Without risk:a social analysis of the vaccination programme in England

In this chapter, we examine the social forces shaping the design and delivery of the COVID-19 vaccination programme in England. Looking beyond direct inclusion or exclusion in policy decision-making, we view health and health care as an arena containing several powerful interest groups. Our approach considers the influences, interests, and strategies that can work to reshape, constrain, challenge, or reject policy—though we also consider if and how actors might collaborate or develop alliances and allegiances that support and facilitate policy. We analyse these dynamics in the context of various dimensions of the COVID-19 vaccination programme in England (in relation to supply and manufacturing, regulation, prioritisation, vaccine nationalism, and vaccine coverage). Overall, we argue that, though there were examples of actors working to challenge or reject policy and decision-making in the development and delivery of the vaccination programme, there were limited impacts on or resulting changes to policy—particularly where this was counter to the interests of government and/or the pharmaceutical industry. Additionally, groups have to a greater extent acted and collaborated in a manner that has been supportive and facilitative of policy