"That's a tricky question": perceptions of mandatory vaccination among parents and paediatricians in Austria

The COVID-19 pandemic and recurrent outbreaks of vaccine-preventable diseases highlight the need to improve vaccine uptake. Vaccine mandates constitute prominent policy instruments that promise a quick increase in coverage. Yet mandates are difficult to implement and bear the potential to increase resistance and polarisation, while diminishing trust. Against this background, studying perceptions towards mandates of groups directly affected by mandates is key to sustainable vaccination governance OBJECTIVE: In this paper, we study parents as decision-makers for childhood immunisation and paediatricians who administer vaccination and mitigate reactance. We explore how these two groups perceive vaccine mandates METHODS: Our study builds on 42 qualitative interviews with parents and paediatricians. We draw on the case of Austria, which is characterised by a fragmented vaccination system and recent experiences with mandates RESULTS: Perceptions overall are ambivalent, with both cohorts weighing positive and negative aspects. We find four lines of reasoning that relate to perceptions of vaccine mandates: political and societal impact, epidemiological reasoning, ethical considerations, and impact on vaccine uptake. Both cohorts show considerable alignment in their perceptions. Crucially, we find that perceptions of mandates are formed in contextual, concrete experiences with the healthcare system CONCLUSIONS: Our findings have critical implications for vaccination policy in Austria and beyond, especially concerning the distribution of responsibility in vaccination systems.