Vaccine Injury Compensation, COVID-19 Vaccine Claim Migration, and Public Trust.

I evaluated the public health governance implications of moving COVID-19 vaccine injury claims from the Countermeasures Injury Compensation Program to the National Vaccine Injury Compensation Program and identified safeguards for the transition. I interpreted US Health Resources and Services Administration data as of April 1, 2026, with governing statutes, regulations, Federal Register materials, and previous scholarship. Migration could involve prospective coverage, transfer of pending claims, revival of denied claims, or retroactive eligibility, each with different access and fiscal consequences. The receiving program is settlement dominated; its trust fund finances counsel and uncertainty resolution as well as awards; and recurrent off-table settlements can create informal compensation expectations. Undifferentiated counts may be misread as causation findings or program generosity. Migration should be paired with pathway-stratified reporting, a settlement-to-evidence review trigger, clearer trust fund accounting, and a narrow public reasoning and evidence review floor for novel injury clusters. These reforms could improve access without making compensation outputs avoidable sources of vaccine-safety confusion. (Am J Public Health. Published online ahead of print October 8, 2026:e1-e9. https://doi.org/10.2105/AJPH.2026.308790).