concept of community immunity, at some level, many parents understand that widespread efforts to immunize children protect both vaccinated and unvaccinated children. The protection offered by community immunity may mislead some parents who decline all immunizations and allow them to believe that childhood vaccines are unnecessary, when vaccination in the community has actually shielded their children from serious infectious diseases (Chen et al., 2005). Finally, some parents are concerned about their child’s risk of complications of immunization with a vaccine on the basis of family history or the child’s medical conditions, and, decide to delay or omit immunizations. Children with certain predispositions are more likely to suffer adverse events from vaccines than are those without that risk factor, such as children with immunodeficiencies who are at increased risk for developing invasive disease from a live virus vaccine (IOM, 2012). The committee recognizes that while the CDC has identified persons who should not be vaccinated because of certain symptoms or conditions, some stakeholders question if that list is complete. Potentially susceptible populations may have an inherited or genetic susceptibility to adverse reactions, and further research in this area is ongoing.

Thus, the committee understands that parental concerns are an expression of concern over and a way to care for their children’s health and well-being. However, the committee also recognizes that a growing pattern of delaying or declining all or some vaccines has already contributed to outbreaks of vaccine-preventable diseases and mortality across the United States. These disease outbreaks place children and adults at risk, including children who are only partially immunized or experience waning immunity. Immunized children and adults in the community represent another group of stakeholders, and the committee recognizes the concern about declining community immunity as well.

Research from telephone surveys and other methods reviewed in this chapter typically provide information about what participants think, but such surveys usually cannot probe into why respondents think the way they do. To develop an effective risk-benefit communication strategy, more detailed research is warranted. The committee concludes that parents and health care professionals would benefit from the availability of more comprehensive and detailed information with which to address parental concerns about the safety of the vaccines in the immunization schedule. Such information should clearly address vaccine-preventable diseases, the risks and benefits of immunizations, and the safety of the vaccines in the immunization schedule.

At present, as described in Chapter 5, relatively few studies have directly assessed the immunization schedule. Although health care professionals have a great deal of information about individual vaccines, they have much less information about the effects of immunization with multiple



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