Abstract
INTRODUCTION: Vaccines are one of the most successful interventions in the history of public health. They are largely responsible for the near eradication of several diseases. However, some people are vaccination averse which can lead to vaccine hesitancy. Vaccine hesitant parents are those that refuse or delay getting their children vaccinated despite the availability of vaccination services. This phenomenon often occurs despite parent’s belief that vaccines are effective. The purpose of this review was to exam available literature to identify predictors of vaccine hesitancy among parents and parental rationale for vaccine hesitancy. 
 
 METHODS: This literature review utilized the SCOPUS database to identify articles examining vaccine hesitancy among American parents, published from 1997 to 2020, inclusive. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was utilized to select articles used in the final literature review. 
 
 RESULTS: Fifty-one articles were included in the final review. Predictors of vaccine hesitancy included demographics (income, education, marital status, race/ethnicity), healthcare practices (provider relationship, use of complementary or alternative medicine), and social-cultural factors. Parental rationale for vaccine hesitancy included concerns about the safety of vaccinations, not fearing diseases covered by vaccinations, and the belief that vaccines were not necessary. The most consistent and prevalent theme of vaccination hesitancy was the strength of the influence that the medical provider has on the parents.
 
 CONCLUSION: Balanced communication with a trusted medical provider that addresses both the benefits and risk of vaccinations, along with parents’ concerns about safety are important factors to reduce vaccine hesitancy among parents.
Highlights
Vaccines are one of the most successful interventions in the history of public health
Parental rationale for vaccine hesitancy included concerns about the safety of vaccinations, not fearing diseases covered by vaccinations, and the belief that vaccines were not necessary
The most consistent and prevalent theme of vaccination hesitancy was the strength of the influence that the medical provider has on the parents
Summary
Vaccines are one of the most successful interventions in the history of public health. In the history of public health, one of its most effective weapons in preventing disease is immunization. This has led to the passage of important legislation and the initiation of programs that have been affective at controlling many infectious diseases. Measles outbreaks during the 1980’s and early 1990’s affecting mostly low-income children who were concentrated in inner cities (Whitney, Zhou, Singleton, & Schuchat, 2014). This highlighted the need to increase access to programs that educate and provide vaccination opportunities for such populations. The historic Vaccines for Children (VFC) program followed in 1993, which aimed to educate communities about vaccines, and to provide them at no cost to low-income, uninsured, and underinsured children (Fisk, 1993; Santoli, Rodewald, Maes, Battaglia, & Coronado, 1999)
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