Need for improved communication

Concerns are frequently raised about vaccines and immunization protocols by members of the general public and in the media. These concerns can be serious and are often misplaced. See the graphic below for some factors that may trigger public concerns.

We need to improve the quantity, quality and targeting of communication about vaccine safety if we are to increase acceptance of vaccination through improved awareness of the risks and benefits.

Challenges to effective communication

Challenges that need to be overcome with effective communication include among others:

Decline of childhood infections in high-income countries

The impressive decline in the rates and severity of childhood infections in high-income, industrialized countries during the twentieth century (see diagram) has effectively faded memories of the threats to health and life posed by once-common diseases such as measles, polio, pertussis, diphtheria and tetanus. The benefits of vaccination are no longer being reinforced by direct experience of the diseases that vaccines prevent.

Crude death rate* for infectious diseases – United States, 1900–1996**

* Per 100,000 population per year.

** Adapted from Armstrong GL, Conn LA, Pinner RW. Trends in infectious disease mortality in the United States during the 20th century. JAMA 1999:281; 61–6.

§ American Water Works Association. Water chlorination principles and practices: AWWA manual M20. Denver, Colorado: American Water Works Association, 1973.

Parents view that infectious disease is a thing of the past

Some parents in countries such as the USA and western Europe may feel that exposing a child to even a small potential risk from vaccination is unnecessary because they assume that infectious diseases are 'a thing of the past'. Parents have to be made aware of the consequences of their decisions not to vaccinate their children – if herd immunityHerd immunityA population with a high proportion of individuals with immunity to a particular pathogen, as a consequence of immunization or infection and recovery, may confer protection from infection on the small proportion of its non-immune members because there are too few susceptible people in the 'herd' for the infection to circulate. falls, the disease may re-emerge and spread through the population. This is what happened when concerns about the safety of the vaccine against measles, mumps and rubella (MMR) in the 1990s led to a sharp decline in vaccine uptake in the UK, followed by an increase in cases of measles, mumps and rubella.

Introduction of new vaccines

New vaccines are being introduced and a wider range of ages is being targeted for routine immunization. For example, teenagers in some countries are offered vaccines against human papillomavirus and bacterial meningitisBacterial meningitisInflammation of the membranes that surround the brain and spinal cord; caused by a bacterial infection.. Likewise, elderly people are encouraged to seek vaccination against influenza. In the developing world, women of childbearing age are targeted for vaccination with at least two doses of tetanus toxoid to protect themselves and their newborns from the disease.

Communication with different age groups requires different skills and the use of age-appropriate language. Staff needs to be prepared and trained to deal with the different target groups and to expect different adverse events (e.g. immunization anxiety may occur at a different frequency in different age groups).

Transparency and accountability

Finally, good communication to all relevant stakeholders is essential to keep the trust of the public towards a transparent and accountable immunization service.