son might more clearly define how an earlier and more intense exposure to microbes might influence the maturation process and alter the proposed impact of immunizations on allergy and autoimmune disease. In theory, collecting data on known markers in the course of vaccine research and testing would present an opportunity to study the prevalence of such markers before and after immunization. Similarly, it might also be possible to study whether the prior presence of a marker was associated with differences in the response to a vaccine. The committee recommends exploring the feasibility of collecting data on surrogate markers for type I diabetes and clinical history of allergic diseases in the vaccine testing and licensing process. Such data might also be useful in vaccine-related studies in high-risk cohorts, such as those in the DAISY study. The committee recommends exploring surrogates for type I diabetes and clinical history of allergic diseases in existing cohort studies of variations in the immunization schedule.

Communication

Along with the increasingly complex immunization schedule has come a dramatic increase in the complexity of vaccine safety issues, and it appears that some people have redefined their conceptions of the related risks and benefits. The focus seems to have shifted from whether children will get a disease if they are not vaccinated to whether children will experience temporary or potentially longer-term adverse events if they are vaccinated (McPhilips and Marcuse, 2001).

The committee is not convinced, however, that available reports on such attitudes provide an adequate scientific basis for understanding either these changes in perception or the groups that are experiencing them. Reports from population-based telephone surveys, for example, typically provide information about what people think, but such surveys rarely can probe adequately about why respondents think the way they do. More information is needed in order to develop effective risk-benefit communication strategies on immunization and vaccine safety.

A deeper understanding of why and how people make decisions as they do is needed, but relying on impressions, assumptions, or any single research method (e.g., survey, focus group, mental modeling, decision analysis) will be too limited. Therefore, the committee recommends that an appropriate panel of multidisciplinary experts be convened by the Department of Health and Human Services. It would develop a comprehensive research strategy for knowledge leading to the optimal design and evaluation of vaccine risk-benefit communication approaches. By communication approaches, the committee is not referring to communication tools, such as vaccine information statements, lists of frequently asked questions (FAQs), or websites. Instead, the committee intends that this panel consider a larger definition of risk-benefit communication goals and strategies. In addition, this multidisciplinary panel



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