Finding a way to address a wicked problem: vaccines, vaccination, and a shared understanding.

A wicked problem is a complex one with innumerable causes, is difficult to describe, and does not have a right answer. Addressing vaccine hesitancy is a wicked problem that has existed since smallpox inoculation began in 1796. Spurred by a now-discredited and retracted paper by Wakefield, et al. in 1998 and facilitated by the ease of connectivity through social media, distrust in vaccination is highly publicized, currently contributing to the largest measles outbreak in the United States since 1994, threatening public health as more vaccine-preventable diseases may be on the rise. Research to address vaccine hesitancy has been focused on building vaccine confidence, understanding the effects of diseases themselves, who is trusted to make a recommendation (i.e. health-care professionals), the need for a strong recommendation, and characteristics of hesitant parents (e.g. values). Strategies focused on disease education and strong provider recommendations have had limited impact on increasing coverage rates and provide little insight into the underlying drivers to vaccination decision-making. With the goal of enhancing public trust and provider effectiveness in conversations between providers and parents, new frameworks are needed to build a richer understanding of provider-parent conversations around vaccination and vaccine decision-making.