uncertainty of other risks about which less is known. In particular, some workshop participants suggested that provision for exemptions for mandatory immunizations in all states on philosophical grounds would improve vaccine risk communication efforts and would not seriously undermine efforts to raise coverage levels.
Introduction and Background
Health risk communication has traditionally consisted of messages designed to encourage behavior that reduces individual and societal risks (e.g., smoking cessation and seat-belt use). Increasingly, risk communication, including health risk communication, is seen as an interactive process of the exchange of information and opinion among individuals, groups, and institutions (National Research Council, 1989). Risk communication has a 20-year history as a field of study (Fischhoff, 1995), arising initially out of controversies over environmental issues between, for example, residents of a community and a company building a potentially polluting plant nearby. Although health risk communication has been an active area of research and practice for several decades, the science and practice of vaccine risk communication are not yet well developed. Much of the complexity is due to a situation, as with any intervention in preventive medicine, in which healthy individuals are exposed to a medication or medical test in the interest of unknown future benefits. The purpose of the workshop summarized in this report was to allow for discussion among experts in risk communication theory and practice in general and those concerned with vaccine risk communication issues.
According to the 1989 NRC report Improving Risk Communication, risk communication "can be considered successful only to the extent that it, first, improves or increases the base of accurate information used by decision makers, be they government officials, industry managers, or individual citizens and, second, satisfies those involved that they are adequately informed within the limits of available knowledge" (National Research Council, 1989, p. 8). The benefits of good risk communication include improved decisionmaking, both individually and collectively, and the development of productive working relationships among diverse interest groups.1
Risk communication can serve one or more of the following purposes: (1) advocacy, to persuade people to take a particular action; (2) education, to give people enough information so that they can make their own decisions effectively;