CPS Statement: Working with vaccine-hesitant parents

CPS Statement: Working with vaccine-hesitant parents

The following was adapted from the Canadian Paediatric Society’s statement on  “Working with vaccine hesitant parents.” Please see the full statement for the full recommendations from the Canadian Paediatric Society.


While the majority of parents ensure that their children receive routine immunizations, a number of parents are hesitant or will refuse to have their children vaccinated.  It is important to remember that these parents' biggest concern is the safety of their children. Exposure to misinformation from the internet or a personal story from a friend can lead to confusion about vaccine safety, especially when most parents have never seen or heard of a child with a vaccine-preventable disease, like measles encephalitis. How healthcare providers' interactions with these parents can have a major impact on decision-making. To help with these conversations, the CPS has outlined the five following tips:

1) Understand the specific vaccine concerns of the parent and use motivational interviewing:

Using a non-judgemental tone, ask parents what their concerns are, and ask them to describe how they understand the risks and benefits of vaccines.  Do not assume that every parent has the same concerns. Bringing up concerns that the parent has not brought forward themselves can plant new concerns that vaccines are dangerous. Ask questions that are client-centered, semidirective, and aimed at changing behaviour.

2) Stay on message and use clear language to present evidence of vaccine benefits and risks fairly and accurately:

Your core message should be: "Vaccines are safe and effective, and serious disease can occur if your child and family are not immunized."  Avoid academic jargon and frame information in a positive way.  For example, saying "The vaccine is 99% safe" is more effective than "There is a 1% chance of side effects."

If parents are concerned about vaccine safety, correct specific misconceptions that parents have. Routine immunizations in Canada (with the exception of influenza) no longer contain mercury in the form of thimerosal. Allegations of the MMR vaccine causing autism were based on fraudulent data and have been disproven. If parents do not see the value in vaccination, you can reinforce the importance of vaccines by sharing stories about how children can be affected by vaccine-preventable diseases. Some parents may rely on herd immunity, however you should inform parents that this is not possible for a disease like tetanus that lives in the soil.

Discuss the consequences of not vaccinating with parents. Parents may believe that their child is at a lesser risk of infection due to good health, however there is significant evidence that non-immunized children are more affected than adults during outbreaks. Remind parents that their decision not to immunize on time can spread vaccine-preventable illness to high risk individuals.  Examples can include: infecting an infant sibling with pertussis, a pregnant woman with varicella, or a grandparent with pneumonia. Some parent may use a "wait and see" approach until an outbreak occurs, but this is dangerous as vaccines are not effective immediately, and many require multiple doses to be effective.

3) Inform parents about the rigour of the vaccine safety system:

Canada has a robust program to ensure the safety of vaccinations.  Recommendations from The National Advisory Committee on Immunization and the CPS are based on evidence, and all decisions are independent of vaccine manufacturers. Vaccines are held to a higher safety standard than drugs, and are often only introduced to Canada after they have been used in other countries for some time.

4) Address the issues of pain with immunization:

Pain is often overlooked and can lead to anxiety, non-adherence and fear of needles in the future.  Strategies to minimize pain in infants include administration of a sucrose solution, or allowing the child to breastfeed during immunization.  In older children, you can use topical anesthetics or use distraction strategies.

5) Do not dismiss children from your practice because parents refuse to immunize:

While working with parents who refuse to immunize may be frustrating, refusing to care for the child is unlikely to change their mind and is not considered to be in the best interest of the child.  While a minority of parents may never change their minds, many do accept vaccination if healthcare professionals respectfully listen to and address their concerns.

Last updated by PedsCases: January 31, 2015

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