Katharine Browne discusses the Canadian Medical Association’s decision not to implement a vaccine injury compensation program.

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Routine vaccinations are usually administered without incident. However, some individuals can suffer grave adverse effects. For example, Guillain-Barré Syndrome, a rare disorder that sometimes results in paralysis, has been linked to the flu vaccine. Likewise, other common vaccines such as those that protect against measles-mumps-rubella and chickenpox have potential serious risks. Where there are no vaccine injury compensation programs, victims of vaccine injury are left to traditional legal means for receiving compensation for their injuries. In tort law, compensation for injuries is based on negligence, which is hard to establish in the case of vaccines. This is because vaccine injury can happen despite the best practice of both vaccine manufacturer and provider. Consequently, vaccine injury victims have historically not fared well in court.

It is for this reason that many countries have implemented “no fault” vaccine injury compensation programs. Such programs provide individuals who have suffered adverse effects of a vaccine with a means of receiving compensation for their injuries without needing to establish fault on the part of either the vaccine manufacturer or provider. The kind of compensation offered varies depending on the particular program. In Quebec, for example, victims of vaccine injury are eligible for compensation for medical expenses associated with the injury, such as income lost because of injury, expenses related to rehabilitation and personal assistance, and funeral expenses in the case of death.

Statue commemorating the 30th anniversary of the eradication of smallpox by Martin Williams (2010), World Health Organization (WHO) headquarters, Geneva Switzerland. Photo Credit: Angel Petropanagos

While Quebec has had its own vaccine injury compensation program since 1987, the rest of Canada has yet to follow suit. In fact, Canada stands with Russia as the only G8 countries that lack national vaccine injury compensation programs. In August of last year, the Canadian Medical Association reaffirmed this stance by rejecting a motion to implement a national vaccine injury compensation program. The main reason given for rejecting the motion was that such a compensation program would constitute a “tacit admission” of the dangers of vaccination and thus deter people from having themselves or their children vaccinated. The Canadian Medical Association’s rejection of the motion to implement a vaccine injury compensation program is thus based ultimately on pragmatic considerations and a prioritization of efforts to increase vaccine uptake. Given the resurgence of infectious diseases like measles and whooping cough, this is an especially important public health initiative.

It is also important to understand that vaccination is a collective action problem. Collective action problems are characterized by a conflict between individual interest and the collective good. It is in everyone’s interest if a sufficient number of people get vaccinated against, say, measles. That way, enough people in the population will be immune to measles, which will prevent the disease from getting a foothold and spreading throughout the population. This is particularly important for those individuals who cannot—for reasons of age or health—be vaccinated themselves against the disease. But it is to no individual’s advantage if he or she gets vaccinated while others do. For when everyone else is vaccinated, the chances of contracting the disease are low. Individuals thus have an incentive to “free ride” off of the efforts of others—to enjoy the benefits of herd immunity without bearing any of the potential costs of vaccination. On this picture of vaccination as a collective action problem it is apparent that individuals who get vaccinated do so not for their own benefit but rather in the service of the good of the collective.

Whether a vaccine compensation program will deter vaccination is ultimately an empirical question. While some have argued that it will, others have argued that such a program may improve vaccination compliance. Those who take this line suggest that the absence of a compensation program creates a barrier to vaccination for those individuals who fear adverse effects.

But these considerations overlook the moral argument in favour of implementing a vaccine injury compensation program. This moral argument consists in recognizing that it is a matter of justice that individuals be compensated for their injuries associated with actions they undertake in order to promote the common good. If individuals are urged—either through legal means, moral persuasion, or withholding information—to become vaccinated to promote the common good, it would seem they should be compensated if they consequently suffer adverse effects. The Canadian Medical Association may respond that it is an individual’s civic duty to take such risks and bear any potential costs of vaccination. But this is not self-evident, and the Canadian Medical Association owes us either an argument for that duty or some other rationale for their decision. Most other industrialized nations in the world have a no fault vaccination compensation program. Why not Canada?

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Katharine Browne is a faculty member in the Department of Philosophy at Langara College. @BrowneKatharine