KEYWORD1:
immunization, vaccination, risk, communication, outrage, hazard, activists

BACKGROUND:
Proponents of childhood immunizations have been facing an onslaught of criticism from vaccine critics. Agencies promoting vaccination can do much to reduce public outrage over perceptions of vaccine risk by understanding certain principles of risk communication. Peter Sandman describes the difference between Hazard (technical risk) and Outrage (public concern) and defines Risk as the sum of Hazard and Outrage. Understanding these two aspects of Risk can help improve communication techniques.

OBJECTIVE:
To improve understanding of the dynamics of controversy over vaccine risk and explore methods of resolving those controversies.

METHOD:
We studied various aspects of the ways in which groups and individuals critical of vaccination have interacted with agencies promoting vaccinations, and applied Peter Sandman's theories about risk communication to these interactions as a model for understanding the dynamics of communication failures, and as a tool for suggesting ways to improve these interactions, improve communication, and reduce hostility on both sides.

RESULT:
Many issues raised by vaccine safety activists are really outrage that leads to concern over hazard (risk of vaccine adverse events), rather than concern over hazard leading to outrage. Improving communication and trust between vaccine proponents and vaccine critics requires that vaccine proponents address outrage issues. For instance, an issue that generates outrage is a breakdown in trust when an agency is found to have understated a risk. An example is the loss of trust in the British National Health Service after the "Mad Cow Disease" debacle, which fueled the MMR controversy in the UK.

CONCLUSION:
Vaccine experts, when they talk about Risk, focus on Hazard, and tend to ignore Outrage. Communicating effectively with vaccine critics requires that Outrage be acknowledged and addressed.
LEARNINGOBJECTIVES:
To teach the difference between Hazard and Outrage, and teach some principles of how to address and reduce public Outrage over vaccine safety.