“Vaccines are safe,” says Narayan Nair. “That’s the message we need to get out there.”

Nair is a physician. He is also the head of the Vaccine Injury Compensation Program—the system through which the U.S. government has, over the past three decades, paid more than $4 billion to people who claim to have been harmed by vaccines.

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“The creation of the VICP was a quid pro quo,” the Stanford Law School professor Nora Freeman Engstrom told me over email. People who may have been injured by vaccines would give up some ability to seek redress through the court system. In return, they would be assured swift and certain compensation. The program was charged by Congress to address claims “quickly, easily, and with certainty and generosity.”

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In a 2015 analysis of the program, Engstrom found that this was not the case. Only about a quarter of claims were being compensated, and often not in a timely manner. She cited the fact that the average vaccine-injury claim took longer to adjudicate than the average case alleging medical malpractice. “The VICP,” Engstrom wrote, “has simply failed to offer compensation as consistently, as quickly, as easily, or as simply as its proponents had predicted.”

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Since Engstrom’s analysis was published, though, there has been a dramatic change. For most of the program’s history, the program denied a large majority of claims. But between 2015 and 2019, 77 percent of claims were compensated. In 2004, the VICP compensated just 57 cases. In 2017, it paid 706. Engstrom called the trend “a big shift.”