in vet school was to think of the immune system as an army. Each type of immune cell has its own job or rank in the army. To me, vaccines are like Mug Shots. They show the body’s army what the bad guys look like and give them a chance to figure out how to fight them. When the body’s army sees the mug shot for the first time only a few of the soldiers see it. When we complete the primary series and give the vaccination again 3-4 weeks later those soldiers realize that this is definitely a bad guy that they need to worry about and they tell everyone! So now we have a whole army ready to fight the diseases that we are the most worried about. Once or twice a year we have to revaccinate to continue to remind the body’s army the watch out for those bad guys.  After this presentation one of our staff members told me that she had never fully understood how vaccine boosters work or why we do them! Why didn’t she ask before?

Another encounter brought this back to my mind not long after that. On a routine visit to vaccinate a horse the owner had requested that the horse receive everything except for “EWT”. The veterinarian at the appointment wondered why this might be, “EWT” is one of the core vaccines that we recommend. “EWT” stands for the three pathogens (bad guys) that are combined in this one vaccine – Eastern Equine Encephalitis Virus, Western Equine Encephalitis Virus, and Tetanus toxin. The tetanus part of the vaccine is one of the most important vaccines that we give to horses. Horses shed the bacteria Clostridium tetani in their manure and it is easily found in their environments. When this bacteria gains entry to the body through a break in the skin it begins to produce a powerful toxin that affects the nervous system and causes the disease Tetanus, a disease that is usually fatal in the horse. Due to the high environmental contamination and the high incidence of wounds, horses are at a very high risk. For that same reason horse people are also at high risk of tetanus and should stay up to date on their vaccines! Eastern and Western Encephalitis are viruses that are passed to horses through mosquito bites. Although they are rare in Ontario, these viruses are 100% fatal and we generally see at least one a year, therefore we consider it worthwhile to vaccinate for them. The vaccine is protective and safe. So why did this owner not want to vaccinate with this very important vaccine? When asked her response was, “Because I don’t know what it is”. It is our job to help teach people what diseases to vaccinate against and why, we never expect anyone to just know this information, we had to learn it at veterinary school too! So once again, why didn’t she ask?

Finally, it was my own behaviour that really brought about this question. I am lucky enough to be travelling to the Caribbean soon for my brother’s wedding. While browsing some travel sites online an advertisement for TwinRix vaccine popped up. I asked my husband if he had ever received this vaccine and if he thought we should get one before going. He asked, “What is it for?” I replied, “I don’t know but you’re supposed to get it before travelling”. As soon as the words were out of my mouth I hung my head. I am a doctor, yes for animals, but with similar training to human doctors, and I am one of the people not asking the questions – What is that for? What do those diseases do? Is the vaccine safe? Why hadn’t I asked?

In this age of Google and quick access to information do we all feel like we should have every answer? We shouldn’t have to ask the questions and we might be judged if we do ask?  I hope that isn’t the case.  I truly believe that everyone is capable of understanding the basic principles of vaccination, the diseases that we vaccinate against, and why. I also believe that your veterinarian or doctor is the best person to teach you. We all had to be taught at some point and we have all found a way to make sense of it. If my army analogy doesn’t work for you I bet I can find 5 other ways of looking at it, just in our one clinic.

So please ask! We all love to help people understand why they vaccinate their horses each year, why we deworm the way that we do, why we choose one antibiotic instead of another, and the list goes on.

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