This article explores why governments do not respond to public compliance problems in a timely manner with appropriate instruments, and the consequences of their failure to do so. Utilising a case study of Italian vaccination policy, the article considers counterfactuals and the challenges of governing health policy in an age of disinformation. It counterposes two methods of governing vaccination compliance: discipline, which uses public institutions to inculcate the population with favourable attitudes and practices, and modulation, which uses access to public institutions as a form of control. The Italian government ineffectively employed discipline for a number of years. Epistemological and organisational constraints stymied its efforts to tackle a significant childhood vaccination compliance problem. With a loss of control over the information environment, vaccinations were not served well by exogenous crises, the sensationalism of the news cycle and online misinformation. Hampered by austerity, lack of capacity and epistemic shortcomings, the Italian government did not protect the public legitimacy of the vaccination programme. Instead of employing communications to reassure a hesitant population, they focused on systemic and delivery issues, until it was too late to do anything except make vaccinations mandatory (using modulation). The apparent short-term success of this measure in generating population compliance does not foreclose the need for ongoing governance of vaccine confidence through effective discipline. This is evident for the COVID-19 vaccination campaign, with many Italians still indicating that they would not accept a vaccine despite the devastation that the disease has wrought throughout their country.

本文探讨了政府为何不及时使用适当的工具对公众合规问题作出反应，以及它们不这样做的后果。本文利用意大利疫苗接种政策的案例研究，考虑了在虚假信息时代管理卫生政策的反事实和挑战。它反对管理疫苗接种合规性的两种方法：纪律，利用公共机构向民众灌输良好的态度和做法，以及调节，它使用对公共机构的访问作为一种控制形式。意大利政府多年来没有有效地使用纪律。认识论和组织上的限制阻碍了其解决重要的儿童疫苗接种依从性问题的努力。由于失去了对信息环境的控制，外生危机、新闻周期的耸人听闻和在线错误信息导致疫苗接种效果不佳。受到紧缩、能力不足和认知缺陷的阻碍，意大利政府没有保护疫苗接种计划的公共合法性。他们没有使用沟通来安抚犹豫不决的人群，而是专注于系统性和交付问题，直到除了强制接种疫苗（使用调制）之外什么都做已为时已晚。该措施在提高人群依从性方面的明显短期成功并不排除通过有效纪律持续治理疫苗信心的必要性。这对于 COVID-19 疫苗接种运动来说是显而易见的，许多意大利人仍然表示他们不会接受疫苗，尽管这种疾病在他们的国家造成了破坏。