Vassilis Karokis-Mavrikos

Vassilis Karokis-Mavrikos

Postdoctoral Research Fellow in Public Policy, Centre for Britain and Europe, University of Surrey | Researcher and Teacher in Public Policy, British, EU, and Comparative Politics, Research Methods | Health Policy, Digital/AI Governance, Crisis Management

Publications

You can also find my articles on my Google Scholar profile.

Journal Articles

Policy Networks and Policy Entrepreneurship in the EU: Explaining Structural Policy Change in Pharmaceutical Innovation Incentives and Health Technology Assessment

Published in European Policy Analysis, 2025

Policy process research has excelled in explaining structural policy change within national settings, but extensions and applications to the EU level have long proven challenging for scholars. Given that the EU is currently experiencing its longest period of Treaty stability since the 1980s—having evolved into a sui generis political system with a distinctive multilevel governance architecture—developing appropriate policy process tools for the EU context is imperative to understanding contemporary policy reform. To address this challenge, this study introduces and applies a modified iteration of the Multiple Streams Framework—the EU‐MSF—to two cases of structural reform in EU pharmaceutical policy: the revision of the General Pharmaceutical Legislation and the establishment of the new EU Health Technology Assessment framework. Drawing on primary data, including document analysis and 40 elite interviews, the research concludes that the levels of policy network integration shape both the nature of viable policy alternatives and the effectiveness of policy entrepreneurship strategies in driving EU‐level structural change. The study introduces two novel strategy archetypes—“snooker‐tactics” and “recoil‐tactics” policy entrepreneurship—and sets out new directions for EU‐level policy process research grounded in contextually fit analytical tools and hypotheses

Recommended citation: Karokis-Mavrikos, V. (2025). Policy Networks and Policy Entrepreneurship in the EU: Explaining Structural Policy Change in Pharmaceutical Innovation Incentives and Health Technology Assessment. European Policy Analysis, 1, https://doi.org/10.1002/epa2.70030.
Download Paper

What Can Drive a Digital Governance Transformation? Greece, the Covid–19 crisis and “a jump–started Lamborghini”

Published in Policy and Internet, 2024

The COVID-19 pandemic tested state preparedness across the globe and exposed cross-sectoral deficiencies in infrastructure, resources and policymaking patterns. However, the prospects of the pandemic facilitating lasting institutional change have received limited attention. This study explores the drivers and resisting forces underpinning Greece’s ongoing digital governance transformation during conditions of crises through a Multiple Streams lens. The analysis is informed by original primary data from elite stakeholders across four policy areas and extends from policy adoption to implementation. The study concludes that the simultaneous surfacing of administrative deficiencies, the enhanced value acceptability for innovation and a series of cross-sectoral spillovers facilitated the introduction of digitization initiatives on an unprecedented scale. However, centralization and cultural resistance from both bureaucracies and the public during implementation pose strains to the completion of the transformative process. The paper’s insights contribute to the young but highly topical research agenda on digital governance transformation drivers.

Recommended citation: Karokis-Mavrikos, V. (2024). What can drive a digital governance transformation? Greece, the Covid-19 crisis and "a jump–started Lamborghini". Policy & Internet, 1, 1–22. https://doi.org/10.1002/poi3.428
Download Paper

Advancing the Operationalization of National Policy Styles

Published in European Policy Analysis, 2023

While national policy styles have (re)gained academic attention in recent comparative public policy work, the concept still needs a widely accepted operationalization that can allow the collection and analysis of data across contexts while steering away from construct validity threats. We build on Tosun and Howlett’s (2022) work and employ a mixed-methods approach, which relies on exploratory factor analysis and hierarchical cluster analysis. We put forth an operationalization, using Bertelsmann’s Sustainable Governance Indicators (SGI) as proxies, that achieves conceptual clarity and distinctiveness, informational robustness, and statistical power. Ultimately, we construct two composite indicators—mode of problem-solving and inclusiveness—calculate them in 41 countries and present policy style classifications based on their combinations. We report the distribution of countries across four policy styles (administrative, managerial, accommodative, adversarial) and conclude with an analysis of the clusters, assessments of robustness, and comparison with other national policy style classification schemes.

Recommended citation: Zahariadis, N., Karokis-Mavrikos, V., Exadaktylos, T., Kyriakidis, A., Sparf, J., & Petridou, E. (2023). Advancing the operationalization of national policy styles. European Policy Analysis, 9(2), 200–218. https://doi.org/10.1002/epa2.1172
Download Paper

The strategy of venue creation: Explaining health policy change in Greece

Published in International Review of Public Policy, 2022

How do policy entrepreneurs affect policy change in environments of institutional instability? The literature has predominantly explored policy entrepreneur strategizing in contexts with established institutional settings. In this paper, we argue that under conditions of institutional fluidity and a weak and politicized public administration, venue creation is the more frequently encountered and the more likely successful strategy. We define venue creation as the entrepreneurial strategy of setting-up institutional arrangements of finite duration, predominantly in the form of committees, delegated exclusively with designing reforms. We test our hypothesis in the Greek health policy sector. We explore two policy instances: the unsuccessful attempt at a public health reform in 1992 and the successful introduction of radical policy change for public health in 2003. We employ a process tracing approach spanning thirty years, processing primary data (elite interviews and documents) applying the Multiple Streams Framework (MSF). We find that under conditions of institutional fluidity and administrative weakness, policy entrepreneurs failed in their pursuit of change using venue shopping in 1992 but succeeded through venue creation in 2003, confirming our hypothesis. We conclude with insights for contingent policy entrepreneurship success, the MSF and patterns of policymaking in Greece.

Recommended citation: Mavrikou, M., Zahariadis, N., & Karokis-Mavrikos, V. (2022). The strategy of venue creation: Explaining health policy change in Greece. International Review of Public Policy, 4(3). https://doi.org/10.4000/irpp.3018
Download Paper

Stakeholder Perceptions and Public Health System Performance Evaluation: Evidence from Greece during the Covid-19 pandemic

Published in Frontiers in Political Science, 2022

The COVID-19 pandemic has been challenging and testing of public health systems across the globe, engaging them in a prolonged scrutinization of their functions, capacity and resources. While in theory, this process can yield invaluable insights for future policy design and mitigate future adversity, it demands a suitable mode of evaluation. Often, innovative and ambitious legislative frames are a far cry from policymaking realities plagued with institutional and operational deficiencies. As a result, we decide to move past assessments of the de jure status quo and examine the de facto modus operandi through the eyes of the systems’ participating agents. We focus on the case of Greece, a country which boasts a modern public health systemic design, aligned with contemporary public health thought and international trends. We develop a new framework iteration for public health system performance evaluation, founded on prominent templates. We rely on elite surveying insights from 261 public health policy stakeholders in Greece, collected between 15.07.2020 and 13.12.2020. We capture the effect of the COVID-19 pandemic both in a latent fashion, through the timing of our survey, and in a direct one, through explicit inquiry. Our results show that the functions of the Greek Public Health System are disproportionally developed, relevant resources come to be narrow in scope and outcomes are suboptimal, failing to fulfill identified aims. Moreover, high centralization, the absence of public health expertise and undeveloped evaluative channels prevent failures from instigating adjustments. The COVID-19 pandemic has brought the system’s deficiencies to light forcefully and highlighted the essentiality of scientific inputs. Our conclusions point to an ill-alignment between the system’s mission and the ideational orientation of its stakeholders, which is likely to contain structural change if it remains unaddressed. We identify future research agendas and present policy directions for the Greek public health system.

Recommended citation: Karokis-Mavrikos, V., Mavrikou, M., & Yfantopoulos, J. (2022). Stakeholder perceptions and public health system performance evaluation: Evidence from Greece during the Covid-19 pandemic. Frontiers in Political Science. https://doi.org/10.3389/fpos.2022.1067250
Download Paper

Book Chapters

Shifting Ideational Paradigms in Public Health: the case of Greece

Published in A Modern Guide to the Multiple Streams Framework: Elgar Modern Guides, 2023

The Multiple Streams Framework (MSF) has long enjoyed prominence as an analytical tool for the study of policy change (Kingdon 1984). Scholarly applications have spanned contexts and policy fields (Jones et al. 2015) and have been highly successful in uncovering the mechanisms underpinning policy shifts, especially in the decision agenda (Herweg, Zahariadis and Zohlnhöfer 2018). As change is dynamic, recent accounts have extended the MSF’s focus to the implementation stage (Fowler 2019; Sager and Thomann 2017). An emerging challenge in the literature concerns connecting policy design and implementation (Fowler 2022; Zahariadis and Exadaktylos 2016) to understand why some bills provisioning radical change succeed in shifting policy trajectories but others do not. We intend to contribute to this research agenda through a longitudinal account of public health policy in Greece. We apply the MSF toolkit to the study of public health policy change, centering our analysis on two focusing events: the 2003 SARS outbreak and the Covid-19 pandemic. The first triggered the institutionalization of public health policymaking for the first time in Greece’s modern history (Bill 3172/2003) and the second tested the degree of entrenchment of the new paradigm nearly two decades later. In doing so, we evaluate the interrelation of policy design and implementation and uncover contextually-driven insights for the potential theoretical advancement of the framework.

Recommended citation: Karokis-Mavrikos, V., & Mavrikou, M. (2023). Shifting ideational paradigms in public health: The case of Greece. In N. Zahariadis, N. Herweg, R. Zohlnhöfer, & E. Petridou (Eds.), A Modern Guide to the Multiple Streams Framework (pp. 123–145). Edward Elgar. https://doi.org/10.4337/9781802209822.00016
Download Paper

Centralization and Lockdown: The Greek Response

Published in Policy Styles and Trust in the Age of Pandemics: Global Threat, National Responses, Routledge, 2022

In this chapter, we have argued that policy style interacted with political trust to shape the Greek response to the crisis created by the COVID-19 pandemic. We showed that when the pandemic hit the country in February 2020, Greece exhibited an administrative style coupled with low trust in government and other relevant public institutions. Focusing on measures taken during the response phase, that is, reaction to the pandemic, we have confirmed our hypothesis. However, we have also uncovered a certain dynamism driven by feedback from earlier response measures. While we anticipated a more-or-less “fixed,” that is, centralized response, we also uncovered centrifugaltendencies during the second wave. Command and coordination remained firmly in central–national hands throughout the two waves. But the message changed as the trade-off between public health and economic performance became more visible, and politically pressing, while there were attempts at more regionally nuanced outcomes. To be sure, centralization is still the norm—after all, policy styles cast a long shadow onto the future— but trust and the direction of response appear to wax and wane, further buttressing our argument for an interactive effect of style and trust on national crisis response.

Recommended citation: Zahariadis, N., & Karokis-Mavrikos, V. (2022). Centralization and lockdown: The Greek response. In N. Zahariadis, E. Petridou, T. Exadaktylos, & J. Sparf (Eds.), Policy styles and trust in the age of pandemics: Global threat, national responses. Routledge.
Download Paper

Working Papers

Studying Policy Entrepreneurship at the Sectoral Level: Strategies, Venues and the Use of Evidence in Greek Health Policy

Published in forthcoming, Oxford Hanbook on Policy Entrepreneurship, 2026

How do policy entrepreneurs pursue their objectives within Greek health policy, and what does a longitudinal perspective contribute to the study of policy entrepreneurship? This study draws on findings from an original survey of policy entrepreneurs active in Greek health policy between 2022 and 2025, complemented by elite interviews, to examine venues, strategies, and the use of evidence. The analysis reveals a) a period of high policymaking activity without corresponding structural policy change; b) the continued prevalence of venue creation extending into agenda setting through conferences and scientific meetings, and c) an increasing “lobby-fication” of the sector marked by growing organizational resources and professionalization among key interest groups. Within a highly centralized and inherently evidence-oriented sector, these developments have enabled policy entrepreneurs to expand their access to decision-makers and their capacity to influence policy, yet their scope for innovation remains constrained. The study contributes to the literature by clarifying the interplay between venues, lobbying, and policy entrepreneurship, and by demonstrating the analytical value of adopting a longitudinal lens beyond single reform episodes.

Recommended citation: Karokis–Mavrikos, V., Mavrikou, M., and Zahariadis, N. (2026). Studying Policy Entrepreneurship at the Sectoral Level: Strategies, Venues and the Use of Evidence in Greek Health Policy. *Working Paper*, forthcoming, Oxford Handbook on Policy Entrepreneurship.
Download Paper

Using Q-Methodology to study Concurrent Policy Change in the EU: The Emergence of the European Health Union

Published in forthcoming, 2026

Policy process research has traditionally focused on testing and refining theories and frameworks through their application to individual instances of structural policy change—typically a single marquee reform or a package of reforms addressing an identified issue that reconfigures the goals and means of public policymaking (Weible, 2023; Hall, 1993). However, comparatively less attention has been paid to the study of concurrent instances of policy change within a sector—often addressing different policy challenges—and to the ways in which their interaction shapes actor dynamics and policy priorities. This paper contributes to addressing this challenge by combining a modified iteration of the Multiple Streams Framework tailored to the EU level—the EU-MSF—with an innovative application of Q-Methodology, a systematic approach to correlating individuals’ viewpoints through non-traditional factor analysis, to study the emergence of the European Health Union. The study concludes the COVID-19 pandemic tested the sustainability of Member States’ health systems, exposed inequalities in health outcomes across EU patients, and scrutinised the institutional capacity of the EU pharmaceutical policy sector across both pharmaceutical and public health functions. Crucially, the nature of the crisis as a public health emergency allowed long-standing problems facing the sector to surface simultaneously, underscoring their interconnectedness while constraining framing contests. In the face of this problem-driven window of opportunity, policy actors found favourable conditions to advance both new and ongoing policy agendas. However, even as these reform processes unfolded concurrently within the sector, stakeholders exhibited markedly different patterns of prioritisation across them, generally attributing greater significance to agendas that had been initiated prior to the COVID-19 outbreak. Across reforms, the analysis highlights that EU pharmaceutical policy stakeholders have coalesced around three overarching policy viewpoints: one most strongly articulated by supranational institutions and policy instruments, one most prominently expressed by patients’ associations, and one most clearly associated with the pharmaceutical innovation industry. At the same time, the sector has experienced a clear shift in its prevailing value orientation, towards the pursuit of health-oriented rather than single-market-focused policy outcomes. This shift has been driven by changes in value acceptability following the widespread surfacing of health and public health challenges under pandemic conditions and reinforced by narrative convergence around health security and resilience. In this sense, the European Health Union can be understood as an extension of pandemic-generated momentum into the post-pandemic period. Beyond its empirical findings, the study demonstrates how the EU-MSF can support robust EU-level policy process research at both the programme and sectoral levels and introduces methodological innovations using Q-Methodology to generate systematic metrics for key policy process variables.

Recommended citation: Karokis–Mavrikos, V. (2026). Using Q-Methodology to study Concurrent Policy Change in the EU: The Emergence of the European Health Union. *Working Paper*, forthcoming.
Download Paper