Towards a new policy analytical methodology in the study of vaccination governance: from values to valuations
2025-05-13
In the face of declining vaccine uptake, public health advocates and decision makers have emphasised the value of vaccination, expressing it in medical and technical terms and metrics, such as in the number of lives saved. This narrow and monolithic understanding of value conceals how different actors value and assess the importance of vaccination – for example, its scientific, economic, ethical, social or personal value. To capture the scientific and political deadlock we observe in vaccination governance, we understand insufficient vaccine uptake as a paradigmatic example of a ‘wicked problem’ – socially complex and resistant to solutions due to differing stakeholder perspectives on what the problem is. We propose a new methodology for the study of wicked problems, labelled policy valuography, and illustrate its novelty by discussing three vignettes from our ongoing research on vaccination against human papillomavirus (HPV), COVID-19 and mpox. Such a methodology entails studying valuation practices to understand how different actors assign value to vaccination, particularly in moments of problematisation. From our perspective, value is not given, nor can it be reduced to quantifiable terms. Instead, value is the result of coordination between different actors and their respective valuations when, over time and in interaction with one another, they become aligned to a considerable extent. This new methodology will be relevant for the study of other wicked problems, too, including those associated with the global climate crisis. In addition, it can contribute to politically sustainable immunisation strategies both for existing and emerging vaccines.