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

Published date01 July 2023
AuthorTom Christensen,Per Lægreid
Date01 July 2023
Subject MatterArticles
Administration & Society
2023, Vol. 55(6) 1171 –1193
© The Author(s) 2023
Article reuse guidelines:
DOI: 10.1177/00953997231167557
The Politics of Vaccines—
How to Determine a
Fair Vaccine Allocation:
Hierarchy, Negotiations,
or Culture?
Tom Christensen1 and Per Lægreid2
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.
instrumentalism, vaccine politics, COVID-19, Norway, negotiation, culture
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,
1167557AAS0010.1177/00953997231167557Administration & SocietyChristensen and Lægreid
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.

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