Safety concerns biggest barrier to vaccination

Most vaccine-hesitant parents aren’t opposed to vaccination but simply have a desire to protect their children from all harms, according to a review.

A clinical practice review penned by Murdoch Children’s Research Institute (MCRI) Professor Margie Danchin and University of Colorado Anschutz School of Medicine Associate Professor Sean O’Leary for the New England Journal of Medicine explained vaccine hesitancy existed on a spectrum, with safety concerns the biggest barrier.

They described decades of evidence that showed routine childhood vaccines recommended by the American Academy of Pediatrics have dramatically reduced serious infectious diseases and have an overwhelmingly excellent safety record. The same results have been produced by Australia’s National Immunisation Program (NIP).

What is key to improving vaccine uptake?

The piece states health professionals such as GPs, immunisation nurses and pharmacists play a critical role in supporting vaccination, as clinicians remain the most trusted source of vaccine information for parents. Clear, confident recommendations from trusted clinicians are strongly associated with higher vaccine uptake.

They noted that communication style matters. Presumptive approaches, which present vaccination as the expected norm, are more effective than open‑ended discussions, particularly when concerns are met with respectful, two‑way dialogue. Empathy‑based, patient‑centred strategies help clinicians address misinformation, acknowledge parental concerns and build trust. The review also includes step-by-step consultation guides and pointers to aid effective vaccine communication.

Professor Danchin said ensuring respectful communication and always leaving the door open when vaccination was delayed or declined, could influence future decisions and improve long‑term immunisation outcomes.

Image: Professor Margie Danchin

Strengthening trust and intention to vaccinate

The review is based on years of clinical experience and vaccine-communication research underpinning the global Vaccine Champions program, which aims to build trust and vaccine uptake. The program, supported by the Australian Government and UNICEF, and co-designed by MCRI, the University of Sydney, UNSW, local Ministries of Health, regional partners and Australian regional immunisation alliance researchers, trains healthcare workers and community leaders to discuss and promote vaccination programs and address misinformation.

The review comes as newly published MCRI led research has found the program in Vietnam, co-designed with the Vietnamese Ministry of Health, has strengthened trust in vaccines and the health system and increased community intention to vaccinate in provinces with historically low coverage.

Published in the Annals of Global Health, the study found those who attended the education sessions, 86 per cent reported an increased intention to vaccinate, highlighting the program’s impact on vaccine confidence among a community. They also reported high satisfaction with the sessions and material.

Supporting public health priorities

Importantly, the vaccine champions in Vietnam have continued to run education sessions beyond the initial program period and are being utilised by the Ministry of Health to support other public health priorities, including nutrition and maternal and child health.

MCRI researcher Belle Overmars said the findings demonstrate that a structured, multi‑level model could strengthen vaccine confidence, empower local leaders and help reduce pressure on the healthcare workforce.

Image: MCRI researcher Belle Overmars

Publication

Isabella Overmars, Jessica Kaufman, Thu-anh Nguyen, Luong Tran, Thi Mai Nguyen, Ngoc Anh Vu Nguyen, Chu Huu Trang, Suzanna Vidmar, Maharajan Muthu, Gregory Fox, Shiva Shrestha, Holly Seale and Margie Danchin. ‘Pragmatic RE-AIM Evaluation of the Train-the- Trainer Vaccine Champions Program in Vietnam,’ Annals of Global Health. DOI: 10 .5334/aogh.5116

Funding

The Vaccine Champions Program in Vietnam was funded by the Australian Government.