all health care providers who immunize children should receive training in communication with the goal of improving provider-parent communication of immunization issues (Gust et al., 2008a).

Apart from the need for training in communication, the committee reviewed several recent studies that identified the need for improved communication about vaccine safety by the scientific community and public media (Gust et al., 2006, 2008b; Levi, 2007). Gust et al. (2006) suggested that enhanced communication training for providers should increase their willingness to engage parents in discussions of vaccine and immunization issues.

Studies are also under way to develop techniques to identify categories of vaccine hesitancy and develop tools to assist providers as they communicate with parents who express concerns about vaccines (Diekema, 2012). The 2002 IOM report Immunization Safety Review: Multiple Immunizations and Immune Dysfunction recommended that an appropriate panel of multidisciplinary experts be convened to “develop a comprehensive research strategy for knowledge leading to the optimal design and evaluation of vaccine risk-benefit communication approaches” (IOM, 2002, p. 16). Furthermore, the 2010 IOM study described in the report Priorities for the National Vaccine Plan emphasized that communication must reflect current research and strategies (IOM, 2010).

Government agencies and professional organizations play a key role in providing parents with information on vaccines and immunizations. However, the public erosion of trust in government and the suboptimal effectiveness of public health campaigns on immunizations in particular highlight the challenges of mounting an effective strategy of communication about the childhood immunization schedule. This challenge is exacerbated by the fact that public decision making as it applies to vaccines is driven not only by scientific and economic evidence but also by political, psychological, and sociocultural factors.

CONCLUSIONS

From the literature review and the comments received online and during the public sessions, the committee determined that although the majority of parents adhere to the ACIP-recommended immunization schedule for their children, many parents remain concerned that their children may face unnecessary risks because of the timing and number of vaccinations.

The decisions that parents make about the risk of disease versus the risk of immunization are attributable, in part, to the significant and sustained declines in most vaccine-preventable diseases that have resulted in the community immunity (also known as herd immunity) that vaccination policy has achieved. Although some parents may not fully understand the



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