cation about the benefits and risks of immunization) was revised in the updated draft plan, and now reads: “support informed vaccine decision-making by the public, providers, and policy-makers” (HHS, 1994, 2008). Communication and risk communication (i.e., two-way communication about threats; Covello, 2008) are implicit in the reframing of the goal, and the language used seems timely and sensitive to public concerns about some aspects of vaccine policy, specifically the contentious area of childhood vaccination.

The goal’s pairing of information and decision making also highlights some major contemporary challenges in the national immunization enterprise. On the one hand, the increasing prominence of vocal opposition to vaccines and immunization accompanied by data indicating diminished trust in government public health agencies and vaccine manufacturers causes great concern that these may lead to lower vaccination rates and increased threat of vaccine-preventable diseases. On the other hand, the high-profile of controversies about the safety of vaccines for children may obscure the fact that immunization is important at every age, and unfortunately adult immunization rates in the United States are low for most vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) (NFID, 2008). Among the public, this is due to limitations in the knowledge or misperceptions about the purpose and effects of vaccination (Johnson et al., 2008). Among providers, barriers to immunization include the lack of an adult equivalent of the “well-child visit” in which immunization could be easily incorporated1 and inadequate insurance coverage (Flowers, 2007; Johnson et al., 2008).

The National Vaccine Plan could be enhanced if the vision seemingly expressed in the title of Goal 3 were described more fully in the plan and traced to its conclusion in the objectives and strategies of that goal. This would mean reconciling the apparent paradox of informed decision making and required vaccination, but more importantly, taking steps to ensure that contemporary communication about vaccines is fully informed by the broad societal context, uses available research and technology effectively, and meets the needs of all age groups and diverse populations. This chapter describes the contemporary societal context of the immunization enterprise, provides a succinct summary of stakeholder input on Goal 3 with references to relevant literature, and communicates two recommendations on priority actions related to this goal.

1

Medicare Part B covers a one-time preventive physical exam within the first 12 months of enrollment, which includes education and counseling about preventive services such as immunizations. However this one-time service is not widely used (fewer than 3 percent of Medicare enrollees) and does not cover the full adult population in need (HHS, 2009).



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