Even a swift glance at the latest statistics demonstrates the stark differences in the pace of the Covid vaccine roll out across the globe.

Inevitably, these disparities raise questions about why it has taken some countries longer to roll out their vaccination programme than others.

Well publicised procurement issues and supply delays are one part of the picture. Another seems to be a lack of trust, whether of the coronavirus vaccine itself or as part of a broader anti-vax movement.

With the Queen commenting on this issue a couple of weeks ago, these concerns are clearly being taken very seriously, and will no doubt only be exacerbated by the recent concern over blood clotting related to the AstraZeneca/Oxford vaccine.

Part of the solution to these issues, recognised as a critical pillar of any vaccine roll out, is the existence of a no-fault compensation scheme. This is a stark recognition that sadly (as with any vaccine) it is likely that some people will experience a serious adverse reaction.

Are vaccine compensation schemes fit for purpose?

Broadly, the purpose of such schemes is to assess claims by individuals who have experienced serious adverse impairment as a result of a vaccine, and, where proven, to administer payment of a sum to them in recognition.

A well-established but much-criticised scheme already exists in the UK. This was created by the Vaccine Damage Act 1979 and was established as a result of concerns over adverse events related to the diphtheria–tetanus–pertussis vaccine.

Critics point to the fact that since its inception, only 941 claims out of 6,352 have been successful. The vast majority of claims are turned down on the basis that it has not been proven that the vaccine ‘caused’ the claimed disability on the balance of probability. The upper limit of £120,000 for an award is also regarded as too low in light of the severe disablement that qualifies for an award (at least 60% disabled).

Commentators say a new bespoke scheme for Covid related events should be established in the UK. Not only should this allow compensation based on need rather than a fixed sum, it should facilitate the process for proving causation, and be more simple, swift and transparent.

A new international approach for COVAX  

The UK scheme sits in a complex puzzle of other no-fault compensation schemes across the world.

The newest of these, and notable for its scale and ambition, is the compensation program linked to the COVAX facility, the international scheme led by the WHO to ensure everyone in the world has access to a Covid vaccine.

It is the first and only international vaccine compensation scheme of its kind, and is open to individuals in 92 low and middle-income countries who have received a vaccine through the COVAX Facility.

There are a number of reported motivations for such a scheme, including a desire to provide reassurance to the public to encourage take up, but also as an alternative to complex indemnity and liability arrangements apparently requested by some manufacturers. Ghana was widely publicised as the first country to receive vaccines through the COVAX facility in late February.

The COVAX Program itself will be available from the end of March and the Program documents, which have recently been published, reflect a number of similar elements that are common to all such schemes:

• rules on administration and funding – the Program is financed through donor funding calculated as a levy charged on each dose of vaccine distributed through the COVAX facility in eligible countries (WHO is working with Chubb to secure insurance coverage for the Program);
• eligibility criteria – the Program covers serious bodily injury or illness (non-serious events are not covered);
• due process and decision making - injury is assessed by a Review Panel of five licensed nurses;
• required standard of proof - the injury must be shown as the ‘Most Probable Cause’ of taking the vaccine, on the balance of probabilities;
• established elements of a compensation award - the amount of any payment is based on the GDP per capita of the country in which the claimant lives x 12 x a harm factor based on the degree of disability suffered (contrast this with the one off lump sum under the UK scheme);
• litigation rights - a claimant will be asked to sign a Release Agreement noting that no admission or fault should be construed from the payment, and they will not be able to pursue compensation through the courts if they accept payment from the Program (contrast this with the UK scheme, which does not prevent claimants from pursuing a court claim to top up the award).

Overcoming systemic barriers to justice

Inevitably similar issues are likely to arise as with the UK scheme, such as the degree of injury required to obtain a payment, and the need to establish the vaccine as the ‘most probable cause’.

However, before these elements of the Program even come into play, there is perhaps a more fundamental issue given the difficulties inherent in promoting and accessing such a scheme in these low and middle-income countries.

At its most basic, individuals will need to know of such a scheme in order to seek payment. Accessing the Program requires online access to obtain the relevant forms and understand the requirements, albeit there is a free global telephone hotline to assist applicants.

Filling out the relevant paperwork and providing supporting evidence will not be an easy task. The launch of the Program will hopefully be accompanied by information campaigns to extend its reach as far as possible.

Criticism on some of these issues has also been made of the UK scheme, which is not well publicised and whose processes have been criticised for lack of transparency. And this in a country with a high level of internet access, literacy and support services.

Applaud the ambition

The promoters of the COVAX Program have to be applauded for their ambition and determination in getting this off the ground.

Where I live in Scotland, a no-blame fast track redress scheme for clinical negligence claims was recommended in a report published in 2011 by Professor Sheila McLean, and consulted on by the Scottish Government in 2014. However, the proposal appears to have stagnated.

With nations becoming increasingly insular, both at a political level with global disputes over roll out and supply of the vaccine, and at a private level as people are confined to narrow city and regional borders, any initiative to increase vaccine uptake is to be welcomed if that propels us forward to a more open future.

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