More than 72 million Americans have immune systems that cannot mount a protective response to vaccines, while others cannot safely receive certain vaccines at all. Their best protection is never being exposed to infectious diseases in the first place. Widespread vaccination is what reduces everyone’s exposure to dangerous pathogens and protects those who cannot protect themselves.
This reliance on widespread vaccination renders those who are immunocompromised sensitive to any erosion of public confidence in vaccines or disruption to their availability. Persistent pressure to weaken the National Vaccine Injury Compensation Program (VICP) endangers all Americans, but those who are immunocompromised have the most to lose.
VICP is designed to ensure that individuals who suffer a genuine vaccine injury have a streamlined path to compensation, one that sidesteps the unpredictability of the civil courts. The program has long supported injured patients, sustained the conditions that make vaccines available and affordable at scale, and maintained adequate vaccine production by reducing manufacturer exposure to endless lawsuits.
The program’s integrity depends on whether compensation follows the evidence, informed by the Vaccine Injury Table, which lists the injuries eligible for compensation. If the table is broadened without clear causal evidence due to claims unsubstantiated by science, resources will be stretched beyond what the VICP can realistically absorb and pay out. As a result, legitimate claimants will sit in the same pool as those with claims that are not supported by causal evidence. What’s worse, if these unsubstantiated claims don’t render VICP insolvent, as some legal scholars warn they will, awards to those who suffer from rare vaccine injuries, will be significantly reduced or delayed—or both.
If these efforts to flood the program with claims succeed, they have the potential to erode Americans’ confidence in vaccines. This public lack of confidence in safe and effective vaccines could further jeopardize those who depend on widespread community immunization to go about their daily lives. For the immunocompromised, particularly those unable to safely receive a live-attenuated vaccine, the immunity of those around them is a primary defense against life-threatening diseases. The immunocompromised community has already witnessed the recent, steady decline in vaccination rates and the notable uptick in vaccine exemptions. Further decline directly translates into an elevated infection risk for this population.
Congress has introduced the End the Vaccine Carveout Act, which claims to protect vaccine injury victims. But this bill would do the opposite, returning the industry to the litigation free-for-all of the pre-VICP era. We are concerned that vaccination rates will continue to drop. And, while vaccines have the potential to get more expensive for everyone, the highest costs will be borne by the immunocompromised who are so exposed to the consequences of others’ vaccine choices.
VICP exists to compensate Americans genuinely harmed by rare complications from vaccines. A program that efficiently and fairly compensates for injuries genuinely caused by vaccines and found to meet criteria informed by science is worth protecting. Improvements that strengthen the program, such as raising the compensation cap or streamlining the claims process, should absolutely be reviewed and considered. But expanding the list of eligible injuries to include conditions for which there is no evidence of a causal link to vaccines weakens VICP and endangers the liability framework that keeps our vaccine supply chain strong. In the end, the damage to VICP will hurt immunocompromised Americans the most.
Effective vaccine policy must continue to weigh the impact on those most at risk. Reforms to VICP should strengthen the program and help protect our most vulnerable Americans. With one in five people being vulnerable to infectious disease, we must remember that by ensuring supply and access to vaccines for all, we are protecting our newborn nephew, our elderly grandmother, our neighbor with cancer, and others in our circle who are immunocompromised.
Lynn H. Albizo, JD, is Chief Public Policy Officer at the Immune Deficiency Foundation.
