Childhood vaccines are extolled for effective prevention of dangerous diseases. However, a persistent anti-vaccine movement resists vaccination due to real and perceived links between vaccines and adverse health effects, including autism. Closely related to the vaccine safety debate is the policy concern about balancing the need to compensate individuals who are harmed by vaccines and to prevent vaccine manufacturers from exiting the market due to the prospect of unmanageable tort liability. The recent Supreme Court decision in Brusewitz v. Wyeth strikes a balance in favor of shielding vaccine manufacturers from design-defect liability and thus limits the options for claimants of certain vaccine-related injuries to recover compensation. The Brusewitz decision held that design-defect claims against vaccine manufacturers are preempted under the National Childhood Vaccine Injury Act (NCVIA). Despite the Court’s focus on statutory interpretation, the public health policy implications and vaccine safety debate lurked beneath the surface of the Court’s reasoning. Although the Court’s decision has largely been lauded as a win for public health, some have criticized the decision as creating a dangerous regulatory vacuum for vaccine improvement and monitoring. This decision has significant ramifications for the vaccine compensation system, including the thousands of pending claims asserting a link between vaccines and autism.