HEALTH, EDUCATION and Welfare Secretary Joseph A. Califano Jr. did the right thing this week by clearing the way for federal compensation for everyone who suffered Guillain-Barre disease, a form of paralysis, after taking a swine-flu shot in 1976. Normally, people who get side effects from vaccines must prove negligence by someone in order to win a damage suit. But this situation was abnormal. Some 40 million unsuspecting Americans had been immunized before officials learned of the gamble involved - that one out of every 100,000 was likely to get Guillain-Barre disease - and one out of every 2 million was likely to die a result. Compensation for those victims - there have been 439 claims so far - is just and humane.
The ruling itself is quite narrow. However, Guillain-Barre disease is now recognized as an occasional side effect of flu vaccines generally. That hasimportant implications for future programs, including the proposed campaign against the so-called Russian flu and other strains this fall. As HEW officials recognize, everyone who considers a flu shot must be fully informed about the nature and frequency of Guillain-Barre, as well as other risks, so that they and their physicians can intelligently weigh those hazards against the dangers of the flu.
The fact that the shots are not totally harmless also means that official immunization campaigns should be carefully focused on the groups who are most susceptible to serious flu attacks. The "Russian" strain, like others, is most threatening to the old, the young and people with chronic health problems.
Yet because every vaccine has some side effects, however infrequent, the compensation issue remains. So do the serious problems in the whole tort system of handling personal-injury claims. Concepts of liability have been stretched to absurd lengths; litigation is far too costly and tedious; damage awards by juries are often outlandishly high. It was these factors, more than any specific safety concerns, that caused the makers of swine-flu vaccine to insist on federal assumption of liability before that program was launched in 1976.
This may well be one more area in which a new, nofault approach is required. As a recent HEW report to Congress shows, it won't be easy to devise a system that provides reasonable benefits to victims of vaccines, eases the manufacturers' worries and yet retains sanctions against lack of care by drug companies or health professionals. Discussion of alternatives would be easier if vaccine makers would release more information about past problems and claims.
One point seems clear to us: The public - which means the taxpayers - should assume more responsibility for compensating the radom victims of massimmunization drives. Campaigns against flu, measles, polio and other communicable diseases do protect society, not just individuals. Where anyone may choose not to get a shot, the case for public payment of damages may be less strong. But where government pre-empts that choice - as by requiring immunizations for attendance at school - it should also accept responsibility for the consequences. Payment may be required in one case in a million, but the principle should be established now.