All Scheme forms must be completed and submitted in English. A form completed or submitted in any other language will be rejected. However, documents and other information that should be provided alongside the Claim Form (Schedule 2), the Supporting Evidence Form (Schedule 3) or the Appeal of Denied Receivable Claim Form (Schedule 5), as described in such forms, may be submitted in other languages.
In order for the Administrator to consider any Scheme Forms each form must be fully completed, signed and dated when submitted.
Any of the forms and documents concerning the Scheme can be downloaded and printed.
|Schedule 1: List of Vaccines
|Schedule 1 lists the Vaccines covered by the COVID-19 Vaccine Facility No-Fault Compensation Scheme.
|Schedule 2: Claim Form
|Schedule 2 contains the Claim Form that a Claimant must complete and submit in order to make a claim for compensation under the COVID-19 Vaccine Facility No-Fault Compensation Scheme.
|Schedule 3: Supporting Evidence Form
|A Claimant must complete the Supporting Evidence Form in order to provide supporting evidence that the Administrator requires to evaluate the Claim. Every Claim Form must be accompanied by a Supporting Evidence Form.
|Schedule 4: Notice of Appeal of Rejected Claim
|The Notice of Appeal of Rejected Claim may be submitted by a Claimant if the Claimant’s original Claim has been rejected on the grounds that it does not constitute a Receivable Claim under the Scheme.
|Schedule 5: Notice of Appeal of Denied Receivable Claim
|A Claimant may submit a Notice of Appeal of Denied Receivable Claim if the Claimant decides to appeal the denial of a Receivable Claim under the Scheme in accordance with the procedure described in Section 8 of the Scheme Protocol.
|Schedule 6: Illustrative Diagram of Reporting Period
|The Illustrative Diagram of the Reporting Period provides a visual representation of the period during which a Claimant may file an Claim for compensation under the COVID-19 Vaccine Facility No-Fault Compensation Scheme.
|Schedule 7: How to Submit a Claim
|The How to Submit a Claim guide provides potential Claimants with a step-by-step walk-through of the process of submitting a Claim. You should refer to this document before submitting a Claim in order to ensure that you submit your Claim correctly.
|Schedule 8: Frequently Asked Questions
|If you have any questions about the Scheme (for example regarding the Vaccines and types of injuries that are covered by the Scheme) please refer to the Frequently Asked Questions before contacting the Administrator with your query.
|Schedule 9: List of Participating Countries
|This list sets out the countries that have elected to participate in the Covid-19 Vaccine Facility No-Fault Compensation Scheme.
In addition to the Schedules above, there are other helpful documents that a Claimant should refer to, including the Scheme Protocol and the definitions used both in the Scheme Protocol and on this website.
|The Scheme Protocol sets out the processes and procedures which will be followed for claiming compensation under the COVID-19 Vaccine Facility No-Fault Compensation Scheme.
|This document sets out the defined terms used in the Scheme Protocol and their meaning.
The Covid-19 Vaccine Facility No-Fault Compensation Scheme, established to provide fair compensation to eligible vaccine recipients who suffer a Serious Adverse Event related to a COVID-19 vaccination that has been either:
- procured and/or delivered by UNICEF on a Participating Country’s behalf;
- donated to a Participating Country through UNICEF; or
- formally included into the Scheme (but otherwise procured and/or delivered but not by or through UNICEF),
as detailed in the Scheme Protocol and its Schedules.
A written claim for compensation completed by a Claimant, using the Claim Form approved by and provided by the Administrator, as set forth in Schedule 2 of the Scheme’s Protocol, which must be accompanied by all Supporting Evidence.
The supporting evidence, using the form in Schedule 3 of the Scheme’s Protocol, required to evaluate a Claim and that shall include:
- detailed medical documentation from a Registered Healthcare Professional describing the Injury and medical treatment required as a result of the Injury, together with details of any Hospitalisation or prolonged Hospitalisation, including but not limited to admission and discharge records;
- a description of the nature, extent, functional impact and prognosis of the Injury, as assessed by the Registered Healthcare Professional.
- a statement from the Registered Healthcare Professional that the Injury was, in the Registered Healthcare Professional’s opinion, the result of the Vaccine or its administration;
- certification from a Registered Healthcare Professional of when, where and which Vaccine was administered;
- in the case of death, a death certificate and any other documentation available from a Registered Healthcare Professional of the cause and manner of death; and
- any further evidence that the Administrator may deem necessary to adjudicate the Claim and/or Receivable Claim, as applicable, guided, as appropriate, by the Scientific Advisory Committee, the Review Panel, and/or the Appeals Panel.
Any duly completed Claim for compensation (i) that is accompanied by all Supporting Evidence, (ii) that is filed/submitted by a Claimant prior to the end of the Reporting Period with the Administrator, and (iii) that is found by the Administrator, and/or by the Administrator’s Vice President of Risk Consulting to be receivable as provided in Section 4 or Section 7 of the Scheme's Protocol.
ESIS, Inc., the claims Administrator appointed to manage and administer the Program, including, but not limited to, the receipt and registration of Applications, distributing acknowledgements of receipt of Applications, setting financial reserves for Receivable Claims, review of Applications, Supporting Evidence, and other documents to assess receivability, assessing Receivable Claims, and approve or deny, as the case may be, Payment for compensation, in accordance with the terms of the Program's Protocol.
A COVID-19 vaccine received in any Participating Country that is either: (i) procured and/or delivered by UNICEF on a Participating Country's behalf; (ii) donated to a Participating Country through UNICEF; or (iii) formally included into the Scheme (but otherwise procured and/or delivered but not by or through UNICEF), that:
- either (A) has licensure or authorisation from a stringent (“functional”) regulatory authority or (B) has received WHO prequalification, following licensure or authorisation from a stringent (“functional”) regulatory authority, or (C) has been issued authorisation for emergency use based on licensure or authorisation by a stringent (“functional”) regulatory authority; and
- is included in Schedule 1 of the Scheme’s Protocol, as updated from time to time; and
- has received all required approvals and authorisations for importation, distribution and use in the relevant country; and
- has not reached its Scope of Coverage Endpoint.
Any individual, who meets all of the following requirements:
- is a Patient who was administered a Vaccine (or in the event the Patient has died, is a child, or is disabled or otherwise lacks the legal capacity to submit a Claim for himself or herself, is an individual who is a duly authorised heir (in the case of death), parent, legal guardian or other legal representative of the Patient); and
- is, or is duly authorised to represent, a Patient who has sustained an Injury which, in the opinion of a Registered Healthcare Professional, is deemed to have resulted from a Vaccine or its administration; and
- the Vaccine was administered before its Scope of Coverage Endpoint (as indicated in Schedule 1 of the Scheme’s Protocol); and
- has submitted a Claim for compensation, using the prescribed form in Schedule 2 of the Scheme’s Protocol, together with all Supporting Evidence, using the prescribed form in Schedule 3 of the Scheme’s Protocol to the Administrator, following the procedures described in the Scheme’s Protocol, and provided that this Claim is submitted: (a) in full observance of the waiting period of 30 days referred to in Section 1(c) and in Schedules 2 and 3 of the Scheme’s Protocol; (b) before the end of the Reporting Period; and (c) otherwise within the time limits set forth in Section 4 of the Scheme’s Protocol; and
- has not received any prior payment from any other public source, including from any governmental or publically funded no-fault compensation scheme, as compensation for the Injury; and
- is not eligible to receive compensation from any other source for the Injury, or if eligible for such compensation, discloses the nature and full extent of such eligibility; and
- has no pending lawsuits or claims for compensation for the Injury; and
- agrees not to seek or make any claims for compensation from any other public source, including from any governmental or publically funded no-fault compensation scheme, for the Injury for as long as the Claim, and/or Receivable Claim, as applicable, is pending with the Scheme; and
- is not and does not represent a Patient in respect of whom the Administrator is by any applicable sanctions regime, including any UN Security Council sanctions regime, precluded from accepting a Claim and/or paying compensation under the Scheme.
An appeal filed by a Claimant, following the denial of receivability of his or her Claim by the Administrator, in accordance with the procedure described in Section 7 of the Scheme’s Protocol and using the form in Schedule 4 of the Scheme’s Protocol.
An appeal filed by a Claimant, following the denial of his Receivable Claim by the Review Panel, in accordance with the procedure described in Section 8 of the Scheme's Protocol and using the form in Schedule 5 of the Scheme’s Protocol.
On a per Vaccine basis, the period during which a Claimant may file a Claim for compensation under the Scheme in respect of such Vaccine. The maximum Reporting Period for each Vaccine extends from:
- the date on which such Vaccine was first put into circulation by the manufacturer following regulatory approval or an emergency use authorisation of such Vaccine by any regulator (as indicated in Schedule 1 of the Scheme’s Protocol); and
- terminates on the date which is 36 calendar months immediately after the Scope of Coverage Endpoint for such Vaccine (as indicated in Schedule 1 of the Scheme's Protocol), provided always that the Vaccine was administered before this Vaccine’s Scope of Coverage Endpoint (as defined in Section 2 of the Scheme's Protocol and indicated in Schedule 1 of the Scheme's Protocol). See the illustrative diagram of the Reporting Period in Schedule 6 of the Scheme’s Protocol.
For each Patient, the Reporting Period depends on the date the Vaccine was administered to the Patient. To calculate the Reporting Period that applies to the Patient, the Patient (or the person who is a duly authorised to represent the Patient as provided in limb (ii) of the definition of Claimant in the Scheme's Protocol) needs to:
- determine (through Schedule 1 of the Scheme’s Protocol) what is the date of the Scope of Coverage End Point that applies to the Vaccine that was administered to Patient; and
- calculate the number of months and days from the vaccination date (i.e. date that the Vaccine was administered to the Patient) until the date of the Vaccine’s Scope of Coverage End Point, and add another 36 months. This establishes the Reporting Period that applies to the Patient.