Bulletin of the World Health Organization

No-fault compensation following adverse events attributed to vaccination: a review of international programmes

Clare Looker & Heath Kelly

Volume 89, Number 5, May 2011, 371-378

Table 1. Common elements of vaccine-injury compensation schemes for six selected countries

Common elements   Finland   Germany   New Zealand   Sweden   United Kingdom of Great Britain and Northern Ireland   United States of America
Administration and funding Manufacturers, distributors, suppliers tax General revenue of the Lander (state governments) ACC earner’s account (funded by personal income tax) and ACC non-earner’s account (funded by government) Percentage levy of member manufacturers’ annual sales National treasury Flat-rate tax paid by manufacturers for every childhood vaccine sold
Eligibility/vaccines covered All All recommended vaccines (child and adult) All All Recommended childhood vaccines, adult influenza, armed forces Recommended childhood vaccines, adult influenza, armed forces
Process and decision-making Finnish Pharmaceutical Insurance Pool claims officer Internal Lander office of social recompensation (medical expert consultation) Review by ACC Treatment Injury Advisory Committee Claims manager with Zurich insurance Evaluation by appointed medical officer Vaccine injury table or proving “causation in fact”a
Standard of proof Balance of probabilitiesb Probable cause Balance of probabilitiesb “Preponderant probability” Balance of probabilitiesb Balance of probabilitiesb
Elements of compensation Unreimbursed medical costs, disability pension, noneconomic loss, death benefits Medical costs, disability pension, funeral costs Medical costs, disability pension, death benefits Unreimbursed medical costs, disability pension, death benefits Lump sum payment Non-reimbursed medical expenses, lost wages, noneconomic loss, future care costs, death, legal fees
Litigation rights No Limited No No Yes If compensation accepted, no further civil claim allowed
Claims compensated 2004–2008: 45 vaccine claims 1961–2001: ~4000 claims 1992–2000: 77/293 Vaccine-specific data not available 2005: 4/106 2008: 145/226 (non-autism claims)c

ACC, Accident Compensation Corporation.

a “Causation in fact” considers an injury to be proven if these 3 criteria are met: (i) a medical theory causally connecting the vaccination and the injury; (ii) a logical sequence of cause and effect showing that the vaccination was the reason for the injury; and (iii) a showing of a proximate temporal relationship between vaccination and injury.

b Balance of probabilities mean that there is a “preponderance of evidence” or more evidence than not to suggest the vaccine caused the injury. This is a lower burden of proof than “beyond reasonable doubt".

c Between 2001 and 2010 more than 5600 claims were made for autism or autism spectrum disorder caused by measles–mumps–rubella vaccine and thimerosal-containing vaccines. These cases were consolidated into the Omnibus Autism Proceedings. After several test cases, no causal link has been found between autism and the vaccines, however a large number of cases have not yet been formally dismissed or withdrawn from the courts. Given the separate process that has been established for this large number of claims, this data is listed separately in the claims data published by the National Vaccine Injury Compensation Programme in the United States of America.38