vaccine safety, the federal government has already prioritized the engagement of stakeholders in multiple activities, as detailed in the 2010 National Vaccine Plan and implementation efforts, as well as the Centers for Disease Control and Prevention’s Immunization Safety Office scientific agenda (CDC, 2011; HHS, 2010). However, an effective national vaccine program will require more complete information on stakeholder concerns about the safety of the immunization schedule, the severity of vaccine-preventable diseases, individual- and population-level immunization rates, vaccine efficacy, and the delivery and supply of vaccines recommended in the childhood immunization schedule. Improved communication between public health authorities and parents requires improvements to the clarity of the information provided, as well as the building of trust and the use of a systematic approach to elicit public concerns. Further research into the type of questions that parents seek to answer by the use of the scientific methods of social, behavioral, and decision science is indicated.

On the basis of the committee’s literature review and public testimony, the committee strongly endorses the need for research to understand the public’s knowledge, beliefs, and concerns about vaccines and vaccine-preventable diseases in particular, which is a key strategy in the 2010 National Vaccine Plan (HHS, 2010). It must be acknowledged that the methods used in most immunization studies do not permit a detailed analysis of the impact of parental concerns on the decision to immunize their children. Although the committee found that the largest safety concerns exist among a subset of parents, the concerns of multiple stakeholders should be included as part of the efforts of the National Vaccine Program Office (NVPO). For example, health care providers have much knowledge about individual vaccines but less information about the effects of administering multiple vaccines at a single visit or the timing of the immunizations.

Recommendation 4-1: The committee recommends that the National Vaccine Program Office systematically collect and assess evidence regarding public confidence in and concerns about the entire childhood immunization schedule, with the goal to improve communication with health care professionals, and between health care professionals and the public regarding the safety of the schedule.

Summary of Scientific Findings

The committee’s findings and conclusions about the safety of the immunization schedule on the basis of the information in the scientific literature are presented in Chapter 5. The committee encountered two major issues. First, the concept of the immunization “schedule” is not well developed in the scientific literature. Most vaccine research focuses on the health outcomes associated with single immunizations or combinations of vaccines



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