UK vaccine injury scheme excludes most harmed by systemic inequities in biomedical response and legal thresholds

Indigenous knowledge systems, such as those in Māori and First Nations communities, emphasise collective harm and intergenerational trauma in vaccine injury responses, contrasting with the UK’s individualistic legal thresholds. Traditional healers in Pacific Island nations often document vaccine-related syndromes (e.g., 'vaccine sickness') that fall outside biomedical diagnostic criteria, highlighting the need for culturally adapted injury recognition. The absence of indigenous representation in the UK inquiry reflects a colonial legacy of excluding traditional knowledge from public health policy.

Historically, vaccine injury compensation schemes have been reactive, emerging only after mass harms (e.g., 1976 swine flu program in the US, 2009 Pandemrix narcolepsy cases in Europe). The 60% disability threshold mirrors past exclusionary practices, such as the UK’s 1950s polio vaccine injury scheme, which required near-total disability for payouts. The inquiry’s focus on the UK’s 'world-leading' biomedical response ignores the global precedent of countries adopting more inclusive compensation models, such as Japan’s vaccine injury system.

Cross-culturally, compensation schemes vary widely: Japan’s no-fault system provides automatic payouts for vaccine injuries without proving fault, while the US Vaccine Injury Compensation Program (VICP) uses a more adversarial model. In Nigeria, community-based reporting of vaccine harms during the 2014 Ebola response led to policy changes, contrasting with the UK’s top-down surveillance. The inquiry’s biomedical-centric approach overlooks how cultural perceptions of disability (e.g., in South Asian communities) shape injury recognition and reporting.

Scientifically, the 60% disability threshold lacks empirical justification, as vaccine injuries often manifest as chronic, non-severe conditions (e.g., postural orthostatic tachycardia syndrome, menstrual disorders) that don’t meet legal definitions of disability. The inquiry’s reliance on biomedical metrics ignores the growing evidence of sub-acute harms, such as autoimmune reactions, which are understudied due to short trial durations. Post-market surveillance in the UK (e.g., Yellow Card Scheme) is voluntary and underreported, skewing injury data toward severe cases.

Artistic and spiritual traditions often frame bodily harm as a communal or spiritual disruption, contrasting with the UK’s legalistic approach. For example, in Afro-Caribbean traditions, vaccine injuries may be interpreted as 'spiritual blockages' requiring holistic healing, which biomedical systems dismiss. The inquiry’s silence on these perspectives reflects a broader devaluation of non-Western epistemologies in public health. Creative works, such as poetry or music from marginalised communities, have documented vaccine harms in ways that challenge institutional narratives.

Future modelling should prioritise adaptive compensation systems that account for emerging harms (e.g., long Covid-like syndromes post-vaccine) and integrate real-time injury reporting via community health networks. Scenario planning must include 'no-fault' models, like Japan’s, to reduce adversarial legal battles and ensure timely support. The UK could adopt a tiered system, where partial injuries receive proportional compensation, aligning with global best practices. Longitudinal cohorts tracking sub-acute harms are critical for preventing future exclusionary policies.

Marginalised voices—particularly women, people of colour, and disabled communities—are systematically excluded from injury recognition due to underrepresentation in clinical trials and bias in medical reporting. The 60% threshold disproportionately affects those with chronic illnesses (e.g., ME/CFS) or autoimmune conditions, who are more likely to be women. The inquiry’s lack of diverse expert testimony (e.g., disability rights advocates, racial equity scholars) reinforces these exclusions. Community-led injury databases, such as those in the US by #MEAction, reveal harms that institutional systems ignore.