Vaccine hesitancy may show up as a request to “wait and space them out,” repeated questions about one ingredient, a stalled appointment, or uncertainty after the schedule is offered. How the clinician responds matters because the conversation can influence both the decision made today and whether the family remains willing to revisit vaccination later (Limaye et al., 2021; O’Leary et al., 2024).
Evidence on vaccine communication points to one important structural choice: how the recommendation is introduced. A participatory opener, such as “What do you think about vaccines today?”, places the decision on the table before the clinician has made a recommendation. A presumptive opener, such as “Today your child is due for the MMR and varicella vaccines,” presents vaccination as routine preventive care. Presumptive recommendations are associated with higher vaccine acceptance and are recommended by the AAP as the starting approach for most families (American Academy of Pediatrics [AAP], 2025; O’Leary et al., 2024).
A presumptive recommendation does not end the conversation when a parent resists. The AAP recommends shifting to additional evidence-based communication strategies, including motivational interviewing, when hesitancy persists. Asking what specifically concerns the parent, reflecting the concern accurately, and responding to that issue rather than delivering a generic lecture keeps the exchange focused and allows the clinician to continue making a clear recommendation without turning the visit into an argument (O’Leary et al., 2024).
A 2025 cluster randomized trial adds an important limitation to that strategy. Training clinicians to begin presumptively and then use motivational interviewing with parents who resisted did not improve overall childhood vaccine uptake among parents with negative vaccine attitudes, although results differed by state (Opel et al., 2025). The finding suggests that communication technique alone may not be sufficient to change vaccine uptake in every setting.
Misinformation still needs to be corrected directly. The AAP recommends a “truth sandwich”: begin with accurate information, briefly identify and correct the false claim, and then restate the accurate information. The goal is to keep the clinically correct message more prominent than the misinformation being corrected (AAP, 2025).
The response also needs to match the concern. A parent worried about a specific ingredient needs different information than a parent worried about the number of injections in one visit. Communication should account for the family’s specific question, health literacy, and cultural context rather than repeating the same pro-vaccine script to every family (Limaye et al., 2021; O’Leary et al., 2024).
A workable clinical sequence is to make a clear recommendation, use a presumptive format, explore the specific concern if resistance emerges, respond with accurate information, and document what was discussed rather than recording only “declined” or “hesitant.” Revisiting the same concern at a later visit preserves an opportunity for the decision to change over time.
References
American Academy of Pediatrics. (2025, October 9). Talking with vaccine hesitant parents. https://www.aap.org/en/patient-care/immunizations/communicating-with-families-and-promoting-vaccine-confidence/talking-with-vaccine-hesitant-parents/
Limaye, R. J., Opel, D. J., Dempsey, A., Ellingson, M., Spina, C., Omer, S. B., Dudley, M. Z., Salmon, D. A., & O’Leary, S. T. (2021). Communicating with vaccine-hesitant parents: A narrative review. Academic Pediatrics, 21(4), S24–S29. https://doi.org/10.1016/j.acap.2021.01.018
O’Leary, S. T., Opel, D. J., Cataldi, J. R., Hackell, J. M., Committee on Infectious Diseases, Committee on Practice and Ambulatory Medicine, & Committee on Bioethics. (2024). Strategies for improving vaccine communication and uptake. Pediatrics, 153(3), e2023065483. https://doi.org/10.1542/peds.2023-065483
Opel, D. J., Robinson, J. D., Zhou, C., Colborn, K., Spielvogle, H., Furniss, A., Spina, C., Perreira, C., & O’Leary, S. T. (2025). Tiered clinician vaccine communication strategy to improve childhood vaccine uptake: A cluster randomized clinical trial. JAMA Network Open, 8(4), e257814. https://doi.org/10.1001/jamanetworkopen.2025.7814