The Federal Government needs to do a much better job of explaining the reasons for its reluctance to introduce a no fault compensation scheme for vaccine-related injuries, according to Associate Professor Heath Kelly. To date, the responses to calls for such a scheme have not been helpful, he suggests.
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Why won’t the Government support such a scheme?
Heath Kelly writes:
A seminar at Sydney University held on Monday 26 March explored ethical issues in immunisation.
One of the questions asked on the day was, why does Australia not have a no-fault scheme for the serious and rare adverse events that on “the balance of probabilities” were caused by a vaccine?
Such schemes exist in 19 countries and the fist scheme was established in Germany more than 50 years ago (1). The scheme in the United States, which is funded by an excise on vaccine doses distributed, is billions of dollars in surplus (2).
In addition to Germany and the US, no fault compensation schemes operate in the UK, Japan and New Zealand, countries with which we would happily compare ourselves. Compensation occurs when the adverse event is shown to be caused by a vaccine and is assessed as being through no fault of the vaccine manufacturer, regulator or administrator.
Over a number of years I have written to various Commonwealth ministers suggesting that a no-fault scheme in Australia was overdue.
These letters were based on our investigation of the case of a Queensland boy, now a young man, whom we argued had developed transverse myelitis caused by his live oral polio vaccine. Live oral polio vaccine viruses can, on extremely rare occasions, revert to a virus that causes a polio-like illness. Myelitis is a rare presentation of infection with wild poliovirus.
Use of live oral polio vaccines in Australia stopped in November 2005, specifically to avoid such outcomes. For this child, however, we showed that the evidence for transverse myelitis being caused by oral polio vaccine was at the level accepted as causation by a prestigious US medical authority (3) and that the vaccine virus associated with the transverse myelitis was similar in its ability to cause disease as a vaccine virus known to have caused polio (4).
However, there is no accepted causal relationship between oral polio vaccine and transverse myelitis and there is no formal way of examining arguments about causality in Australia. In countries where compensation schemes exist, there are mechanisms to decide on causality.
At the ethics in immunisation seminar I was asked why our government does not support such a scheme. Unfortunately letters from various ministers and health department staff throw no light on this issue.
In 2009, after providing copies of the third and fourth referenced articles, I was told by a representative of the Health Minister that “in Australia there is no compensation scheme for adverse events caused by vaccination. A person seeking compensation would need to explore other legal mechanisms such as proceedings in the civil courts. It is not the Department’s role to give advice on those other areas of redress.”
In 2011, after drawing attention to the first two references mentioned, a representative of the Health Minister reminded me that “the implementation of a no-fault compensation scheme requires careful consideration” and went on to discuss the possibility of a National Disability Insurance Scheme.
This was followed by a letter from the Parliamentary Secretary for Disabilities and Carers, who reassured me that the Commonwealth government was “committed to delivering a National Disability Insurance Scheme”. This would entitle “all Australians to support in the event of significant disability.” This would be a great outcome but no time line was given.
From these letters it is unfortunately not possible to understand the specific problems in Australia that impede the implementation of a no-fault scheme.
Whatever these problems are, they have been overcome by our major trading partners and there is evidence to suggest the existence of such a scheme actually improves confidence in publicly funded vaccination programs.
It is easy to imagine various reasons why a no fault compensation scheme might not be attractive to Australian politicians and bureaucrats over a period of more than 40 years, during which time such a scheme has been advocated by a number of different people.
Our imaginings may, however, be wide of the mark. It would be helpful to be able to address specific concerns.
• Associate Professor Heath Kelly holds an appointment at the National Centre for Epidemiology and Population Health, Australian National University. He has previously written for Croakey on this issue.
References
1. Looker C, Kelly H. No-fault compensation following adverse events attributed to vaccination: a review of international programs. Bull World Health Org 2011; 89:371-378.
2. Kelly HA, Looker C, Isaacs D. A no fault compensation scheme for adverse events attributed to vaccination in Australia. Med J Aus 2011; rapid online 6 June 2011.
3. Kelly H. Evidence that the association between oral poliovirus vaccine and transverse myelitis may be causal: a case history and review of the literature. J Paediatr Child Health 2006; 42:155-159.
4. Thorley B, Kelly H, Nishimura Y, Roberts J, Yoon Y, Brussen KA, Shimizu H. Oral poliovirus vaccine type 3 from a patient with transverse myelitis is neurovirulent in a transgenic mouse model. J Clin Virol 2009; 44:268-71.
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Some tweet-reporting from the conference
