Chandrakant Lahariya | ‘No-Fault’ Policy on Compensation To Boost India’s Immunisations

India’s Supreme Court, in a recent ruling, directed the Union government to frame a “no-fault compensation policy” for serious adverse events following Covid-19 vaccinations. The direction marks an important moment for India’s public health policy and its nearly five-decade-old national immunisation programme. The court’s observation that vaccination campaigns are carried out under the authority of the State and therefore must include mechanisms for redress touches the core of the social contract between citizens and the government.When governments encourage people to participate in public health programmes for collective benefit, they also assume a responsibility to support those who may, in rare circumstances, experience unintended harm. Vaccines save millions of lives every year and remain among the most effective and cost-efficient tools in modern medicine.Vaccines have helped eliminate or dramatically reduce diseases that once caused widespread suffering and death in various age groups. Yet, like all medical interventions, vaccines can occasionally be associated with adverse events. India’s response to the Covid-19 pandemic included one of the largest vaccination drives in human history. More than 220 crore doses were administered across the country within a relatively short period. As expected in any programme of such scale, adverse events following immunisation or AEFI were recorded through national surveillance systems. Though most were minor reactions, a very small number involved severe complications and a few deaths were reported during post-vaccination monitoring. Establishing a causal relationship between vaccination and these outcomes is often complex and requires careful scientific investigation.This is where the concept of a “no-fault compensation” system becomes relevant. Unlike conventional legal proceedings where victims must prove negligence or wrongdoing, a “no-fault” mechanism recognises that rare adverse outcomes may occur even when vaccines are developed, tested and administered according to the highest scientific and regulatory standards. The objective is not to assign blame but to provide timely financial assistance to individuals who experience serious harm after participating in a public health programme. Several countries have already institutionalised such mechanisms. In the United States, the National Vaccine Injury Compensation Programme was established in 1986 and operates through a specialised claims process financed by a small excise tax on each vaccine dose.The United Kingdom runs the Vaccine Damage Payment Scheme. Countries such as Japan, Germany and several Nordic nations maintain similar government-backed systems that allow individuals to seek financial compensation without navigating lengthy court proceedings. In recent years, India’s vaccination landscape has expanded with the introduction of additional antigens and broader campaigns targeting adolescents and adults. In this backdrop, establishing a structured compensation mechanism would not only align India with global best practices but also reinforce transparency and accountability in public health programmes.At the same time, the introduction of such a policy raises legitimate concerns. In an era shaped by rapid information flows and the amplifying effects of social media discussions about vaccine injury can easily be misinterpreted. If poorly communicated, compensation policies might unintentionally fuel vaccine hesitancy by creating the impression that vaccines are inherently dangerous. India witnessed during the pandemic how misinformation spread widely with rumours linking vaccines to infertility, sudden deaths or other unverified medical conditions. In such an environment, even well-intentioned policy measures must be accompanied by careful communication and clear scientific messaging.Experience from countries with established compensation programmes, however, suggests that transparency tends to strengthen trust rather than weaken it. When governments openly acknowledge that rare adverse events may occur and create structured systems to assist those affected, citizens are more likely to view the health system as fair and accountable. By contrast, ignoring or dismissing concerns can deepen suspicion and provide fertile ground for misinformation. A well-designed compensation programme therefore becomes not only a welfare measure but also an important instrument for strengthening public trust.The importance of public confidence becomes even clearer when considering the introduction of newer vaccines. India has recently expanded access to the Human Papillomavirus vaccine for adolescent girls aged nine to fourteen years, a major step toward preventing cervical cancer. Yet, uptake remains uneven in several regions. Despite strong global evidence showing the vaccine’s safety and effectiveness, lingering doubts and past controversies continue to influence public perception. Policies that demonstrate transparency and preparedness to support those affected by rare adverse events could help strengthen public confidence in such vaccination initiatives.Designing the compensation framework carefully will therefore be essential. The system must rely on robust scientific methods for assessing causality in adverse events after immunisation. Independent panels comprising medical experts, epidemiologists and legal specialists should evaluate claims based on established evidence rather than political or public pressure. Efficiency will also be critical. The mechanism must avoid the delays that often characterise litigation, ensuring that affected individuals and families receive support within a reasonable timeframe. Funding mechanisms must be sustainable potentially through a dedicated public health fund or a small levy incorporated into vaccine procurement systems similar to international models.Communication will remain central to the policy’s success. Policymakers must emphasise that serious adverse events remain extremely rare and that vaccines continue to represent one of the most powerful tools for preventing disease and death. The compensation programme should be framed as a protective safety net within a responsible health system rather than as an indication of widespread risk. Doctors, public health professionals and community leaders will play a crucial role in explaining this distinction and maintaining confidence in immunisation programmes. A transparent and compassionate “no-fault vaccine compensation policy” could therefore serve a broader purpose. It could strengthen the foundations of vaccine confidence in India, protect families facing rare but serious health consequences and reinforce the credibility of public health institutions. Such a policy would also signal that the State will stand beside citizens who support collective health efforts in good faith.Dr Chandrakant Lahariya is a leading cardio-metabolic physician and specialist in public health policy, parenting and child development



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