Recently we have seen a re-emergence of diseases (i.e. measles) that were all but eradicated due to vaccines. That is because vaccines are victims of their own success. Childhood vaccines have provided the greatest contribution to improved infant survival during the past 50 years, with an estimated 154 million deaths averted. Most parents today have not nursed their children through measles, polio, diphtheria, or other vaccine-preventable diseases rarely seen today. There was a time when children in iron lungs filled pediatric wards and struggled to breathe because of paralysis of their respiratory muscles caused by polio, with no vaccine available to prevent the disease. Now, some parents fear vaccines more than the diseases they prevent often because of widely debunked falsehoods, such as the myth that vaccines cause autism. The science is abundantly clear that the benefits of vaccines far outweigh the potential risks, yet parents still question the safety of vaccines and often decline them. Why is this?
Vaccine hesitancy exists in the middle of a spectrum and can be defined as a motivational state of being conflicted about or opposed to getting vaccinated. Hesitant parents generally want to protect their child from vaccine preventable diseases but have questions or even serious concerns about vaccines, mostly regarding vaccine safety. Hesitancy often varies according to vaccine; can be influenced by vaccine safety scares, which are often false but amplified by the media; and can change over time. People can be influenced by antivaccine stories and are unsure who to trust, so they decide to delay vaccination or not to vaccinate owing to fear. These fears have been exacerbated in the U.S. since 2025 with the confirmation of a known vaccine skeptic as Secretary of Health and Human Services.
Trust in vaccines, those who recommend them, and those who develop them are important factors affecting uptake (usage) of childhood vaccines. A recommendation from a healthcare provider has been shown repeatedly to be the strongest predictor of vaccine acceptance; health care providers remain the most trusted sources of information. A recent survey of 1,200 U.S. clinicians showed that the largest contributors to vaccine misinformation among patients were social media (91.0%), followed by celebrities (63.5%) and mass media (61.1%). Parents generally express a high degree of trust in their children’s pediatric clinicians (pediatricians, family practitioners, nurse practitioners, or physician assistants) who play a crucial role in parental decision making with respect to vaccines.
The general consensus is that clinicians should introduce routine vaccinations in a so-called presumptive format (“Sarah is due three vaccines today.”) rather than in a participatory manner (“Would you like to get Sarah vaccinated today?”). The presumptive strategy is grounded in behavioral science and is supported by strong observational data and a randomized, controlled trial. But there are no formal guidelines on communication about vaccines. The American Academy of Pediatrics published a clinical report in 2024 that summarizes the evidence and suggests the use of a presumptive recommendation for initiating vaccine conversation, motivational interviewing when encountering hesitancy, as well as “pursuit” (meaning continuing the conversation) when parents resist vaccines. When encountering parental fear regarding the risk of autism, it would help to remind the parents that the main source of this fear stems from a fraudulent article written by a British physician whose article was subsequently so totally discredited as being fraudulent that he also lost his medical license.
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