Governance in action: the role of pediatricians in childhood immunization

Pediatric vaccination consultations are central to how childhood vaccination is organized and sustained in practice, particularly in contexts where vaccination is voluntary, delivery is physician-led, and formal provider oversight is limited. Drawing on street-level bureaucracy literature and a biopolitical perspective on health governance, we conceptualize pediatric vaccination consultations as sites of governance-in-action and explore how pediatricians interpret and shape childhood vaccination governance. Our analysis builds on qualitative data collected in Austria between 2023 and 2025, including ethnographic observations of 243 pediatric consultations and 43 interviews with parents and pediatricians. We identify four roles pediatricians assume: guidance through expertise; facilitating education; advocacy for individual health; and safeguarding public health. Building on this, we propose conceptualizing vaccination consultations as public encounters in which pediatricians and parents negotiate responsibilities, values, and health-related concerns through relationships of care while simultaneously advancing population-level health goals. This study sheds light on the often informalized work through which pediatricians sustain vaccination governance and calls for greater scholarly and policy attention to clinical encounters through which public health is realized.