Pediatric vaccine hesitancy and refusal represent a critical and growing public health challenge, undermining global immunization coverage and disease prevention efforts. This mini-review argues that prevailing strategies, which predominantly target individual-level communication, are insufficient to address the deep-seated structural and social determinants underpinning parental decision-making. The review overviews recent literature to examine the limitations of communication focused interventions; explores the framework of structural and social determinants of health, including systemic racism; analyzes the roles of cultural beliefs, socioeconomic factors, and historical mistrust; and evaluates community-based and culturally informed intervention strategies. It further presents key findings from clinical studies to illustrate the prevalence and drivers of hesitancy. Future scope necessitates robust implementation science to evaluate the real-world efficacy of multi-level interventions and the development of unified theoretical frameworks that integrate structural competency into public health practice. Ultimately, achieving equitable vaccine coverage requires a paradigm shift toward systemic, trust-building reforms that address the root causes of hesitancy.

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