As pediatricians, especially in DPC, we find ourselves in a unique and often challenging position when it comes to vaccines. We believe in science, public health, and the incredible power of immunizations to protect children and communities. But we also believe in people—flawed, anxious, curious, deeply human people—trying to make the best decisions they can with the information they have, even when that information is incomplete or misleading.
Many of us have chosen to accept vaccine-hesitant families into our practices because we believe that all children deserve compassionate, consistent care. We’ve seen the consequences when families are dismissed or turned away—missed diagnoses, worsening chronic conditions, and in one unforgettable case, a child with undiagnosed rickets because the family avoided medical care for years after feeling rejected elsewhere.
In the DPC world, we don’t rely on 15-minute visits or transactional care. We rely on relationships. And that puts us in a powerful position to make a real difference—even, and especially, with families who are hesitant about vaccines.
Why the Conversation Feels Harder Right Now
The urgency is real. Measles outbreaks are popping up across the country, fueled by declining vaccination rates in certain communities. These outbreaks are not just a public health concern—they’re a reminder that the buffer of herd immunity is thinning. We’re seeing firsthand what happens when vaccine uptake dips below safe thresholds.
At the same time, the cultural climate around vaccines remains polarized. Misinformation spreads easily, trust in medical institutions has taken a hit, and social media continues to amplify fear and doubt. For many families, especially those who already felt dismissed or talked down to by medical professionals, vaccine decisions have become not just medical choices but identity statements.
That’s why our approach as DPC pediatricians matters so much. We’re not just offering vaccines—we’re offering a relationship where truth can be heard.
Here I’ve outlined some strategies that I’ve found helpful in navigating these hard conversations:
1. Make Curiosity Your Default Mode
When a family expresses hesitancy, it’s tempting to jump in with facts, correct the record, or push back immediately. But before we can hope to be heard, we have to listen. Not superficially, not performatively, but with genuine curiosity and patience.
I often start with a version of this:
“Do you mind sharing why you’d like to avoid or delay vaccines? I know everyone has different experiences, and I’d really like to understand your perspective.”
The words are simple, but the tone matters just as much. Calm, open, and disarming.
From there, I ask clarifying questions—not to cross-examine, but to truly understand:
- “What kinds of things have you read or heard that made you feel concerned?”
- “Which vaccines are you most hesitant about?”
- “Has someone you know had a difficult experience that influenced how you feel?”
You might hear broad statements like “I’ve done my research” or “I just don’t trust pharma.” Resist the urge to react. Instead, keep pulling the thread with warmth. You’ll often find that beneath the surface is a mix of fear, confusion, and a desire to feel agency in their child’s care.
2. Slow Down and Stay Grounded
Our own internal responses matter. When we hear blatant misinformation or conspiracy thinking, it’s easy to feel our temperature rise. But reactivity on our end will always trigger defensiveness on theirs.
Before going into these conversations, I do a gut check: Am I feeling calm? Curious? Able to sit in ambiguity without forcing resolution? If not, I pause. Sometimes I’ll say, “Let’s keep talking about this over a few visits. I don’t want you to feel rushed or pressured.” That alone can be a powerful statement.
Parents can sense whether you’re truly present or just waiting for your turn to rebut. Slowing down and staying grounded helps build the kind of trust that can eventually shift deeply held beliefs.
3. Use Motivational Interviewing, Not Debates
Motivational interviewing (MI) is one of the most useful tools we have when it comes to vaccine hesitancy. It’s not about persuading with facts—it’s about guiding families to explore their own motivations for health and safety.
You might ask:
- “What are your biggest hopes for your child’s health over the next few years?”
- “What worries you about not vaccinating, if anything?”
- “If you decided to do one vaccine, what would feel like a place to start?”
Then affirm and reflect:
“It’s clear that you care deeply and are putting a lot of thought into these choices. That kind of intentionality is something I really respect.”
MI research shows that when people feel heard and respected, they’re more likely to express their own ambivalence—which is where real change begins. When we respond with empathy instead of argument, we give space for openness to grow.
4. Create Safety Through Body Language and Tone
Vaccine-hesitant families often carry a history of feeling judged, dismissed, or talked over by previous clinicians. In many cases, the emotional residue of those experiences is what’s keeping them from re-engaging with traditional care.
That’s why our non-verbal communication can be just as important as our words. Keep your posture open. Lean in slightly. Maintain soft eye contact. Speak slowly and with warmth. Let your tone be curious, not corrective.
A few phrases that I’ve found helpful:
- “You’re not the first family I’ve talked with about this, and I know it can feel hard to bring up. I appreciate your honesty.”
- “I may not agree with everything you’ve said, but I hear where you’re coming from, and I’m here to help however I can.”
- “We can always revisit this conversation later. I’m not going anywhere.”
These moments of safety—however small—accumulate over time and build the kind of relational trust that ultimately makes families more open to reconsidering their decisions.
5. Offer On-Ramps, Not Ultimatums
One of the most practical things we can do is offer vaccine-hesitant families a series of small, manageable steps toward immunization—without making them feel forced or cornered.
You might say:
“Even one vaccine is better than none. If you’re open to starting with just one—maybe the MMR or DTaP—we can build from there when you’re ready.”
Some parents have started with a custom schedule, spacing vaccines out over several months. Others were open to specific vaccines due to recent headlines, like MMR during a local measles outbreak. I’ve had families start with just a dose of polio after learning about its complications. The key is to meet them where they are—and keep the door open.
Even a partial schedule is a win. And once families begin vaccinating and don’t experience any adverse effects, their confidence often grows.
6. Know When—and How—to Share Information
After establishing trust, I do eventually share facts. But I choose carefully when and how.
Rather than launching into a lecture, I might say:
“Would it be okay if I shared what I’ve read about this? You’re always free to agree or disagree, but I want you to have the information I base my advice on.”
Some gentle facts that can be helpful:
- Measles is extremely contagious. In a room where someone has measles, 9 out of 10 unvaccinated people will catch it.
- The measles vaccine is very safe—serious side effects are extremely rare, and the benefits are profound.
- Many of the “natural immunity” arguments are based on outdated or cherry-picked data.
- Disease complications like pneumonia, brain swelling, and hearing loss are much more common than most people realize.
Citing respected sources like the CDC, WHO, or Immunize.org helps. Sometimes I share personal clinical experiences—seeing a baby hospitalized with pertussis, or a toddler with rotavirus complications—to help humanize the conversation.
But even then, I tread lightly. One or two pieces of new information, shared calmly, are far more powerful than a flood of facts.
7. Respect Autonomy—While Naming Responsibility
Even with all the listening, all the empathy, and all the careful education in the world, some families may still decline vaccines. As pediatricians, this can feel frustrating, heartbreaking—even tragic—especially when we’ve seen the real consequences of vaccine-preventable diseases.
But it’s important to remember: we are not responsible for our patients’ decisions. We are responsible for the care we offer, the integrity with which we offer it, and the compassion we bring to the relationship. That’s it.
Parents ultimately bear the responsibility for the health decisions they make on behalf of their children. And when I’ve taken the time to build rapport and understand their perspective, I find that I can be honest with them—direct, but kind.
I might say:
“I’m willing to be flexible and adapt to what you’re comfortable with regarding vaccines, as long as you’re also willing to accept the consequences of those decisions. I’ll be here to care for your child no matter what—but I want to make sure we’re both clear about the risks and responsibilities involved.”
Said too early or too harshly, that statement could feel like an ultimatum. But in the context of a trusted relationship, it often lands as intended: not as a judgment, but as a sober and respectful reminder.
Setting that boundary protects you, too. You don’t have to carry the emotional weight of every family’s decision. You can offer the best of your care, your knowledge, and your heart—without taking responsibility for the outcome.
In Summary: Compassion Is the Most Powerful Tool We Have
If we want to help hesitant families move toward vaccination, we have to do more than make the scientific case—we have to make the relational case. That starts with being the kind of doctor they can talk to without fear of judgment. The kind of doctor who listens before speaking. The kind of doctor who sees the child in front of them, not just the choices their parents have made.
In DPC, we have the freedom to do this right. To take our time. To cultivate trust. To walk alongside families, even when the journey is slow.
And in a moment when measles is spreading again, that kind of connection might be the most important form of public health work we can do.
Further Reading & Resources:
- Nyhan B, et al. Effective Messages in Vaccine Promotion: A Randomized Trial. Pediatrics, 2014.
- Opel DJ, et al. The Architecture of Provider-Parent Vaccine Discussions at Health Supervision Visits. Pediatrics, 2013.
- Rollnick S, Miller WR. Motivational Interviewing in Health Care: Helping Patients Change Behavior.
- CDC’s Measles Toolkit: www.cdc.gov/measles
- Immunization Action Coalition: www.immunize.org
