Vaccine Hesitancy

Newborn 
  • Hepatitis B 
  • RSV-mab 

1-2 months 
  • Hepatitis B: 2nd dose should be given 1–2 months after the first dose. 

2 months 
  • DTaP: Diphtheria, tetanus, and acellular pertussis vaccine  
  • Hib: Haemophilus influenzae type b vaccine  
  • IPV: Inactivated poliovirus vaccine 
  • PCV: Pneumococcal conjugate vaccine  
  • RV: Rotavirus vaccine 

4 months 
  • DTaP: 2nd dose 
  • Hib: 2nd dose 
  • IPV: 2nd dose 
  • PCV: 2nd dose 
  • RV: 2nd dose 

6 months 
  • DTaP: 3rd dose 
  • Hib: 3rd dose may be needed, depending on the brand of vaccine used in previous doses.  
  • PCV  
  • RV: 3rd dose may be needed, depending on the brand of vaccine used in previous doses. 
  • Flu vaccine can be given starting at 6 months and annually after that. 
  • Children younger than 9 who get the flu vaccine for the first time will get it in 2 separate doses at least a month apart. 

6-18 months 
  • HepB: 3rd dose 
  • IPV: 3rd dose 

12-15 months 
  • Hib: 3rd or 4th dose  
  • MMR: Measles, mumps, and rubella vaccine. Sometimes given together with the varicella vaccine and called MMRV.  
  • PCV: 4th dose 
  • Varicella (chickenpox) 

12-23 months 
  • HepA: Hepatitis A vaccine; given as 2 shots at least 6 months apart 

15-18 months 
  • DTaP: 4th dose 

4-6 years 
  • DTaP: 5th dose 
  • MMR: 2nd dose 
  • IPV: 4th dose 
  • Varicella: 2nd dose 

9 years 
  • HPV: Human papillomavirus vaccine, given in 2 shots over a 6- to 12-month period. It can be given as early as age 9. If the first dose is given at age 15 or later, give 3 shots over 6 months. 

11 years 
  • Tdap: Tetanus, diphtheria, and pertussis booster. 
  • MenACWY: Meningococcal vaccine. Protects against meningococcal bacteria types A, C, W, and Y. A booster dose should be given at age 16. 

16 years 
  • MenB: Meningococcal vaccine. Protects against meningococcal bacterium type B. Teens and young adults (ages 16–23) can get the MenB vaccine in 2 doses 

A 2-year-old child presents for a well-child visit. The parents express concerns about the safety of vaccines and question whether their child needs the recommended immunizations. They mention hearing conflicting information online about vaccine side effects.

History

  • Parental concerns: Ask about specific fears or sources of misinformation (e.g., safety, efficacy, or necessity). 
  • Cultural or religious beliefs: Explore any underlying values or practices influencing their decision. 
  • Past experiences: Inquire about prior adverse reactions or family history of vaccine-related issues. 
  • Access barriers: Assess logistical challenges, such as transportation or cost. 

Use a presumptive format for initiating the vaccine discussion 

  • Researchers found that pediatricians who used a "presumptive recommendation" approach were more effective in getting parents to accept vaccines compared to those who took a "participatory recommendation" approach.
  • Participatory Example: "Would you like to hear about the vaccines we offer for today's visit?"
  • Presumptive Example: "Today your child is due for 2 vaccines. We will be giving MMR and Varicella."  

Use motivation interviewing 

  • For parents who express hesitancy, ask open-ended questions to explore parents’ beliefs and concerns. Reflect their statements to show understanding and guide them toward making informed decisions.  
  • For example, ask, “What concerns you most about vaccines?” and follow up with, “What information would help you feel more confident about vaccinating your child?” 

“Truth sandwich” messaging 

  • When certain messages about vaccines get repeated, the information sticks whether it is true or false. Try addressing an incorrect statement made by a parent with a “truth sandwich,” in which the bread slices are correct statements, and the filling is a falsehood. This works because the brain remembers best what you hear first and last, and what we hear more often.  
  • For example, “Parents and doctors agree that vaccines are safe and effective, and we want our children to be healthy. Some people continue to promote the false message that vaccines can cause autism. However, extensive research shows that there is no link between vaccines and autism.” 

Provide clear, evidence-based information  

  • Share accurate, science-backed information about vaccine safety and efficacy. Address common myths and misconceptions directly, such as concerns about autism or vaccine ingredients.
  • Use Vaccine Information Statements (VIS) to explain the benefits and potential risks of vaccines in a clear and concise manner.
  • Share the link to the Vaccine Education Center at the Children's Hospital of Philadelphia. 

  • Empathy is key: Parents are more likely to trust providers who listen and validate their concerns. 
  • Misinformation spreads quickly: Proactively address common myths and provide accurate, accessible resources. 
  • Vaccination is a process: Hesitant parents may need multiple conversations before deciding to vaccinate. 

  • Role-play scenarios to practice addressing vaccine hesitancy with empathy and evidence. 
  • Create a Kahoot! Game about the timing of various childhood vaccines.