As of Aug. 2, 2021, 1693 injury claims associated with COVID-19 medical countermeasures have been filed in the Countermeasures Injury Compensation Program (CICP), of which 686 claims were related to COVID-19 vaccines and urgently needed compensation decisions. However, from an economic and public policy perspective, we find that the CICP design has unintended consequences: locating CICP in the executive agency DHHS potentially creates a conflict of interest, and not permitting judicial review generates a lack of checks and balances, both of which could jeopardize justice. These fundamental problems would subsequently weaken four key performance indicators of CICP compared with its judicial counterpart in the Court of Federal Claims. CICP lacks accountability, transparency, and cost-effectiveness efficiency, with 94% of its total costs spent on administration rather than compensation. CICP’s ability to compensate is also questionable. If COVID-19 claims were compensated at its historical rate, CICP would face around $21.16 million in compensation outlays and $317.94 million in total outlays, 72.1 times its current balance. To ensure just compensation for injured petitioners during COVID-19 and future public health emergencies, we recommend Congress (1) initiate a major reform by relocating CICP from DHHS to the Claims Court or (2) keep CICP within DHHS and make incremental changes by permitting judicial review of DHHS administrative adjudication of CICP claims. We further recommend Congress audit and adjust budgets for CICP and DHHS promptly propose an injury table for COVID-19 claims. This is the first study that contributes an economic perspective to the limited literature on CICP and also provides unique and rich economic data.

Context: American Indians and Alaska Natives (AIANs) are historically disadvantaged, losing 20 million (95%) of their population largely through epidemics since 1,520 and continuing lower overall vaccination coverage than other races. Determinants of this lower coverage are underexamined.Methods: Among peer-reviewed relevant articles since 1968, 39 studied AIANs solely; 47 drew general population samples, including AIANs. We employed rigorous economic definitions and framework of Individual Decision-Making Under Uncertainty. The Social-Ecological model identified determinants and mechanisms at five levels.Findings: Individual-level determinants include: (1) vaccine-preventable disease (VPD) and vaccine knowledge; (2) vaccine safety, efficacy, moral hazard beliefs; (3) preferences; (4) income and post-subsidy costs. Interpersonal-level determinants include others’ knowledge and preferences. Organizational-level characteristics of Indian Health Service, Tribal, Urban Indian (IHS/T/U) facilities include: (1) supply of vaccine products, providers, services; (2) provider cultural competency, vaccine recommendations, standing orders; (3) patient reminder/recall. Community-level characteristics include: (1) socioeconomics and geographics; (2) information infrastructure; (3) cultural values, practices, languages; (4) historical epidemic knowledge; (5) historical harms thus distrust in government, health system, science. Societal-level determinants include: (1) federal recognition and entitlements; (2) tribal self-determination; (3) state Medicaid enrollment; (4) structural racism.Policy recommendations: Tribal interventions may (1) increase AIANs’ knowledge about VPDs, vaccines, Medicaid enrollment; (2) design risk/cost–benefit calculations using scientific objective probabilities of vaccine safety and efficacy; (3) tailor messages to epidemic histories, narratives, values; (4) outreach by trusted messengers. I/T/U organizational interventions may reduce transportation costs while increasing provider supplies, cultural competency, and vaccine standing orders. Federal policies may increase IHS funding, tribal infrastructure, and AIAN data representativeness while eliminating structural racism and generational trauma.Conclusion: This article contributes to literature and practice. It is the first multidisciplinary, comprehensive overview of multi-level determinants and mechanisms of AIAN vaccination. Its findings highlight the gaps and limitations of laws and policies impacting AIAN vaccination. It recommends future research, culturally-appropriate interventions, and policies to close the gap to enhance AIAN vaccination and healing.

Objectives: As one type of vaccine policy, the effectiveness and spillover effects of the US CDC vaccine recommendations are inadequately evaluated. This study aims to fully evaluate its impacts on male adults, in addition to children, using better data.Design: A before-after study design to examine the CDC’s 2011 HPV vaccine recommendation for men aged 11–21.Data analysis: Individual-level data included the 2010–2015 US National Health Interview Survey full sample of 7,000 male children aged 11–18, younger adults aged 19–21 and 22–25, and older adults aged 26–60. Pooled cross-sectional surveys contained individual-level vaccination, socioeconomic, and demographic information. Outcome variable is an individual HPV vaccination status, measured as individual probability of HPV vaccination. Dummy regressions were estimated by a Linear Probability Model (LPM) with fixed effects for target and non-target age groups.Results: The policy was significantly associated with a 14.8% (p < 0.001) increased individual likelihood of HPV vaccination for men aged 11–21. It was also associated with a modest spillover effect, a 5.6% (p < 0.001) increased individual likelihood for men aged 22–25 and marginally for men aged 26–60. African American men and men with poor health were 2.7 and 15.4% less likely to uptake HPV vaccines than white men and men with good or fair health, respectively.Conclusion: This study complements the existing policy evaluation literature on HPV vaccine recommendation among male children by including adults and using better data. Findings offer comprehensive evidence of the effectiveness and spillover effects of this recommendation type of federal-level policy, provide policy lessons for other vaccines, and identify vulnerable subpopulations as targets for future policies.