For almost 40 years, those suspected of being harmed by a vaccine could rely on a lesser-known system called the Vaccine Injury Compensation Program.
Health and Human Services Secretary Robert F. Kennedy Jr. has long been a vaccine court critic and has called it “biased” against people who are slowly and unfair. He says he wants to “innovate” or “fix” the system.
I am a law, health and medicine scholar. I have looked into the history, politics and discussions regarding the vaccine injury compensation program in my book Vaccine Courts: Law and Politics of Injury.
Vaccines are extensively tested and monitored, both of which are overwhelmingly safe and highly cost-effective for the majority of people, but some people experience adverse reactions to the vaccine. Vaccine courts have established ways to get a grasp of who those people are and provide justice to them.
After studying vaccine court for 15 years, I agree that it can use some modifications. However, it is difficult to change it dramatically and can damage public health.
Deciphering vaccine damage
Vaccine Injury Compensation Programs are essentially a process that allows doctors, lawyers, patients, parents and government officials to determine who is worthy of compensation for a legitimate vaccine injury.
It was established in 1986 by the act of Congress to resolve certain social issues. In other words, there is the possibility of vaccine injury to children from a whole-cell pertussis vaccine. The vaccine, which was discontinued in the US in the 1990s, can cause surprising side effects like long-term crying and convulsions. The parents sued the vaccine maker, and some stopped producing the vaccine.
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Congress was worried that the lawsuit would disrupt the country’s vaccine supply and allow the disease to revive. The National Childhood Vaccine Injury Act of 1986 created a vaccine court process to protect vaccine manufacturers from these cases.
Here’s how it works: Those who feel they have experienced a vaccine-related injury will file a request heard by a legal person called a special master’s degree in the US Federal Claims. The Secretary of Health and Human Services has been appointed defendant and is represented by Justice Department attorneys.
Doctors working at HHS will evaluate their medical records and recommend whether they believe the vaccine has caused a medical problem for the person. Some of the agreed vaccine injuries are listed for automatic compensation, but other scientifically contested results will go through hearings to determine if the vaccine has caused problems.
The award comes from the Trust Fund, built through an excise tax of 75 cents for each dose of covered vaccine sold. The petitioner’s lawyers who specialize in vaccine injury claims are paid by the Trust Fund, whether they win or lose.
Some updates are needed
There have been many changes in the decades since Congress wrote the law, but Congress has not enacted an update to keep up.
For example, the law only supplies eight special masters to hear all cases, but caseloads have risen dramatically as more vaccines are covered by the law. In 1986, it set a $250,000 damages incurred, but did not take into account inflation. The injury limit law is three years, but my research shows that many people are too late to miss the chance.
When the law was written, it only covered vaccines recommended for children. In 2023, the program expanded to include vaccines aimed at pregnant women. Vaccines just for adults like shingles are not covered. The claims of the Covid-19 vaccine will be sent to another system for the widely criticized emergency measures vaccine. These vaccines can be added to the program, as proposed by the lawyers claiming there.
These reform ideas are “friendly revisions” with bipartisan support. Kennedy also mentions some of them.
Complex systems are difficult to revolutionize
Kennedy has not publicly provided sufficient details about the vaccine court’s plan to clarify changes he intends to make. The first and most destructive course of action is to ask Congress to pass the above bipartisan reforms.
However, some of his comments suggest that he might try to dismantle it, but not to fix it. However, none of his options are easy and it is difficult to predict the outcome.
Revising the vaccine court structure straight is perhaps the most difficult path. Congress calls for amending the 1986 law that established it and for President Donald Trump to sign the law. To pass the bill to dismantle it, you need the same process. Either direction includes all the difficulties of getting a controversial bill through Congress. Even “friendly fixes” are difficult. A 2021 bill amending vaccine courts was introduced, but it failed to move forward.
However, there are several direct possibilities.
Add autism to your injury list
Kennedy has long supported unreliable claims about harm from vaccines, but vaccine courts have been a breakwater against allegations lacking mainstream scientific support. For example, the vaccine court held an annual court process between 2002 and 2010, finding that autism is not a vaccine damage. The autism trial has 50 expert reports, 939 medical articles, and 28 experts testified the records. Special masters deciding on the case have found that any of the causal hypotheses proposed to connect autism with vaccines can be trusted as medical or scientific theories.
Much of Kennedy’s rage is directed at special masters who claim to “prioritize solvency” in the system “about the obligation to compensate victims.” However, no special master works for him. Rather, they are appointed by the majority of judges in the Federal Claims Court for a four-year term, and those judges themselves have a term of 15 years. Kennedy cannot legally remove any of them in the middle of the service to set up a new judge to share his views.
Given that, he might try to put conditions like autism on his list of presumed vaccine injuries. Revising the list of perceived injuries and adding people with no medical evidence is within Kennedy’s power, but it will still be difficult. It requires a long management process with advisory committees and public feedback. Such revisions are historically controversial and are usually associated with a major scientific review of their effectiveness.
Public health and health groups have already been mobilized for Kennedy’s vaccine policy moves. If he fails to follow legally required procedures while adding new injuries to the list, he could be sued to stop the changes.
Targeting vaccine maker
Kennedy could also rely on a newly restructured advisory board on vaccination practices to withdraw recommendations for certain vaccines. A lawsuit against the manufacturer could go straight to a regular court. On August 14, 2025, the Department of Health and Human Services may have taken a step in this direction by announcing the revival of the Childhood Vaccine Safety Task Force in response to a lawsuit by anti-vaxing activists.
Kennedy also supports laws that allow claims currently being heard in vaccine courts to go to regular court. These dramatic reforms could inherently dismantle vaccine courts.
Those claiming vaccine injuries are hoping to obtain damages through personal injury cases in the civil justice system on behalf of vaccine courts, perhaps by persuading ju judges or getting a settlement. These types of settlements were what prompted the creation of vaccine courts in the first place. However, these cases can be difficult to win. Regular courts have a higher standard for scientific evidence than vaccine courts, and plaintiffs must sue large corporations rather than submitting government claims.
By raising the idea of reforming the vaccine court, it has funded the program and sparked a strong response across many groups. This is a complex system with multiple components, and Kennedy’s approach has drawn in many directions so far. Revolution tests the strength of its complex design, but vaccine courts could still be maintained.
This edited article will be republished from the conversation under a Creative Commons license. Please read the original article.
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