Reopening to the world: how safety, normality and trust in government shape young adults' COVID-19 vaccine intentions

During the COVID-19 pandemic, and particularly 2020-2021, young adults were often significant transmitters of the virus. Prior to the availability of vaccines for young adults, we sought to understand what would contribute to their uptake of a COVID-19 vaccine and how government policy might intervene. We undertook qualitative interviews between February and April 2021 with 19 participants (aged 18-29) in Perth, Western Australia. Despite Western Australians' lives changing little during the pandemic, almost all wanted to receive a vaccine. Motivating factors included protecting themselves and others and having life return to normal. Participants' significant levels of trust in the state government response to the pandemic did not extend to the Federal government. This research uncovers what influences young people to receive new vaccinations, how trust in governments develops, and how ideas of normality and safety influence vaccine demand.Alternate :在新冠疫情其间，尤其是2020-2021年，年轻人往往成为病毒的传播者。在新冠疫苗普及到年轻人之前，我们试图了解哪些因素会有利于他们接种新冠疫苗，以及政府应该如何进行干预。我们在2021年2月至4月间对西澳大利亚帕斯市的19位参与者做了定性访谈。虽然西澳大利亚人的生活在疫情其间变化甚小，但几乎所有人都希望接种疫苗。原因包括保护自己及他人、让生活回到常轨。参与者对州政府应对疫情的做法有显著的信任，但不延及联邦政府。本文揭示了哪些东西影响了年轻人接受新疫苗、对政府的信任如何形成、以及正常观与安全观如何影响对疫苗的需求。

'I'm provax': Pro-vaccination personal histories and socialities of older Australians in the COVID-19 pandemic.

Vaccination scholarship often explores how social networks foster vaccine refusal and delay, revealing how social and institutional relations produce refusing or delaying parents and un- or under-vaccinated children. It is likewise critical to understand the development of pro-vaccination orientations by researching those who want to be vaccinated since such attitudes and associated practices underpin successful vaccination programmes. This article explores pro-vaccination sociality, personal histories and self-understandings during the COVID-19 pandemic in Australia. We draw upon 18 in-depth interviews with older Western Australians, documenting how they articulate 'provax' identities in opposition to those they depict as 'antivax' others. Provax identities were clearly anchored in and solidified through social relations and personal histories, as interviewees spoke of 'likeminded' friends and families who facilitated each other's vaccinations and referenced childhood experiences of epidemics and vaccinations. Access barriers relating to the vaccine programme drove interviewees to reimagine their provax status in light of not yet being vaccinated. Thus, interviewees' moral and ideological understandings of themselves and others were interrelated with supply-side constraints. We examine the development of self-proclaimed 'provaxxers' (in a context of limited access); how they imagine and enact boundaries between themselves and those they deem 'antivax'; and possibilities for public health research.

Mandating COVID‐19 vaccinations for children: Attitudes of Western Australian parents

Australian governments have used vaccine mandates to drive high uptake of routine childhood vaccines and adult Coronavirus Disease 2019 (COVID‐19) and influenza vaccines. We sought to understand the attitudes of Western Australian parents regarding mandating COVID‐19 vaccines for children, interviewing 44 parents of children aged up to 18 years between May and December 2021. Transcripts were analysed to ascertain parents' attitudes and sources of reasoning. Over half of the parents supported COVID‐19 vaccine mandates for children, while the rest had opposing, nuanced or indifferent views. Participants invoked community and health‐related reasoning;policy and government‐related reasoning;and concerns based on practical implementation. There was a high degree of consistency in parents' attitudes toward COVID‐19 vaccines and whether they supported mandating them for children, although some who planned to delay vaccination nevertheless supported the idea of mandates. Some participants reported that a mandate would prompt them to vaccinate, but others were willing to accept the consequences of keeping their children unvaccinated, or said that a mandate would not affect them as they would vaccinate regardless. Understanding how parents think and feel about mandating COVID‐19 vaccines with educational exclusions or financial penalties is critical to inform policymakers, who may consider these strategies for future pandemic vaccines. [ FROM AUTHOR] Copyright of Australian Journal of Social Issues (John Wiley & Sons, Inc. ) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

'COVID Is Coming, and I'm Bloody Scared': How Adults with Co-Morbidities' Threat Perceptions of COVID-19 Shape Their Vaccination Decisions.

Adults with comorbidities have faced a high risk from COVID-19 infection. However, Western Australia experienced relatively few infections and deaths from 2020 until early 2022 compared with other OECD countries, as hard border policies allowed for wide-scale vaccination before mass infections began. This research investigated the thoughts, feelings, risk perceptions, and practices of Western Australian adults with comorbidities aged 18-60 years in regard to COVID-19 disease and COVID-19 vaccines. We conducted 14 in-depth qualitative interviews between January and April 2022, just as the disease was starting to circulate. We coded results inductively and deductively, combining the Extended Parallel Process Model (EPPM) and vaccine belief models. Non-hesitant participants believed COVID-19 vaccines were safe and effective at mitigating COVID-19's threat and subsequently got vaccinated. Vaccine hesitant participants were less convinced the disease was severe or that they were susceptible to it; they also did not consider the vaccines to be sufficiently safe. Yet, for some hesitant participants, the exogenous force of mandates prompted vaccination. This work is important to understand how people's thoughts and feelings about their comorbidities and risks from COVID-19 influence vaccine uptake and how mandatory policies can affect uptake in this cohort.

The role of ‘non-knowledge' in crisis policymaking: a proposal and agenda for future research

Background:Recent complex and cross-boundary policy problems, such as climate change, pandemics, and financial crises, have recentred debates about state capacity, democratic discontent and the ‘crisis of expertise'. These problems are contested and open to redefinition, misunderstanding, spin, and deception, challenging the ability of policymakers to locate, discriminate, comprehend, and respond to competing sources of knowledge and expertise. We argue that ‘non-knowledge' is an under-explored aspect of responses to major policy crises.Key points:While discussed in recent work in sociology and other social sciences, non-knowledge has been given less explicit attention in policy studies, and is not fully captured by orthodox understandings of knowledge and evidence use. We outline three main forms of non-knowledge that challenge public agencies: amnesia, ignorance and misinformation. In each case, ‘non-knowledge' is not simply the absence of policy-relevant knowledge. Amnesia refers to what is forgotten, reinvented or ‘unlearned', while claims of ignorance involve obscuring or casting aside of relevant knowledge that could (or even should) be available. To be misinformed is to actively believe false or misleading information. In each instance, non-knowledge may have strategic value for policy actors or aid the pursuit of self-interest.Conclusions and implications:We demonstrate the relevance of non-knowledge through a brief case study, emerging from the inquiry into the COVID-19 hotel quarantine programme in the Australian state of Victoria. We argue that both amnesia and ‘practical' forms of ignorance contributed to failures during the early part of the programme.

School staff as vaccine advocates: Perspectives on vaccine mandates and the student registration process.

Recently, several states in the US have made it more difficult to receive nonmedical exemptions to school vaccine mandates in the hope of better orienting parents towards vaccination. However, little is known about how public-facing school staff implement and enforce mandate policies, including why or how often they steer parents towards nonmedical exemptions. This study focused on Michigan, which has recently added an additional burden for families seeking nonmedical exemptions. We used an anonymous online survey to assess Michigan public-school employees (n = 157) about their knowledge, attitudes, and behaviors regarding Michigan's school enrollment vaccine mandate policy. Our main conclusions are that frontline school staff are generally knowledgeable about vaccines and immunization policy, but are at best ambivalent about their role in immunization governance, believing that other agents should be responsible for ensuring that children are vaccinated. Furthermore, some respondents indicated low vaccine confidence, which was associated with increased ambivalence about, or opposition to, their role in immunization governance. As more jurisdictions within and beyond the US consider introducing or tightening childhood vaccine mandates, it is increasingly important to understand how these policies can be improved by attending to the attitudes and roles of relevant frontline actors.

COVID-19 vaccine knowledge, attitudes, and experiences of health care workers in Perth, Western Australia: A qualitative study.

INTRODUCTION: Health care workers (HCWs) faced an increased risk of Coronavirus Disease 2019 (COVID-19). Australia's COVID-19 vaccine rollout commenced in February 2021 to priority groups, including HCWs. Given their increased risk, as well as influence on patients' vaccine uptake, it was important that HCWs had a positive COVID-19 vaccination experience, as well as trusting the vaccine safety and efficacy data. METHODS: Semi-structured interviews were undertaken with 19 public- and privately-practicing HCWs in Western Australia between February-July 2021. Data were deductively analysed using NVivo 12 and guided by the Capability-Opportunity-Motivation-Behaviour model. RESULTS: 15/19 participants had received at least one COVID-19 vaccine. Participants were highly motivated, mostly to protect themselves and to get back to "normal", but also to protect patients. Many had a heightened awareness of COVID-19 severity due hearing from colleagues working in settings more impacted than Western Australia. Participants trusted the COVID-19 vaccine development and approval process; their histories of having to accept vaccines for work helped them to see COVID-19 vaccination as no different. Many recalled initially being unsure of how and when they'd be able to access the vaccine. Once they had this knowledge, half had difficulties with the booking process, and some were unable to access a clinic at a convenient location or time. Participants learnt about COVID-19 vaccination through government resources, health organisations, and their workplace, but few had seen any government campaigns for the wider public. Finally, most had discussed COVID-19 vaccination with their social network. CONCLUSION: HCWs in Western Australia demonstrated good knowledge about COVID-19 vaccination, with many reasons to vaccinate themselves and support the vaccination of others. Addressing the barriers identified in this study will be important for planning to vaccinate health workforces during future pandemics.

Parents' COVID-19 vaccine intentions for children under 5 years: Brief reflections from a qualitative study.

AIM: Australian authorities made COVID-19 vaccines available for children aged under 5 years old with serious comorbidities in August 2022. There is presently no universal programme for young children, but crucial to any rollout's success is whether parents are motivated and able to vaccinate. By examining parents' vaccine intentions, this study aims to inform current and future COVID-19 vaccine roll-outs for children aged under 5 years. METHODS: As part of the mixed methods project 'Coronavax: Preparing Community and Government' we interviewed 18 Western Australian parents of young children about their intentions in late 2021. RESULTS: Two thirds intended to vaccinate if and when they could, with one third intending to delay for reasons including risk and safety perceptions, fears about side effects and influence from their social networks. However, even those choosing to delay were waiting rather than refusing. CONCLUSIONS: To improve uptake, targeted messaging should emphasise that COVID-19 can be a serious disease in young children, with such messaging drawing on the reputability and esteem of scientific and technical authorities. Such messaging should be oriented towards parents of children with serious comorbidities at the present time. It will be important to emphasise that government vaccine recommendations are based on supporting families to protect their children and keep them healthy.

COVID-19 vaccine Mandates: An Australian attitudinal study.

BACKGROUND: The rollout of vaccines against COVID-19 is prompting governments and the private sector to adopt mandates. However, there has been little conceptual analysis of the types of mandates available, nor empirical analysis of how the public thinks about different mandates and why. Our conceptual study examines available instruments, how they have been implemented pre-COVID, and their use for COVID-19 globally. Then, our qualitative study reports the acceptability of such measures in Western Australia, which has experienced very limited community transmission, posing an interesting scenario for vaccine acceptance and acceptability of measures to enforce it. METHOD: Our conceptual study developed categories of mandates from extant work, news reports, and legislative interventions globally. Then, our empirical study asked 44 West Australians about their attitudes towards potential mandatory policies, with data analysed using NVivo 12. RESULTS: Our novel studies contribute richness and depth to emerging literature on the types and varying acceptability of vaccine requirements. Participants demonstrated tensions and confusion about whether instruments were incentives or punishments, and many supported strong consequences for non-vaccination even if they ostensibly opposed mandates. Those attached to restrictions for disease prevention were most popular. There were similar degrees of support for mandates imposed by employers or businesses, with participants showing little concern for potential issues of accountability linked to public health decisions delegated to the private sector. Participants mostly supported tightly regulated medical exemptions granted by specialists, with little interest in religious or personal belief exemptions. CONCLUSION: Our participants are used to being governed by vaccine mandates, and now by rigorous lockdown and travel restrictions that have ensured limited local COVID-19 disease and transmission. These factors appear influential in their general openness to COVID-19 vaccine mandates, especially when linked explicitly to the prevention of disease in high-risk settings.

Children, COVID, and confusion: How frontline workers cope with the challenges of vaccine mandates

With the emergence of COVID-19, many governments around the world co-oped non-health actors into enforcing comprehensive mandatory vaccination policies. Implementing these policies can be challenging, creating irreconcilable goals and problems with knowledge and understanding of areas outside the implementers' direct field of expertise or scope of work. We know very little about how such frontline workers cope with these challenges associated with implementing policies whose goals lie well outside their remit (which we describe as generating exogenous policy pressures), and what this means for the operation of the policies. This article uses policies in place prior to the pandemic to fill this gap. It examines attitudes and experiences of frontline childcare educators who implement Australia's No Jab, No Play childhood vaccine mandate policies within the states of New South Wales, Queensland, and Victoria. Through qualitative analysis of interview and focus group data, we find that these frontline workers cope with moral conflict, confusion, and a lack of knowledge by moving against clients: they rigidly follow the rules beyond legislative requirements, and sometimes break them, generating a new coping category we call 'rigid rule breaking'. However, their need to employ coping strategies is informed by the extent to which government has designed the policy to coerce the behaviour of the providers, families, or both. The implementation of more coercive variants of No Jab, No Play policies deviates more from what legislators intended, while providers given scope to make their own decisions about enrolling unvaccinated children report satisfaction in their decision-making. Points for practitionersAustralian state mandatory vaccination policies generally require childcare providers to exclude unvaccinated children.Street level bureaucrats face pressures when implementing coercive policies exogenous to their remit.They may simplify policy implementation in ways that counter governments' goals.Actors given more discretion about passing on coercion to policy targets demonstrate better understanding and ownership of policies.

The role of ‘non-knowledge’ in crisis policymaking: a proposal and agenda for future research

Background: Recent complex and cross-boundary policy problems, such as climate change, pandemics, and financial crises, have recentred debates about state capacity, democratic discontent and the 'crisis of expertise'. These problems are contested and open to redefinition, misunderstanding, spin, and deception, challenging the ability of policymakers to locate, discriminate, comprehend, and respond to competing sources of knowledge and expertise. We argue that 'non-knowledge' is an under-explored aspect of responses to major policy crises.Key points: While discussed in recent work in sociology and other social sciences, non-knowledge has been given less explicit attention in policy studies, and is not fully captured by orthodox understandings of knowledge and evidence use. We outline three main forms of non-knowledge that challenge public agencies: amnesia, ignorance and misinformation. In each case, 'non-knowledge' is not simply the absence of policy-relevant knowledge. Amnesia refers to what is forgotten, reinvented or 'unlearned', while claims of ignorance involve obscuring or casting aside of relevant knowledge that could (or even should) be available. To be misinformed is to actively believe false or misleading information. In each instance, non-knowledge may have strategic value for policy actors or aid the pursuit of self-interest.Conclusions and implications: We demonstrate the relevance of non-knowledge through a brief case study, emerging from the inquiry into the COVID-19 hotel quarantine programme in the Australian state of Victoria. We argue that both amnesia and 'practical' forms of ignorance contributed to failures during the early part of the programme.

Consolidating a research agenda for vaccine mandates.

A workshop on mandatory vaccination was pitched to the World Public Health Congress in 2019 and the resultant special issue was pitched to Vaccine in 2020. During this project, the COVID-19 pandemic pushed vaccine policy to the forefront of global public health policy, and the imposition of vaccine mandates prompted a new wave of scholarship in the field. This introductory article employs the heuristic of Lasswell's (1956) policy cycle to synthesise the findings of the articles in the special issue. It considers the temporal lifetime of mandates and highlights findings regarding: the emergence of mandates as a policy option, public support and policy instrument design, what matters in the implementation of mandates, and what we can learn from evaluating them. The second half of the paper categorizes the included papers in terms of what aspects of mandates they study and the methods they employ to do so, in order to formulate a guide for future researchers of vaccine mandates. Scholars study either speculative or existing mandates - research can address several stages of the policy cycle or just one of them, ranging from attitudinal research to implementation studies and impact studies. Historical and contextual studies that take deep dives into a particular mandate are a much needed resource for studying emerging mandates, too, and scoping and framework- building work will undoubtedly be valuable in understanding and appreciating the wealth of knowledge production in this growing field. This special issue can serve as a roadmap for a consolidation of this interdisciplinary research agenda, and provide a helpful resource for decisionmakers at this historical juncture.

'Corona is coming': COVID-19 vaccination perspectives and experiences amongst Culturally and Linguistically Diverse West Australians.

BACKGROUND: Culturally and Linguistically Diverse (CALD) groups within high-income countries are at risk of being left behind by the COVID-19 vaccination rollout. They face both access and attitudinal barriers, including low trust in government and health authorities. OBJECTIVE: To explore perceptions and attitudes towards COVID-19 vaccination, as well as facilitators, barriers and strategies to promote uptake among CALD residents of Western Australia (WA), where there were almost no COVID-19 cases for 2 years. DESIGN AND PARTICIPANTS: Perth, WA's capital, was chosen as the state's study site because most of the state's CALD population lives there. Eleven semistructured in-depth interviews and three focus groups (with 37 participants) were conducted with CALD residents between August and October 2021. Thematic analysis was conducted, informed by the 'Capability', 'Opportunity', 'Motivation', 'Behaviour' model. RESULTS: CALD participants faced barriers including a lack of knowledge about COVID-19 and the vaccines, low self-rated English proficiency and education levels, misinformation, passive government communication strategies and limited access to vaccine clinics/providers. They were, however, motivated to vaccinate by the imminent opening of state and international borders, trust in government and healthcare authorities, travel intentions and the desire to protect themselves and others. CONCLUSIONS: Despite high levels of trust and significant desire for vaccines among CALD communities in Perth, current strategies were not meeting their needs and the community remains at risk from COVID-19. Tailored intervention strategies are required to provide knowledge, address misinformation and facilitate access to ensure uptake of COVID-19 vaccines-including for additional doses-amongst CALD communities. Governments should work with trusted CALD community members to disseminate tailored COVID-19 vaccine information and adequately translated resources. PATIENT OR PUBLIC CONTRIBUTION: The Wesfarmers Centre of Vaccines and Infectious Diseases Community Reference Group at Telethon Kids Institute consulted on this project in September 2020; Ishar Multicultural Women's Health Services consulted on and facilitated the focus groups.

Communication Is Not a Virus: COVID-19 Vaccine-Critical Activity on Facebook and Implications for the 'Infodemic' Concept.

In February 2020 the World Health Organization declared an 'infodemic' in relation to COVID-19. The label infers that people are being contaminated by 'misinformation' as they would be by a virus. However, this metaphor conveys a simplistic empirical understanding of communication, which may encourage 'information control' responses. This article argues for the importance of understanding the diverse factors that impact the effectiveness of communication - including the context in which it is received, and the emergent properties created through communication processes. Analyzing 'vaccine-critical' Facebook activity in Australia between 1 December 2020 and 28 February 2022, we find that controlling access to or censoring vaccine-critical misinformation does not lead to a reduction in vaccine-critical narratives. Rather, discussions continue based on more tenable political and social arguments. Further, bans antagonize vaccine-critical Facebook users and encourage them to move to other platforms where they may be radicalized. Crucially, recruitment to vaccine-critical sites accelerated following both bans of 'misinformation' and the introduction of vaccine mandates, suggesting that such responses can lead to increased discontentment. Accordingly, we call for researchers, policy makers and media platforms to engage with a more nuanced view of communication, acknowledging the powerful role of audiences' uses and gratifications in determining the effectiveness of public health messaging.

COVID-19 Vaccine Mandates: Attitudes and Effects on Holdouts in a Large Australian University Population.

Many governments and institutions mandated COVID-19 vaccines. In late 2021, we sought to ascertain the perspectives of staff and students from The University of Western Australia about the State or the University mandating COVID-19 vaccines. The survey captured vaccination status and intentions along with attitudes towards mandates and potential types of exemptions with 2878 valid responses which were quantitatively analysed and 2727 which were qualitatively analysed. The study found generally high levels of vaccination or intent, and strong support for mandates, underpinned by beliefs that vaccination is a moral duty and that mandates make campus feel safer. These sentiments were not more prevalent amongst individuals with comorbidities; often healthy individuals supported mandates to reduce their risk of transmitting disease to vulnerable family members. Individuals with comorbidities were, however, more supportive of excluding the unvaccinated from campus. Most opponents were unvaccinated, and many indicated that mandate policies would backfire, making them less likely to vaccinate. Despite the strong overall support, 41% of respondents did not want to see non-compliant staff or students lose their positions, and only 35% actively sought this. Institutions or governments introducing mandates should emphasise community concerns about catching COVID-19 and becoming sick or transmitting the disease to vulnerable loved ones.

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

Background: Health care workers (HCWs) are at an increased risk of catching and spreading Coronavirus Disease 2019 (COVID-19) compared with the general community, putting health systems at risk. Several jurisdictions globally have mandated or are looking to mandate COVID-19 vaccines for this cohort, but little is known about the acceptability of this measure, especially in different contexts, and there is little qualitative data to explore nuance, depth, and the reasons behind HCWs' opinions. Methods: In-depth semi-structured qualitative interviews were undertaken with 39 HCWs in Western Australia (WA) between February-August 2021, ascertaining their views on the prospective introduction and implementation of mandates for COVID-19 vaccines. Data were thematically analysed using NVivo 20. Results: There was broad support for COVID-19 vaccine mandates for HCWs amongst our participants, but also different views about what such a mandate would mean (redeployment versus termination) and how it would impact the rest of the workforce. One vaccine hesitant participant said that mandates would be their prompt to get vaccinated. Other participants invoked an informal code whereby HCWs have an obligation to be seen to support vaccination and to protect public health more broadly. However, they also raised concerns about implementation and procedural and policy fairness. Conclusion: Policymakers should consider how to mobilise the informal code of health promotion and public health support if introducing mandates. They should also consider whether HCWs will bring the same attitudes and approaches to mandates for additional vaccine doses.

How Vaccination Rumours Spread Online: Tracing the Dissemination of Information Regarding Adverse Events of COVID-19 Vaccines.

Objectives: To trace the emergence and dissemination of the most prominent rumours about potential adverse effects of COVID-19 vaccines. Methods: We use a weekly Google Trends search to gather information about what alleged adverse events are being associated with COVID vaccines by the general population. We then use CrowdTangle and Factiva searches to examine how discussions about the five most prominent adverse events have spread through traditional media channels and Facebook. Results: Traditional mass media reporting remains crucial in both promoting and moderating discussions around alleged adverse events. While some cases illustrate that social media networks can synthesise and amplify rumours about adverse events, traditional media coverage remains crucial as a forum for exploring and debunking spurious claims. Conclusion: Traditional media stories still bear signficant responsibility as credibility markers for rumours about vaccine adverse events. Journalists should therefore be encouraged to be particularly earnest when reporting such stories, and the scientific community should aid journalists in this task by clearly responding to any rumours emerging online.

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 2015 and 2017, 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 2019 (COVID-19) global rollout, this article engages with four case studies assembled from qualitative analysis of semi-structured in-country interviews and document analysis between November 2018 and November 2020. 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.