Vaccine Adherence: Addressing Myths and Hesitancy

Full update August 2022

 Determining which vaccines are appropriate for your patient is based on several factors (e.g., age, health conditions, lifestyle).  Patient fears, myths, and scheduling may be barriers to vaccine adherence.  Use this checklist to improve vaccination rates, increase adherence, and overcome barriers.


Suggested Approach

Identify candidates


☐  Ask about vaccine history.  For example, you can ask:

  • “Which vaccines have you received?”
  • “When was your last tetanus shot?”

☐  Use these tools to stay current on available vaccines and the latest recommendations for all age groups:

☐  When available, review immunization registry data to determine which vaccine(s) a patient may need.

☐  Develop strategies to identify eligible patients.  Consider patient ages and chronic medical conditions.  For example:1,2

  • Help parents stay on track with childhood vaccinations for infants and young children.
  • Adolescents may need the human papilloma virus (HPV) and meningitis vaccines.
  • Elderly patients may be candidates for the pneumococcal or zoster vaccines.
  • Patients with chronic obstructive pulmonary disease (COPD), diabetes, or heart disease may need a pneumococcal vaccine.
  • Make sure ALL patients six months and older, including pregnant women, receive a flu vaccine yearly.

☐  Be familiar with and follow policies for giving vaccines to minors with and without parental consent.


Address hesitancy


☐  Ask about vaccine hesitancy.  For example, you can ask, “What keeps you or your child from getting a recommended vaccine?”

  Infants:  Ease fears about the number of vaccines infants receive at one time.  Evidence suggests that a healthy child’s immune system will NOT be damaged or overwhelmed by receiving multiple vaccines at once.3

  Adolescents:  Reassure that the HPV vaccine does NOT increase sexual promiscuity or sexually related outcomes (e.g., pregnancy).4

  Adults:  Educate that vaccines not only prevent infections, but also significant infection-related complications.

  • For example, the flu vaccine lowers the risk of flu-related complications (e.g., hospitalizations).5


Ease fears about unfounded myths


☐  Ask about fears and questions.  For example, you can ask, “What fears or questions do you have because of things you have heard about vaccines?”

☐  Remind patients that the flu vaccine may cause mild malaise or flu-like symptoms, but it does NOT cause the flu.6

☐  Tell patients that they can’t believe everything they see on the internet about vaccines, as some of the information is false.  But reassure them that studies consistently show that vaccines (even old ones that had thimerosal) DO NOT cause autism.7

☐  Some prefer natural immunity over vaccines.     It is not worth the risk, especially for some infections.

  • Stress the risks and complications of disease.  For example
    • Severe allergic reactions to the measles, mumps, and rubella (MMR) vaccine occur in about 1 in 1,000,000 doses.  But, about one in 1,000 patients infected with measles will die.8,10
    • In adults, data suggest that COVID-19 vaccine-induced immunity protects against reinfection five times better than a previous COVID-19 infection.9


Improve adherence


☐  Use strong endorsements.  

☐  Consider using an “opt-out” approach instead of an “opt-in” approach.  

  • Some data suggest proactively scheduling appointments for patients (opt-out approach) to receive a vaccine increases vaccination rates compared to notifying patients that vaccination appointments can be made (opt-in approach).11

☐  Personalize the conversation.  Share that you vaccinate your kids.  Ask if they were vaccinated when they were young.

☐  In the US, encourage booking future vaccine doses with the first dose.  Enroll patients in reminder programs (e.g., calls, texts).

☐  In Canada, follow school vaccination programs (where available) to ensure required vaccines are received on schedule.

☐  Suggest coordinating care with other providers who offer vaccines (e.g., pharmacies, other medical appointments).



  1. CDC. Immunization Schedules: for healthcare providers. Updated February 17, 2022. (Accessed July 12, 2022).
  2. Government of Canada. Provincial and territorial immunization information: immunization schedule by province and territory. Updated August 7, 2020. (Accessed July 12, 2022).
  3. CDC. Vaccine safety: multiple vaccines at once. Updated August 14, 2020. (Accessed July 12, 2022).
  4. Bednarczyk RA, Davis R, Ault K, et al. Sexual activity-related outcomes after human papillomavirus vaccination of 11- to 12-year-olds. Pediatrics. 2012 Nov;130(5):798-805.
  5. CDC. Influenza (flu). Vaccine effectiveness: how well do flu vaccines work? Updated October 25, 2021. (Accessed July 12, 2022).
  6. CDC. Influenza (flu). Misconceptions about seasonal flu and flu vaccines. Updated November 18, 2021. (Accessed July 12, 2022).
  7. Vaccine safety. Autism and vaccines. Updated December 1, 2021. (Accessed July 12, 2022).
  8. CDC. Measles (rubeola). Complications. Updated November 5, 2020.  (Accessed July 12, 2022).
  9. Bozio CH, Grannis SJ, Naleway AL, et al. Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-19-Like Illness with Infection-Induced or mRNA Vaccine-Induced SARS-CoV-2 Immunity - Nine States, January-September 2021. MMWR Morb Mortal Wkly Rep. 2021 Nov 5;70(44):1539-1544.
  10. CDC. Understanding MMR vaccine safety. Updated February 2013. (Accessed July 12, 2022).
  11. Chapman GB, Li M, Colby H, Yoon H. Opting in vs opting out of influenza vaccination. JAMA. 2010 Jul 7;304(1):43-4.

Cite this document as follows:  Clinical Resource, Vaccine Adherence:  Addressing Myths and Hesitancy.  Pharmacist’s Letter/Prescriber’s Letter.  August 2022[380805]

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