Vaccine hesitancy remains one of the most pressing challenges in preventive health. Despite the availability of safe and effective vaccines, many patients delay or refuse immunizations, threatening herd immunity and increasing the risk of vaccine-preventable disease outbreaks. So far in 2025, we have seen how decreased vaccination rates for measles in the US has resulted in one of the highest cases of measles since it was deemed eradicated in 2000. As a nurse practitioner, you're often on the frontlines of these conversations—and your approach can make all the difference.
The World Health Organization defines vaccine hesitancy as the delay in acceptance or refusal of vaccines despite availability of vaccination services. This complex phenomenon is influenced by a variety of factors, including:
Misinformation and disinformation
Distrust in healthcare systems or government
Cultural or religious beliefs
Literacy or language barriers
Access challenges
These influences often intersect, making vaccine hesitancy a dynamic and individualized issue that requires nuanced, patient-centered care.
The provider-patient relationship is foundational. Studies consistently show that healthcare providers are the most trusted source of vaccine information, even among hesitant individuals. The American Academy of Pediatrics recommends using a strong, presumptive approach when discussing vaccines:
“Today your child is due for their routine vaccines.”
This kind of confident, matter-of-fact recommendation can set the tone for acceptance. Still, you should be prepared to respond compassionately to concerns. Use culturally sensitive, evidence-based language to address myths and fears. Remember, persistence over time matters—patients may need to hear the same message repeatedly from a provider they trust before choosing to vaccinate.
Motivational interviewing is a powerful, non-confrontational communication technique that emphasizes empathy, collaboration, and respect for autonomy. It's been shown to reduce hesitancy and increase vaccine uptake.
MI includes four key steps:
Engage the patient to build rapport
Explore their specific concerns and motivations
Inform by offering accurate, personalized information
Empower the patient to make a decision aligned with their values
Instead of pushing or correcting, MI seeks to draw out the patient’s own reasons for change, which makes acceptance more likely.
Be ready to address safety fears head-on with clear, factual information. Emphasize the rigor of vaccine testing and surveillance systems (e.g., VAERS, VSD). Reassure patients that serious adverse events are extremely rare. Explain why multiple vaccines are safe when given together, using analogies or visuals to illustrate the body’s immune capacity. Frame the conversation around shared values. For example:
“Vaccines help support your child’s natural immune defenses.”
“Immunizing helps protect those in your community who can’t be vaccinated.”
Tailoring your message in this way aligns recommendations with what matters most to your patient.
Clinic-wide strategies can reinforce your one-on-one counseling efforts. Reminder and recall systems help patients stay on schedule. Standing orders for vaccination during routine visits and electronic health record prompts can support continuity across providers. For persistent refusals, some practices adopt vaccine refusal documentation policies or dismissal protocols. These are ethically complex and should be used with caution and consistency.
Vaccine attitudes are shaped by more than just healthcare providers. Broader strategies include partnering with community leaders (e.g., pastors, local influencers) to disseminate trusted messaging. Offering vaccines in accessible locations (e.g., mobile clinics, school-based programs) can improve vaccine uptake. Policy tools such as school mandates and incentive programs can be effective in some contexts but must be tailored to the community and applied thoughtfully.
Vaccine hesitancy is not a one-size-fits-all issue. Your approach must be patient-specific, culturally competent, and sustained over time.
Strong, confident recommendations from a trusted provider carry weight.
Motivational interviewing can bridge the gap between patient ambivalence and action.
Be prepared to debunk misinformation with facts—but always lead with empathy.
Combine individual, system, and community-level strategies for the greatest impact.
As a nurse practitioner, you are in a powerful position to shape attitudes and protect communities through effective vaccine counseling. With patience, empathy, and evidence-based tools, you can help guide even the most hesitant patients toward informed, confident decisions.