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Traditional approaches to increase vaccination rely upon educating patients about vaccines. However, research shows that "knowing" vaccines are important is often insufficient: patients need to believe that getting vaccinated is important. Evidence-based motivational approaches, such as motivational interviewing/communication (MI/MC), have become increasingly popular for promoting good health behaviors, including vaccination. The objective of this review was to compare the efficacy of educational and MI/MC interventions on vaccination rates relative to each other and to usual/standard care. Pubmed, PsycINFO, and Cochrane trials databases were searched to identify articles that assessed vaccination rates post-patient education or MI/MC vaccine counseling in the context of adult or child vaccination (PROSPERO: CRD42019140255). Following the screening, 118 studies were included (108 educational and 10 MI/MC). The pooled effect sizes for vaccination rates corresponded to 52% for educational interventions (95% CI: 0.48-0.56) and 45% for MI/MC interventions (95% CI: 0.29-0.62) (P = .417). Fifty-nine randomized controlled studies (55 educational and 4 MI/MC) showed that, compared with usual/standard of care, exposure to education and MI/MC was associated with a 10% (RR =1.10; 95% CI =1.03-1.16, P = .002) and 7% (RR =1.07; 95% CI =0.78-1.45, P = .691) increased likelihood of getting vaccinated, respectively. Results suggest comparable efficacy of educational and MI/MC interventions on vaccination uptake and a small superiority of educational interventions compared with usual/standard of care. The overall poor quality of the studies, including lack of fidelity assessments of MI/MC studies, contributes to low confidence in the results and highlights the need for better quality intervention trials examining the efficacy of MI/MC for vaccine uptake.