Vaccine Hesitancy

Disclaimer

These guidelines have been produced to guide clinical decision making for general practitioners (GPs). They are not strict protocols. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.

Introduction

Vaccine hesitancy refers to a spectrum of parental positions regarding vaccination. This spectrum may include:

refusal of all vaccines
selective concerns about specific vaccines or vaccine components
a desire to delay or otherwise alter the standard vaccine schedule
families who continue to vaccinate despite minor concerns.

Vaccine hesitancy has different underlying causes and concerns for different families, and requires an individualised, patient-centred approach.

It is important that primary care providers start conversations about immunisation early with parents and carersⁱ. The key to addressing vaccine hesitancy is non-judgmental discussion and the provision of clear, targeted, information to support decision making.

Research shows that families place trust in their health care providers more than online resources1. When families change their mind and proceed with vaccination for their child, the main reason given by parents is “information or assurances from health care provider”².

Pre-referral investigations

N/A

Pre-referral management

Many instances of vaccine hesitancy can be appropriately managed in the primary care setting. This may require extended or multiple appointments to allow caregivers time to express their concerns and to have them addressed.

Relevant resources to support these decisions are listed in the Useful Resources section.

Adverse reactions

Children who have had an adverse reaction following immunisation (AEFI) should be reported through WA Vaccine Safety Surveillance (WAVSS) (About Western Australia - SAFEVAC Reporting). Most AEFIs are not a contraindication to continued vaccination.

Medical exemptions

Immunisation Medical Exemptions are governed by federal regulations and can only be issued for specific reasons as outlined by Services Australia.

Referrals requesting exemptions outside these criteria will not be accepted.

Communication approaches for vaccine hesitant and vaccine refusing families

Vaccine hesitant or delaying vaccines

Vaccine refusing

Allow adequate time for discussion
Ask permission to discuss vaccine concerns
Elicit specific concerns and address each one individually
Acknowledge genuinely felt concern without dismissing or minimising them
Discuss disease and vaccine risks as well as benefits
Tailor the information to the family’s health literacy and information needs, and avoid overwhelming them with large amounts of data
Communicate risks with words, numbers, and/or graphics
Provide printed or online resources for review outside the consultation
Offer follow-up appointments to continue discussions as needed

Ask permission to discuss vaccine concerns
Acknowledge genuinely felt concern without dismissing or minimising them
Avoid overstating vaccine safety
Avoid directly challenging firmly held philosophical, religious or personal beliefs
Avoid direct confrontation or debate
Identify shared goals and values, such as protecting the child’s health and wellbeing
Provide printed or online resources for review outside the consultation
Explore whether a tailored schedule is acceptable
Aim to keep the conversation open for future discussions
Offer follow-up appointments to continue discussions as needed

Table adapted from Danchin et al³

When to refer

Refer to the PCH Infectious Diseases – Specialist Immunisation Service when:

Families remain open to discussions about vaccination but have reached the limits of what can be supported in the primary care setting through counselling and provision of resources. The family must consent to the referral and be willing to engage with the service.

Families of children without medical risk factors requiring specialised immunisation input are likely to face significant wait times to access this service, which may delay protection through vaccination. Clinicians should continue discussions with families after referral and inform the service if the family proceeds with vaccination.

How to refer

Routine non-urgent referrals from a GP or a Consultant should go to the Central Referral Service

Routine non-urgent referrals from a nurse practitioner, non-medical referrers or private hospitals go to the PCH Referral Office.

Essential information to include in referral

Specific immunisation concerns or questions raised by the family.
The child’s immunisation history.
Details and WAVSS report details for any adverse events following previous immunisations.
Relevant medical history, especially immunodeficiency, asplenia, or other medical risk factors affecting vaccination.
Details of any family court orders relevant to consent for vaccination.

References

Gary L. Freed, Sarah J. Clark, Amy T. Butchart, Dianne C. Singer, Matthew M. Davis; Sources and Perceived Credibility of Vaccine-Safety Information for Parents. Pediatrics May 2011; 127 (Supplement_1): S107–S112. 10.1542/peds.2010-1722P
Deborah A. Gust, Natalie Darling, Allison Kennedy, Ben Schwartz; Parents With Doubts About Vaccines: Which Vaccines and Reasons Why. Pediatrics October 2008; 122 (4): 718–725. 10.1542/peds.2007-0538
Danchin M, Nolan T. A positive approach to parents with concerns about vaccination for the family physician. Aust Fam Physician. 2014 Oct;43(10):690-4. PMID: 25286425.

Reviewer/team:	Infectious Diseases department	Last reviewed:	August 2025
		Next review date:	August 2028

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