Politics and culture as an explanation for vaccine skepticism: The case of Türkiye and the USA

Politics and culture as an explanation for vaccine skepticism: The case of Türkiye and the USA

Politics and culture play just as important a role as health in explaining the vaccination hurdle. In Turkey there is distrust of the state, in the USA there are religious reasons and resistance to abortion. "No matter what they say, I do the opposite. If they tell me to wear a mask, I won't wear a mask. And I won't get vaccinated." This quote comes from Ercan, a pharmacist and homeopath from Istanbul and one of many Turks who do not want to be vaccinated against COVID-19. “In Turkey, many people use the vaccination issue as an opportunity to defend themselves against the power of the state,” says Einar Wigen, associate professor of Turkish studies at the University of Oslo. Together with Nalan Azak, a doctoral student in Middle Eastern studies, he analyzed the importance of vaccinations, both historically and in the context of the new coronavirus vaccine. According to Wigen, this is essential knowledge in the fight against infectious diseases. “It is not enough just to develop a vaccine, you also have to understand its cultural and political significance in society,” he emphasizes. Compulsory vaccination versus distrust of the state In the Nordic countries, the high level of trust between the population and public authorities is often highlighted as the most important tool in the fight against the coronavirus pandemic. In Turkey, however, there is far less trust between citizens and the state, and authoritarian President Recep Tayyip Erdoğan is known for his extensive use of power against his opponents. In Turkey, all vaccinations are currently voluntary. However, compulsory vaccination was an effective instrument in Turkish health policy long before Erdoğan's term in office. "Turkey has one of the highest childhood vaccination rates in the world, but one of the lowest influenza vaccination rates among the elderly. This can be explained by the fact that the WHO child vaccination program was mandatory, while influenza vaccination was voluntary," explains Wigen. He points to a long history of mandatory vaccination. From 1884, vaccination was compulsory to attend school, and from 1930 it was compulsory for all people living or staying in Turkey, regardless of nationality. “The success of coercion has led to the neglect of other means, such as building trust or convincing people that vaccinations are good for them.” Not just an individual decision Wigen believes that people can also be pressured to vaccinate. “Although vaccination is completely voluntary, there are many factors in society that push people to take it.” In December 2021, just under 60 percent of Türkiye's population had been vaccinated against COVID-19. Wigen refers to an interview in which an employee of a large Turkish oil company said that unvaccinated people were threatened with losing their jobs. "I don't know if they will actually be released, but that says something about the different ways to encourage people to get vaccinated other than through coercion by the state. For example, some people have assumed that if they are not vaccinated they will not be allowed to travel." Wigen believes that vaccine skepticism in Turkey cannot be explained by individualism. "I haven't seen any studies on this recently, but Turks tend to score high in collective thinking. However, that doesn't necessarily lead to trust in the state because the state is not seen as the collective." Turning point for vaccinations in 2015 Although Erdoğan has disregarded many of Turks' rights, it was constitutional human rights that led to the abolition of mandatory vaccination. In 2015, two parents who refused to have their children vaccinated ended up in court. Turkey's Supreme Court ruled that forcing someone to get vaccinated is unconstitutional. Since then, the number of families exempting their children from the vaccination program has risen sharply. In 2018, this number was around 13,000. The parents argued that the vaccinations may contain harmful substances that can cause, among other things, autism. This is a common argument that dates back to former academic and discredited doctor Andrew Wakefield, who published a heavily criticized study in 1998 on the link between the measles, mumps and rubella (MMR) vaccine and autism. Wigen recognizes Wakefield's arguments among anti-vaccination activists in Turkey. “Information and misinformation about possible side effects of vaccinations have spread in many communities and channels since 2015. It seems that more and more people are picking up on these arguments from outside, and in that sense this is part of a broader international picture.” Vaccine nationalism and prophetic medicine Wigen sees additional and overlapping reasons for vaccine skepticism in Turkey. Some people associate resistance to vaccinations with so-called “prophetic medicine.” "This is a culture-specific form of alternative medicine that combines various 'ancient stories' with examples from hadith. The Prophet Muhammad serves as a role model, and the emphasis is on prayer and fasting, not to mention nuts, dates and honey: diet and lifestyle rather than pharmaceutical drugs." Nationalism also influences the prevailing view of vaccinations in Turkey. Various coronavirus vaccines are on offer, and President Erdoğan has specifically urged the population to take the vaccine developed by Turkey, which he describes as a “traditional” vaccine. Turkey's Turkovac vaccine is different from the Pfizer, BioNTech and Moderna vaccines based on new mRNA technology, and more similar to the AstraZeneca vaccine, for example. Religious vaccine exemption in the USA Hanne Amanda Trangerud researches religiously based vaccine skepticism in the USA.