Negotiated compliance at the street level: Personalizing immunization in England, Israel and Sweden

Often portrayed as behaviour that is inconsistent with policy goals, public noncompliance poses a significant challenge for government. To explore what compliance efforts entail on the ground, this study focuses on childhood immunization as a paradigmatic case where a failure to ensure compliance poses a public health risk. The analysis draws on 48 semi-structured interviews with frontline nurses and regional/national public health officials in England (N = 15), Sweden (N = 17) and Israel (N = 16), all of which have experienced periodic noncompliance spikes, but differ in direct delivery of vaccination provision. Compliance efforts emerged as a joint decision-making process in which improvisatory practices of personalized appeals are deployed to accommodate parents’ concerns, termed here ‘street-level negotiation’. Whereas compliance is suggestive of compelling citizens’ adherence to standardized rules, compliance negotiation draws attention to the limited resources street-level workers have when encountering noncompliance and to policy-clients’ influence on delivery arrangements when holding discretionary power over whether or not to comply.