Vaccine Injury Compensation Program

March 18, 2026

Key Findings

More than three-quarters of survey respondents (78%) felt that weakening liability protections for drug manufacturers conferred by the Vaccine Injury Compensation Program (VICP) would substantially reduce pharmaceutical innovation leading to new vaccines and 67% felt that it would increase prices for existing vaccines.
Half the respondents (50%) agreed or strongly agreed that weakening VICP liability protections for clinicians would reduce their willingness to administer vaccines. Another 21% were uncertain about the effects of such a policy change. Several panelists said that most clinicians are likely unaware of the program, so it would not affect their behavior, but others believed that clinicians are sensitive to perceived malpractice risks even when they are small.
There was little agreement about whether individuals who experience vaccine-related injuries would receive higher compensation through traditional litigation than under the current VICP. A number of respondents noted that there could be a meaningful increase in stress, uncertainty, and administrative complexity under a traditional litigation system.

Read the full Health Affairs Forefront summary of results here

Survey Questions

Please note: our surveys will consistently use two modifiers to describe the size of an effect: “Substantial”: when an effect is large enough to meaningfully influence policy decisions, program implementation, or outcomes of interest “Measurable”: when the direction of an effect is clear, but the effect may not be sufficiently large to make much of a difference for a given policy, program, or outcome.

Response rate of 94% (58 out of 62 panelists responded, 1 panelist abstained)

In 1986, Congress passed the National Childhood Vaccine Injury Act in response to rising vaccine-injury litigation, rising liability costs for vaccine manufacturers, and concern that manufacturers were exiting the market, threatening the stability of the nation’s vaccine supply. The law created the Vaccine Injury Compensation Program (VICP), which limits the ability of individuals who experience rare but serious side effects following vaccination to pursue lawsuits against manufacturers or clinicians who administer vaccines. The program serves as an alternative to traditional litigation, allowing eligible individuals to seek compensation through a federally administered system funded by an excise tax on vaccines. In recent discussions, some federal policymakers have proposed reforms to the program, including weakening liability protections for manufacturers and clinicians and expanding the range of conditions eligible for compensation.

Question 1: Weakening liability protections provided by the VICP for vaccine manufacturers would (select all that apply):

a. Substantially reduce pharmaceutical innovation leading to new vaccines
b. Substantially increase the prices of existing vaccines
c. None of the above
d. Don’t know

Question 2: Weakening liability protections provided by the VICP for clinicians would substantially reduce clinicians’ willingness to administer vaccines.

a. Strongly agree
b. Agree
c. Uncertain
d. Disagree
e. Strongly disagree
f. Don’t know

Question 3: Individuals who experience vaccine-related injuries would receive substantially higher compensation through traditional litigation than under the current VICP.

a. Strongly agree
b. Agree
c. Uncertain
d. Disagree
e. Strongly disagree
f. Don’t know

Individual Survey Responses

Question One

Weakening liability protections provided by the VICP for vaccine manufacturers would (select all that apply)

Name	Vote	Confidence	Comments
Margarita Alegria	None of the above	7
David Asch	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	6	We have segments of the US population primed to believe in vaccine harm and they overlap considerably with those who have the kind of outrage to use litigation. I am not sure how large the second category is, but perceptions of the size of the intersection will drive risk management in this industry.
John Ayanian	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	4
Peter Bach	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	8
Laurence Baker	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	5
David Blumenthal	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	9
Erin Fuse Brown	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	3
Melinda Buntin	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	8
Michael F. Cannon	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	1	These effects do not necessarily indicate the changes would be undesirable. (Also, I’m not terribly sure about ‘substantial.’)
Lawrence Casalino	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	7
Amitabh Chandra	Don’t know	0
Lanhee J. Chen	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	8
Michael Chernew	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	7
Janet Currie	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	9
Lesley Curtis	Substantially reduce pharmaceutical innovation leading to new vaccines	10
David Cutler	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	7
Julie Donohue	Substantially reduce pharmaceutical innovation leading to new vaccines	8
Joseph Doyle	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	3
David Dranove	Substantially reduce pharmaceutical innovation leading to new vaccines	10
Stacie Dusetzina	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	5
Jose Esarce	No Response
Elliott Fisher	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	8
Richard Frank	Substantially increase the prices of existing vaccines	6
Craig Garthwaite	No Response
Darrell Gaskin	Substantially increase the prices of existing vaccines	6
Martin Gaynor	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	7	It seems very likely that weakening liability protections for manufacturers would reduce vaccine innovation and increase the prices of existing vaccines. However, the magnitudes of these effects are unclear to me.
Sherry Glied	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	6	I am not sure it’s innovation — but I would expect reductions in the rate at which vaccines are brought to market.
David Grabowski	Substantially reduce pharmaceutical innovation leading to new vaccines	8
Jonathan Gruber	Substantially reduce pharmaceutical innovation leading to new vaccines	8
Vivian Ho	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	10
Jason Hockenberry	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	6
Haiden Huskamp	Don’t know	0	This answer depends on the extent to which the liability protections would be weakened. I don’t know the details of the proposals being considered and the question stem doesn’t provide specifics, so I am not able to answer.
Benedic Ippolito	Don’t know	0
Anupam Jena	Abstained
Nancy Keating	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	5	Uncertain how big the effects would be.
Aaron Kesselheim	Substantially increase the prices of existing vaccines	8	By potentially driving out some vaccine manufacturers and reducing competition within certain markets
Jonathan Kolstad	No Response
R Tamara Konetzka	Substantially increase the prices of existing vaccines	6
Rick Kronick	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	4
Valerie Lewis	Don’t know	0
Nicole Maestas	Substantially reduce pharmaceutical innovation leading to new vaccines	9
Tom McGuire	Substantially increase the prices of existing vaccines	6
Ellen Meara	Substantially reduce pharmaceutical innovation leading to new vaccines	6
Ateev Mehrotra	Substantially reduce pharmaceutical innovation leading to new vaccines	8
David Meltzer	No Response
Joseph Newhouse	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	9	I’d give it a 10, but I think there is some very small positive probability of being wrong.
Sean Nicholson	Substantially reduce pharmaceutical innovation leading to new vaccines	7	Amy Finkelstein’s paper, which is now a bit dated, demonstrates the importance of this policy on vaccine development. The dated part is why I don’t put a 10 here
Steve Parente	Don’t know	0
Stephen Patrick	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	10	This will be devastating. It’s part of an ongoing attack to impede and destroy one of the foundations of our public health system.
Harold Pollack	Substantially reduce pharmaceutical innovation leading to new vaccines	5
Daniel Polsky	Don’t know	0
Ninez Ponce	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	6
Thomas Rice	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	7
Meredith Rosenthal	Substantially reduce pharmaceutical innovation leading to new vaccines	8
Joseph Ross	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	8	The VICP liability protections have been strongly credited with promoting vaccine innovation, with more willingness among companies to foster development of products in this space. While the price argument is murkier, because prices are affected by so many different aspects of the market, I have little doubt that any weakening of the liability protections would be used as a justification for price increases.
Brendan Saloner	Substantially increase the prices of existing vaccines	6	I think manufacturers would price litigation risk into their existing vaccines
Kosali Simon	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	8
Jon Skinner	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	8
Ben Sommers	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	5
Neeraj Sood	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	7	Amy QJE paper
David Stevenson	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	7
Kevin Volpp	Substantially increase the prices of existing vaccines, Substantially reduce pharmaceutical innovation leading to new vaccines	6
Rachel Werner	Substantially reduce pharmaceutical innovation leading to new vaccines	5

Question Two

Weakening liability protections provided by the VICP for clinicians would substantially reduce clinicians’ willingness to administer vaccines.

Name	Vote	Confidence	Comments
Margarita Alegria	Agree	9
David Asch	Disagree	9
John Ayanian	Uncertain	3
Peter Bach	Disagree	6
Laurence Baker	Agree	4
David Blumenthal	Uncertain	8
Erin Fuse Brown	Don’t know	0
Melinda Buntin	Strongly agree	9
Michael F. Cannon	Agree	1	These effects do not necessarily indicate the changes would be undesirable. (Also, I’m not terribly sure about ‘substantial.’)
Lawrence Casalino	Strongly agree	10
Amitabh Chandra	Disagree	7
Lanhee J. Chen	Agree	8
Michael Chernew	Agree	7
Janet Currie	Strongly agree	8	Given that the federal government has reduced the number of vaccines that are suggested, I think that clinician’s comfort level with supplying vaccines like RSV or Covid for children would fall.
Lesley Curtis	Disagree	5	Although I don’t believe that the change would make clinicians less willing to administer a vaccine, I expect that they would be less likely to promote /encourage vaccination.
David Cutler	Uncertain	5
Julie Donohue	Agree	7
Joseph Doyle	Disagree	3
David Dranove	Strongly agree	10
Stacie Dusetzina	Uncertain	7	Safety events are still rare, even if more liability.
Jose Esarce	No Response
Elliott Fisher	Strongly agree	9
Richard Frank	Uncertain	5
Craig Garthwaite	No Response
Darrell Gaskin	Agree	8
Martin Gaynor	Agree	8	It’s likely that clinicians would be concerned about their liability and that would have a negative effect on their willingness to administer vaccines, however, I don’t have a clear sense of how large the impact might be.
Sherry Glied	Agree	6
David Grabowski	Uncertain	7
Jonathan Gruber	Uncertain	5
Vivian Ho	Agree	8	Clinicians might require patients to sign forms that release the clinician of liability. While that might reduce clinicians’ reluctance to administer vaccines if VICP is eliminated, it would significantly reduce the percentage of people getting vaccinated.
Jason Hockenberry	Uncertain	7	The effects of and change in VICP would be dependent on how standards of care evolved and whether the use of informed consent in vaccine provision became the default. If vaccine provision remained a standard of care or informed consent were made the default it would likely blunt the effects of VICP changes.
Haiden Huskamp	Don’t know	0	Same issue as #1. In theory, weakening liability protections could reduce willingness to administer vaccines among some (but not all) clinicians. I don’t think we have enough information in the literature on clinician views on these issues to know how this would play out.
Benedic Ippolito	Don’t know	0
Anupam Jena	Abstained
Nancy Keating	Agree	5
Aaron Kesselheim	Agree	7	Physicians are sensitive to perceived malpractice risks even when the actual risks are low.
Jonathan Kolstad	No Response
R Tamara Konetzka	Strongly agree	8
Rick Kronick	Don’t know	0
Valerie Lewis	Disagree	8
Nicole Maestas	Agree	7
Tom McGuire	Agree	8
Ellen Meara	Agree	6
Ateev Mehrotra	Agree	6
David Meltzer	No Response
Joseph Newhouse	Strongly disagree	7	If patients ask for the vaccine, I think almost all clinicians would administer. Then the issue comes down to how many clinicians would ask if their patients want a vaccine if the patients themselves don’t ask. I think most clinicians would ask, at least for most vaccines, but I have no evidence for that.
Sean Nicholson	Strongly disagree	9
Steve Parente	Don’t know	0
Stephen Patrick	Strongly agree	10
Harold Pollack	Agree	5
Daniel Polsky	Don’t know	0
Ninez Ponce	Agree	6
Thomas Rice	Uncertain	7
Meredith Rosenthal	Agree	8
Joseph Ross	Disagree	8	My suspicion is that clinicians’ will continue to be willing to administer vaccines, perhaps with more documentation of shared decision-making with patients, as most medical product litigation is targeted at manufacturers and vaccine adverse events are not likely to be related to the clinician administration (as opposed to the product itself).
Brendan Saloner	Don’t know	0	I’m not sure how much clinicians could be at fault.
Kosali Simon	Strongly agree	8
Jon Skinner	Uncertain	5
Ben Sommers	Uncertain	4	My guess is most clinicians have never heard of VICP and it doesn’t factor in their decision-making.
Neeraj Sood	Agree	6
David Stevenson	Uncertain	5
Kevin Volpp	Agree	6
Rachel Werner	Disagree	7

Question Three

Individuals who experience vaccine-related injuries would receive substantially higher compensation through traditional litigation than under the current VICP.

Name	Vote	Confidence	Comments
Margarita Alegria	Agree	5
David Asch	Agree	8
John Ayanian	Uncertain	3
Peter Bach	Disagree	5
Laurence Baker	Disagree	6
David Blumenthal	Agree	6
Erin Fuse Brown	Disagree	4
Melinda Buntin	Don’t know	0
Michael F. Cannon	Agree	1	The ‘efficiency of the common law hypothesis’ posits that the iterative process of tort litigation will more closely approximate optimal compensation than is the legislative process, because the former is less susceptible to industry capture than the latter. The potential for industry capture of VICP suggests that traditional litigation would produce higher compensation for victims.
Lawrence Casalino	Uncertain	6
Amitabh Chandra	Don’t know	0
Lanhee J. Chen	Strongly agree	10
Michael Chernew	Uncertain	5
Janet Currie	Uncertain	8	Litigation is a very uncertain way to pursue compensation. Most cases are dismissed while a few win big. Moreover, not everyone can get legal representation.
Lesley Curtis	Uncertain	8	Although causality can be established between vaccine administration and promixmal outcomes, proving that a vaccine is related to a distal outcome is very challenging.
David Cutler	Disagree	5	It would increase administrative costs a lot.
Julie Donohue	Uncertain	7
Joseph Doyle	Don’t know	0
David Dranove	Disagree	8
Stacie Dusetzina	Agree	7
Jose Esarce	No Response
Elliott Fisher	Disagree	6
Richard Frank	Disagree	6
Craig Garthwaite	No Response
Darrell Gaskin	Uncertain	7	There would probably be more litigation but not more expensive litigation.
Martin Gaynor	Uncertain	5	I don’t have the information to assess whether compensation would be higher via litigation versus the VICP.
Sherry Glied	Disagree	6	Given high costs and uncertainty of litigation, I’d expect there to be some much bigger awards but more people receiving nothing.
David Grabowski	Agree	7
Jonathan Gruber	Strongly agree	9	Depends if you are talking about median or mean. I answered here for the mean, which will be higher due to some huge settlements. The median may very well be lower.
Vivian Ho	Uncertain	10
Jason Hockenberry	Disagree	6	Standards of care provisions and informed consent in vaccination are likely to evolve with a change in VICP.
Haiden Huskamp	Don’t know	0	Again, I don’t know the details so am unable to answer.
Benedic Ippolito	Don’t know	0
Anupam Jena	Abstained
Nancy Keating	Agree	5
Aaron Kesselheim	Disagree	7	Maybe a small number, but overall outweighed by the greater time, uncertainty, and complexity of traditional litigation
Jonathan Kolstad	No Response
R Tamara Konetzka	Disagree	5
Rick Kronick	Don’t know	0
Valerie Lewis	Uncertain	10
Nicole Maestas	Uncertain	6
Tom McGuire	Uncertain	6
Ellen Meara	Disagree	6	While a small number of people would likely receive larger awards under such a scheme, it would most likely delay compensation for legitimate safety events related to vaccines (and hinder access to safe vaccines).
Ateev Mehrotra	Agree	4
David Meltzer	No Response
Joseph Newhouse	Strongly agree	9	But there would be considerable delay and stress.
Sean Nicholson	Agree	8
Steve Parente	Don’t know	0
Stephen Patrick	Don’t know	0	It’s less about individual compensation and more about what would happen to the overall fund.
Harold Pollack	Uncertain	5
Daniel Polsky	Strongly agree	10
Ninez Ponce	Don’t know	0
Thomas Rice	Uncertain	9
Meredith Rosenthal	Disagree	6
Joseph Ross	Uncertain	10
Brendan Saloner	Uncertain	2	I don’t know enough about how often victims are getting paid right now
Kosali Simon	Agree	8
Jon Skinner	Agree	7
Ben Sommers	Agree	6
Neeraj Sood	Agree	7
David Stevenson	Disagree	6
Kevin Volpp	Don’t know	0
Rachel Werner	Don’t know	0

Meet our panel of experts

Cornell Health Policy Center

Cornell Health Policy Center

Vaccine Injury Compensation Program

Key Findings

Survey Questions

Individual Survey Responses

Question One

Question Two

Question Three

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