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In the last decade, California, Australia, Italy, and France were the first jurisdictions to impose consequences on parents who were not vaccinating their children. Governments and commentators frequently depicted this as necessary responses to public health crises. However, governments choose coercive vaccine mandates from multiple strategies available and analyses of these first four jurisdictions reveals inherent failures within prior approaches. All four cases relied upon “incomplete modulation” to ensure vaccination occurred, using pre-existing vaccine mandates developed for different purposes. 

By the present century, these did not cover all vaccines, were poorly enforced, or selectively exempted refusers by design via personal belief exemptions. The lack of sufficient vaccination discipline to maintain universally high vaccination coverage generated political and technical demands (Italy and France) or public demands (Australia and California) to institute “complete” modulation. Institutions, elected officials, policy entrepreneurs, and/or publics pushed to expand coercion to cover more vaccines, more settings, and more policy targets.  The resultant new mandatory policies respond to the shortcomings of the previous modes of governance but do not correct them. Instead, prior deficits in state capacity and action – failures to instill “vaccine discipline” in populations – infuse the new mandatory vaccination policies. 

Prior deficits drive how governments formulate the role and function of their new policies within the contemporary regulatory state. They also shape how policymakers navigate emergent governance demands and opportunities, using additional forms of coercion upon new policy actors. Finally, prior deficits inform public statements and private reservations about whether governments can ever remove the measures that – in continental Europe – they promise are temporary. Likewise, exemption policies that “undid themselves” (Australia and California) would be unlikely to re-emerge following the reframing of vaccine refusal as social deviance.

Speaker 

, Associate Professor, University of Western Australia

Associate Professor Katie Attwell is a political science and public policy scholar at the University of Western Australia, where she leads the interdisciplinary VaxPolLab and supports a range of senior and junior scholars in vaccination social and political research. Prof Attwell currently holds a four year research fellowship funded by the Medical Research Future Fund of Australia (MRFF) and the University of Western Australia. She is a former Australian Research Council Discovery Early Career Researcher Award (DECRA) Fellow. 

Prof Attwell has engaged in community, systems and behavioural research in the area of vaccination uptake since 2014. Her DECRA (2019-2022) explored mandatory childhood vaccination policies in Australia, Italy, France, and California. Katie led the interdisciplinary West Australian project “Coronavax: Preparing Community and Government”, which engaged in community and government research for the COVID-19 vaccine roll-out, funded by Wesfarmers and the Health Department of Western Australia. Katie presently leads MandEval, a mixed methods and multi-country study of the implementation and impact of COVID-19 vaccine mandates, funded by the MRFF.

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