Why experts worry more pet owners may skip rabies shots over vaccine hesitancy

Eve and Tibbers aren’t vaccinated for rabies. They live near the foot of California’s Mt. Shasta — where bears, raccoons, foxes and opossums all wander — with their humans, Susie Lux and her husband.

While Eve, a lab, stays by Lux’s side “24/7,” Tibbers, their cat, lives both indoors and outdoors and is “exposed to everything, but we’ve lived here forever and have never had a problem.”

Decades ago, Lux, 64, said one of her dogs had developed a severe reaction after receiving the rabies vaccine. She then decided to forgo any vaccines for her animals, including rabies, which California law requires without exemption.

With a rise in vaccine hesitancy and a decline in vaccine uptake, some researchers fear there might be a spillover effect among pet owners who then choose to forgo rabies vaccines for their cats and dogs.

Data is scant about how widespread the decision to not vaccinate pets against rabies has become. There is, however, a small but growing number of surveys of pet owners that suggests an association between these attitudes and avoiding shots. Public health experts and veterinarians are concerned about the potential for an increase in cases of rabies, a vaccine-preventable illness, for both companion animals and humans.

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“We’re aware that we live in a world where rabies transmission is relatively low,” said Matthew Motta, an assistant professor of health law, policy and management at Boston University. “But we worry very much about a world in which that won’t be the case, and the way you get there is through vaccine hesitancy.”

Very few humans die in the U.S. from rabies, which has been fairly consistent since the 1960s, but that was no accident, said Dr. Rodney Rohde, Regents’ professor and global fellow at Texas State University.

“It’s really tied to our really largely successful dog and cat vaccine programs and livestock to a lesser extent over the last 50 years,” Rohde said.

Globally, 59,000 people die from rabies each year, predominantly in Asia and Africa, according to the World Health Organization. Of those deaths, young children make up an estimated 40 percent, and unvaccinated dogs are most commonly linked to these deaths overall.

In the United States, in 2021, five humans were found to have rabies, which is nearly always fatal once symptoms develop, according to the American Veterinary Medical Association. That same year, more than 3,600 animals were confirmed to have rabies, the association reported, marking an 18-percentage point decline from the previous year, when nearly 4,500 rabid animals were reported. Bats, raccoons and skunks were primary drivers of those confirmed cases, and dogs, cats and cattle were more rarely linked to rabies.

Chart by Megan McGrew/PBS NewsHour

Matthew Motta became interested in exploring if there was a connection between anti-vaccine attitudes among humans and withholding rabies vaccines from pets after talking to his sister, Gabriella Motta, who is a veterinarian outside Philadelphia. Together, they created and launched a survey of a nationally representative sample of 2,200 U.S. adults, including pet owners, with YouGov, publishing their results last August in the journal Vaccine.

Seeking to gauge canine vaccine hesitancy, the authors found that 37 percent of dog owners thought vaccines were unsafe for pets, 22 percent viewed vaccines as ineffective and 20 percent regarded them as unnecessary. While the authors admitted this research is imperfect (answers were self-reported and could be subject to bias), they added that it offers “an important first step in understanding canine vaccine hesitancy and its public health consequences.”

While the researchers had encountered canine vaccine hesitancy through anecdotal experiences, the survey surprised them by suggesting “just how prevalent this phenomenon is — how many Americans express some level of canine vaccine hesitancy,” Motta told the PBS NewsHour.

The COVID-19 pandemic “changed the game” in terms of how people think about vaccines, Motta said. In recent years, vaccine misinformation has spiraled into “a vaccine revolution right now,” where concern about public safety and health has been eroded by a combination of defiance and lost trust, said Michael Osterholm, an epidemiologist who directs the Center for Infectious Disease Research and Policy. The Centers for Disease Control and Prevention estimates that fewer than 1 in 5 Americans have received the latest COVID vaccine, and people are turning to misinformation to validate those choices. According to Sander van der Linden, a social psychologist who directs the Cambridge Social Decision-Making Lab at Cambridge University, misinformation plays “a major role in vaccine hesitancy and the extent to which people trust institutions and the media.”

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By analyzing the survey data, Matthew Motta said they found that if people held negative views of one vaccine, they tended to regard all vaccines negatively. In addition, people who expressed higher levels of canine vaccine hesitancy “are less likely to think that vaccinations ought to be mandated,” he said.

The survey results published in Vaccine echo what researchers are beginning to find elsewhere. In November, different researchers published another study in the same journal, which surveyed nearly 4,000 U.S. respondents and found that “attitudinal measures of human and pet vaccine hesitancy are closely related to each other.” Motta said he wants to continue to ask these survey questions for years to come to study the relationship between canine vaccine hesitancy and human vaccine hesitancy.

“The more Americans who express hesitancy for vaccinating their pets, the more demand there is for policies that curtail vaccine mandates and the greater likelihood is that people take action into their own hands and don’t vaccinate,” he said.

It is unclear what national trends, if any, have emerged in the way states regulate pet vaccination since the start of the COVID-19 pandemic, but Shannon Kolman, senior policy strategist at the National Conference of State Legislatures, has analyzed a handful of state laws enacted between 2019 and 2023. Most laws that Kolman examined made it easier for people to protect their animals against rabies, expanding the pool of veterinary staff who are qualified to administer vaccine doses.

Chart by Megan McGrew/PBS NewsHour

But a 2020 law enacted in Delaware “enables licensed veterinarians to exempt an animal from the mandated rabies vaccination” if that veterinarian judged that “the vaccine would endanger the animal’s health.” Pets can develop side effects, such as low fever or fatigue, after receiving some vaccines, according to AVMA. But the organization still urges vaccination (and consulting one’s veterinarian immediately if severe side effects emerge after vaccination). “These side effects typically are minor, and they’re far outweighed by the benefits of protecting your pet, your family, and your community from potentially fatal diseases,” it says.

Because rates of rabies have declined so steeply after years of work, Rohde said, “We’re in a difficult time of getting people to understand and trust some of these measures.” For those success stories to continue, Rohde said, “We have to keep educating people.”

Decades ago in Texas, Rohde worked with research teams to reduce rabies transmission among wildlife. They flew in a grid over animal ranges across South Texas, dropping baits filled with liquid vaccine that burst when an animal ingested it.

Today, he said, more work needs to be done to mitigate transmission from bats – what he calls “the last frontier.” Bats can fly, and “there’s no geographic boundaries they can’t navigate,” he said. But perhaps more formidably, a bat’s bite does not resemble puncture wounds as one might see in a horror film. Instead, they are more subtle, as if one got snagged by a rose bush. They can be easily missed, Rohde said, making them dangerous, especially if the biting bat was infected with rabies.

For Arielle Henson, who owns a dog and a cat in South Hadley, Massachusetts, the rabies vaccine poses an easily answered question of ethics and is “a fundamental shot that all of my pets have received.” Rabies is deadly, and the vaccine to prevent those deaths are inexpensive and “not hard to get,” Henson said.

“If your personal bias interferes with your ability to be an ethical pet owner, maybe you should reexamine owning a pet,” she said. “It seems like it’s a given. Why wouldn’t you?”