The Politics of Vaccines—How to Determine a Fair Vaccine Allocation: Hierarchy, Negotiations, or Culture?

• Published date: 01 July 2023
• DOI: http://doi.org/10.1177/00953997231167557
• Author: Tom Christensen,Per Lægreid
• Date: 01 July 2023
• Subject Matter: Articles

https://doi.org/10.1177/00953997231167557

Administration & Society

2023, Vol. 55(6) 1171 –1193

© The Author(s) 2023

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DOI: 10.1177/00953997231167557

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Article

The Politics of Vaccines—

How to Determine a

Fair Vaccine Allocation:

Hierarchy, Negotiations,

or Culture?

Tom Christensen1 and Per Lægreid2

Abstract

This study examines vaccine allocation policy during the COVID-19

pandemic by applying a hierarchical, a negotiation, and a cultural perspective.

It addresses how vaccine allocation principles under conditions of scarcity

are translated into practice in the case of Norway. A main finding is that the

policy was informed by instrumentalism as well as by path dependencies, but

over time the issue became more salient by activating stakeholder interests,

which resulted in an adaptation of established norms. The three perspectives

reveal how different approaches to a “fair vaccine allocation” policy can lead

to different explanations of the same phenomenon.

Keywords

instrumentalism, vaccine politics, COVID-19, Norway, negotiation, culture

Introduction

This paper analyzes the vaccine allocation process under conditions of

scarcity during the COVID-19 pandemic by applying three theoretical lenses

(cf. Allison, 1971). Allison used three alternative and supplementary

1University of Oslo, Norway

2University of Bergen, Norway

Corresponding Author:

Per Lægreid, Department of Government, University of Bergen, Christiegt 17, Bergen 5007,

Norway.

Email: per.lagreid@uib.no

1167557AAS0010.1177/00953997231167557Administration & SocietyChristensen and Lægreid

research-article2023

1172 Administration & Society 55(6)

conceptual frames of reference to analyze the decision-making process

around the Cuban missile crisis. The article begins with a hierarchical-instru-

mental perspective (cf. Allison’s Rational Actor model), examining whether

the decision-making process was characterized by hierarchical control, and

analyzes how clearly the goals, problems, and solutions were defined and

coupled (Christensen et al., 2020). A negotiation perspective (cf. Allisons

Governmental Politics model) sees vaccination policy as informed by actors

with differing interests and by power struggles and coalition-building (March

& Olsen, 1983). Our third perspective deviates from Allison’s models and

instead applies a cultural perspective, whereby vaccination policy is informed

by existing norms and values, path dependencies, and a logic of appropriate-

ness (March & Olsen, 1989; Selznick, 1957).

In addition to all the regulatory measures adopted to combat the COVID-

19 pandemic, vaccines were seen worldwide as the best way to prevent severe

illness and to stop the virus spreading (Ansell et al., 2021). The roll-out of

vaccination programs became a subject of major political debate in many

countries (Boin et al., 2021). When supplies are limited, deciding which

groups should have priority access to the vaccine becomes a pressing issue

and a challenge for policymakers (Duch et al., 2021; Persad et al., 2021). It

was therefore important that the reasoning underlying the decision-making

process on vaccine distribution was sound, particularly in the initial phases

when vaccine availability was limited (Bubar et al., 2021). Analogous to their

handling of the pandemic, different countries used different combinations of

a set of common principles to allocate vaccines and succeeded in speeding up

the vaccination process in a variety of ways (Chapman et al., 2022; Yang

et al., 2021).

Vaccine allocation is a political, administrative, scientific, and ethical pro-

cess, and it is also a volatile one. Politically, the allocation and re-allocation

of vaccines was a highly sensitive issue that reflected ambiguity and various

trade-offs, not to mention the political aspects of gaining access to vaccines

(Ferranna et al., 2021). Administratively, it was about the capacity of the

government to organize the provision and administering of vaccines

(Christensen et al., 2016). For scientists, vaccine allocation is complex, both

because it involves balancing the different strategies and criteria underlying

the vaccine programs and because of uncertainties regarding means-end rela-

tions, leading to tensions and disagreements among experts (Baekkeskov,

2016). Ethically it is challenging, since vaccine programs often need to bal-

ance different ethical allocation principles (Bell et al., 2020). But the process

is also volatile, given the constantly shifting parameters of the pandemic and

the resulting changes in needs and hence in vaccine allocation.