Clinical Notes Contain Limited Documentation of Shared Decision Making for Colorectal Cancer Screening Decisions.

Vaccination remains one of the most effective public health interventions for preventing infectious diseases and reducing global morbidity and mortality. Yet achieving and sustaining high vaccine uptake is never guaranteed. Communication—the transmission of information, ideas, and values through symbolic processes—plays a central role in shaping vaccine confidence, addressing hesitancy, and guiding public health behavior. Successful immunization campaigns, such as those targeting smallpox and polio, demonstrate how clear messaging, trusted institutions, and coordinated public health infrastructures can translate scientific advances into widespread population protection. Importantly, however, these successes were not driven by communication alone. The high transmissibility, visible symptoms, and severe consequences of these diseases created strong, shared perceptions of risk, which likely enhanced public receptivity to vaccination messages. In this sense, the diseases themselves functioned as powerful “signals” that reinforced the urgency and credibility of public health communication. By contrast, more recent vaccination efforts—most notably during the COVID-19 pandemic—have unfolded under conditions in which perceived risk has been more variable and, at times, contested. These differences highlight that the effectiveness of vaccine communication is shaped not only by message design and institutional trust but also by how populations perceive the threat posed by the disease itself. Additionally, the communication environment surrounding vaccines has become increasingly complex. The COVID-19 pandemic highlighted both the importance and the fragility of vaccine communication. Rapid scientific progress enabled the development of new vaccines in record time, yet the rollout occurred in a highly contested informational landscape. Digital media ecosystems accelerated the spread of misinformation and disinformation, political polarization shaped interpretations of public health guidance, and evolving scientific evidence created uncertainty that was often exploited by competing narratives. These dynamics contributed to declining trust in public health institutions in some contexts and revealed the limitations of traditional communication approaches that rely primarily on one-way dissemination of scientific information.