Convergence on Coercion: Functional and Political Pressures as Drivers of Global Childhood Vaccine Mandates

Background  Vaccine hesitancy is a global problem with diverse local policy responses, from voluntaristic to coercive. Between ۲۰۱۵ and ۲۰۱۷, California, Australia, France, and Italy increased the coerciveness of their childhood vaccine regimes. Despite this apparent convergence, there is little evidence of imposition, policy learning, or diffusion – the drivers that are usually discussed in scholarly literature on policy convergence. The fact that the four governments were oriented across the political spectrum, with quite different political and institutional systems, further indicates an empirical puzzle.Methods  To better understand the drivers of enhanced vaccine mandates, a crucial issue during the coronavirus disease ۲۰۱۹ (COVID-۱۹) global rollout, this article engages with four case studies assembled from qualitative analysis of semistructured in-country interviews and document analysis between November ۲۰۱۸ and November ۲۰۲۰. Key informants had specific expert knowledge or played a role in the introduction or implementation of the new policies. Interview transcripts were coded inductively and deductively, augmented with extensive analysis of legal, policy, academic and media documents.Results  The case analysis identifies two key and interacting elements in government decisions to tighten vaccine mandates: functional and political pressures. Policy-makers in Italy and France were primarily driven by functional challenges, with their vaccination governance systems under threat from reduced population compliance. California and Australia did not face systemic threats to the functioning of their systems, but activists utilised local opportunities to heighten political pressure on decision makers.Conclusion  In four recent cases of high-income jurisdictions making childhood vaccination policies more coercive, vaccine hesitancy alone could not explain why the policies arose in these jurisdictions and not others, while path dependency alone could not explain why some jurisdictions with mandates made them more coercive. Explanation lies in restrictive mandates being attractive for governments, whether they face systemic functional problems in vaccine governance, or political pressures generated by media and activists. Mandates can be framed as targeting whole populations or localised groups of refusers, and implemented without onerous costs or policy complexity.

کلیدواژه ها:

Vaccination ، Vaccine Hesitancy ، Mandatory Vaccination ، Policy ، Convergence