Acta PaediatricaRecognising and Addressing Vaccine Hesitancy That Is Not Always Directly Voiced by a Child’s Parents

🎓 Expert Commentary / Peer Perspective

This perspective article examines a potential gap in current vaccine communication strategies. Existing approaches generally recommend a presumptive vaccination recommendation followed by motivational interviewing or other empathic communication techniques when parents explicitly decline vaccination or express concerns. The author argues that many vaccine-hesitant parents never trigger this second step because their uncertainty is communicated indirectly through delays, questions about timing, requests for schedule modifications, or nonverbal behaviors. To address this, the article proposes an “announce, detect, switch” model in which clinicians first recommend vaccination, then actively interpret the parent’s response before deciding whether exploratory discussion is needed. The proposal is conceptual and educational in nature and has not yet been prospectively validated.

Clinical Considerations

• The article suggests that vaccine hesitancy may present as delay requests, silence, timing questions, or selective vaccine acceptance rather than direct refusal.
• Current communication models often transition to motivational interviewing only after parents express concerns or decline vaccination outright.
• The proposed framework treats the initial vaccine recommendation as a diagnostic communication probe, with the parent’s response guiding subsequent conversation.
• Examples of potential hidden hesitancy include requests to postpone vaccination, questions about age appropriateness, and concerns prompted by changing immunization recommendations.
• The author proposes that a second question following an adequate informational response may indicate unresolved ambivalence rather than a lack of information.
• No clinical trial has yet validated the “announce, detect, switch” approach, and the article specifically calls for future comparative research evaluating detection of vaccine hesitancy and vaccine uptake outcomes.

Practice Applications

• Recognize that vaccine hesitancy may be communicated indirectly through scheduling requests, delays, or repeated questioning.
• Interpret parental responses as potential indicators of underlying concerns rather than assuming all questions are purely informational.
• Discuss vaccine recommendations using established communication approaches while remaining alert to nonverbal and indirect signals.
• Evaluate whether repeated questions persist after adequate factual responses, which may indicate unresolved ambivalence.
• Monitor emerging evidence evaluating communication frameworks designed to improve recognition of vaccine hesitancy.