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Clin Ther. 2017 Aug;39(8):1550-1562. doi: 10.1016/j.clinthera.2017.07.003. Epub 2017 Jul 31.

Vaccine Hesitancy: Where We Are and Where We Are Going.

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Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado. Electronic address:
Department of Pediatrics, Section of Infectious Diseases, University of Colorado Denver, Denver, Colorado.
Department of Pediatrics, Sections of Pediatric Infectious Diseases and General Academic Pediatrics, University of Colorado Denver/Anschutz Medical Campus, Children's Hospital Colorado/University of Colorado School of Medicine, and Adult and Child Consortium for Health Outcomes Research and Delivery Science, Denver, Colorado.



Vaccines represent one of the most important aspects of pediatric preventive care. However, parents are increasingly questioning the safety of and need for vaccines, and as a result, vaccination rates have fallen to dangerously low levels in certain communities. The effects of vaccine hesitancy are widespread. Community pediatricians who interact regularly with vaccine-hesitant parents report higher levels of burnout and lower levels of job satisfaction. Not surprisingly, vaccine hesitancy has also had direct influence on vaccination rates, which in turn are linked to increased emergency department use, morbidity, and mortality.


Literature from 1999 to 2017 regarding vaccines and vaccine hesitancy was reviewed.


Few evidence-based strategies exist to guide providers in their discussions with vaccines-hesitant parents. Recent research has shown a presumptive approach (ie, the provider uses language that presumes the caregiver will vaccinate his or her child) is associated with higher vaccination uptake. Motivational interviewing is a promising technique for more hesitant parents.


At the community level, evidence-based communication strategies to address vaccine hesitancy are needed. The practice of dismissing families from pediatric practices who refuse to vaccinate is common, although widely criticized. Other controversial and rapidly evolving topics include statewide vaccination mandates and school exemption policies. Electronic interventions, such as text-messaging services and social media, have recently emerged as effective methods of communication and may become more important in coming years.


Motivational Interviewing; Vaccine Hesitancy; Vaccine Refusal

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