How did Ontario healthcare institutions implement and legitimize Covid-19 vaccine mandates? A mixed-methods study protocol

Background: Upon the WHO declaration of COVID-19 as a pandemic, healthcare workers (HCWs) - unvaccinated by necessity - were celebrated as heroes for their service under difficult conditions. Later, as some of them resisted vaccine mandates, they were reframed as threats, regardless of personal behaviour, workplace setting, or evidence of their harmfulness. This discursive shift and the institutional mechanisms supporting it remain underexamined. Goal: This protocol outlines a mixed-method study investigating the implementation of COVID-19 vaccine mandates in medical establishments across Ontario, Canada. Methods: This is a two-phase mixed methods planned study. Phase 1 is an environmental scan of institutional vaccine mandate policies across a purposive sample of diverse Ontario medical establishments. It will track policy implementation timelines, mandates scope, exemptions eligibility criteria, and supporting scientific evidence presented. Phase 2 is a critical interpretive analysis of documents collected in Phase 1 that draws on the theory of bureaucracy and legitimacy developed by Max Weber, the What Is the Problem Represented to Be (WPR) approach developed by Carol Bacchi, and a framework on suppression of dissent developed by Brian Martin to identify patters in the institutional framing and treatment of challenges to mandated vaccination. Expected Outcomes: This study is expected to yield descriptive and interpretive insights into how bureaucratic structures shaped mandate enforcement and dissent suppression. Results are expected to inform academic debates on institutional legitimacy, governance, and public health ethics.