Adapting Coercion: How Three Industrialized Nations Manufacture Vaccination Compliance

Abstract

Context: This research examines the development of vaccination policy in Britain, the United States, and Australia to begin to understand the different forms of coercion that industrialized states utilize to achieve vaccination compliance from the majority of their citizens. Methods: This research applies a comparative-historical analysis of the three countries listed, using a combination of primary and secondary documents. Findings: The different degrees of compulsion in the vaccination policies of Britain, the United States, and Australia is explained through an analysis of the path-dependent ways that each nation adapted coercion in response to civil society resistance. Each nation has moved up and down a continuum of coercion searching for a policy that balances overcoming passive noncompliance without engendering active resistance. Arriving at different balancing points between these two objectives, the three nations have now institutionalized policies with different degrees of coercion. Conclusions: This research shows that vaccination policy is not just created top-down by the state, but through an ongoing interactive process with citizens and civil society. Furthermore, as vaccination is a “wicked problem” that faces ongoing civil society resistance, states will need to perpetually adapt the coerciveness of their policies into the foreseeable future.

Inaction, under-reaction action and incapacity: communication breakdown in Italy’s vaccination governance

“…However, the necessity of high coverage underpins almost all research, and scholars’ exhortations that health professionals, public health actors, community groups and governments promote vaccine acceptance (Opel et al, 2013 ; Leask et al, 2012 ; Saeterdal et al, 2014 ). Less coercive policy instruments are generally preferred to coercive policies (Leask & Danchin, 2017 ; Navin & Largent, 2017 ; Omer et al, 2019 ), despite many jurisdictions at least partially coercing populations to vaccinate (McCoy, 2019 ; Gravagna et al, 2020 ). More recent work on mandates is starting to consider vaccination an exemplar of a compliance problem centred on vaccine refusing families (Attwell & Navin, 2019 ; MacDonald et al, 2018 ).…”

“…Scholars of governance have paid attention to the strategies that governments can employ to extract compliance with vaccination programmes. McCoy’s ( 2019 ) study of Australia, the USA and the UK employed Vedung’s ( 1998 [2011]) tripartite framework of carrots, sticks and sermons. Attwell and Smith’s ( 2018 ) theoretical commentary utilised the five-pronged approach advanced by Mols et al ( 2015 ), consisting of hierarchy, markets, networks, persuasion and nudge.…”

“…By contrast, well-researched and targeted public communications can change attitudes and beliefs (Attwell & Freeman, 2015 ) and build and protect public trust. High-functioning public health systems can successfully maintain voluntary compliance, with the UK as an exemplar (Elliman & Bedford, 2013 ; McCoy, 2019 ).…”

“…These help us to make deeper sense of vaccine voluntarism centred on effective public engagement on the one hand and vaccine mandates on the other. Discipline and modulation allow us to treat the continuum of coercion (Attwell et al, 2018 ; McCoy, 2019 ) like an iceberg, exploring the submerged properties of vaccination regimes.…”

Financial Interventions to Increase Vaccine Coverage

“…It is notoriously difficult to obtain those last few percentage points of coverage. 33 In the Australian context, ∼2 percent of children had registered objections, and a further 1.3% were estimated to be incompletely vaccinated because of unregistered objection. 32 At least that number again remained poorly reached by government efforts.…”