Exploring the Policy Feedback Effects of a No-Fault Compensation Scheme for COVID-19 Vaccine Injuries in Thailand: A Qualitative Study

Background Thailand implemented a no-fault compensation scheme (NFCS) for COVID-19 vaccine-related injuries during the pandemic as part of its Universal Health Coverage (UHC) framework. This policy aimed to promote vaccine confidence, reduce litigation and enhance healthcare system resilience. This study investigates the policy feedback effects of Thailand’s NFCS and its implications for healthcare governance in low- and middle-income countries (LMICs). Methods A qualitative multi-method approach was employed. Data sources included government policy documents, peer-reviewed literature, media content, official NHSO reports, five semi-structured interviews with key stakeholders and a focus group discussion with public health experts. Media content analysis included over 100 news reports published between March 2021 and October 2022. The analysis was guided by Policy Feedback Theory to identify self-reinforcing and self-undermining feedback loops. Results Between April 2021 and September 2023, 22,695 compensation claims were filed, with 84.0% approved. The NFCS reduced litigation risks, built public trust and contributed to high vaccine uptake. Self-reinforcing feedback effects were observed in administrative innovations, public engagement strategies and cross-scheme equity. However, self-undermining effects such as financial strain and increased public expectations emerged. Media narratives and public interviews confirmed the importance of rapid compensation and transparent communication in driving public acceptance. Conclusions Thailand’s NFCS illustrates how a well-designed compensation mechanism can enhance vaccine confidence and public trust during health emergencies. However, sustained political and financial commitment is necessary to mitigate unintended fiscal and administrative challenges. The findings offer relevant policy lessons for LMICs in designing resilient, inclusive compensation systems during future health crises.