For nearly four decades, Americans who believe they have been harmed by a vaccine have had access to a little-known legal process called the Vaccine Injury Compensation Program (VICP) — often referred to simply as the vaccine court.
Now, Health and Human Services Secretary Robert F. Kennedy Jr. — a longtime critic of the system — has vowed to “revolutionize” or “fix” it, calling the program “biased,” unfair and punitive toward claimants. But transforming it wholesale would be far more complex — and potentially far more damaging to public health — than he seems to appreciate. Or perhaps he simply wants to open the door to the kind of vaccine-causes-injury suits and large settlements that were his forte as a tort lawyer.
The four-decade-old legal fix for a public health crisis
The vaccine court was created by Congress in 1986 amid a crisis in the nation’s vaccine supply. At the time, lawsuits over side effects from whooping cough (whole-cell pertussis) vaccine had driven several manufacturers out of the market, threatening shortages and risking the resurgence of deadly diseases.
To stabilize the situation, Congress passed the National Childhood Vaccine Injury Act, which shielded vaccine makers from most lawsuits and established a specific process within the U.S. Court of Federal Claims to handle vaccine injury claims. Instead of suing manufacturers directly, petitioners could bring cases before legal officials known as special masters.
The law also created a dedicated trust fund, financed by a 75-cent excise tax on every vaccine dose sold — to pay both compensation and attorneys’ fees. Some injuries with well-established causal links, such as certain allergic reactions or shoulder injuries from injection, qualify for automatic compensation. Others, where the science is disputed, go through evidentiary hearings involving physicians, attorneys, and medical experts.
This system has long been praised as an ingenious compromise — a humane and science-based way to deliver justice for the small number of people genuinely harmed by vaccines, while maintaining confidence in the nation’s immunization program.
A system in need of modernization. But by Kennedy?
Still, much about the vaccine court reflects 1980s realities, not 21st-century ones. The number of special masters remains capped at eight, even as the caseload has surged with the inclusion of new vaccines. The $250,000 cap on damages for pain and suffering — set nearly forty years ago — has never been adjusted for inflation. And the three-year statute of limitations has proved too short for many petitioners who fail to file in time.
The program’s scope also remains uneven and seems arbitrary. Originally limited to childhood vaccines, it was only recently expanded to include shots given during pregnancy. Adult vaccines, such as shingles, are still excluded. Claims related to COVID-19 vaccines are routed through a separate emergency countermeasures system that has been widely criticized as opaque and inefficient.
Many experts across party lines support modest, bipartisan reforms to address these issues. Kennedy himself has mentioned several of these ideas.
What remains unclear is what Kennedy actually intends to do. His broad promise to “revolutionize” the vaccine court could mean anything from modest modernization to total dismantling.
The first path — pursuing incremental, congressionally approved reforms — would be the least disruptive and most achievable. But Kennedy’s rhetoric sometimes suggests more radical ambitions. Some of his statements imply a desire to overturn past vaccine-court rulings or even reopen long-settled questions about vaccines and autism.
Kennedy’s involvement in this system is uniquely perilous because he is not merely a critic of bureaucratic inefficiency but an activist who has built his career on sowing distrust in vaccines themselves. Unlike most reformers who seek to strengthen public-health infrastructure, Kennedy approaches the issue from the conviction that the system is fundamentally corrupt — a worldview that casts regulators, scientists, and courts as co-conspirators in a vast cover-up of vaccine manufacturers’ misdeeds. From his years leading anti-vaccine organizations to his amplification of scientifically debunked claims linking vaccines to autism and chronic illness, he has consistently blurred the line between policy skepticism and medical disinformation. He now has the power to reshape the very mechanism that guards vaccine confidence. That could legitimize pseudoscience under the guise of reform.
The autism precedent
From 2002 to 2010, the vaccine court oversaw one of its largest and most complex legal proceedings: the Omnibus Autism Proceedings, which examined whether vaccines could cause autism. After eight years, 50 expert reports, 939 medical articles, and testimony from 28 scientific experts, the court concluded decisively that autism is not a vaccine injury.
These findings were and remain consistent with the global scientific consensus. Yet Kennedy has continued to challenge them, asserting that the special masters “prioritize the solvency” of the system over justice for claimants.
He has no direct authority to remove or replace the special masters, who are appointed for four-year terms by judges serving 15-year terms on the Court of Federal Claims. But he could, in theory, try to revise the official list of recognized vaccine injuries to include autism or other conditions — a complex administrative process requiring public comment, scientific justification, and credible evidence. Doing so without credible evidence would trigger legal challenges and near-universal opposition from medical and public health organizations.
Return to the civil courts?
Kennedy could also undermine the vaccine court indirectly — for instance, by reshaping the Advisory Committee on Immunization Practices (ACIP), which determines which vaccines are covered — and which he has already reconstituted with a sorry assortment of anti-vaccine ideologues. Removing a vaccine from that list would again expose manufacturers to direct lawsuits, potentially making vaccine production unprofitable.
Kennedy has also supported legislation allowing claimants to bypass the vaccine court entirely and sue manufacturers in civil court — precisely the scenario Congress sought to avoid in 1986. That would potentially turn vaccine-injury claims into high-stakes jury trials, requiring plaintiffs to meet stricter standards of evidence and to face formidable corporate defendants.
Such a shift could vastly increase litigation, destabilize vaccine manufacturing, raise prices, discourage innovation, and undermine public trust — returning us to the crisis that prompted Congress to create the vaccine court in the first place.
The danger lies not only in the content of Kennedy’s proposals but in his ability to undermine public confidence in scientific evidence. As a cabinet-level official, his statements carry the imprimatur of federal authority; misinformation that once circulated on the fringe now emanates from the top of the nation’s health apparatus. This institutionalization of nescience and conspiracy thinking could erode trust in vaccines, embolden litigation built on junk science, and weaken the fragile social contract that keeps herd immunity intact. Thereby, Kennedy represents a greater threat than a single misguided reform effort; he embodies the convergence of populist politics and medical denialism, a combination that history shows can undo decades of progress in a single news cycle.
The stakes for public health
The Vaccine Injury Compensation Program is an ingenious hybrid of science, law, and social policy that has compensated thousands of people while sustaining confidence in vaccines as a collective good. Reform is needed — more special masters, higher caps on compensation, broader coverage, and simpler filing rules — but radical, unjustifiable changes could undo decades of stability and progress.
As Kennedy proceeds with his review, he will face resistance not only from pharmaceutical companies but also from physicians, patient advocates, and public health professionals who understand how much is at stake.
Reforming the vaccine court requires careful evolution, not revolution. If its critics succeed in tearing it down rather than improving it, the result could be a return to the chaotic, litigious landscape that once threatened America’s vaccine supply — and, with it, the health of millions.
Henry I. Miller, a physician and molecular biologist, is the Glenn Swogger Distinguished Fellow at the Science Literacy Project. He was the founding director of the FDA’s Office of Biotechnology. Find him on his website: henrymillermd.org
