With the exception of calling for vaccine information on risks and benefits to be provided to parents and patients, the 1986 statute2 makes no mention of the National Vaccine Program (and thus, the National Vaccine Program Office’s [NVPO’s]) role in communication about immunization in general and about risks in particular. However, societal trends and the public perception of vaccines over the years since 1986 have made communication a central function and need. These factors clearly contributed to NVPO and its partners’ reframing of Goal 3 (compared to the 1994 version) in the draft update of the National Vaccine Plan, and include the following:

  • Public complacency about vaccine-preventable diseases driven by the great success of earlier immunization programs and resultant declines in or elimination of such diseases (e.g., polio) as evident in low rates of vaccine-preventable diseases,

  • Change in the patient-clinician relationship, including patients who are more engaged participants in health care,3

  • Greater interest and dialogue in the public arena about the benefits, risks, and areas of scientific uncertainty about vaccines (among other medical interventions),

  • Change in how people communicate, and how they access and exchange information about all topics, including health in general and immunization in particular4 (e.g., tools such as the Internet offer opportunities for both greater knowledge and greater confusion or misinformation), and

  • Hesitancy to receive vaccines and skepticism about their safety, much of which may be influenced by some representations of vaccination in the mass media, by the new media-heightened profile of individuals and groups opposed to childhood immunization or to immunization in general5 and by the social amplification of risk (Fischoff, 1995) fueled by several well-publicized vaccine injury compensation cases.

As discussed in Chapter 2, monitoring and assuring6 vaccine safety are the responsibility of several government agencies, most notably the Food


National Childhood Vaccine Injury Act, Public Law 99-660, 42 U.S.C. 300aa-1, § 2101 1986.


Examples include the safety and quality movements in health care; the emergence of; consumer interest in and questions about professional and scientific conduct and conflicts of interest; public awareness of the effects of political processes on the scientific enterprise; and the proliferation of health-related information on the World Wide Web.


This has been substantially documented by the Pew Internet & American Life Project.


Such individuals and groups constitute a diverse array of viewpoints and motivations.


Refers to the assurance function of public health (one of three core functions [IOM, 1988]).

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