Drug Safety

, Volume 35, Issue 11, pp 1053–1059 | Cite as

The Globalization of Risk and Risk Perception

Why We Need a New Model of Risk Communication for Vaccines
  • Heidi Larson
  • Pauline Brocard Paterson
  • Ngozi Erondu
Review Article


Risk communication and vaccines is complex and the nature of risk perception is changing, with perceptions converging, evolving and having impacts well beyond specific geographic localities and points in time, especially when amplified through the Internet and other modes of global communication.

This article examines the globalization of risk perceptions and their impacts, including the example of measles and the globalization of measles, mumps and rubella (MMR) vaccine risk perceptions, and calls for a new, more holistic model of risk assessment, risk communication and risk mitigation, embedded in an ongoing process of risk management for vaccines and immunization programmes. It envisions risk communication as an ongoing process that includes trust-building strategies hand-in-hand with operational and policy strategies needed to mitigate and manage vaccine-related risks, as well as perceptions of risk.


Measle Risk Perception Risk Communication Immunization Programme Vaccine Coverage 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



No sources of funding were used to prepare this manuscript. Heidi Larson has received grants from the Bill & Melinda Gates Foundation, and an honorarium from Pfizer for lecturing (a one-off). Pauline Brocard Paterson has worked as a Research Fellow with Heidi Larson on the Bill & Melinda Gates Foundation grant. Ngozi Erondu has no conflicts of interest to declare.

This paper is part of a theme issue co-edited by Priya Bahri, European Medicines Agency, UK, and Mira Harrison-Woolrych, New Zealand Pharmacovigilance Centre, New Zealand, and no external funding was used to support the publication of this theme issue.


  1. 1.
    National Research Council. Improving risk communication. Washington, DC: National Academy Press, 1989Google Scholar
  2. 2.
    Fischhoff B. Risk perception and communication unplugged: twenty years of progress. Risk Analysis 1995; 15 (2): 137–45PubMedCrossRefGoogle Scholar
  3. 3.
    Slovic P. Perception of risk. Science 1987; 236: 280–5PubMedCrossRefGoogle Scholar
  4. 4.
    General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). Preventing and managing adverse reactions: benefit and risk communication. MMWR Recomm Rep 2011; 60 (2): 1–64Google Scholar
  5. 5.
    Leach M, Fairhead J. Vaccine anxieties: global science, child health and society. London: Earthscan, 2007Google Scholar
  6. 6.
    Wildavsky A, Dake K. Theories of risk perception: who fears what and why?. Daedalus 1990; 119 (4): 41–60Google Scholar
  7. 7.
    Kaler A. Health interventions and the persistence of rumour: the circulation of sterility stories in African public health campaigns. Soc Sci Med 2009; 68: 1711–9PubMedCrossRefGoogle Scholar
  8. 8.
    Evans G, Bostrom A, Johnston RB, et al., editors. Risk communication and vaccination. Washington, DC: Institute of Medicine, National Academy Press, 1997Google Scholar
  9. 9.
    Pidgeon N, Kasperson R, Slovic P. The social amplification of risk. London: Cambridge University Press, 2003CrossRefGoogle Scholar
  10. 10.
    WHO. World health report: reducing risks, increasing healthy lives. Geneva: WHO, 2002Google Scholar
  11. 11.
    Sandman PM. Responding to community outrage: strategies for effective risk communication. Fairfax (VA): American Industrial Hygiene Association, 1993CrossRefGoogle Scholar
  12. 12.
    Sandman PM. Hazard versus outrage in the public perception of risk. In: Covello VT, McCallum DB, Pavlova MT, editors. Effective risk communication: the role and responsibility of government and nongovernment organizations. New York (NY): Plenum Press, 1989: 45–9CrossRefGoogle Scholar
  13. 13.
    Slovic P, Finucane ML, Peters E, et al. Risk as analysis and risk as feelings: some thoughts about affect, reason, risk, and rationality. Risk Anal 2004; 24 (2): 311–22PubMedCrossRefGoogle Scholar
  14. 14.
    Yahya M. Polio vaccines — difficult to swallow: the story of a controversy in Northern Nigeria. IDS working paper 261 [online]. Available from URL: http://www.ids.ac.uk/files/Wp261.pdf [Accessed 2012 Apr 17]
  15. 15.
    Jegede AS. What led to the Nigerian boycott of the polio vaccination campaign?. PLOS Medicine 2007 Mar; 4(3): e73PubMedCrossRefGoogle Scholar
  16. 16.
    Obregon R, Waisbord S. The complexity of social mobilization in health communication: top-down and bottom-up experiences in polio eradication. J Health Commun 2010; 15: 25–47PubMedCrossRefGoogle Scholar
  17. 17.
    Larson H, Brocard P, Garnett G. The India HPV vaccine suspension. Lancet 2010; 376 (9741): 572–3PubMedCrossRefGoogle Scholar
  18. 18.
    Gangarosa EJ, Galazka AM, Wolde CR, et al. Impact of anti-vaccination movements on pertussis control: the untold story. Lancet 1998; 351: 356–61PubMedCrossRefGoogle Scholar
  19. 19.
    WHO. EPI brief (February 2012). Geneva: WHO, 2012Google Scholar
  20. 20.
    WHO/UNICEF. Joint statement: global plan for reducing measles mortality 2006–2010 [online]. Available from URL: http://www.who.int [Accessed 2012 Mar 27]
  21. 21.
    Mnookin S. The panic virus. New York: Simon and Shuster, 2011Google Scholar
  22. 22.
    Elliman D, Bedford H. MMR: where are we now?. Arch Dis Child 2006; 92 (12): 1055–7CrossRefGoogle Scholar
  23. 23.
    Larson H, Heymann D. Public health response to influenza A (H1N1) as an opportunity to build public trust. JAMA 2010; 303 (3): 271–2PubMedCrossRefGoogle Scholar
  24. 24.
    Betraying the public over nvCJD risk [editorial]. Lancet 1996; 348 (9041): 1529Google Scholar
  25. 25.
    UK Department of Health. NHS immunisation statistics, England: 1997–1998 (table 2) [online]. Available from URL: http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/StatisticalWorkAreas/Statisticalhealthcare/DH_4016221 [Accessed 2012 Mar 12]
  26. 26.
    UK Department of Health. NHS immunisation statistics, England: 2010–11. Immunisations received by first and second birthday [online]. Available from URL: http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles/immunisation/nhs-immunisation-statistics-england-2010-11 [Accessed 2012 Mar 12]
  27. 27.
    Offit P, Coffin S. Communicating science to the public: MMR vaccine and autism. Vaccine 2003; 22 (1): 1–6PubMedCrossRefGoogle Scholar
  28. 28.
    Madsen KM, Hviid A, Vestergaard M, et al. A population-based study of measles, mumps, and rubella vaccination and autism. N Engl J Med 2002; 347: 1477–82PubMedCrossRefGoogle Scholar
  29. 29.
    Wilson K, Mills E, Ross C, et al. Association of autistic spectrum disorder and the measles, mumps, and rubella vaccine: a systematic review of current epidemiological evidence. Arch Pediatr Adolesc Med 2003; 157 (7): 628–34PubMedCrossRefGoogle Scholar
  30. 30.
    Honda H, Shimizu Y, Rutter M. No effect of MMR withdrawal on the incidence of autism: a total population study. J Child Psychol Psychiatr 2005; 46 (6): 572–9CrossRefGoogle Scholar
  31. 31.
    Parker SP, Schwartz B, Todd J, et al. Thimerosal-containing vaccines and autistic spectrum disorder: a critical review of published original data. Pediatrics 2004; 114 (3): 793–804PubMedCrossRefGoogle Scholar
  32. 32.
    Katz S. Has the measles-mumps-rubella vaccine been fully exonerated?. Pediatrics 2006; 118 (4): 1744–5PubMedCrossRefGoogle Scholar
  33. 33.
    Kirkland A. Credibility battles in the autism litigation. Soc Stud Sci 2012; 42 (2): 237–61PubMedCrossRefGoogle Scholar
  34. 34.
    Wakefield AJ. Callous disregard: autism and vaccines — the truth behind a tragedy [online]. Available from URL: http://www.callous-disregard.com/ [Accessed 2012 Apr 24]
  35. 35.
    Pearce A, Law C, Elliman D, et al., Millennium Cohort Study Child Health Group. Factors associated with uptake of measles, mumps, and rubella vaccine (MMR) and use of single antigen vaccines in a contemporary UK cohort: prospective cohort study. BMJ 2008; 226 (7647): 754–7CrossRefGoogle Scholar
  36. 36.
    Casiday R, Cresswell T, Wilson D, et al. A survey of UK parental attitudes to the MMR vaccine and trust in medical authority. Vaccine 2006; 24 (2): 177–84PubMedCrossRefGoogle Scholar
  37. 37.
    Casiday R. Children’s health and the social theory of risk: insights from the British measles, mumps and rubella (MMR) controversy. Soc Sci Med 2007; 65 (5): 1059–70PubMedCrossRefGoogle Scholar
  38. 38.
    Burgess DC, Burgess MA, Leask J. The MMR vaccination and autism controversy in United Kingdom 1998–2005: inevitable community outrage or a failure of risk communication?. Vaccine 2006; 24 (18): 3921–8PubMedCrossRefGoogle Scholar
  39. 39.
    Messenger S. Melanie’s marvellous measles. Australia: Nature Matters, 2010Google Scholar
  40. 40.
    Black S, Rappuoli R. A crisis of public confidence in vaccines. Sci Transl Med 2010; 2 (61): 61mr1CrossRefGoogle Scholar
  41. 41.
    Shetty P. Experts concerned about vaccination backlash. Lancet 2010 Mar 20; 375 (9719): 970–1PubMedCrossRefGoogle Scholar
  42. 42.
    Poethko-Müller C, Ellert U, Kuhnert R, et al. Vaccination coverage against measles in German-born and foreign-born children and identification of unvaccinated subgroups in Germany. Vaccine 2009 Apr 28; 27 (19): 2563–9PubMedCrossRefGoogle Scholar
  43. 43.
    CDC. Measles: United States, January–May 20, 2011. MMWR 2011; 60 (20): 666–8 [online]. Available from URL: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6020a7.htm?s_cid=mm6020a7_w [Accessed 2012 Mar 22]Google Scholar
  44. 44.
    WHO. Weekly epidemiological record. Progress in global measles control, 2000–2010 [online]. Available from URL: http://www.who.int/wer/2012/wer8705.pdf [Accessed 2012 Mar 27]
  45. 45.
    WHO. Weekly epidemiological record. Measles outbreaks and progress towards meeting measles pre-elimination goals: WHO African region, 2009–2010 [online]. Available from URL: http://www.who.int/wer/2011/wer8614.pdf [Accessed 2012 Mar 27]
  46. 46.
    WHO. Global elimination of measles: report by the Secretariat. WHO Executive Board, 125th Session; 2009 April 16. Report No:EB125/4 [online]. Available from URL: http://apps.who.int/gb/ebwha/pdf_files/EB125/B125_4-en.pdf [Accessed 2012 Aug 28]
  47. 47.
    Woonink F. Objections against vaccination: the perspective of those who refuse. National Institute for Public Health and the Environment, the Netherlands, 2009 [online]. Available from URL: http://www.rivm.nl [Accessed 2012 Sept 18]
  48. 48.
    CDC. Measles: United States, 2011. MMWR 2012; 61 (15): 253–7 [online]. Available from URL: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6115a1.htm#tab [Accessed 2012 Apr 21]Google Scholar
  49. 49.
    Burnett RJ, Larson HJ, Moloi MH, et al. Addressing public questioning and concerns about vaccination in South Africa: a guide for healthcare workers. Vaccine 2012; 30 Suppl. 3: C72–8PubMedCrossRefGoogle Scholar
  50. 50.
    Waisbord S, Larson H. Why invest in communication for immunization? Evidence and lessons learned. A joint publication of the Health Communication Partnership, Johns Hopkins Bloomberg School of Public Health (Baltimore) and UNICEF (New York) [online]. Available from URL: http://www.globalhealthcommunication.org/tool_docs/21/why_invest_in_communication_for_immunization.pdf [Accessed 2012 Mar 27]
  51. 51.
    Larson H, Cooper LZ, Eskola J, et al. Addressing the vaccine confidence gap. Lancet 2011; 378 (9790): 526–35PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2012

Authors and Affiliations

  • Heidi Larson
    • 1
  • Pauline Brocard Paterson
    • 1
  • Ngozi Erondu
    • 1
  1. 1.Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK

Personalised recommendations