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The National Vaccine Injury Compensation Program: Awareness, Perception, and Communication Considerations

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The National Vaccine Injury Compensation Program: Awareness, Perception, and Communication Considerations The National Vaccine Injury Compensation Program: Awareness, Perception, and Communication Considerations Developing a Comprehensive National Vaccine Injury Compensation Program Research Report Presented by Banyan Communications and Altarum Institute For the U.S. Health Resources and Services Administration Division of Vaccine Injury Compensation June 2010 Table of Contents 1. Introduction and Background ................................................................................................................. 1 a. VICP BACKGROUND: RELATED LEGISLATION ................................................................................................. 2 2. Review of the VICP Literature ................................................................................................................. 4 a. METHODOLOGY ............................................................................................................................................. 4 b. VICP PERCEPTION AND REACTION ................................................................................................................ 4 c. VICP MESSAGING AND PROMOTION ............................................................................................................. 7 3. Scan of the Field: VICP Players, Media, and the Online Environment .................................................... 12 a. METHODOLOGY ............................................................................................................................................. 12 b. VICP AND VACCINE-RELATED STAKEHOLDERS, MEDIA DISCUSSION, AND EVENTS ...................................... 12 c. ONLINE ENVIRONMENTAL SCAN OVERVIEW ................................................................................................ 19 4. Conversations with Subject Matter Experts ........................................................................................... 20 a. METHODOLOGY ............................................................................................................................................. 20 b. EXPANDED INTERVIEW RESULTS ................................................................................................................... 21 5. Target Audience Focus Groups ............................................................................................................... 26 a. METHODOLOGY ............................................................................................................................................. 26 b. EXPANDED HEALTH CARE PROVIDER RESULTS .............................................................................................. 27 c. EXPANDED VACCINE CONSUMER RESULTS ................................................................................................... 30 d. EXPANDED FOCUS GROUP CONCLUSIONS .................................................................................................... 34 6. Discussion: Major Themes and Future Considerations .......................................................................... 37 7. References .............................................................................................................................................. 38 8. Appendices .............................................................................................................................................. 42 Review of the VICP Literature ............................................................................................................. 43 Scan of the Field: VICP Players, Media, and the Online Environment ................................................ 57 Conversations with Subject Matter Experts ....................................................................................... 75 Target Audience Focus Groups ........................................................................................................... 79 The National Vaccine Injury Compensation Program: Awareness, Perception, and Communication Considerations Developing a Comprehensive National Vaccine Injury Compensation Program Research Report i 1. Introduction and Background In 2009, Banyan Communications (Banyan), in partnership with Altarum Institute (Altarum), was contracted by the U.S. Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA) Healthcare Systems Bureau’s Division of Vaccine Injury Compensation (DVIC) to develop a comprehensive national marketing and outreach campaign to address the National Childhood Vaccine Injury Act of 1986 legislative mandate for the publicity of the National Vaccine Injury Compensation Program (VICP) (42 USC, Section 300aa-10). With this Developing a Comprehensive National Vaccine Injury Compensation Program contract, DVIC sought support to: Conduct formative research with key target audiences, Design a multifaceted outreach campaign, and Identify key measures of success for the campaign. The Banyan-Altarum approach to this work includes three distinct phases: PHASE I Formative Research PHASE II Create Marketing and Outreach Plan PHASE III Prepare Final Presentation of Plan This research report summarizes and provides a synthesis of the formative research activities and addresses the following research areas. PHASE I: Formative Research Literature Review Vaccine-related legislation Understanding the target audiences Trusted sources of VICP information Current and past VICP messaging Effective communication strategies Traditional and Online Environmental Scans Trusted sources of VICP information Current and past VICP messaging Current and past online VICP discussions Effective communication strategies Subject Matter Expert Discussions Current and past VICP messaging Trusted sources of VICP information Effective communication strategies Focus Groups Understanding of the target audiences Trusted sources of VICP information Effective communication strategies The National Vaccine Injury Compensation Program: Awareness, Perception, and Communication Considerations Developing a Comprehensive National Vaccine Injury Compensation Program Research Report 1 a. VICP BACKGROUND: RELATED LEGISLATION Legislative context of vaccine injury compensation and outreach During the early 1980s, vaccine safety gained national attention with a sharp increase in the number of civil lawsuits filed on behalf of children who presumably experienced adverse events (e.g., injury or death) as a result of diphtheria, tetanus, and pertussis (DTaP) vaccine exposure (Evans, 2006). Through the civil tort system, rulings and awards were made in favor of plaintiffs who claimed that they experienced adverse events from DTaP vaccine exposure. Due to the high costs incurred by these lawsuits, several major vaccine manufacturers halted production, which destabilized the entire U.S. vaccine market. In turn, vaccine shortages caused eminent concern about the resurgence of contagious disease epidemics (Anderson, 2003; Mello, 2007; Moreland, 2008; National Vaccine Program Office, 2010). To simultaneously address these growing public health concerns and reduce liability for vaccine manufacturers and administrators, Congress passed the National Childhood Vaccine Injury Act (the Act) in 1986. The Act, which has since been amended, led to the creation of the VICP, which became operational in October 1988. The VICP is housed within DVIC and is administered by HHS; the Department of Justice (DOJ) and the U.S. Court of Federal Claims (the Court) also have a role in its administration. The VICP was designed to compensate individuals on a “no-fault” basis, such that vaccine-related injury or death claims must be submitted to the VICP before further litigation directly against vaccine manufacturers and/or health care providers (i.e., vaccine administrators) may be sought (HRSA, n.d.). In addition, individuals who submit claims to the VICP are afforded a reduced burden of proof compared to the level of proof required for civil suits; i.e., presumptive causation versus actual causation may in some cases be sufficient proof to establish vaccine-related injury or death through the VICP (the Court’s Office of Special Masters [OSM], n.d.). The determination of presumptive causation is dependent on whether a case’s circumstances align with the Vaccine Injury Table (Table) and Qualification and Aids to Interpretation (Aids to Interpretation),1 which list covered vaccines as well as associated adverse events and prescribed time frames within which the adverse events must occur. If a given claim meets the criteria specified by the Table and Aids to Interpretation, then the requirement for proof substantiating actual causation is waived. Such claims are referred to as “on-Table.” However, if a claim does not directly correspond to the Table and Aids to Interpretation, then proof (e.g., “evidence in the form of scientific studies or expert medical testimony”) must be presented to establish actual causation (OSM, n.d.). Compensation paid by the VICP may be awarded for (1) past and future un-reimbursable medical, custodial care, and rehabilitation costs; (2) up to $250,000 for actual and projected pain and suffering or emotional distress; (3) lost earnings; and/or (4) attorneys’ fees and costs. For cases where compensation is being paid for vaccine-related deaths, up to $250,000 for the estate of the deceased in addition to attorney costs may be awarded. Individuals may be compensated for attorney costs regardless of whether causation if determined for their cases (HRSA,
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