The Autism Showdown

The autism cases (termed the Omnibus Autism Proceedings) present the court’s biggest recent challenge, and the story of how the court found that autism is not a vaccine injury is the topic of this chapter. The autism cases were a showdown because the court had previously provided compensation for vaccine injuries without much population-level evidence but with a reasonably credible causal story of how they could have happened to individuals, and thus it seemed at the start that the claims could go either way. Instead the vaccine court strongly repudiated a vaccine-autism link in ways that delegitimized vaccine critics, who nonetheless argued that the vaccine court was hopelessly stacked against them.

Knowing Vaccine Injury through Law

This chapter poses the question of how it matters that we have legalized vaccine injury in the ways that we have. Describing our institution in detail, the chapter focuses on the contemporary, ordinary business of the vaccine court, describing the kinds of professionals who work there and how they do their jobs. The most interesting cases are the middle-ground cases, in which there is some reputable story of how a vaccine might have caused the injury and no studies accepted as definitive that rule it out, and so the court has adapted a way of compensating these people but without full agreement that vaccines are truly the cause. The U.S. vaccine court design is part of a globally shared understanding that some kind of vaccine injury compensation is appropriate, but the chapter shows how the U.S. program stands out among the nineteen other systems across the industrialized world. The chapter also compares the vaccine court to other kinds of domestic alternative compensation schemes such as the September 11th Victim Compensation Fund.

The Solution of the Vaccine Court

The vaccine court was created by federal legislation in 1986. This chapter tells the story of the founding and shifts in the vaccine court over time, placing it in a rich context of parental protest against the diphtheria-tetanus-pertussis vaccine in the 1980s and showing how the scientific and legal conflicts that have riven it over time have shaped its responses to vaccine injury claims. After the pertussis vaccine scare of the 1980s subsided, fears of autism cropped up in the late 1990s. Parents wanted to bring lawsuits in regular civil courts, not in the vaccine court. The chapter presents the challenge posed by the potentially massive lawsuits claiming that thimerosal in vaccines caused autism and notes the court’s flexibility over time and its shrewd balancing of science and policy in the face of panic and uncertainty. Claims that autism is a vaccine injury would have to be adjudicated in the vaccine court.

What Counts as Evidence?

Activists and scientists cannot see vaccine injuries in the same way even after they have argued over the evidence in courtrooms and meeting rooms for years. This chapter recounts the full range of contested evidence the special masters draw upon to decide cases at the vaccine court and shows how incommensurate the competing views of that evidence often are. This chapter also sets out how activists tried to use the legal process and the vaccine court itself to expose what they saw as conspiracy and misconduct. In turn, government scientists and bureaucrats also mobilized their story of vaccine safety through the vaccine court.

Health and Rights in the Vaccine-Critical Movement

This chapter introduces the leaders, organizations, and underpinning ideologies of the vaccine-critical social movement mobilized around the vaccine court. Activists understand fundamental concepts like risk, harm, health, and parental duty in ways that are incompatible with the mainstream, and these divergences in turn help explain why they do not see vaccine court evidence in the same way. They perceive themselves as fighting for individual health freedom at the same time as they muster an aggrieved and vulnerable minority status to protest vaccination and to criticize the vaccine court.

Introduction

This chapter introduces major themes of the book by placing the U.S. Vaccine Injury Compensation Program (and the court that decides claims, the so-called vaccine court) at the center of recent controversies over vaccine safety. Scholars have long debated whether courts and legal actors can do justice to scientific and medical disputes. The vaccine court and the claims of vaccine injury can help us understand how law can do justice to science and to injured people at the same time. The book is based on six years of legal and social science research through interviews, observations, and primary source document analysis and approaches the vaccine court from a pro-immunization perspective.

Conclusion

Overall, the book offers a positive view of how law and courts can support immunization while hearing and even subsidizing a critical social movement that opposes it. The end result is more democratic, open, and accountable than would be the case with no court. This chapter reprises how the vaccine court served as a gatekeeper to constrain the damage of false claims about autism as a vaccine injury, how it became an audience for evidence of vaccine injuries but also helped to produce evidence, and how it expresses our ethical obligation to compensate injured people as well as gives them a chance to tell their story. The vaccine court maintains the legitimacy of science and law in ways that deeply reflect American political and cultural values and strategies for problem solving.

How Are Vaccines Political?

This chapter presents a social scientific perspective on vaccines, showing how to think of vaccines as thoroughly social and political, that is, created through law, regulation, political will, and ideologies as well as through scientific development. This chapter explains how vaccines are approved and recommended, what the current recommended vaccine schedule for children in the United States looks like, and how it has changed over time and examines the state-level politics of school entry immunization requirements. It also describes the structure of our federal vaccine safety monitoring system, underscoring how federalism and our lack of a comprehensive national health care system create difficulties in detecting vaccine injuries.