Lucy Cavendish Cottrell Essay - First Prize Winning Essay

Should people who refuse vaccination for themselves/their pets be denied treatment for any associated illnesses they develop?

The word vaccine comes from the Latin word for cow after the first vaccine was developed in 1796 by Edward Jenner. He found that those individuals who contracted cowpox, a skin disease caused by the handling of an infected animal, were immune to smallpox. He developed a vaccine containing pus from an infected animal. Injecting this into humans, caused mild responses, far less dangerous than contracting smallpox itself. This formed the basis of acquired immunity. Vaccinations are a biological preparation, containing antigens from an infectious pathogen, which are then injected into the body. This provokes an immune response, where antibodies are produced. These antibodies remain within the body, so any time the organism is infected with the same illness, an immune response is provoked, using the antibodies created from the vaccine. This is a much faster response and is essential in stopping the spread of life-threatening diseases. In our pets, vaccines prevent several highly contagious diseases such as canine distemper, parvovirus, and respiratory tract diseases. It also protects the health of the general public by reducing the spread of zoonotic diseases like rabies.

Oppositions to vaccinations have been present since the beginning of vaccines themselves. In 1853, when the government made the vaccine mandatory, the anti-vaccination movement began. Many people believed that the government has no right to tell people how to take care of their health, taking a libertarian stance. While others had religious or ideological differences. Those who believed in natural treatments opposed medical interventions and relied on plants and water to fulfil their belief in keeping the body pure. They believed that the vaccine was just another form of toxicity entering their body. Vaccine hesitancy has continued into the 21st century, with people opposing the development of the Covid-19 vaccination. The quick development time of this vaccine caused people to believe that it isn’t safe because it hasn’t been through enough clinical trials to know its long-term effect. This stems from the popular belief in the late 1990s when British researchers published a paper stating that the MMR vaccine caused autism. The World Health Organisation has declared “vaccine hesitancy” to be among one of the 10 biggest threats to global health.

The fear around vaccines has caused a significant reduction in the number of people vaccinating their pets. In the most recent annual report, the PDSA found that around 2.2million dogs, 25% of all dogs, have not received the necessary vaccination when they were young. In addition to this, 23% of dogs have not received their regular boosters. The reasons for this varied: owners believe the vaccine was unnecessary, the vaccine is too expensive, and they don’t agree with the need for annual boosters. According to this same study, 35% of cats haven’t received their primary course of vaccination, with a further 41% not receiving regular booster vaccinations. If these animals aren’t receiving the correct vaccinations, at the correct time, there will be disastrous effects on their health. For example, canine parvovirus has a 90% mortality rate in those who are infected, due to a lack of immunisation.

Veterinary professionals must make animal health and welfare their first consideration when attending to an animal. Therefore, the veterinary surgeon has a primary, overriding duty to the welfare of the patient (McCulloch et al. 2014). This means that any animal that has fallen ill, must be looked after by the vet, even if the illness could have been prevented. Canine distemper is a contagious disease caused by a virus that attacks the respiratory, gastrointestinal and nervous systems of dogs. It is mostly spread through airborne exposure. There is no cure for this disease, so prevention is favoured. However, if a client decides not to get their dog vaccinated, and the dog contracts this disease, the vet is still obligated to provide the correct treatment if the client wishes for it. Treatment for distemper consists of efforts to prevent secondary infections. This is done by controlling vomiting, diarrhoea and neurological symptoms, while also combating dehydration through the administration of fluids. As stated in the RCVS code,” A veterinary surgeon on duty should not unreasonably refuse to provide first aid and pain relief for any animal of a species treated by the practice during working hours”. As an RCVS registered vet, you have the responsibility to treat the animal, regardless of disagreement with the client, meaning that the pet should still receive treatment for the illness, even if the owner did not get the pet vaccinated.

However, many may argue that the diseases that have preventative medicine in place are often incurable, and therefore a waste of time and money to treat. For example, the Feline Leukaemia Virus (FeLV), causes the development of tumours in infected individuals. Cats infected with FeLV can develop leukaemia, lymphoma, and other types of tumours. This results in immunosuppression, and the development of anaemia, causing the fatality of cats. This is an extremely fatal virus, with an 85% mortality rate, and no cure. Because there is no current reliable treatment for FeLV, the vets just aim to keep the cat in good health for as long as possible. This is done by easing the symptoms of the illness through chemotherapy and drugs like interferon. These treatments can be expensive, ranging from 200 – 1000 GBP. Majority of the cats who test positive for FeLV only live for up to 2.5 years after infection. Sadly, many cats who contract this disease are put to sleep. It may be argued that if the cat has not had the appropriate vaccination to prevent FeLV, then no treatment should be given as it is extremely expensive, and the cat only has a short time left to live. This also applies to many other preventative diseases, as most of them are incurable, resulting in death soon after diagnosis.

On the other hand, vets must respect the client's wishes regarding the treatment of the animal. This is stated in the RCVS code, “Veterinary surgeons must be open and honest with clients and respect their needs and requirements”. If a client is demanding treatment for an illness that could have been prevented, the veterinary surgeon has a responsibility to provide said treatment. Alternatively, if the client refuses to get the pet vaccinated, the vet must educate, but not force. One of the four pillars of ethics in healthcare is autonomy. Autonomy is the principle that considers the rights of the patients, with respect for the clients and their right to make decisions for their pets. Respecting the client’s autonomy means that they must be provided with knowledge about their pet’s situation, allowing them to make the decision they wish to for their pet. While the decision to not get the pet vaccinated may seem like a bad idea to the vet, to respect the client’s autonomy, they must adhere to the wishes. If the pet is to contract a disease that the owner rejected vaccination for, the vets must inform the owner of all possible treatments, leaving the decision to the owner. It is important to follow the pillars of ethics as they create the moral principles that healthcare professionals must conduct themselves to ensure that everyone receives the same standard of healthcare, whether that is an animal or a human patient.

Additionally, veterinary professionals have a responsibility to protect public health. This is stated in the RCVS veterinary code, “Veterinary surgeons must seek to ensure the protection of public health and animal health and welfare and must consider the impact of their actions on the environment.” This means that any disease that poses a threat to the health of the general public must be dealt with properly, to ensure that the disease does not get spread further. Leptospirosis in dogs is a bacterial infection, that spreads through the bloodstream. There is vaccination in place for this, as a part of the annual yearly booster injection. Leptospirosis spreads throughout the dog’s entire body, reproducing in the liver and kidneys, causing damage to these organs if the infection progresses. This disease is zoonotic and transmitted to humans and other mammals through the urine of an infected animal, infected water and soil or handling an infected animal’s blood or flesh. If this disease is left untreated in a dog, it may be spread to other animals such as cows. It is a very common infection within dairy and beef herds, causing infertility, abortion and poor milk yield, resulting in economic losses for the farmer. Additionally, it causes kidney damage, meningitis and liver failure when transmitted to humans, which can sometimes be fatal. If a pet presents with the disease, despite opting out of the vaccine, the vet must understand their responsibility within society, and treat the animal to prevent any further spread of the disease. This means that there will be a less economical loss for farmers, and better public health if there is less spread of the disease.

In essence of this, I believe that as a veterinary professional, you must give the animal the adequate care it needs, regardless of whether the disease could have been prevented. It is the responsibility of the vet and owner to provide the animal with the five basic welfare needs, one of which is to be protected from pain, suffering injury and disease. While the owner may fail to meet this due to their lack of understanding or willingness to accept the vaccine, the vet should always have this as their main priority. We become veterinarians to ease the suffering of our beloved furry friends, who struggle in communicating their pain the way humans do. If we deny them treatment, we are no longer setting out to achieve the main goal of veterinary medicine. In my opinion, there should not be deliberation within the veterinary community about this question, as there is a clear-cut answer. Every animal deserves treatment.