No-Fault Vaccine Injury Compensation Systems Adopted Pursuant to the COVID-19 Public Health Emergency Response

No-fault vaccine injury compensation systems have developed over the course of the twentieth century, mostly in the richest countries in the world. Acknowledging that severe reactions to vaccines are rare, but can result in serious and sometimes complex injury, these systems provide financial and social support for those suffering these rare side effects. During the COVID-19 pandemic, and the rapid development and deployment of vaccines using novel technologies, these systems have proliferated not only among wealthy countries, where in their modern form they originated and spread, but also low- and middle-income ones. Adopting varying approaches to funding, eligibility, administration, process, and components of compensation and rights of appeal, these new systems offer protections to populations in low- and middle-income countries that until 2020 covered only those in relatively wealthy states, especially Europe and North America. The purpose of this Article is twofold. First, it provides the first comprehensive landscape analysis of no-fault vaccine injury compensation systems since before the COVID-19 pandemic. That analysis identifies twenty-five such systems, almost all of which were established for routine immunizations. Second, it provides an accessible resource for advocates and planners in low- and middle-income countries that may benefit from an analysis of administrative, funding, eligibility, and compensation alternatives that they may consult when considering whether and how to construct their own no-fault vaccine injury compensation systems

No Future but a Shared Future

The COVID-19 pandemic revealed the fractured and inadequate state of national and global health law and institutions, revealing deeply embedded inequalities. In response to a World Health Assembly resolution proposing a special session to consider the benefits of developing a WHO convention or other international instrument on pandemic preparedness and response, the O’Neill Institute for National and Global Health Law and the Foundation for the National Institutes of Health (FNIH) convened 30 of the world’s leading authorities on global health law, financing, biomedical science, implementation, and emergency response along with leaders from prominent international organizations deeply engaged in responding to the pandemic. This meeting was followed by regional consultations convened in Africa, Latin America-Caribbean, and Southeast Asia. The O’Neill Institute/FNIH also held a consultation with civil society representatives. This article is a concise, edited excerpt of the report of those meetings, outlining the options for such an international instrument

Advancing Equity In The Pandemic Treaty

There is a broad consensus around equity’s importance. Even countries that hoarded supplies during the acute phase of COVID-19 seem to understand that the international community must find a means to ensure fairer allocation of medical resources when the next health crisis hits. But there has been little agreement about the concrete steps needed to operationalize fairer access and benefit sharing. That is, what are the workable mechanisms that could reduce the divide between richer and poorer populations? The World Health Assembly, the governing body of the World Health Organization, has appointed an Intergovernmental Negotiating Body to develop a pandemic convention, agreement, or other instrument under the WHO constitution. The February 2023 draft is designed “to achieve greater equity … through the fullest national and international cooperation.” It is important that the negotiators develop specific, measurable metrics that directly impact equity. The mechanisms and metrics agreed upon should allow the public to evaluate whether a more equitable system is emerging through this new regime. Equity won’t just happen. We need to plan and prepare for equity, and we need international norms with which nations must comply to achieve the fairness we strive for

Exploring sources of insecurity for Ethiopian Oromo and Somali women who have given birth in Kakuma Refugee Camp: A Qualitative Study.

BACKGROUND:According to the United Nations High Commissioner for Refugees, 44,000 people are forced to flee their homes every day due to conflict or persecution. Although refugee camps are designed to provide a safe temporary location for displaced persons, increasing evidence demonstrates that the camps themselves have become stressful and dangerous long-term places-especially for women. However, there is limited literature focused on refugee women's perspectives on their insecurity. This qualitative study sought to better understand the ways in which women experienced insecurity at a refugee camp in Kenya. METHODS AND FINDINGS:Between May 2017 and June 2017, ethnographic semi-structured interviews accompanied by observation were conducted with a snowball sampling of 20 Somali (n = 10) and Ethiopian Oromo (n = 10) women, 18 years and older, who had had at least 1 pregnancy while living in Kakuma Refugee Camp. The interviews were orally translated, transcribed, entered into Dedoose software for coding, and analyzed utilizing an ethnographic approach. Four sources of insecurity became evident: tension between refugees and the host community, intra- or intercultural conflicts, direct abuse and/or neglect by camp staff and security personnel, and unsafe situations in accessing healthcare-both in traveling to healthcare facilities and in the facilities themselves. Potential limitations include nonrandom sampling, the focus on a specific population, the inability to record interviews, and possible subtle errors in translation. CONCLUSIONS:In this study, we observed that women felt insecure in almost every area of the camp, with there being no place in the camp where the women felt safe. As it is well documented that insecure and stressful settings may have deleterious effects on health, understanding the sources of insecurity for women in refugee camps can help to guide services for healthcare in displaced settings. By creating a safer environment for these women in private, in public, and in the process of accessing care in refugee camps, we can improve health for them and their babies

What Nations Owe Each Other Before the Next Pandemic

On December 1, 2021, the World Health Assembly adopted a resolution establishing an Intergovernmental Negotiating Body (INB) to determine the content and form of a new pandemic agreement. A portion of the public has advocated for a non-binding agreement while others stress that nationalism should be prevented, with steps taken to monitor and enforce national compliance. The INB has needed to grapple with how the principle of national sovereignty, and the accompanying principle of non-interference, will be addressed with respect to the agreement’s content and form, including obligations to share data, resources, and personnel, and to relinquish control over certain aspects of national coordination and response. To provide technical assistance to the World Health Organization (WHO), INB, and the public concerning this challenge, the O’Neill Institute for National and Global Health Law, a WHO Collaborating Center, and the Foundation for the National Institutes of Health (FNIH) convened leading authorities from every WHO region on international agreements in trade, regional integration, public health emergency preparedness, finance, biomedical science, climate change, maritime affairs, tobacco control, and human rights. Through a series of written, bilateral, and group discussions, we sought to provide the INB with a learned analysis of the stringency and stickiness of international commitments and the often nonobvious relationship between norm-setting and regime compliance to inform its dialogue. This paper is a condensed version of the outcomes of those discussions, which have utility for contemplating any new agreement under international law. The full report, National Sovereignty Implications of a Pandemic Instrument can be found at: https://oneill.law.georgetown.edu/wp-content/uploads/2022/07/ONeill-FNIH-Sovereignty-Implications-of-a-Pandemic-Instrument.pdf

What Nations Owe Each Other Before the Next Pandemic

On December 1, 2021, the World Health Assembly adopted a resolution establishing an Intergovernmental Negotiating Body (INB) to determine the content and form of a new pandemic agreement. A portion of the public has advocated for a non-binding agreement while others stress that nationalism should be prevented, with steps taken to monitor and enforce national compliance. The INB has needed to grapple with how the principle of national sovereignty, and the accompanying principle of non-interference, will be addressed with respect to the agreement’s content and form, including obligations to share data, resources, and personnel, and to relinquish control over certain aspects of national coordination and response. To provide technical assistance to the World Health Organization (WHO), INB, and the public concerning this challenge, the O’Neill Institute for National and Global Health Law, a WHO Collaborating Center, and the Foundation for the National Institutes of Health (FNIH) convened leading authorities from every WHO region on international agreements in trade, regional integration, public health emergency preparedness, finance, biomedical science, climate change, maritime affairs, tobacco control, and human rights. Through a series of written, bilateral, and group discussions, we sought to provide the INB with a learned analysis of the stringency and stickiness of international commitments and the often nonobvious relationship between norm-setting and regime compliance to inform its dialogue. This paper is a condensed version of the outcomes of those discussions, which have utility for contemplating any new agreement under international law. The full report, National Sovereignty Implications of a Pandemic Instrument can be found at: https://oneill.law.georgetown.edu/wp-content/uploads/2022/07/ONeill-FNIH-Sovereignty-Implications-of-a-Pandemic-Instrument.pdf