Abstract Public perceptions of vaccination are complex and ambivalent. People often fear the vaccine more than the disease itself. They fear the unknown substance or adjuvants, worry that vaccines weaken their immunity system, or resent the involuntariness of mandated vaccination. The risk of the disease, on the other hand is often attenuated. Many vaccine-preventable diseases are rarely encountered in everyday situations and remain abstract concepts. Others, like influenza, may not be taken seriously; it is often seen as nothing worse than a “bad cold”. The sensationalist coverage of disease outbreaks is often perceived first as apocalyptic, then as “false alarms”. To fight these cognitive biases many risk communicators have focused on top-down persuasion, for instance telling parents that they must give the vaccine to their children and blaming them for not doing so. From a risk science perspective, however, it is well established that top-down persuasion that neglects to address negative perceptions is counter-productive. Any effort to bridge cognitive gaps and improve vaccine communication requires to understand perceptions. It is essential to understand the drivers that motivate parents' decision making and the dilemma they face between vaccinating and not vaccinating. The immunisation of children is particularly difficult because the communication's recipient are typically adults, which calls for strategies to talk to parents as well as reach children. Variations are observed across age as well as countries, which raises questions about national attitudes towards different types of vaccination affecting different age groups. This creates a more complex environment that is particularly challenging for healthcare professionals who have been identified as the primary “go to” authoritative source of information for adults. Obstacles to effective communication therefore needs to be addressed in a science-informed manner, if the objective is truly to ensure better uptake rates.