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 practitioners

• Australian 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.