Getting Off to the Right Start

Among all states, Washington has one of the highest percentages of parents who opt-out of vaccines required for children to enter kindergarten. Many of these parents ask their child’s doctor to delay some or all vaccinations for their child. These “vaccine-hesitant” parents are reluctant for many reasons. Pediatrician and bioethics faculty Dr. Douglas Opel, along with bioethics staff member Katherine Lepere, is focusing on how best to communicate with vaccine-hesitant parents in order to promote ongoing discussions and ultimately increase vaccination rates in children. Focusing on vaccine-hesitant parents is important because this is a growing group, yet their minds are not made up one way or the other yet.

By videotaping conversations between doctors and parents during well-child visits when vaccinations normally are given, Opel and his collaborators have pinpointed a few communication techniques that doctors can use to improve vaccine acceptance. One particularly promising technique is how the vaccine conversation is started. In an initial study, when doctors started the conversation by telling the parents which vaccines their child would be getting, such as “So today we’re doing X and Y vaccines, is that OK?”, more parents accepted the recommended vaccines due for their child at that visit than if doctors began the conversation with an open-ended question asking parents for their preference, such as “What do you want to do about shots today?”

The fact that this simple change in framing could have dramatic effects in parental acceptance underscores the importance of empirical studies to understand what constitutes effective communication in medical settings, and also raises important ethical questions, such as how does this framing affect a doctor's ability to obtain informed consent? And are there other interventions in pediatrics in which this type of framing can also be used?

“Finding divergent outcomes due to simply how a conversation is started suggests we are only at the beginning of our understanding of what constitutes effective communication with parents about vaccines.”

Douglas Opel

Opel is conducting a follow-up study to see whether the effect on vaccine acceptance from how a vaccine conversation is started persists over time. He is also exploring the ethical issues of framing techniques in conversations with parents. The outbreak of measles at Disneyland and other recent outbreaks of diseases that are preventable with vaccines have garnered Opel’s research much media attention. Major newspapers have interviewed him and featured his research. He was mentioned in a February 4, 2015, New Yorker article as one of a handful of academics who are doing “excellent work” on this topic.

Ultimate Goal

To improve childhood immunization rates by teaching providers how best to communicate with vaccine-hesitant parents.


  • Nora Henrikson, Kaiser Permanente Washington Health Research Institute
  • John Heritage, University of California, Los Angeles
  • Rita Mangione-Smith, Seattle Children’s
  • Jeffrey Robinson, Portland State University
  • James Taylor, University of Washington School of Medicine


  • Eunice Kennedy Shriver National Institute of Child Health and Human Development
  • Faculty Scholars Program, The Greenwall Foundation

Representative Publications