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

Abstract

This article explores why governments do not respond to public compliance problems in a timely manner with appropriate instruments, and the consequences of their failure to do so. Utilising a case study of Italian vaccination policy, the article considers counterfactuals and the challenges of governing health policy in an age of disinformation. It counterposes two methods of governing vaccination compliance: discipline, which uses public institutions to inculcate the population with favourable attitudes and practices, and modulation, which uses access to public institutions as a form of control. The Italian government ineffectively employed discipline for a number of years. Epistemological and organisational constraints stymied its efforts to tackle a significant childhood vaccination compliance problem. With a loss of control over the information environment, vaccinations were not served well by exogenous crises, the sensationalism of the news cycle and online misinformation. Hampered by austerity, lack of capacity and epistemic shortcomings, the Italian government did not protect the public legitimacy of the vaccination programme. Instead of employing communications to reassure a hesitant population, they focused on systemic and delivery issues, until it was too late to do anything except make vaccinations mandatory (using modulation). The apparent short-term success of this measure in generating population compliance does not foreclose the need for ongoing governance of vaccine confidence through effective discipline. This is evident for the COVID-19 vaccination campaign, with many Italians still indicating that they would not accept a vaccine despite the devastation that the disease has wrought throughout their country.

Explaining Government Policy Inaction on International Student Housing in Australia: The Perspectives of Stakeholders

“…There is, for example, a high opportunity cost of individuals taking their concerns to the political arena, and some people may not have appropriate skills or training, while some are conflict averse. Attwell et al ( 2021 ) apply similar reasoning in their analysis of the Italian government’s COVID-19 response. They also consider ‘policy underreaction’, where governments simply do not do enough to fix problems (Maor 2014 ), while Zahariadis et al ( 2021 ) focus their interpretation of national responses to the pandemic on ‘calculated inaction’.…”

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

“…As such, both governments perceived the need to reboot their existing mandatory regimes to comply with legal requirements (France) and to lift coverage rates, both seeing mandates as communicating the necessity of vaccination to the public. 57,100 In Australia and California, non-compliance was less severe and more localised. Vaccination coverage rates were generally high, and governments did not regard non-vaccination as a major widespread threat.…”

“…A series of compounding events over the preceding decade -court cases, falling vaccination rates, regional governance experiments, and finally a significant measles outbreak -led the government to view existing arrangements as unsustainable. 57 This was despite many actors investing considerable resources into increasing vaccination rates over several years. Health Ministry officials, who supported elected officials' eventual resort to stronger mandates, described 'a lot of movement in different sectors' with collaborations arising from 'strong relationships' with medical and public health experts who produced campaign content, regional actors who organised Italy had historically required four vaccines for children to access school.…”

Western Australian health care workers’ views on mandatory COVID-19 vaccination for the workplace

“…[8] However, vaccine mandates can be a controversial policy instrument more generally. Recent analyses of new mandatory childhood vaccination policies in various high-income countries demonstrate a range of drivers for governments to resort to mandates; these sometimes include political pressures and governance failures ([ 9 , 10 ]). Jurisdictions that already mandated vaccinations for children – such as Italy, France, Australia and California – were at the forefront of recent policy changes to make vaccine refusal more consequential for parents, indicating the role of path dependence in governments adopting such policies ([ 11 , 12 ]).…”