Reforming the Vaccine Injury Compensation Program: balancing victims’ rights with public health stability
Nearly four decades into existence, the Vaccine Injury Compensation Program (VICP) remains the built-in path for people who believe they have been harmed by a vaccine to seek redress. The program was created in 1986 through the National Childhood Vaccine Injury Act to resolve vaccine injury claims without threatening the nation’s vaccine supply, which had come under pressure as manufacturers faced rising liability from reactions to the old whole-cell pertussis vaccine.
Under the system, a claim is filed to be heard by a special master in the U.S. Court of Federal Claims. The Health and Human Services secretary is named as the defendant and is represented by the Department of Justice. Doctors who work for HHS review medical records and advise on whether the vaccine likely caused the injury. Some injuries are listed for automatic compensation, while others go through hearings to determine causation. Awards are paid from a dedicated trust fund, financed by a 75-cent excise tax on each dose of covered vaccine, with petitioners’ attorneys paid from the same fund regardless of outcome.
The scholar who has written about this program for 15 years argues that the system has evolved far more slowly than the vaccines and injuries it covers. While vaccines remain among the safest and most cost-effective medical interventions, a subset of people do experience harm, and the program was designed to deliver fair compensation while shielding vaccine manufacturers from a flood of lawsuits that could threaten vaccine availability.
Despite its enduring purpose, the law has not kept pace with changing public health needs. Notable gaps include a relatively small pool of eight special masters handling a rising caseload, a damages cap of $250,000 that hasn’t kept up with inflation, and a three-year statute of limitations that leaves some potential claimants outside the window. The program’s reach has expanded gradually: it now covers vaccines administered during pregnancy, but still does not cover vaccines solely for adults, such as shingles. Claims related to COVID-19 vaccines are handled in a separate system for emergency countermeasures, a division some advocates say should be incorporated into the main program. Reform proposals—described as bipartisan “friendly amendments” by supporters—have gained some traction but remain politically challenging.
The debate over how to reform the VICP is nuanced. The simplest path would be for Congress to enact targeted amendments, a process that can be slow and uncertain. Some observers warn that even modest changes could ripple through the system in unforeseen ways. Others push for broader changes that would add new injuries to the list or alter how vaccines are recommended, potentially redirecting more claims away from vaccine court and into regular courts. Such shifts could fundamentally alter incentives and the structure of vaccine safety oversight.
A prominent policy question concerns whether to expand the list of presumed injuries—such as autism—despite historically inconsistent scientific support. The vaccine court previously concluded that autism was not a vaccine injury after an extensive review process. Expanding the roster would require a rigorous, transparent review and could provoke fierce debate among scientists, clinicians and public health officials.
There are also calls to give more authority to the Advisory Committee on Immunization Practices to withdraw or adjust vaccine recommendations, which could influence whether certain vaccines remain eligible for compensation under the program. In parallel, some advocates support moving claims from the VICP to regular courts, shifting the burden of proof and potentially changing who bears responsibility.
Political and public health stakeholders are watching closely. The stakes are high: reform could improve fairness and efficiency for claimants without undermining vaccine safety and supply, or it could complicate public health protections if not carefully designed. The argument, at its core, is about balancing accountability and access to compensation with the need to maintain a robust vaccination program that protects the public.
A concrete development cited in the coverage of this topic is a recent move by the Department of Health and Human Services to revive a childhood vaccine safety task force, in response to litigation from anti-vaccine activists. The step signals continued engagement with safety oversight and suggests reform efforts may favor procedures grounded in expert analysis rather than sweeping structural change.
In summary, the Vaccine Injury Compensation Program remains a central, contested feature of the U.S. vaccine landscape. Reform advocates emphasize the need to modernize funding, expand coverage, and streamline processes while keeping a shield against disruption to vaccine supply. Those who favor a cautious approach argue that meaningful improvements should strengthen both victims’ rights and public health, preserving trust in vaccines and the systems designed to protect those who are injured.
Key takeaways
– The VICP was established to protect vaccine supply while ensuring compensation for injuries.
– It operates through a no-fault process funded by a per-dose tax, with decisions made by special masters and reviewed by the Court of Federal Claims.
– The program has gradually expanded but still omits some vaccines, notably adult-only vaccines, and uses a separate track for COVID-19 vaccines.
– Reform proposals range from targeted amendments to broader structural changes, each with potential public health implications.
– Ongoing developments, including the revival of a childhood vaccine safety task force, indicate continued attempts to balance safety oversight with practical changes to the program.
Positive angle
– Thoughtful modernization could improve fairness and efficiency for claimants while reinforcing public confidence in vaccination programs and their safety monitoring systems. By aligning compensation timelines, updating inflation-adjusted limits, and clarifying coverage across age groups, reforms could strengthen both victims’ rights and the resilience of public health.