[Vaccination in Workplace and Compensation for Adverse Events].

Several types of SARS-Cov-2 vaccine have been quickly developed and officially approved for emergency use in accordance with the Pharmaceutical Act. Mass vaccination in workplaces in Japan was subsequently promoted, targeting health care workers and senior citizens. We overviewed the pathophysiology of COVID-19 and reviewed reports containing fatal outcomes, compensation programs, and remedial measures for health damage after vaccinations, in relation to their relevant legislations. The Immunization Act was amended prior to the mass vaccination to authorize the indemnity agreement between the government and pharmaceutical companies to compensate for losses based on health damages after vaccination. Pursuant to the Civil Code and the State Redress Act, employers reserve the right to obtain reimbursement when they are liable to pay compensation for damages inflicted on a third party. There are no provisions to exclude healthcare workers and occupational health staff who participated in practical procedures from lawsuits and liability. We propose legislative reformation and careful contracts with responsible organizations concerned with emergency vaccinations in order to confront forthcoming new or re-emerging infections beyond this pandemic.

[Study of U.S. regulations on determination of work-relatedness of mental health disturbance and cerebrovascular and cardiac diseases].

Recently, work-relatedness of mental health disturbance, cerebrovascular and ischemic heart diseases has been generously recognized in the determination of workers' compensation, in administrative or civil suits in Japan. Companies that operate overseas enterprises need to investigate legislature and court opinions in countries and regions in which they operate. In this study, we studied legislative materials concerning mental health, and cerebrovascular and cardiac diseases by reviewing official documents published on homepages provided by governmental and academic bodies in the United States. Our main findings are as follows: 1. In the United States, the state authorities have wide powers. The areas where federal employment statutes are directly applied are limited to the employment conditions of the federal government or some interstate commerce. However, almost all employers in every state are required to record and report occupational injuries and illnesses, based on which, nationwide statistics are maintained. 2. The occupational injury and illness recording criteria are clearly stated in the 2001 revision of Code of Federal Regulations(CFR). During the process of amendment, various opinions were raised concerning mental illnesses. In the final ruling, employers are required to record mental illnesses when "the employee voluntarily provides the employer with an opinion from appropriate health care providers stating that the employee has a mental illness that is work related" (29CFR1904.5(b)(2)(ix)). 3. No specific criteria were found concerning cerebrovascular and ischemic heart disorders, except for the statement that injury or illness is considered if an event or exposure in the work environment significantly aggravates a pre-existing injury or illness(29CFR1904.5(a)). 4. According to the safety and health statistics(2004), around 3,000 cases(0.3 cases per 10,000 full-time workers)of mental disorders were reported in private industry workplaces. On the other hand, less than 500 cases of cerebrovascular and ischemic heart disorders were recorded. In the U.S., where significant numbers of work related mental disorders are reported, the necessity of mental health programs in workplaces is emphasized by state governments. It seems to be necessary to take care not to perform actions which might be considered as disturbance of privacy or discrimination due to disability in carrying out management measures, reflecting peoples' attitudes and legislation concerning these items. Few cases of work related cerebrovascular or ischemic heart disorders are reported in the U.S. However, recently, a reference review was published and a conference was held on this problem. Therefore it might become topical in the near future.