risks of the vaccine against them. Studies have also addressed issues of mandatory vaccination, informed consent, individual rights versus societal welfare, and people's trust in information providers.

Information on vaccine benefits and risks is currently limited in availability and scope. Information available to consumers today includes the vaccine information statements issued by the Centers for Disease Control and Prevention (CDC), material from other federal agencies such as the Food and Drug Administration (FDA) and National Institutes of Health (NIH), manufacturers' package inserts that accompany vaccines, oral communications from health care providers, and information provided by a variety of nonprofit and consumer organizations.

Three major themes emerged during the workshop. First, risk communication is a dynamic process in which many participate, and these individuals are influenced by a wide range of circumstances, interests, and information needs. Effective risk communication depends on the providers' and recipients' understanding more than simply the risks and benefits; background experiences and values also influence the process (Zeckhauser, 1973). Good risk communication recognizes a diversity of form and context needs in the general population. Both the method and content of risk communication should reflect the goals of the communication, which could include advocacy, education, and development of a decisionmaking partnership (in any combination).

Second, the goal that all parties share regarding vaccine risk communication should be informed decisionmaking. Consent for vaccination is truly ''informed'' when the members of the public know the risks and benefits and make voluntary decisions. The discussion of mandatory vaccination at the workshop suggested that it may interfere with informed consent and may damage trust and deter effective communication, and thus needs to be carefully weighed against its benefits.

Finally, there is often uncertainty about estimates of the risk associated with vaccination. Risk communication is more effective when this uncertainty is stated and when the risks are quantified as much as science permits. Trust is a key component of the exchange of information at every level, and overconfidence about risk estimates that are later shown to be incorrect contributes to a breakdown of trust among public health officials, vaccine manufacturers, and the public. Continued research to improve the understanding of vaccine risks is critical to maximizing mutual understanding and trust.

Workshop participants suggested a number of ways to improve vaccine risk communications, including: tailoring it to audience needs, abilities, and interests; improving the format and structure of printed material; presenting more balanced information; adding references and bibliographies to communications; and providing estimates of the likelihood of risks when known, while stating the



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