Judicial Notebook

The National Childhood Vaccine Injury Act of 1986 (Pub. L. 99-660) created the National Vaccine Injury Compensation Program in the U.S. Court of Federal Claims as an alternative to litigation for resolving claims involving vaccine injuries. The VICP "was established to ensure an adequate supply of vaccines, stabilize vaccine costs, and establish and maintain an accessible and efficient forum for individuals found to be injured by certain vaccines."

To be compensated under the program, claimants must show that they suffered one of several specific side-effects within a set time period after getting a particular vaccine. These side-effects are listed on the VICP's "Vaccine Injury Table" and are presumed to be caused by the vaccine. Alternately, claimants can show that they experienced another (non-listed) injury, but in such cases they are required to show a causal link between the injury and the vaccine. Successful claimants are compensated from the Vaccine Injury Compensation Trust Fund, which is funded via a 75-cent tax on each dose of vaccine administered.

Test cases

In 2001, parents of autistic children began filing claims that asserted a link between the administration of certain childhood vaccinations and the onset of autism in children. Autism is not a side-effect listed in the Vaccine Injury Table. Thus, claimants are required to prove a causal link between autism and a vaccine. In an effort to efficiently handle the more than 5,000 autism-related cases filed with the program, the VICP began proceedings on several test cases to separately explore several different theories of causation.

Three of these test cases, Cedillo v. Secretary of Health and Human Services (No. 98-916V), Hazelhurst v. Secretary of Health and Human Services (No. 03-654V) and Snyder v. Secretary of Health and Human Services (No. 01-162V), designed to explore one theory of causation, were decided on Feb. 12. The child involved in the first test case, Michelle Cedillo, received an MMR (measles, mumps and rubella) vaccination in December 1995. In the weeks following the MMR vaccination, Michelle experienced fever, a rash and vomiting. In a checkup several months later, Michelle's pediatrician noted that she was talking less. In July 1997, Michelle was diagnosed with "severe autism" and "profound mental retardation." In addition, Michelle suffers from other medical problems, including gastrointestinal symptoms. In 1998, Michelle's parents filed a claim with the VICP asserting that her autism and gastrointestinal dysfunction were caused by the MMR vaccine.

In Cedillo, a special master considered the contentions "(1) that thimerosal-containing vaccines can cause immune dysfunction, (2) that the MMR vaccine can cause autism, and (3) that the MMR vaccine can cause chronic gastrointestinal dysfunction." The special master reviewed a large body of scientific evidence and determined that the Cedillos had not adequately proven a causal link between thimerosal and immune dysfunction or between the MMR vaccine and the onset of autism or gastrointestinal dysfunction. Two other special masters reached similar conclusions in Hazelhurst and Snyder.

Questions for psychologists

The Cedillo case and the VICP present interesting questions for psychologists. First, Cedillo raises questions about how scientific knowledge is transmitted and comes to be understood, how parents and others understand the risks vaccines pose and make causal attributions related to vaccines, how parents make decisions about vaccinating their children and how science affects the public debate. The case also raises questions about the role of a legal decision in how science is understood. Following the ruling, the U.S. Department of Health and Human Services issued a statement that expressed the department's hope that "the determination by the special masters will help reassure parents that vaccines do not cause autism."

Second, the VICP itself has been the subject of psychological inquiry. Researchers are studying the VICP's functioning, the factors that affect how cases are decided, the nature and role of the scientific evidence presented by the parties, how key actors experience VICP procedures, the program's evolution over time, and its effectiveness as a forum for dispute resolution. Recently, the VICP has been noted as a possible model for how to compensate other kinds of injuries, such as those related to pharmaceuticals. Thus, understanding how the VICP system functions effectively and how it fails to function is crucial to evaluating its role in resolving vaccine disputes, as well as its potential application to other contexts.