Public Trust in Vaccines: Defining a Research Agenda


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Public Trust in Vaccines

Recent headlines tell the story. “Measles rates triple in 2013 due to unvaccinated communities.”1 “Health officials urge vaccination in response to multiple chickenpox outbreaks.”2 Over the past half-decade, there have been scores of outbreaks of vaccine-preventable diseases caused by deliberately unvaccinated children.

After virtually eliminating many serious and sometimes deadly infectious diseases, the U.S. public health system has seen a recent increase in vaccine-preventable diseases. Growing numbers of parents are either delaying or selectively administering these vital immunizations—and a few are choosing not to vaccinate their children at all.3 These trends reflect diminished public trust in the system that protects all of us against the timeless threat of communicable diseases—and the result is dangerous and costly outbreaks that are poised to grow worse in the future.

There is evidence that for some parents simply providing accurate information about vaccines is not enough. How can physicians, nurses, and other health professionals engage the growing ranks of “vaccine-hesitant” parents? And what is at stake if our public health and scientific leadership do not respond to this worrisome turn of events?

These questions get to the crux of the reshaped communication landscape we all face. It is no longer enough for scientists and federal institutions to issue recommendations; they also need to develop evidence-based communication strategies and implement them in consultation with those whom they are committed to protect. The expectation that experts will engage in a dialogue with citizens was addressed in a 2010 report of the American Academy of Arts and Sciences, Do Scientists Understand the Public?, which concluded that just as the public must be educated on scientific topics, so too must the scientific community be educated on public attitudes and opinions.4

Taking the 2010 report as its inspiration, the American Academy convened a workshop of leading researchers, practitioners, and policy-makers across a range of disciplines, from anthropology and communications to pediatric medicine and public health. The goal was to delineate the types of research that would yield insights to inform evidence-based strategies for effective communication about childhood vaccination. The workshop, “Public Trust in Vaccines: Defining a Research Agenda,” was held on September 26–27, 2013.

As the cochairs of the workshop, we are indebted to the workshop participants and to the Academy staff who assisted with the organization of the workshop and the preparation of this report, notably John Randell, Dorothy Koveal, Nathan Yozwiak, Kimberly Durniak, Catherine McPherson, Hilary Dobel, and Phyllis Bendell. Madeline Drexler (Brandeis University and Harvard School of Public Health) served as rapporteur and provided an initial write-up of the workshop. We would also like to thank Duke University School of Medicine Dean Nancy Andrews and Institute of Medicine President Harvey Fineberg for their support and encouragement.

The Academy gratefully acknowledges support for the Public Trust in Vaccines project from the Burroughs Wellcome Fund, CVS Caremark, the American Academy of Pediatrics, Vax Northwest, and the Hellman Foundation.

Barry R. Bloom
Harvard School of Public Health

Edgar K. Marcuse
University of Washington

Seth Mnookin
Massachusetts Institute of Technology


1 Centers for Disease Control and Prevention, “Measles—United States, January 1-August 24, 2013,” Morbidity and Mortality Weekly Report (MMWR) 62 (36) (September 13, 2013): 741–743,

2 “Largest Chickenpox Outbreak in the U.S. Hits Vigo County in Indiana,” Huffpost Healthy Living, November 27, 2011,

3 Douglas J. Opel et al., “Social Marketing as a Strategy to Increase Immunization Rates,” Archives of Pediatrics and Adolescent Medicine 163 (5) (May 2009): 432–437; doi: 10.1001/archpediatrics.2009.42.

4 Chris Mooney, Do Scientists Understand the Public? (Cambridge, Mass.: American Academy of Arts and Sciences, 2010),