Between information campaign and controversy: a quantitative newspaper content analysis about COVID-19 vaccination in Switzerland and Austria.

AIMS: Because media portrayal reflects and shapes public opinion and health policy, investigating news coverage of public health issues is highly relevant for public health research and practice. Addressing a topical issue, this study investigated how newspaper coverage framed COVID-19 vaccines in Austria and German-speaking Switzerland and how it developed over time. METHODS: A quantitative newspaper content analysis of six newspapers from Austria and German-speaking Switzerland published between January 1 and 31, 2022 was conducted. Frames were identified for each country separately through hierarchical cluster analysis (Ward's method) based on frame elements. RESULTS: Four frames were identified in both countries: (1) Evaluating new vaccines, (2) Discussing mandates, (3) Promoting vaccination, (4) Mentioning vaccines. In Frames 1 (Switzerland 86.4%, Austria 93.3%) and 3 (Switzerland 92.7%, Austria 98.9%), most articles included vaccine-endorsing statements, with Swiss coverage including additional negative statements more often than Austrian coverage (43.2%/44.6% vs 4.0%/3.3%). Frame 2 was closely linked to vaccine skepticism only in Austria and contained more evaluative statements in Austrian newspapers (25.4% endorsing, 35.4% rejecting; in Switzerland 14.5%/18.1%). The Austrian tabloid Kronen Zeitung published most articles (497/1091, 45.6%). CONCLUSIONS: The commercialized and comparatively high share of tabloid news coverage in Austria may have contributed to oversimplified and polarizing COVID-19 vaccine debates in this context. Insufficiently balanced and adequate information may contribute to a loss of public trust in vaccination and may therefore affect vaccination uptake. Authorities and public health professionals should consider this effect when designing information campaigns.

Citizenship in times of crisis: biosocial state-citizen relations during COVID-19 in Austria.

Drawing upon 152 in-depth qualitative interviews with residents in Austria carried out in the first year of the pandemic, this article discusses how people's experiences with COVID-19 policies reflect and reshape state-citizen relations. Coinciding with a significant government crisis, the first year of COVID-19 in Austria saw pandemic measures justified with reference to a biological, often medical understanding of health that framed disease prevention in terms of transmission reduction, often with reference to metrics such as hospitalisation rates, etc. Instead of using this biomedical frame, our interviewees, however, drew attention to biopsychosocial dimensions of the crisis and problematised the entanglements between economy and health. We call this the emergence of a biosocial notion of citizenship that is attentive to psychological, social and economic dimensions of health. Insights into the biosocial nature of pandemic citizenship open a window of opportunity for addressing long-standing social injustices.

The social and socio-political embeddedness of COVID-19 vaccination decision-making: A five-country qualitative interview study from Europe.

The uptake ofCOVID-19 vaccines has varied considerably across European countries. This study investigates people's decision-making process regarding vaccination by analyzing qualitative interviews (n = 214) with residents from five European countries: Austria, Germany, Italy, Portugal, and Switzerland. We identify three factors that shape vaccination decision-making: individual experiences and pre-existing attitudes towards vaccination, social environment, and socio-political context. Based on this analysis, we present a typology of decision-making regarding COVID-19 vaccines, where some types present stable stances towards vaccines and others change over time. Trust in government and relevant stakeholders, broader social factors, and people's direct social environment were particularly relevant to these dynamics. We conclude that vaccination campaigns should be considered long-term projects (also outside of pandemics) in need of regular adjustment, communication and fine-tuning to ensure public trust. This is particularly pertinent for booster vaccinations, such as COVID-19 or influenza.

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.

Democratic research: Setting up a research commons for a qualitative, comparative, longitudinal interview study during the COVID-19 pandemic.

The sudden and dramatic advent of the COVID-19 pandemic led to urgent demands for timely, relevant, yet rigorous research. This paper discusses the origin, design, and execution of the SolPan research commons, a large-scale, international, comparative, qualitative research project that sought to respond to the need for knowledge among researchers and policymakers in times of crisis. The form of organization as a research commons is characterized by an underlying solidaristic attitude of its members and its intrinsic organizational features in which research data and knowledge in the study is shared and jointly owned. As such, the project is peer-governed, rooted in (idealist) social values of academia, and aims at providing tools and benefits for its members. In this paper, we discuss challenges and solutions for qualitative studies that seek to operate as research commons.

Anticipating hopes, fears and expectations towards COVID-19 vaccines: A qualitative interview study in seven European countries.

Vaccine uptake is essential to managing the ongoing COVID-19 pandemic, and vaccine hesitancy is a persistent concern. At the same time, both decision-makers and the general population have high hopes for COVID-19 vaccination. Drawing from qualitative interview data collected in October 2020 as part of the pan-European SolPan study, this study explores early and anticipatory expectations, hopes and fears regarding COVID-19 vaccination across seven European countries. We find that stances towards COVID-19 vaccines were shaped by personal lived experiences, but participants also aligned personal and communal interests in their considerations. Trust, particularly in expert institutions, was an important prerequisite for vaccine acceptance, but participants also expressed doubts about the rapid vaccine development process. Our findings emphasise the need to move beyond the study of factors driving vaccine hesitancy, and instead to focus on how people personally perceive vaccination in their particular social and political context.

Austria's Digital Vaccination Registry: Stakeholder Views and Implications for Governance.

In this study, we explore the recent setup of a digital vaccination record in Austria. Working from a social-scientific perspective, we find that the introduction of the electronic vaccination pass was substantially accelerated by the COVID-19 pandemic. Our interviews with key stakeholders (n = 16) indicated that three main factors drove this acceleration. The pandemic (1) sidelined historical conflicts regarding data ownership and invoked a shared sense of the value of data, (2) accentuated the need for enhanced administrative efficiency in an institutionally fragmented system, and (3) helped invoke the national vaccination registry as an indispensable infrastructure for public health governance with the potential to innovate its healthcare system in the long term.

Beyond the "information deficit model" - understanding vaccine-hesitant attitudes of midwives in Austria: a qualitative study.

BACKGROUND: Healthcare workers are considered key stakeholders in efforts to address vaccine hesitancy. Midwives' influence in advising expectant parents on early-childhood vaccinations is unquestioned, yet they remain an understudied group. The literature on midwives' attitudes towards vaccinations is also inconclusive. We therefore conducted an explorative qualitative study on midwives' vaccine-hesitant attitudes towards MMR (measles-mumps-rubella) vaccinations in Austria. METHODS: We conducted 12 in-depth interviews on their knowledge, concerns, and beliefs with midwives who self-identified as hesitant or resistant towards early-childhood MMR vaccinations. We analyzed the data using a grounded theory approach to distill common themes and meanings. RESULTS: Healthcare workers' stewardship to address vaccine hesitancy is commonly framed in terms of the "information deficit model": disseminate the right information and remedy publics' information deficits. Our findings suggest that this approach is too simplistic: Midwives' professional self-understanding, their notions of "good care" and "good parenthood" inflect how they engage with vaccine information and how they address it to their clients. Midwives' model of care prioritized good counseling rather than sharing scientific information in a "right the wrong"-manner. They saw themselves as critical consumers of that information and as promoting "empowered patients" who were free, and affluent enough, to make their own choices about vaccinations. In so doing, they also often promoted traditional notions of motherhood. CONCLUSIONS: Research shows that, for parents, vaccine decision-making builds on trust and dialogue with healthcare professionals and is more than a technical issue. In order to foster these interactions, understanding healthcare professionals' means of engaging with information is key to understanding how they engage with their constituents. Healthcare workers are more than neutral resources; their daily praxis influenced by their professional standing in the healthcare system. Similarly, healthcare professionals' views on vaccinations cannot be remedied with more information either. Building better and more diverse curricula for different groups of healthcare workers must attend to their respective roles, ethics of care, and professional beliefs. Taken together, better models for addressing vaccine hesitancy can only be developed by espousing a multi-faceted view of decision-making processes and interactions of healthcare workers with constituents.

Policy-Relevant Attitudes Toward COVID-19 Vaccination: Associations With Demography, Health Risk, and Social and Political Factors.

Background: Vaccination is considered to be a key public health intervention to end the COVID-19 pandemic. Yet, the success of the intervention is contingent on attitudes toward vaccination and the design of vaccination policies. Methods: We conduct cross-sectional analyses of policy-relevant attitudes toward COVID-19 vaccination using survey data of a representative sample of Austrian residents collected by the Austrian Corona Panel Project (ACPP). As outcomes, we examine the individual readiness to get vaccinated, the support for compulsory vaccinations, and the preference for making the vaccine available free of charge. The independent variables include demographics, objective and perceived health risks, and social and political factors. Results: Although there is broad public support for making the vaccine available free of charge, vaccine hesitancy and the opposition to a vaccine mandate are widespread. The protective function of the vaccine for the individual only motivates limited support for vaccinations. Opposition to COVID-19 vaccination also stems from a lack of sense of community and an ongoing politicization of the issue through conspiracy theories and party politics. Conclusion: We propose that overcoming the inherent free-rider problem of achieving sufficiently high vaccination rates poses a potential dilemma for policymakers: Given the politicized nature of the issue, they may find themselves having to choose between making vaccinations compulsory at political costs and a lingering pandemic at high costs for public health and the economy. We propose that promoting a sense of community and addressing potential practical constraints will be key in designing an effective COVID-19 vaccination policy.

Beyond evidence versus truthiness: toward a symmetrical approach to knowledge and ignorance in policy studies.

Current political developments in established liberal democracies in both Europe and North America have fundamentally called into question the normative relations between truth, knowledge and politics. Whether labeled "posttruth" or truthiness, commentators lament the willful spread and deployment of nonknowledge and ignorance as important political forces. In this paper, we discuss ignorance in its strategic dimension by weaving together insights from the sociology of ignorance with a policy-scientific approach. By means of three empirical vignettes, we demonstrate that ignorance is more than the flipside of knowledge or merely its lack: it is a constitutive feature of the policy process and is thus not uniquely symptomatic of the current era. We conclude by arguing for what we call a symmetrical approach in which ignorance receives the same quality of attention that knowledge has historically received in the policy sciences. To make fully visible the different forms of ignorance that shape policy processes, policy scholars must hone their "agnoto-epistemological sensibilities" to cope with the current challenges and advance a policy science for democracy.

Contemporary vaccination policy in the European Union: tensions and dilemmas.

This paper seeks to contribute to a more nuanced discourse on vaccination policy. Current polarization between either mandatory and entirely voluntary is misleading, as virtually all immunization programs feature a combination of instruments that comprise mandatory and voluntary elements. We develop this argument by presenting five case studies from the European Union (EU). By systematically acknowledging the nuances of political and institutional varieties, we build the case for reframing the terms of the debate in the EU and beyond.

Putting public health infrastructures to the test: introducing HPV vaccination in Austria and the Netherlands.

This article presents two cases of policymaking concerning the vaccine against Human Papilloma Virus (HPV), which is sexually transmitted and carcinogenic. Our analysis focuses on its introduction in Austria and the Netherlands. In both contexts, we find prevention and screening to be at once complementary and competing public health logics and we draw on the concept of 'infrastructure' to understand their roles in shaping the reception of the vaccine. We reveal how the HPV vaccine had to be made 'good enough', much like the Pap smear (Casper and Clarke ), by means of diverse tinkering practices that transformed both the technology and the infrastructures in which they emerged. At the same time, it was important that the vaccine would not come to problematise Pap smear-based screening. The article points to the contextually contingent nature of policymaking around new medical technologies, and the skillful care with which public health infrastructures such as immunisation and screening programmes are handled and tinkered with.

"Saving lives": Adapting and adopting Human Papilloma Virus (HPV) vaccination in Austria.

Vaccination against the sexually transmitted Human Papilloma Virus (HPV), a necessary agent for the development of cervical cancer, has triggered much debate. In Austria, HPV policy turned from "lagging behind" in 2008 into "Europe's frontrunner" by 2013. Drawing on qualitative research, the article shows how the vaccine was transformed and made "good enough" over the course of five years. By means of tinkering and shifting storylines, policy officials and experts disassociated the vaccine from gender, vaccine manufacturers, and youth sexuality. Ultimately, the HPV vaccine functioned to strengthen the national immunization program. To this end, preventing an effective problematization of the extant screening program was essential.

The use of mystery guests by the Dutch Health Inspectorate: Results of a pilot study in long-term intramural elderly care.

This paper examines the use of 'mystery guests' as an instrument for monitoring quality and safety in healthcare. The Dutch Health Inspectorate initiated a mystery guest pilot project in elderly care as a response to political and social pressure. An independent evaluation of this project revealed that the primary goal of this approach--to provide a better view of the exigencies of daily practice in elderly care--was not met. Inspectors did not use the information delivered by the mystery guests because how they evaluated quality and reported findings did not align with practices used by the health inspectorate. Additionally, the inspectors felt that other instruments being developed were more appropriate for providing a better view of practice. While political pressure is important for effecting change in general, the specific instruments to be used for formal supervision of health institutions should be developed and implemented within the organization in accordance with existing standards and approaches. The choice to implement a new supervision instrument, including sending mystery guests into care institutions, should be preceded by an ethical analysis that takes into account the specific context of its use.

Organ donation as transition work: Policy discourse and clinical practice in The Netherlands.

An increasing number of patients become eligible for organ transplants. In the Netherlands, at the level of policy discourse, growing waiting lists are often referred to as a persistent "shortage" of organs, producing a "public health crisis." In this way, organ donation is presented as an ethical, social, and medical necessity. Likewise, policy discourse offers a range of seemingly unambiguous solutions: improving logistical infrastructure at the level of hospitals, developing organizational and legal protocols, as well as public information campaigns. Instead of taking these problem and solution definitions as given, we critically examine the relationship between policy discourse and clinical practice. Based on a historical review, first, we trace the key moments of transformation where organ donation became naturalized in Dutch policy discourse, particularly in its altruistic connotation. Second, based on in-depth interviews with medical professionals, we show how those involved in organ donation continue to struggle with the controversial nature of their clinical practice. More specifically, we highlight their use of different forms of knowledge that underlie clinicians' "transition work": from losing a patient to "gaining" a donor.