Czech Republic

Junkies ride buses and prick children with syringes. Who’s against vaccination in Czechia?

In the communist period, Czech vaccination policy was top-down and paternalistic. Despite its successes, it was openly undemocratic. Today some people are challenging this legacy and demanding a more individualised approach to healthcare.

Last year the Czech director Robert Sedláček released a new film dedicated to Jan Palach, a young humanities student from Charles University who set himself on fire with gasoline in Prague’s Wenceslas Square on 16 January 1969 to protest the country’s occupation by armies of the Warsaw pact. Palach considered himself ‘torch No. 1’. He wanted to rouse the Czechoslovak people from their collective lethargy, and force them into active opposition against the forces that were commandeering their land. Although a few people did follow Palach’s example, his vision of triggering mass protest on the part of society at large ultimately did not materialize.

Sedláček’s film, though, looks at much more than this single gesture. Amongst other things it explores Palach’s everyday life with his girlfriend, another humanities student at the university. The action begins by documenting their relationship, which developed when they were both enrolled in a rehabilitation program offered by Prague’s Podolí pool. As a child, Palach’s partner was a victim of polio, and her lower extremities were permanently paralyzed. Subsequently she was forced to use crutches to walk. We watch as, during the revolutionary days, Palach joins his girlfriend in the protests, helping her in her awkward navigation of the city streets and the orchards at Prague’s Petřín park. It was here, at the nearby Strahov dormitories, that the first large-scale student protest took place on 31 October 1967, helping to kick-start the Prague Spring.

Illustration by Elena Dan

These historical moments are all interesting to note, but I mention Sedláček’s film mainly as a timely reminder of just how widespread polio was in post-war Czechoslovakia. The polio epidemic struck the Eastern bloc mostly in the 1950s, at a moment when there was a decrease in population due to a loosening of abortion laws and the exodus of unwanted individuals into foreign exile. For the communist regimes, which were at that time still reeling from the onslaught of the Second World War, this was a big problem, particularly given that hard manual labor was a central tenet of their political ideology. In the 1930s, 1.52 out of every 100,000 children became ill with the disease, while in the 1950s the number of affected rose to 10 children per every 100,000. Although these figures did not constitute a major existential threat to post-war Czechoslovakia, at least in relation to some other factors, the eradication of polio became a significant political challenge.

In the spring of 1958, about 140,000 children from the ages of two to six were vaccinated with the so-called Sabin’s vaccine which consisted of a low dose of an impaired strain of the polio virus which was supposed to help develop the body’s immunity. This program was successful and in 1960 a state-wide campaign of vaccination was launched in which 93% of children between the age of two and fourteen were vaccinated (about 3.5 million individuals). This massive campaign led to the disease being virtually eradicated in Czechoslovakia. The method of its eradication, though, also encapsulates the approach that communist regimes adopted towards their citizens. In ensuring a better state of health for its population, the Czech state did not shy away from paternalistically ordering the patients’ course of action, despite the fact that it was not one hundred percent sure of the polio vaccine being effective. Ultimately the authorities went ahead with inoculating a massive segment of the population without any preemptive expert discussion on the part of hygiene experts, doctors or scientists. In the event that the vaccination was successful, as was the case with polio, the communist state used this to demonstrate its power and increase its legitimacy.

These vaccination programs soon became the flagship of so-called ‘preventive medicine’, which the communist regimes considered the most important feature of the state’s struggle to ensure its society’s health and safety. The legacy of this policy is evident when we compare the present situation in former Eastern bloc countries with the vaccination policy among other EU countries. In the post-socialist states of Poland, Hungary, Slovakia and Czechia, the policy is dominated by compulsory vaccination programs, and the coverage of the Czech population was, as recently as 2012, at 98-99% of the population.

Faceless institutions

What then is the present state of the vaccination program in Czechia? A study entitled The Views of Parents Who Reject Compulsory Vaccination (2014) by Jaroslava Hasmanová Marhánková sets out the context. It begins by describing a procedure in which “children undergo a sequence of compulsory vaccinations against nine illnesses when they are between nine and twenty-six weeks old.” If the parents refuse to vaccinate their child in the allotted term, and the child does not have any form of so-called ‘contraindication’ (i.e. neurological of immunity-related defects which would prevent the application of the vaccine), they can be sanctioned by the state with a fine of up to 10,000 CZK (400 EUR). In the rest of this scientific study, Marhánková maps the opinions of parents who refuse compulsory vaccination, contextualizing the debate using Foucault’s theory of biopolitics.

Through a series of detailed interviews with dozens of parents who criticize the vaccination policy, Marhánková offers a complex probe into peoples’ skeptical reasoning. Most of the mothers, for example, are university-educated women (there was only one male participant in the study). Many of those who are vocal opponents of the vaccination program are also skeptical towards other aspects of infant and child health care. Another important feature is their resistance towards a ‘rigid approach’ to obstetrics, and a similar tone is adopted to discuss infant nursing. All these cases constitute the fallout of the methods through which the communist modernist project wanted to prevent child mortality (hospital births, compulsory vaccination), or wanted to integrate women back into the work process as fast as possible (via artificial baby food).

We are currently seeing a battle between two methods and ideas of the health care system, with little space for debate between them. As Marhánková writes in her study: “the environment of an individualistic society which has placed health on a pedestal while at the same time making it more than ever before a question of personal choice has created new possibilities for action, as well as new challenges.” While the collectivist image of the health care system of socialist regimes was based on the authority of health experts who attempted to resolve the population’s health situation as effectively as possible while largely disregarding the patients’ personal needs, the individualist society is going the other way, and adopts a new perspective on the formerly dominant position of experts.

Critics of vaccination policy in the Czech Republic are usually advocates of a more individualized care which is sensitive to their needs. They perceive the “arrogant”, paternalistic approach of most doctors as a means through which “the state” or “the system” meddles in their freedoms and individual choices. Most of the people interviewed underwent this change of heart mostly due to a personal or vicarious experience with the negative side effects of vaccination. “I met parents whose children had died due to the vaccination. That was huge for me: one mother for example told me how still some doctors tell them that it was a necessary sacrifice for everyone else remaining healthy, that it happens to one in a million” writes Marhánková. One woman, Barbora (39), took active part in the seminars and conferences of the parent association Rozalio which works to spread awareness about the dangers of compulsory vaccination. Rozalio and Pro Volbu (Pro Choice) are the most visible associations fighting against compulsory vaccination in Czech Republic. Both of them come from an urban liberal millieu in Prague and few other bigger Czech cities. They began as bottom-up organizations, which originally just gathered parents to discuss their experiences, and later on decided to consolidate into a more recognizably institutional structure.

Doctors in the Czech Republic remain well-respected, and as a result their actions and conclusions are rarely disputed. “The absence of a strong critical discussion on vaccination resulted in most of the participants being dumbstruck when informed of the risks of vaccination,” writes Marhánková. This phase of initial shock was then further supported by the response of the doctors when they confronted them with the side effects of vaccination. The patient’s complaints were downplayed, or the causal relationship between the illness and the vaccination was put in question. Most of the respondents encountered a dismissive or hostile reaction, and there is also mention of outright yelling.

For many respondents, the responses of the doctors bordered on “emotional blackmail,” as they appealed to the child’s health and put forth insensitive arguments about it potentially dying. Monika (35) claims that arguments between parents and doctors are particularly frequent on the topic of the so-called ‘compulsory hexavaccine’ which also includes the vaccine against Hepatitis B. “I simply told my doctor that we do not want the hexavaccine because Hepatitis B is also included. I told her that there is no way the child can contract it because it is transmitted by blood, or sexual contact, so how could a baby get it? And she said that ‘junkies ride on buses and prick children with syringes.’ She really said that.” Similar experiences with family doctors prompted many parents to question the legitimacy of compulsory vaccination. It was as if the health staff were not ready for such discussions, and its motivations were often interpreted as counterproductive. The staff, in turn, reported that they were overbooked, and that during office hours they did not have the time to discuss the problems in more detail or on an individual basis.

A polarized debate

The poor quality of debate is attested by th media sociologist Lenka Vochocová who is currently researching online discourse surrounding vaccination in the Czech Republic. “There is never enough information, and as soon as you want to have a conversation on the topic you become labeled as being ‘anti-vaccine’ and a troublemaker, despite the fact that these people might simply have doubts and want to get a better understanding of the issue.” Vochocová is also mapping the Czech discourse about migration and has drawn a number of parallels between the two cases. “The polarization is strong, as is the ad hominem labeling of someone who might have a different opinion. People do not pose counterarguments but rather immediately start labeling people as ‘forest-women’ and ‘bio-moms.’ Similar labels are used on both sides of the conflict. It is the same situation with the debate on migration. On the one hand, there are the ‘welcomers’ and ‘do-gooders’, while on the other, anyone who voices any reservations towards migration is labeled a ‘racist’ or a ‘fascist’. Upon closer analysis of the internet comments, we find that most people fall into one or the other slot on the opinion spectrum, and that there are almost no ambivalent stances.”

The very label of the ‘anti-vaccination movement’ is problematic. It has been rejected by many Czech critics of compulsory vaccination simply for the fact that they do not consider themselves to be ‘anti-vaccine.’ They criticize very specific features of the Czech discourse on vaccination. Compulsory vaccination is usually opposed by liberal, university-educated individuals, so the crux of the debate can be found in distrust towards the health care system as such, and the suspicion that doctors make a profit on the vaccination through their cooperation with the pharmaceutical industry. Doctors and health experts, on the other hand, suspect associations such as Rozalia or Pro Volbu, of being financed by associations who do business in alternative medicine, as well as of abusing the trust of their supporters for personal financial profit.

The fact that the Ministry of Health has recently established a special committee devoted to vaccination policy, and that they have invited the parent association Rozalia to play a role in the commission, is certainly of interest. But the actual meeting showed communication to still be very limited – the inclusion of Rozalia rather functions as a token alibi, giving the impression that the government is also in communication with their opponents, and that they are indeed trying to find a satisfactory solution for everyone involved. Despite this, it is a step in the right direction and indicates that the state has interest in debating its critics, and does not consider them a direct threat to their health policy.

Right-wing populism?

The fight against compulsory vaccination does not use any Czech political subject as a vehicle for its political agenda, barring the marginal libertarian party Svobodní (Party of Czech Free Citizens), which basically repeats the points of American libertarian parties, and which received a mere 1,56% in the 2017 elections.  Svobodní openly advocate for a voluntary approach to vaccination and reject the state’s repression against those citizens who refuse vaccination. However, researchers of the anti-vaccination movements in Czechia from Charles University’s Faculty of Social Sciences have confirmed that the stance towards vaccination in no way determines political preferences.

We find the staunchest supporters of mandatory vaccination among the Communist Party of Bohemia and Moravia. Its representatives often put the necessity for compulsory vaccination in context with the migration crisis, arguing, without evidence, that new arrivals from Africa and the Near East are potential carriers of infectious diseases which might put Czech society in serious jeopardy. This stance contrasts with that of the Naštvané Matky organization (Angry Mothers), which is part of an obscure Czech political party called Blok proti Islámu (Bloc Against Islam). Although Angry Mothers are radical opponents of migration, their agenda is also shored up by their fight against vaccination. The members of the communist party are at least consistent in that they back up their fight against migration with a strictly pro-vaccination policy. The extreme-right movement of Angry Mothers does not accent this connection, and their policy exhibits certain continuity with the Italian extreme-right movement, where resistance to migration is also sometimes coupled with rejection of vaccination.

How to explain this inconsistency? The sociologist Lenka Vochocová partly answers by stating that the Angry Mothers movement “falls into the so-called anti-liberal discourse. They adopt a conservative position which is opposed to anything perceived as foreign, or liberatory in terms of its gender or sexual politics. In their case, the fight against vaccination constitutes a small part in a whole package of anti-liberal opinions.” Angry Mothers are thus the only political association in the Czech Republic whose anti-vaccination opinions have any connection with the new tendencies of the so-called anti-liberal populism. Their criticism of compulsory vaccination exhibits a single underlying logic: by means of vaccination, the state and the elites threaten our bodily health.

The communist backlash

While opponents of vaccination in Western Europe and America explain their stance through their disgust for the state (libertarians, conservatives), or their distrust of big pharmaceutical firms, who have only their own profit in mind rather than the well-being of their patients (left liberals, anarchists), the biggest problem Czech protagonists have is with the paternalistic approach of the health care system towards its patients. In this sense it also reflects the population’s latent anti-communist leanings. On the surface it might seem that this line of argumentation simply mimics the Western libertarian criticism of healthcare, but things are not quite so simple. American libertarians and some conservatives articulate this discrepancy when they mention having compulsory vaccination as part of their health insurance, for which they of course pay large amounts of money. The state’s wish to keep a large portion of the population vaccinated runs against the patients’ freedom of choice, in part due to the fact that they invest their own money into the system. It is a frequent opinion that the state shouldn’t intervene at all in their healthcare situation.

Among the Czech anti-vaccination crowd, though, we would be hard pressed to find anyone who would wish to privatize the health care system. This would mean the end of free health coverage, which for most people is not an attractive prospect. The bigger perceived problem is that the present health care system retains some connection to that of communist times. While this system greatly improved the living conditions of hundreds of thousands of Czechoslovak citizens it was also known for its authoritative and paternalistic approach to its patients. Czech doctors, especially the older generation, are simply not used to their decisions being challenged, or the idea that their patients want to actively discuss the methods of their treatment with them. Monika’s experience, for example, is by no means an isolated one.

The approach of Czech opponents to compulsory vaccination reflects the basic difference between free health care available to most people in the post-socialist countries, and the health care systems which require a financial contribution from their patients on a treatment by treatment basis. The health care systems in the post-socialist countries simply do not regard themselves as providing a service to the patients, although this situation is slowly changing. Since its inception by the communist Constitution of 1948, free health care has been perceived as a political benefit which the state graciously bestows upon its populace. This idea remains firmly rooted in the Czech health care system to this day. Anticommunist sentiment plays into the resistance against vaccination especially in those moments when the patients experience a moment of helplessness faced with what Marhánková and other testimonies demonstrate to be the doctors’ callousness or arrogance. It is this moment in particular which triggers their ideas about an authoritarian state which puts the alleged welfare of collective society above that of the individual.

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Translated by Vít Bohal

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This article was created as part of the Reporters in the Field program, supported by the Robert Bosch Stiftung and hosted together with the media network n-ost.

Bio

Jan Bělíček is an editor of the Czech progressive daily website A2larm.cz

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