Populism and health policy: three international case studies of right-wing populist policy frames

Leaky bodies, vaccination and three layers of memory: bio-immune, social-collective and lived experience

This paper focuses on the omnipresent yet analytically almost invisible role of memory and bodily experiences in childhood vaccination. Previous scholarship on the sociocultural aspects of vaccination has primarily focused on the individual and sociodemographic factors underpinning vaccine hesitancy, the role of healthcare professionals and the politicisation or mediatisation of vaccination. Social practices considering vaccination were primarily explored as a matter of the present. Only little consideration was given to the past, individual biographies and sociohistorical temporalities. To complement this body of work, we focus on cognitively-based, embodied and emotionally-experienced memory related to vaccination. Based on a qualitative study of childhood vaccination conducted in Czechia between 2017 and 2019 consisting of ethnographic observations, in-depth interviews and a document review, we identified three interconnected forms of vaccination memory: bio-immune, social-collective and lived experience. Bio-immune memory refers to the body's physical memory, gained to protect itself from diseases. Social-collective memory focuses on socially shared narratives about diseases and vaccination in the past. The memory of lived experience refers to feelings, embodied knowledge and pain. Our findings may inspire further analysis of childhood vaccination in other geographical contexts and amidst the reconfiguration of attitudes and newly established memories following the COVID-19 pandemic.

How to Build Healthy Societies: A Thematic Analysis of Relevant Conceptual Frameworks

BACKGROUND

As the Sustainable Development Goals deadline of 2030 draws near, greater attention is being given to health beyond the health sector, in other words, to the creation of healthy societies. However, action and reform in this area has not kept pace, in part due to a focus on narrower interventions and the lack of upstream action on health inequity. With an aim to guide action and political engagement for reform, we conducted a thematic analysis of concepts seeking to arrive at healthy societies.

METHODS

This paper drew on a qualitative thematic analysis of a purposive sample of 68 documents including political declarations, reports, peer reviewed literature and guidance published since 1974. Three independent reviewers extracted data to identify, discuss and critique public policy levers and 'enablers' of healthy societies, the "how."

RESULTS

The first lever concerned regulatory and fiscal measures. The second was intersectoral action. The final lever a shift in the global consensus around what signifies societal transformation and outcomes. The three enablers covered political leadership and accountability, popular mobilization and the generation and use of knowledge.

CONCLUSION

Documents focused largely on technical rather than political solutions. Even as the importance of political leadership was recognized, analysis of power was limited. Rights-based approaches were generally neglected as was assessing what worked or did not work to pull the levers or invest in the enablers. Frameworks typically failed to acknowledge or challenge prevailing ideologies, and did not seek to identify ways to hold or governments or corporations accountable for failures. Finally, ideas and approaches seem to recur again over the decades, without adding further nuance or analysis. This suggests a need for more upstream, critical and radical approaches to achieve healthy societies.

Losing trust: Processes of vaccine hesitancy in parents' narratives

Lack of trust is central in becoming hesitant towards vaccines, but research on vaccine hesitancy lacks detailed examination of the processes of losing trust. Based on ethnographic interviews with 38 parents in Finland, we explore how and why they have lost their trust in vaccination. We identified two paths to losing trust in vaccination. One was connected to mistrust - a cumulating suspicious attitude toward vaccines and related institutions. The other was associated with distrust - a more sudden loss of trust. We identified four ideal type narratives of losing trust: the activist, the hesitant, the disillusioned and the negotiator. The narratives of the activist and the hesitant were connected to mistrust. The activists were certain of their vaccination decisions whereas the hesitant parents were not. The narratives of the disillusioned and the negotiator were connected with distrust. The disillusioned parents had lost their trust due to adverse effects of vaccination and a lack of institutional support. The negotiators suspected adverse effects and were less certain about their decisions. The article provides insight into the ways in which people lose trust in vaccination, which is crucial for supporting trusting relationships between vaccine-advocating institutions and the publics.

Promoting conspiracy theory: From AIDS to COVID-19

Conspiracy theories (evidence-free, improbable narratives about powerful agents conspiring to harm people) circulated widely during the acquired immune deficiency syndrome (AIDS) and COVID-19 epidemics. They travelled over time and space, adapted to local conditions and anxieties, and were promoted for commercial and political purposes. Russian conspiracy theories claiming the viruses were United States bioweapons appeared in both epidemics. So did 'cultropreneurs' who, as a marketing strategy for their 'alternative' therapies, promoted conspiracy theories about scientific medicine. Pro-science activists sought to counter medical misinformation and debunk faux cures, but their task was harder in the 'post-truth' social-media driven context of COVID-19. Conspiracy theories about vaccines are an ongoing challenge for public health.

The Effect of Science-Related Populism on Vaccination Attitudes and Decisions

As the COVID-19 pandemic has sadly shown, the decision against vaccination is often linked to political ideologies and populist messages among specific segments of the population: People do not only have concerns about a potential health risk associated with vaccination but seem to have also adopted more populist attitudes towards science. In this study, the relationship between science-related populism and individuals' attitudes towards vaccination was examined, presuming that scientific-related populism also influences individual responses towards different vaccinations. As different types of diseases and their vaccines might be perceived rather distinctively by the public, different vaccinations were considered. The survey is based on responses from 870 people from Germany and Austria. Results indicate that science-related populism influences responses towards some vaccination types, especially for those that receive extensive media coverage such as COVID-19 and measles (MMR). There was no significant impact of science-related populism on individuals' vaccination intentions for other vaccines like seasonal influenza, human papillomavirus, or tick-borne encephalitis. In conclusion, limitations and directions for future research are addressed.

Population health, not individual health, drives support for populist parties

Recent electoral shifts toward populist parties may have been partly driven by deteriorating health, although empirical evidence on this link is primarily confined to ecological designs. We performed both ecological- and individual-level analyses to investigate whether changes in health are associated with changes in the support for populist parties. Data were used on the strategic Dutch case, the only liberal democracy featuring leftist and rightist populist politicians in parliament for over a decade. We used: (a) fixed effects models to examine whether changes in the standardized mortality ratios and self-assessed health (SAH) in municipalities were associated with changes in the populist vote share in four parliamentary elections (2006/2010/2012/2017); and (b) 10 waves of panel data collected in 2008 to 2018 to investigate if changes in individual-level SAH were linked to movement in the sympathy, intention to vote, and actual voting for populist parties. The ecological analyses showed that: changes in municipality mortality ratios were positively linked to changes in the vote share of right-wing populist parties, while changes in the prevalence of less-than-good SAH were negatively associated with changes in the vote share for left-wing populist parties. The individual-level analyses identified no such associations. Our findings imply that support for populist parties may be driven by health concerns at the ecological, but not the individual, level. This suggests that sociotropic (e.g. perceiving population health issues as a social problem), but not egotropic (e.g. relating to personal health issues like experienced stigma), concerns may underlie rising support for populist parties.

The Impact of COVID-19 on the Support for the German AfD: Jumping the Populist Ship or Staying the Course?

Populist parties enjoy stable support in various European countries. The literature on the rise of populism argues that this support especially increases in times of crises. Surprisingly, the German right-wing populist Alternative für Deutschland (AfD) did not increase its support in the wake of the COVID-19 pandemic. Moreover, the party even lost 2.3 percentage points in the 2021 federal election. We address this puzzle and ask why the AfD has not been able to use the crisis to its advantage. Our main argument in answering this question is that, although the AfD pursued the classic populist strategy of fundamental opposition, the support base of the AfD is strongly divided on the preference towards measures containing the spread of COVID-19. This division is reinforced by individual affectedness by the pandemic. Introducing a novel weekly dataset on voter preferences, we show that the AfD support base is strongly divided on the issue with approval of the government measures being a significant and substantial contributor to vote switching away from the AfD. Using regional-level data and a difference-in-differences approach, we further show that western German regions hit especially hard by the pandemic display a lower AfD vote share than other regions. Our findings have important implications for the impact of exogenous shocks on electoral competition and also on the future of populist parties.

Political Populism, Institutional Distrust and Vaccination Uptake: A Mediation Analysis

Politics is ubiquitous in public health, but vaccines had never been weaponized to instill distrust to gain political advantage. In pandemic and post-pandemic scenarios, populist political parties could use vaccine-related issues to generate distrust in evidence-based knowledge. Therefore, some questions arise. What impact could populist political parties impinge on vaccination uptake rates through sowing political discontent? What could the medical institutions do to avoid the adverse effects that these political strategies could infringe? For answering these research questions, we first hypothesized that vaccine uptake was negatively associated with distrust in the institutions. Furthermore, we analyzed whether populism mediates this relationship. In doing so, we hypothesized a positive association between distrust and populism, because populists, mainly fueled by politically discontent citizens, offer hope of a better future, blaming their misfortune on the actions of the elite. Additionally, we hypothesized that those citizens with a higher level of political dissatisfaction, following the claims of the populist political parties, will have lower vaccine uptake results, because they will be discouraged from making the efforts to counter the pandemic. Based on a survey carried out by the European Commission that covered 27 E.U. + U.K. countries (totaling 27,524 respondents), this paper proves that an individual’s political discontent fully mediates the relationship between distrust in institutions and vaccine uptake. Targeting the vaccine-hesitant population is quite convenient for populists because they only need to convince a minority of citizens not to be vaccinated to achieve their destabilizing goals. New outbreaks will appear if the minimum herd immunity coverage is not reached, reinforcing a vicious circle of distrust in elites, in consequence. For tackling this matter, recommendations are given to institutional managers from a social marketing standpoint.

Vaccine Hesitancy and Political Populism. An Invariant Cross-European Perspective

Vaccine-hesitancy and political populism are positively associated across Europe: those countries in which their citizens present higher populist attitudes are those that also have higher vaccine-hesitancy rates. The same key driver fuels them: distrust in institutions, elites, and experts. The reluctance of citizens to be vaccinated fits perfectly in populist political agendas because is a source of instability that has a distinctive characteristic known as the “small pockets” issue. It means that the level at which immunization coverage needs to be maintained to be effective is so high that a small number of vaccine-hesitants have enormous adverse effects on herd immunity and epidemic spread. In pandemic and post-pandemic scenarios, vaccine-hesitancy could be used by populists as one of the most effective tools for generating distrust. This research presents an invariant measurement model applied to 27 EU + UK countries (27,524 participants) that segments the different behaviours found, and gives social-marketing recommendations for coping with the vaccine-hesitancy problem when used for generating distrust.

Medical populism and the politics of dengue epidemics in the Global South

With millions of cases and thousands of deaths every year in Asia and Latin America, dengue fever continues to be of global public health significance. This article uses the concept of 'medical populism' to analyse the political construction of the 2019 dengue epidemics in Bangladesh, the Philippines, and Honduras. Through this framework, we examine the narratives of these outbreaks by reconstructing how political actors simplified the discourse, spectacularised the crises, offered multiple knowledge claims, and forged divisions between the people and 'dangerous others'. Taken together, our case studies, obtained through government, journalistic, and scholarly sources, illuminate the role of medical populists (who are almost always politicians) in defining and responding to public health emergencies, underscoring the performative dimension of disease outbreaks. By detracting attention from less spectacular but more substantive policies and programs, these 'performances' of health crises perpetuate health inequities, especially in fragile democracies like the aforementioned Global South countries. We conclude by reflecting on the implications of medical populism to public health, health communications, and the inevitable recurrence of epidemics.

Medical Populism and COVID-19 Testing

This paper uses the lens of medical populism to analyze the impact of biocommunicability on COVID-19 testing through a case study approach. The political efficacy of testing is traced through two mini-case studies: the Philippines and the United States. The case studies follow the approach of populism scholars in drawing from various sources that ‘render the populist style visible’ from the tweets and press releases of government officials to media reportage. Using the framework of medical populism, the case studies pay attention to the ways in which coronavirus testing figured in (1) simplification of the pandemic; (2) spectacularization of the crisis; (3) forging of divisions; and (4) invocation of knowledge claims. Identifying and critically analyzing how knowledge is generated is an essential step to recognizing the impact that political styles have on the COVID pandemic. The political actors in each case study have shaped knowledge of the epidemic, in the way they construct the idea of ‘testing’, and in how they mobilize testing as an ‘evidence-making practice’. Their actions shaped how the pandemic—as well as their responses—is measured. This framework contributes to public policy debates by providing evidence of the impact of medical populism on pandemic response efforts.

Politicisation, depoliticisation, and repoliticisation of health care controversies: Vaccination and mental health care reform in the Czech Republic

This article analyses the politicisation of public health debates by focusing on vaccination and mental health care in the Czech Republic. The mainstream understanding of politicisation commonly refers to politics-as-sphere, linked with the political instrumentalisation of health care controversies as part of electoral campaigning and power struggles. In our analysis, we conceive politicisation more broadly, as politics-as-activity, which encompasses the role of civic engagement and the involvement of patients in these processes. We thus view politicisation as a process which encompasses a plurality of political actors and, in addition to politicians, includes patients, users, carers, citizens, and experts. Our analysis draws on extensive empirical evidence, consisting of observations, semi-structured interviews, and a review of available documents. The study took place in the Czech Republic from 2017 to 2019. We conclude that politicisation takes place alongside four dimensions: (1) contingency, (2) agency, (3) a plurality of opinions and approaches, and (4) visibility. We further argue that the contingent nature of biomedical controversies is articulated in three different, possibly interconnected layers. Thus, the politicisation of the two Czech analysed cases refers to (a) uncertainties and problematic aspects of biomedical objects of controversy; to (b) social rights, economic needs, and legal aspects as well as social representations of illness and vaccinations in the public debate; and to (c) the political processes which determine the previous two layers of politicisation, labelled as meta-politicisation. Last but not least, we stress the dynamic and non-linear nature of politicisation processes, the varieties of connections between the third sector and expertise, and the necessity to analyse the politicisation of public health controversies hand in hand with its connection to depoliticisation and repoliticisation.