and understanding the range of stakeholder concerns about the childhood immunization schedule and its safety. To gain a fuller understanding of this system, the committee developed a strategy to gather and analyze stakeholder concerns, which included a review of the existing literature, listening to public testimony, and soliciting comments on a commissioned paper.


Given the committee’s charge, the first step was to identify stakeholders whose concerns focused on the safety of the immunization schedule rather than the safety of individual vaccines or nonsafety issues such as cost or convenience. To begin, the committee consulted the list of stakeholders from the 2008 Institute of Medicine (IOM) report Initial Guidance for an Update of the National Vaccine Plan: A Letter Report to the National Vaccine Program Office (IOM, 2008), which is also referenced in the 2010 National Vaccine Plan of the U.S. Department of Health and Human Services. As a second step, the committee categorized the extensive list of stakeholders by their general interest in immunization (Box 4-1).

BOX 4-1
Stakeholders in the U.S. National Vaccine System

  • Academic researchers
  • Advocacy groups
  • Federal government agencies, departments, and federal advisory committees
  • General public (including parents)
  • Health care system and providers
  • International organizations
  • Media
  • Nongovernmental organizations
  • Philanthropic organizations
  • State, local, and tribal governments and public health agencies
  • Travel industry
  • Vaccine distributors
  • Vaccine industry
  • Vaccine investors

SOURCES: IOM (2008) and adapted from the 2010 National Vaccine Plan (

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