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No-Fault Compensation Schemes for
COVID-19 Vaccines: Best Practice
Hallmarks
Duncan Fairgrieve
1
,
2
, Marco Rizzi
3
*, Claas Kirchhelle
4
, Sam Halabi
5
, Geraint Howells
6
and
Normann Witzleb
7
1
British Institute of International and Comparative Law, London, United Kingdom,
2
Centre de Recherche Droit Dauphine,
Université Paris Dauphine, Paris, France,
3
UWA Law School, The University of Western Australia, Perth, WA, Australia,
4
School of
History, University College Dublin, Dublin, Ireland,
5
O’Neill Institute for National and Global Health Law, School of Law,
Georgetown University, Washington, DC, United States,
6
School of Law, University of Galway, Galway, Ireland,
7
Faculty of Law,
The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
Keywords: vaccine, compensation claims, best practice, COVID-19, injury
The global race for and roll-out of safe and effective COVID-19 vaccines to billions of people is one of
the main ways in which the pandemic will be remembered. However, this overwhelmingly positive
story of international collaboration and successful vaccine design also contains darker chapters of
stark global inequality, vaccine hesitancy, and the way in which (the comparatively few) victims of
adverse effects were often failed by governments and existing compensation schemes.
It is now widely accepted that equity and fairness dictate that a swift and effective legal and
financial remedy should be available for victims of vaccine injury (1). Vaccination provides both a
direct benefit to the person receiving it in terms of personal immunization and an indirect benefitto
the broader community as a contribution to wider immunity. Those who suffer serious adverse
effects pay a high price for benefits that accrue not only to themselves but to the rest of the
population, especially if they are at low risk of severe disease or long-term effects resulting from a
specific pathogen.
Prior to the pandemic, the unfortunate reality was that gaining a remedy for vaccine injury, if
available at all, was often a Kafkaesque process with a slow and complex route to compensation.
Newly published research by an international group of legal and historical scholars shows that official
vaccine injury compensation schemes existed in only 25 countries in 2020 (2). Although concerns
about rare forms of vaccine adverse effects have led to the near-doubling of international schemes to
43 in 2021, schemes’performance has been highly uneven. While programs in Nordic countries
provide rapid and transparent access to compensation, other schemes erect high hurdles or offer only
inadequate redress.
A concerning example is the UK’s Vaccine Damage Payment Scheme (VDPS). Created in 1979,
the scheme provides a one-off payment for those who suffer serious disablement because of
vaccination. Originally designed as a temporary measure, the VDPS remains on the statute
books despite cross-party calls for reform. Criticism has long centred on the fact that the
scheme’s payment of £120,000 is far too little for cases of serious injury and is well below
comparable damages payments awarded by the courts for such injuries (3). The substantial yet
arbitrary hurdle of showing 60% disablement also means that very few payments have actually been
made in recent times. The stalling of VDPS payments contrasts sharply with the entirely predictable
rise in the number of suspected cases of serious adverse effects reported by patients and medical
professionals to the Medicines and Healthcare products Regulatory Agency since the mass-rollout of
COVID-19 vaccines (4). Although payments may eventually be made, lack of access to timely and
adequate compensation for victims and their families risks leading to legal proceedings, which can
damage vaccines reputationally and provide an unwelcome platform for vaccine sceptics.
Edited by:
Sarah Mantwill,
University of Lucerne, Switzerland
*Correspondence:
Marco Rizzi
marco.rizzi@uwa.edu.au
This Editorial is part of the IJPH Special
Issue “COVID-19: Guidance From
Research for Policy and Practice”
Received: 09 March 2023
Accepted: 24 April 2023
Published: 03 May 2023
Citation:
Fairgrieve D, Rizzi M, Kirchhelle C,
Halabi S, Howells G and Witzleb N
(2023) No-Fault Compensation
Schemes for COVID-19 Vaccines:
Best Practice Hallmarks.
Public Health Rev 44:1605973.
doi: 10.3389/phrs.2023.1605973
Public Health Reviews | Owned by SSPH+ | Published by Frontiers May 2023 | Volume 44 | Article 16059731
Public Health Reviews
EDITORIAL
published: 03 May 2023
doi: 10.3389/phrs.2023.1605973
The UK’s mixed track record with regards to vaccine
compensation is far from unique. Many of the world’s poorer
countries are unable to compensate victims of adverse effects. The
pioneering COVAX No-Fault Compensation Program, which
covers 92 low and middle income countries and economies, is
attempting to redress this (5). However, the problem is
widespread as even high-income countries often provide
inadequate support and publish insufficient data to evaluate
schemes’performance. A particular problem remains the
opacity of the procedures and the difficulties claimants
encounter with access and information.
The global community’s mixed track record in providing for
citizens who have behaved altruistically is concerning and contrasts
markedly with the extensive legal indemnities and insurance cover
provided for vaccine producers. COVID-19 is not over and will not
be the last pandemic the world will witness this century. Amidst
recent reports of sharp declines of routine vaccine rates, there is an
urgent need not only to protect and boost public confidence in
COVID-19 vaccines, but also in the many other vaccine regimes we
rely on to control diseases. Learning from the past 3 years to create a
common best practice framework for vaccine compensation is one
way of doing so.
The recent international review of existing vaccine
compensation schemes identified four hallmarks signifying
best practice across all analysed countries (1): accessibility:
compensation funds should be accessible, with low legal and
financial barriers, good sign-posting, and facilitate the evaluation
of harm (2); transparency: decision-making processes and
compensation frameworks should be transparent with clear
funding responsibilities (3); timeliness: each scheme should
include clear and short time-frames for compensation
decision-making (4). Finally, adequacy of compensation: the
potential significance of vaccine injuries, no matter how rare,
should be reflected in compensation that is materially
proportionate to the harm suffered.
Legislators around the world would do well to check if their
own scheme hits these best practice hallmarks.
AUTHOR CONTRIBUTIONS
DF was lead author and contributed to the concept, draft and
revisions ahead of submission; CK and MR contributed to the
concept, draft and revisions ahead of submission; SH, GH, and
NW contributed to revisions ahead of submission.
CONFLICT OF INTEREST
The authors declare that they do not have any conflicts of interest.
REFERENCES
1. Halabi S, Omer S. A Global Vaccine Injury Compensation System. JAmMed
Assoc (2017) 317:471–2. doi:10.1001/jama.2016.19492
2. Fairgrieve D, Borghetti JS, Dahan S, Goldberg R, Halabi S, Holm S, et al.
Comparing No-Fault Compensation Systems for Vaccine Injury. Tulane J Int
Comp L (2023) 35 (1):75–118.
3. Judicial College. Guidelines for the Assessment of General Damages in Personal Injury
Cases.16thed.Oxford,UnitedKingdom:OxfordUniversityPress(2022).
4. UK Government. Coronavirus Vaccine - Summary of Yellow Card Reporting
(2023). Retrieved from: https://www.gov.uk/government/publications/
coronavirus-covid-19-vaccine-adverse-reactions/coronavirus-vaccine-
summary-of-yellow-card-reporting (Accessed on February 16, 2023).
5. COVAX. COVAX No-Fa ult Compensation Program for AMC Eligible Economies
(2023). Retrieved from: covaxclaims.com (Accessed on April 28, 2023).
Copyright © 2023 Fairgrieve, Rizzi, Kirchhelle, Halabi, Howells and Witzleb. T his is
an open-access article distributed under the terms of the Creative Commons
Attribution License (CC BY). The use, distribution or reproduction in other
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terms.
PHR is edited by the Swiss School of Public Health (SSPH+) in a partnership with
the Association of Schools of Public Health of the European Region (ASPHER)+
Public Health Reviews | Owned by SSPH+ | Published by Frontiers May 2023 | Volume 44 | Article 16059732
Fairgrieve et al. No-Fault Compensation for COVID-19 Vaccines
