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The U.S. government has paid out more than US$4-billion to victims of “vaccine injury” over the past three decades. Skeptics frequently cite this as the ultimate proof that vaccines are harmful – but it’s nothing of the sort.

Worldwide, 19 countries have compensation plans for vaccine injuries, an approach based on the legal principle of reciprocity: Citizens are urged (and in some cases compelled) to get vaccinated for the greater good, so, in the rare instances when they are harmed, they should be compensated by the collectivity.

No one argues that vaccines are perfect. Every drug, every medical intervention, that has a benefit also carries the risk of harm. But vaccines do far more good than harm.

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Consider the numbers: Since 2006, more than 3.2 billion vaccines have been administered in the United States. In that period, the Vaccine Injury Compensation Program (VICP) received 6,293 claims, for everything from fainting to brain damage; 4,311 of them were compensated. In 70 per cent of cases, there is no evidence harms were caused by vaccines, but claimants are given the benefit of the doubt (and money) anyhow.

In short, the rate of injury or illness attributable to vaccines is one in 4.5 million. One would be hard-pressed to find a less risky medical act.

In a recent article in the Atlantic, James Hamblin recalled the origins of the VICP. In 1970, a young girl, Anita Reyes, received the oral polio vaccine, she contracted polio and was paralyzed.

Her parents sued the drug-maker and were awarded US$200,000. The court said that while the benefits of vaccination far outweighed the risks, warnings about potential harm were inadequate. As vaccine-preventable illnesses disappeared, the number of lawsuits increased, and so did the big payouts.

Manufacturers began to stop producing vaccines because it wasn’t worth the grief. So, U.S. lawmakers passed the National Childhood Vaccine Injury Act. The law said vaccine-makers could not be sued; instead, claims would be adjudicated by a tribunal, the VICP, which was supposed to provide quick and generous relief.

This has fuelled all manner of conspiracy theories about the evil pact between government and Big Pharma.

The no-fault insurance approach is a good one in theory but by 2017 total payouts soared to about US$282-million. This is not because vaccines are more harmful but because the VICP has become a safety valve for families of sick children in a country where health costs are obscenely high and public health insurance is cruelly lacking.

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The VICP operates with the “presumption of causation.” If, for example, a child is found to be suffering from chronic arthritis within 42 days of having the measles-mumps-rubella (MMR) vaccine, it will be assumed to be the cause, and compensation paid.

It’s worth noting that no claim has ever been paid for vaccination causing autism because there is no evidence, biologically or otherwise, that this could happen.

Over the years, the tribunal has become too much like a court ruling on lawsuits, and a tort system is not an efficient way of adjudicating these complex cases.

In Canada, only one province, Quebec, has a compensation plan for vaccine injury. It too has its origins in a sad story. In 1972, five-year-old Nathalie Lapierre developed viral encephalitis after receiving the measles vaccine and was left brain-damaged.

Her parents sued the government and the case went all the way to the Supreme Court. In 1985, the learned justices ruled that there was no legal obligation for the state to compensate the family but that it would be an “excellent thing” to do so.

The Quebec government heeded that advice, and created the Vaccine Injury Compensation Program. It does not operate on the presumption of causation; rather, there must be evidence that the vaccine caused the harms suffered.

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Since 1988, there have been 271 claims, of which 43 were accepted. Total compensation paid to date is $5.5-million.

The amounts paid are paltry compared to the United States principally because Canada has universal health care.

In Quebec, parents also retain the right to sue, but there has never been a successful lawsuit for vaccine injury.

It’s a shame that other provinces have not followed Quebec’s lead. Vaccination is the cornerstone of public health and compensating the rare cases where vaccines cause injury is the fair and just thing to do.

If you do it right, a compensation plan should bolster, not undermine, trust in vaccination.

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