臺灣在 2021 年起大規模接種 COVID-19 疫苗，而 2021-2022 年
間預防接種受害救濟申請案例暴增為 8,564 件。截至 2023 年 6 月 8
日，臺灣衛生福利部預防接種受害救濟審議小組（VICP）審議完成
COVID-19 疫苗案件共 2,689 例，其中 303 例獲得救濟佔 11.26%，
而 2,386 例則是不予救濟佔 88.73%。相較之下，日本、香港、紐西
蘭、芬蘭、挪威通過救濟比例皆遠高於臺灣，似乎顯示臺灣 VICP 採
納證據標準稍嫌嚴格。
本文由證據法角度分析臺灣現行制度下疫苗不良事件因果關係
判斷標準及所採用證據種類，檢視臺灣 VICP 審議 COVID-19 疫苗
案件現況，發現 VICP 引用醫學證據的方式有以下特徵：一、致病機
轉明確實驗室檢驗結果擁有最高證據力；二、選擇性採納人口群醫
學證據；三、是否採納醫學個案報告標準不明確、不一致；四、過度
重視統計學常態而忽略極端值（離群值）；五、VICP 原則上認為接
種者體質（既有健康風險）阻斷因果關係；六、VICP 傾向採取診斷
立場判斷 COVID-19 疫苗傷害因果關係。
為增進疫苗傷害救濟制度效能與客觀性，優化 VICP 使用科學
證據方式之明確性與一致性，並滿足社會大眾合理期待，本文提出
一些解決疫苗傷害因果關係爭議可能方案如下：一、因果關係分類
更加細緻化、彈性化；二、適用民法「蛋殼頭蓋骨理論」承認多重因
果關係；三、以舉證責任轉換、證明度降低方式採信疑似接種受害人
事實主張；四、以法律規範目的判斷預防接種不良事件因果關係；
五、科學不確定時可採納部分人口群及案例報告證據；六、適度承認
新疫苗極端值案例因果關係；七、政府根據新證據主動職權撤銷以
往行政處分。

Taiwan began large-scale vaccination against COVID-19 in 2021,
and since then, the number of applications for vaccine injury
compensation has surged to 8,564 between 2021 and 2022. As of June 8,
2023, the Vaccine Injury Compensation Working Group (VICP) in the
Ministry of Health and Welfare has reviewed a total of 2,689 cases of
COVID-19 vaccine applications. Of these, 303 cases (11.26%) received
compensation, while 2,386 cases (88.73%) were not granted
compensation.
This study analyzes the criteria used to assess the causality of adverse
events following immunization under Taiwan's current system and
examines the reasons behind the Vaccine Injury Compensation Working Group's (VICP) acceptance or rejection of compensation applications.
How VICP cites medical evidence exhibits the following characteristics:
Firstly, medical evidence with clear pathogenic mechanisms is given the
highest evidentiary weight. Secondly, population-based or cohort studies
are selectively utilized by VICP. Thirdly, VICP selectively adopts case
report evidence without clear and consistent standards. Fourthly, there is
an overemphasis on statistical normality, while outliers are often ignored.
Fifthly, pre-existing medical conditions are often used to preclude any
causal link between vaccination and adverse events. Finally, VICP is
prone to consider the vaccine injury causality from a diagnostic point of
view.
To enhance the effectiveness and objectivity of the vaccine injury
compensation system, ensure clarity and consistency in the utilization of
scientific evidence by the VICP, and meet the reasonable expectations of
the public, this article proposes several solutions to address the dispute
over the causality of vaccine injuries. Firstly, creating additional causality
types to provide more flexibility in assessing causality. Secondly,
applying the "Eggskull Theory" to acknowledge multiple causes of
adverse reactions. Thirdly, shifting the burden of proof through the
application of evidence rules. Fourthly, assessing causality in accordance
with the purpose of legal norms. Fifthly, utilizing population-based
studies and case reports to provide more support for the applicants.
Sixthly, recognizing the causality of extreme value cases for new
vaccines. Finally, based on new evidence and revised decisions, the
government can proactively grant compensation to victims who were
previously not compensated.