ABSTRACT This study adapts the Multiple Streams Framework (MSF) to explore why COVID‐19 vaccine mandates were applied at sectoral and subnational levels in Vietnam while the central government maintained that vaccination was voluntary. Document analysis reveals that these mandates arose from the effective coupling of the three streams—problem, policy, and politics—in a setting of authoritarian rule, where the streams function differently (and more uniformly) compared to democratic contexts. In the problem stream, insufficient community immunity, negative feedback from macro policies, and pressure from the central government posed challenges for sectoral and subnational policymakers. Within the policy stream, vaccine mandates offered a feasible and politically viable solution. The politics stream demonstrates that political leadership and determination both facilitated and exerted pressure for the adoption of vaccine mandates. A strong decentralized approach to pandemic responses granted substantial autonomy to the ministries and subnational governments, opening a window of opportunity for them to mandate despite the national position of vaccine voluntarism. The findings indicate that Vietnam's vaccine policy reflects a whole‐of‐government approach, with the mandatory vaccination policy emerging from the interaction of institutional hierarchies, functional responsibilities, and broader socio‐political pressures. The study nuances the assumption of stream independence in the MSF, highlighting the significant influence of political dynamics on all streams and the uniformity of key policy actors. It proposes a flexible application of the MSF for authoritarian contexts, where adherence to central government directives is generally strictly enforced with minimal allowance for modification.
Duong et al. (Sun,) studied this question.