RFK Jr. and the Vaccine Court

Anna Kirkland has an interesting article about the so-called vaccine court, and RFK Jr.’s possible attempts to sabotage it:

For almost 40 years, people who suspect they’ve been harmed by a vaccine have been able to turn to a little-known system called the Vaccine Injury Compensation Program – often simply called the vaccine court. 

Health and Human Services Secretary Robert F. Kennedy Jr. has long been a critic of the vaccine court, calling it “biased” against compensating people, slow and unfair. He has said that he wants to “revolutionize” or “fix” this system. 

I’m a scholar of law, health and medicine. I investigated the history, politics and debates about the Vaccine Injury Compensation Program in my book “Vaccine Court: The Law and Politics of Injury.” 

Although vaccines are extensively tested and monitored, and are both overwhelmingly safe for the vast majority of people and extremely cost-effective, some people will experience a harmful reaction to a vaccine. The vaccine court establishes a way to figure out who those people are and to provide justice to them. 

Having studied the vaccine court for 15 years, I agree that it could use some fixing. But changing it dramatically will be difficult and potentially damaging to public health.

I had never heard of the vaccine court, which is embarrassing because I’ve known Anna for 20 years — we fought on the same side in the obesity wars back in the day — and she’s written a whole book about it. She argues that the desirable tweaks to the system are pretty straightforward — adjusting for inflation and the like — and actually have (or had anyway) a good amount of bipartisan support. But now . . .

Kennedy hasn’t publicly stated enough details about his plan for the vaccine court to reveal the changes he intends to make. The first and least disruptive course of action would be to ask Congress to pass the bipartisan reforms noted above. 

But some of his comments suggest he may seek to dismantle it, not fix it. None of his options are straightforward, however, and consequences are hard to predict. . . .

Kennedy has long supported discredited claims about harms from vaccines, but the vaccine court has been a bulwark against claims that lack mainstream scientific support. For example, the vaccine court held a yearslong court process from 2002 to 2010 and found that autism was not a vaccine injury. The autism trialsdrew on 50 expert reports, 939 medical articles and 28 experts testifying on the record. The special masters deciding the cases found that none of the causation hypotheses put forward to connect autism and vaccines were reliable as medical or scientific theories. 

Much of Kennedy’s ire is directed at the special masters, who he claims “prioritize the solvency” of the system “over their duty to compensate victims.” But the special masters do not work for him. Rather, they are appointed by a majority of the judges in the Court of Federal Claims for four-year terms – and those judges themselves have 15-year terms. Kennedy cannot legally remove any of them in the middle of their service to install new judges who share his views.

Given that, he may seek to put conditions like autism on the list of presumed vaccine injuries, in effect overturning the special masters’ decisions. Revising the list of recognized injuries to add ones without medical evidence is within Kennedy’s powers, but it would still be difficult. It requires a long administrative process with feedback from an advisory committee and the public. Such revisions have historically been controversial, and are usually linked to major scientific reviews of their validity. 

Public health and medical groups are already mobilized against Kennedy’s vaccine policy moves. If he failed to follow legally required procedures while adding new injuries to the list, he could be sued to stop the changes.

This seems like a classic case where a basically rational bureaucratic process that could use some ameliorative reform is going to be subjected to a chainsaw-wielding maniac, because of the crazed anti-science agenda of the American right wing, as manifested through the avatar of Brainworm Bobby and his Gang of Hacks.

NYU is going to publish Vaccine Court in paperback, with an updated preface and epilogue, which is a nice example in its own way of why the Trump administration is trying to get rid of actual research universities.

This is exactly the kind of important and highly technical legal and scientific set of issues that we need scholars like Kirkland and journalists like Josh Marshall to cover, rather than merely amusing ourselves to death.