Although vaccines are critical for public health and proven to be safe and effective, vaccination rates remain dangerously low. Notably, lack of widespread COVID-19 vaccination in the US has contributed to high mortality rates. Even before COVID-19, both childhood and adult vaccination rates were below goal and exhibited racial/ethnic and socioeconomic disparities. Efforts to increase vaccination rates must be multi-pronged, but communication strategies should be a focus for quality improvement. Physicians have control over the vaccine recommendation process, and the process can be taught and learned. The biggest influence on the parental decision to vaccinate is an unequivocal provider recommendation. Using "presumptive" rather than "participatory” language also increases uptake. For vaccine hesitant patients or parents, motivational interviewing has been shown to be helpful. This handout lists main barriers to vaccination, reviews the evidence of what works and what doesn’t, and proposes a stepwise process for vaccine recommendations to increase vaccination rates that is based on the literature.