Metaphorical Language in Paediatric Vaccine Communication: Framing Risk and Building Trust Among Children and Adolescents

Aim: To examine the effectiveness of metaphorical language in framing risk and building trust among parents, children and adolescents in paediatric vaccine communication. Methods: A narrative synthesis was conducted using empirical studies, institutional reports from the Istituto Superiore di Sanità, European Centre for Disease Prevention and Control, and National Institute for Health Research, alongside an original survey involving 2681 Italian adolescents, providing preliminary results. The survey compared three message framings: war metaphors, protective/caring metaphors and neutral factual statements. Results: Protective metaphors emphasising safety, care and collective responsibility achieved the highest Vaccine Confidence Index scores (mean 9.1), significantly outperforming both war metaphors and neutral messages (p < 0.01). While war metaphors may initially mobilise urgency, they risk inducing anxiety, resistance and reduced perceived personal agency, particularly among younger audiences. Conclusion: Integrating age-appropriate protective and caring metaphors into paediatric vaccine communication enhances trust and vaccine acceptance. Future campaigns should prioritise language that fosters safety, community and personal responsibility while avoiding metaphors likely to trigger fear or alienation.