Paeds · preventive-and-community-paediatrics
Vaccine hesitancy and risk communication
Also known as Vaccine hesitant parents · Immunisation refusal counselling · Vaccine risk communication · Parental vaccine concerns · Vaccine confidence
Fellowship approach to vaccine hesitancy as a continuum, SAGE confidence–complacency–convenience assessment, evidence-based clinic communication, motivational interviewing, ethical response to delay and refusal, documentation and regional programme context.
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Red flags
- Unprotected infant during a measles or pertussis outbreak with ongoing delay
- True medical contraindication mislabelled as hesitancy or the reverse
- Hostile encounter with risk of care withdrawal without safety-netting
- Adolescent dissent ignored while only the parent is counselled
- Open-ended 'spread out' plan with no booked return and no documentation
- Shaming, coercion or fabricated absolute safety guarantees
Life stages
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- General and Community Paediatrics
- Prevention and population health
- Current 2026 PREP curriculum — Learning Objective 1.2.1: Communicate with a child or young person in a way which is appropriate to the position of that child within their own culture
- Current 2026 PREP curriculum — Learning Objective 1.2.2: Communicate with parents or carers
- Renewed curriculum for first-year trainees from 2027 — Learning goal 5: Clinical assessment – essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 6: Clinical management – essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 12: Communication with patients, families, and health professionals
- Renewed curriculum for first-year trainees from 2027 — Learning goal 15: Essential general paediatrics
- Clinical Applications
- Population health and prevention
- Long Cases
- Short Cases
- Communication
- 2. Professional skills and knowledge: Communication
- 4. Professional skills and knowledge: Patient management
- 5. Health promotion and illness prevention
- 7. Patient safety, including safe prescribing
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- History
- Clinical
- General Pediatrics Content Outline — Domain 1: Preventive Pediatrics/Well-Child Care
- General Pediatrics EPA 1: Provide a Medical Home for Well Children of All Ages
- General Pediatrics EPA 11: Promoting Equitable Care at the Level of Each Individual Patient and the Population to Address Racism and Other Contributors to Health Inequities
- Patient Care 1: History
- Patient Care 5: Patient Management
- Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
- Systems-Based Practice 1: Patient Safety and Quality Improvement
- Professionalism 1: Professional Behavior and Ethical Principles
- Communicator
- Health Advocate
- Professional
- Pediatrics: Foundations EPA — Providing preventive care including immunisation counselling
Overview & Definition
You are in a six-week check. The baby is well. The parent says, "We are not anti-vaccine — we just want to wait a bit." That sentence is the clinical problem this page is built for. It is not a debate club. It is a preventive consultation with a child who still needs protection, a family who still needs a relationship with you, and a schedule that still has a clock.[1]
Vaccine hesitancy is delay in acceptance or refusal of vaccines despite availability of vaccination services. The SAGE Working Group definition matters because it separates attitude from access. A family who cannot get an appointment is not the same clinical problem as a family who can but will not.[1][3]
Think of hesitancy as a continuum, not a binary. At one end sit confident acceptors. In the middle sit parents with specific questions, selective delays, or requests to "spread out" antigens. At the far end sit firm refusals. People move along that line after a fever, a news story, a trusted relative, or a good conversation with you.[1][2]
Risk communication here has four practical aims:[5]
- Help the caregiver see disease risk and vaccine risk in proportion.
- Support an informed decision without bullying.
- Preserve trust so the child can return.
- Where clinically appropriate, improve on-time uptake.[5][6]
Full antigen schedules, catch-up tables, and true contraindications live on sibling pages. This leaf owns the conversation, assessment of determinants, and ethical plan.[1]
References18ShowHide
- [1]MacDonald NE Vaccine hesitancy: Definition, scope and determinants. Vaccine, 2015.PMID 25896383
- [2]Larson HJ, Jarrett C Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007-2012. Vaccine, 2014.PMID 24598724
- [3]Dubé E, Laberge C Vaccine hesitancy: an overview. Human vaccines & immunotherapeutics, 2013.PMID 23584253
- [4]Larson HJ, Jarrett C Measuring vaccine hesitancy: The development of a survey tool. Vaccine, 2015.PMID 25896384
- [5]Goldstein S, MacDonald NE Health communication and vaccine hesitancy. Vaccine, 2015.PMID 25896382
- [6]Eskola J, Duclos P How to deal with vaccine hesitancy? Vaccine, 2015.PMID 25896378
- [7]Opel DJ, Mangione-Smith R The Influence of Provider Communication Behaviors on Parental Vaccine Acceptance and Visit Experience. American journal of public health, 2015.PMID 25790386
- [8]Opel DJ, Zhou C Impact of Childhood Vaccine Discussion Format Over Time on Immunization Status. Academic pediatrics, 2018.PMID 29325912
- [9]Nyhan B, Reifler J Effective messages in vaccine promotion: a randomized trial. Pediatrics, 2014.PMID 24590751
- [10]Betsch C, Renkewitz F The influence of vaccine-critical websites on perceiving vaccination risks. Journal of health psychology, 2010.PMID 20348365
- [11]Brewer NT, Chapman GB Increasing Vaccination: Putting Psychological Science Into Action. Psychological science in the public interest : a journal of the American Psychological Society, 2017.PMID 29611455
- [12]Opel DJ, Mangione-Smith R Development of a survey to identify vaccine-hesitant parents: the parent attitudes about childhood vaccines survey. Human vaccines, 2011.PMID 21389777
- [13]Diekema DS Responding to parental refusals of immunization of children. Pediatrics, 2005.PMID 15867060
- [14]Healy CM, Montesinos DP Parent and provider perspectives on immunization: are providers overestimating parental concerns? Vaccine, 2014.PMID 24315883
- [15]Gagneur A, Gutnick D From vaccine hesitancy to vaccine motivation: A motivational interviewing based approach to vaccine counselling. Human vaccines & immunotherapeutics, 2024.PMID 39187772
- [16]Verger P, Cogordan C A postpartum intervention for vaccination promotion by midwives using motivational interviews reduces mothers' vaccine hesitancy, south-eastern France, 2021 to 2022: a randomised controlled trial. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin, 2023.PMID 37733238
- [17]McDonald C, Leask J A Consent Support Resource with Benefits and Harms of Vaccination Does Not Increase Hesitancy in Parents-An Acceptability Study. Vaccines, 2020.PMID 32887503
- [18]Hofstetter AM, Robinson JD Clinician-parent discussions about influenza vaccination of children and their association with vaccine acceptance. Vaccine, 2017.PMID 28392141