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The benefits of vaccines, particularly childhood vaccines, are undeniable, even in a wealthy country such as Canada.

The virtual elimination of once-common conditions such as measles, mumps and diphtheria through routine childhood immunization programs has prevented thousands of deaths and untold suffering.

Immunization against hepatitis B has spared many health-care workers, firefighters and police officers from the ravages of liver disease. Newer vaccines can prevent chicken pox, meningitis, shingles and even infection with HPV, the virus that can cause cervical cancer.

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And vaccination remains our best weapon against the threat of pandemic influenza, not to mention an effective protection against run-of-the-mill flu that, in a "normal" year, sickens one-fifth of the population and kills about 5,000 people.

Like all drugs, however, vaccines have side effects. Thankfully, most reactions are minor - some pain at the site of injection or a little fever. The allegations that vaccines cause autism and a variety of other conditions have little or no scientific basis.

But a tiny number of those who are inoculated suffer serious side effects such as paralysis, brain damage and even death.

From a societal perspective, effective prevention of devastating disease is desirable. That is why public-health officials aggressively promote vaccination. (Canada has long resisted mandatory vaccination, though those who refuse to be vaccinated can face severe restrictions, such as being barred from school or denied the ability to work in some health-care settings.)

But public-health officials cannot and should not limit themselves to being vaccine cheerleaders.

A credible vaccination program must also make every effort to minimize the possibility of adverse reactions and ensure that, when people are inadvertently harmed, they are cared for and compensated.

The provinces and territories - with the notable exception of Quebec - have failed miserably in this regard. Currently, people harmed by vaccination have no effective recourse.

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Sure, they can sue. But as Mr. Justice Horace Krever, author of the landmark report on the tainted-blood tragedy, said, the adversarial litigation process simply does not work for patients who suffer harm from medical procedures such as vaccination.

The reality is that risks are small, but they are not zero. We must incorporate that reality into public policy.

Currently, those who are harmed by vaccines are treated as collateral damage in the war against vaccine-preventable illness.

Madam Justice Mary Anne Sanderson of the Ontario Superior Court made that point eloquently in a judgment late last year: "The road to protecting public health should not be paved with individual victims. Fair, meaningful, no-fault compensation should be made available to individuals suffering from serious adverse events from vaccines."

Judge Sanderson ruled on a lawsuit by Lucia Morgan, a social worker who developed chronic fatigue syndrome after being inoculated against hepatitis B, and who sued the City of Toronto (a city health nurse had administered the vaccine).

That it took 12 years between Ms. Morgan falling ill and a judgment being rendered speaks volumes about the inappropriateness of the courts for such matters. That Ms. Morgan lost just added insult to injury.

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A measure of justice can

still emerge if lawmakers

heed the advice of Judge Sanderson, who called for a no-fault program, saying it is a necessity "for the sake of the health of citizens and fairness to individuals."

A number of jurisdictions have no-fault insurance for the vaccine-damaged - Japan, New Zealand, South Korea, Denmark, France, Germany, Switzerland and the United States, to name a few.

The legislators worry that an insurance program would be costly and unwieldy. The fear is unfounded.

Quebec has had a no-fault program since the mid-eighties. During the two decades of operation, there have been only about 100 claims, and a couple of dozen awards. (The Canadian Paediatric Society estimates that, among the approximately 400,000 children born each year in Canada, about five will potentially suffer a serious adverse event from vaccination.)

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It is noteworthy that Quebec acted after a Supreme Court of Canada ruling on the tragic case of Nathalie Lapierre, a girl who suffered severe brain damage after a measles vaccination. The country's top court, in throwing out the case, said the state had no legal obligation to compensate the girl but, in an unusual move, said it would be an "excellent thing" to do so.

What the court said, in essence, is that people exposed to a potential harm while undergoing an intervention that is in the greater public good, particularly at the urging of the state, should be compensated by the state.

It's hard to argue with that logic.

It's unconscionable that governments, apart from Quebec, have not acted on this issue. It is a just, ethical and sensible thing to do.

Until we have a no-fault plan in place, we cannot say that our vaccination programs are complete; nor can we say we are truly prepared for a pandemic.

apicard@globeandmail.com

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