Vaccine Risk Communication

Abstract

Childhood vaccines are among the most effective preventive interventions that exist. In recent years, however, concerns about the risks of vaccination have arisen and, in some cases, have caused parents to consider not having their children immunized. In order to improve the process of communication and decision-making by parents and physicians, the Institute of Medicine’s Vaccine Safety Forum convened a workshop to discuss risk communication. This article summarizes the workshop’s discussions; a more complete report1 is available on the World Wide Web at www2.nas.edu/hpdp/. Health risk communication has traditionally consisted of messages designed to encourage behavior that reduces individual and societal risk (e.g., smoking cessation and seat-belt use).2 Increasingly, risk communication is seen as an interactive process of an exchange of information and opinion among individuals, groups, and institutions.3 To be effective, risk communications must address the experiences, beliefs, values, and attitudes of message recipients as well as providers. Understanding how risks are perceived and the inherent biases of both message providers and recipients is key to good risk communication.4 Although health risk communication has been an active research area for several decades, the science and practice of vaccine risk communication are not yet well developed. Many of the problems with risk communication in general, however, apply to vaccine risks.5 Recent studies illustrate specific factors influencing how vaccine risks and benefits are perceived by and acted on by consumers and vaccine providers. Individuals’ immunization decisions, for instance, are influenced by decisions that others make. People might prefer to do what a majority of others do or may take advantage of the protection afforded by high immunization rates and not be vaccinated; they may also be influenced to vaccinate by the fact that vaccination would protect others. Other factors include perceptions of disease risk and the ability to control those risks, and preferences for the risks of diseases per se over risks of the vaccine against them. In particular, the rarity of vaccinepreventable diseases in the vaccine era makes it more difficult to communicate the risks of these diseases. Information on vaccine benefits and risks is currently limited in availability and scope. Information available to consumers today includes the vaccine information statements (VIS) issued by the Centers for Disease Control and Prevention (CDC), material from other federal agencies such as the Food and Drug Administration (FDA) and National Institutes of Health (NIH), manufacturers’ package inserts that accompany vaccines, oral communications from health care providers, and information provided by a variety of nonprofit and consumer organizations. Three major themes emerged during the workshop. First, risk communication is a dynamic process in which many participate, and these individuals are influenced by a wide range of circumstances, interests, and information needs. Effective risk communication depends on the providers’ and recipients’ understanding more than simply the risks and benefits; background experiences and values also influence the process. Good risk communication recognizes a diversity of form and content needs in the general population. Both the method and content of risk communication should reflect the goals of the communication, which could include advocacy, education, and development of a decision-making partnership (in any combination). To be effective, it was suggested, risk communication about vaccines needs to take into account what people already know or believe about the risks and benefits associated with immunization. Vaccine risk communicators should consider the varied information needs of the audience. Some recipients of risk communication material prefer short, simple messages that explain the risks and benefits of vaccines in nontechnical language; others want as much scientific information as is available. Currently, the primary sources of consumer information on vaccines are criticized either as being too simplistic and incomplete (the VISs, for instance) or having too much technical information for some people to understand and process effectively (for example, From the Institute of Medicine, Washington, DC 20418 Address Correspondence to: Michael A. Stoto, Institute of Medicine, 2101 Constitution Avenue N.W., Washington, DC 20418