At the climax of the election campaign last October, the Babis PR team was firing on all cylinders. The content flooding his party’s social media channels included two slickly produced Instagram videos featuring Finance Minister Alena Schillerova. The account’s 23,000 followers were treated to a montage of interviews with supporters, interspersed with footage of the minister glad-handing pensioners, practising at a firing range, and joshing with a group of nurses. Two of these nurses were also interviewed in the videos, praising the finance minister as an “ordinary woman” who had restored the spirit of “goodness, morality and pride” to Czech society. “As a person, she is already a winner for me,” said one of the nurses, “so I wish her victory in politics as well.”
The global coronavirus pandemic has brought medical expertise to the heart of government, highlighting the political implications of public health decisions. The nurses in the videos, however, had nothing to do with the Czech Republic’s Covid response. They were employees of the country’s leading cancer hospital, the Masaryk Memorial Cancer Institute, in the city of Brno. Babis had been campaigning on a promise to transform cancer care, and the renowned hospital had been held up as a template for the transformation. The videos with the nurses rounded off a series of media appearances – op-eds, photo-shoots and news reports – in which the hospital and its employees had been featured alongside the prime minister and his party colleagues. The content, produced by Babis’ PR team or affiliated media outlets, would blur the line between public health information, political propaganda and the promotion of the prime minister’s personal brand.
This story traces the evolution of a campaign pledge from its inception at the height of the Covid pandemic to an election defeat and beyond. It examines how the Babis government used cancer care as governments elsewhere have used the fight against Covid – as an opportunity to borrow the cloak of medical expertise and shape public health strategy for partisan gain.
According to Professor Lubomir Kopecek, a professor of political science at Masaryk University in Brno, the fight against cancer appealed to Babis’ campaign because it emphasised his capacity to deliver healthcare – a vote-winner within his mostly elderly base. At the same time, talking about cancer distracted from his mismanagement of the Covid pandemic, which had left the Czech Republic with one of the highest excess death rates in the EU. “It was a way of covering up the consequences of the pandemic,” Kopecek said.
The Babis brand rests on a reputation for giving people what they want and getting things done; for bringing to politics the efficiency and responsiveness of an entrepreneur answering the needs of the market. The oligarchic founder of the Agrofert conglomerate launched his ANO party a decade ago, promising to “run the state like a firm”. He adopted policies from across the spectrum, lambasted elites and the establishment for their corruption and incompetence, and marketed himself as the fix for a broken system.
Defeated in last year’s parliamentary elections, he has just gone on trial in Prague over an alleged EU subsidy fraud. He denies the charges and has spent much of this year touring the country, eyeing up a run for the presidency. For while Babis’ time in government was dogged by allegations of power grabs and conflicts of interest, he remains popular. To his supporters, he evokes the paradoxical appeal of a politician who is at once extraordinary and accessible. He is extraordinary because of his wealth and success in business, and accessible on account of a blunt, seemingly un-scripted public persona, presented to voters through personalised social media feeds – most notably a weekly show streamed on Facebook and YouTube.
“Babis understands the power of establishing a one-on-one relationship with voters, and social media is a fantastic tool for that,” said Lenka Bustikova, an associate professor at the University of Oxford’s Department of Politics and International Relations. “He is an absolutely brilliant political strategist, his PR team is the best – it makes his opponents look like schoolboys.”
Babis has been described by political scientists, including Bustikova, as a “technocratic populist”. The term can seem oxymoronic because populist government is commonly associated with disdain for experts and expertise. Technocratic populism has been described as a form of populist government that uses the claim of technical expertise to cultivate an emotional bond with the people. It can overlap with the populism of the left, which focuses on economic grievances, and the populism of the right, which appeals to nativist or nationalist instincts, but it is also distinct from them, with policies devised through focus groups and pollsters zig-zagging across the left-right divide.
Commonly cited examples include Silvio Berlusconi in Italy, Rafael Correa in Ecuador, and former Slovakian PM Igor Matovic. Donald Trump also came close, boasting on Twitter of applying his deal-making talents to US foreign policy. When such leaders invoke expertise and experts, Bustikova said, the goal is not to govern well but “to glue the voter to you, as a person and as a party, and to de-legitimise everyone else… the bottom line is this emotional connection with the voter that is un-mediated.”
Technical expertise, often in fields such as medicine, business and the hard sciences, provides the ideal channel for that connection. “This personal relationship in the domain of medicine is very do-able,” Bustikova said. “You can establish a direct link on Facebook, saying here I am, I’m a good businessman, I’m a good manager, I’m going to run the state as a firm, I’m going to solve Covid, I’m going to cure cancer.”
When the Covid pandemic arrived in Europe, healthcare systems scaled back non-essential procedures. By restricting treatment to emergencies, they freed up capacity for an anticipated surge of Covid cases – and laid the foundations for an ethical dilemma. What if the deaths from Covid ended up outnumbered by the excess deaths from conditions that had been neglected because of the focus on Covid? Delays in the diagnosis and treatment of cancer, a leading cause of death, were of particular concern. To mitigate the impact of the pandemic, cancer services across Europe were hastily re-organised and, in some cases, promoted with public information campaigns, reassuring citizens that they could still come forward for screening.
In the Czech Republic, a former director of the Masaryk Memorial Cancer Institute, Jan Zaloudik, went a step further. In a speech to the upper house of parliament on April 17, 2020, he launched a tirade against Czech public TV, attacking the broadcaster for obscuring the risks from cancer with its daily tally of Covid deaths and infections.
After leaving healthcare, Zaloudik had entered the Senate as a member of the Czech Social Democratic Party, a junior partner in the ANO-led coalition government. His Senate outburst echoed the increasingly hostile rhetoric adopted by government allies towards the Czech public service broadcaster. The speech would be credited by Babis as having inspired him to fight for better cancer care. Throughout his re-election campaign, Babis would repeat a statistic highlighted in the speech: “A Czech citizen dies of cancer every 20 minutes”.
Former Italian prime minister Silvio Berlusconi, pictured here being embraced by his mother, argued that his success as a businessman made him a better politician – like Babis, his fellow ‘technocratic populist’. PHOTO: EPA-ANSA/FARINACCI/cl
Cancer is the biggest cause of death in the Czech Republic, after heart disease. As elsewhere, many of these deaths can be prevented with lifestyle changes and earlier screening. Within the 27-member EU, the Czech Republic has the ninth highest standardised death rate from cancer. In other words, the disease accounted for roughly 272 deaths per 100,000 people in the Czech Republic in 2019, the latest year for which figures were compiled. Across the EU, the average for the same year is lower – 252 deaths from cancer per 100,000 people.
Babis turned his focus to cancer in the late spring of 2020. His government had won praise for its management of the first wave of the pandemic, in marked contrast to the criticism it would face in subsequent waves. It had declared a lockdown, sealed borders, imposed a nationwide curfew and enforced Europe’s first mask mandate – all within the early days of the pandemic, in March 2020. The measures helped suppress the infection, giving the Czech Republic one of the lowest excess death rates in the EU. That summer, the residents of Prague would hold a “farewell” party to Covid on the city’s famous Charles Bridge.
I think Babis eats experts for lunch… I absolutely don’t think he has any deference to expertise, to strategic plans – he just needs to deliver in these short electoral cycles. So of course when it suits him, he will appropriate the legitimacy of experts.”
Lenka Bustikova, University of Oxford
Buoyed by his successful management of a healthcare crisis, Babis paid a well-publicised visit to the Masaryk Memorial Cancer Institute, on May 30, 2020. He submitted to nearly four hours of tests and scans to screen for the disease and, in the first of many media appearances to feature the Institute, spoke of the need to raise awareness of cancer risks. “We need to have a national plan to fight cancer, just as we saved thousands of lives from coronavirus,” he told Blesk, the Czech Republic’s best-selling tabloid. “We have to – I don’t want to say ‘scare’ – but we do have to scare people a little, just as the virus scared us.” Over the course of May and June, Babis would also hold a press briefing on cancer, speak at a conference of cancer experts, and outline his vision for cancer prevention and treatment to the media.
The money for the government’s vision for improving cancer care would be sought from the European Union. Through the summer of 2020, the bloc had been putting together proposals for a coronavirus stimulus fund, branded Next Generation EU. The extraordinary package of loans and grants, worth nearly 750 billion euros, was designed to help the bloc’s economies recover from the pandemic. Member states applied for the fund’s so-called Recovery and Resilience Facility, RRF, which gave priority to the tech and green economy – projects that would smooth the transition to an increasingly digital, and less environmentally damaging, future.
Andrej Babis, seen here launching his campaign for re-election in 2021, has used social media to forge a direct bond with his base and bypass traditional channels. EPA-EFE/MARTIN DIVISEK
The Czech Republic applied for a total seven billion euros, of which a small fraction, some 335 million euros, were allocated to “oncological resilience” – improving cancer prevention and care. Nearly 70 per cent of this money – some 230 million of the 335 million euros – was earmarked for the construction of a brand new hospital in Prague, dedicated to the treatment of cancer. Babis told reporters that the new facility, the Czech Institute of Oncology, would be modelled on the Masaryk Memorial Cancer Institute in Brno. The plan would prove controversial from the outset, effectively dividing medical experts into pro and anti-Babis camps.
‘Politically tangible results’
Brno’s Masaryk Institute is an exception within the Czech Republic’s cancer infrastructure – the only hospital-sized institution entirely dedicated to fighting the disease. Across the rest of the country, the treatment of complex cancers is handled at smaller oncological units affiliated to major hospitals. There are 15 such centres in total, including three in Prague, affiliated to five teaching hospitals.
Babis proposed to build a Masaryk-in-Prague, claiming it would serve as an international research hub, gathering the country’s top oncologists under one roof and attracting recruits from across the region. Several leading experts came out in favour of the proposal, endorsing the claim that it would revolutionise cancer care in the Czech Republic.
However, many experts felt that the EU funds should have been spent on improving existing cancer services nationwide rather than on the construction of a new facility in the capital. They also expressed concern that the new hospital would draw doctors and nurses away from the smaller regional centres, exacerbating staff shortages.
Among the most prominent critics of the planned institute was the head of the Czech Society of Oncology, the country’s leading association of cancer professionals. Jana Prausova said the cancer burden in Prague had been managed adequately within the existing system, with dispersed units performing complementary functions. “The decision to build one stand-alone building, where all oncological care would be concentrated, was taken with no regard for the context,” she told BIRN. “It is completely unrealistic, and very problematic in terms of staffing.”
The Masaryk Memorial Cancer Institute in Brno occupies a unique position within the Czech Republic’s cancer treatment infrastructure. Photo: Masaryk Memorial Cancer Institute
Cancer services are particularly under-staffed in the western Czech region of Karlovy-Vary, bordering Germany. The region’s medical workers flock to better-paid jobs at German hospitals, a short commute across the border, forcing nearly one in five of its cancer patients to seek treatment in Prague, more than two hours’ drive away. “There is no need to build a new institute – it would concentrate resources and personnel in Prague, to the detriment of regional centres,” Vit Ulrych, an oncologist from the central region of Pardubice and representative of the opposition Christian Democratic party, KDU-CSL, told BIRN.
While oncological experts debated the proposals in the media, Babis pushed ahead. In press conferences, the planned new hospital was invoked as a much-needed symbol of national pride. “When Ursula von der Leyen visits, where will I take her?” Babis said, responding to a critical journalist. “I don’t know where to welcome Ursula von der Leyen, what venue would not fill me with shame. You should see the state of healthcare in Prague – we have great hospitals but we’ve neglected them.”
Critics say the decision to commission a grand new hospital, rather than overhaul existing cancer services, was guided by political imperatives. “People like Babis are obsessed with having to build something,” said Daniel Prokop, a sociologist at Charles University in Prague and member of NERV, an independent board of economic advisors to the government. “He wants to see politically tangible results. I know he doesn’t like re-skilling projects because they are hard to evaluate and not always effective.”
However, Prokop said, the Babis government’s focus on fighting cancer and chronic diseases was indeed appropriate as they “are a huge problem for the Czech healthcare system”. He noted that the planned new hospital had attracted some support from high-profile experts, and had been justified on the grounds that it would also boost an economy reeling from Covid.
According to Lenka Bustikova, the associate professor at the University of Oxford, Babis’ cancer strategy was based on political expediency rather than healthcare expertise. “I think Babis eats experts for lunch,” she said. “I absolutely don’t think he has any deference to expertise, to strategic plans – he just needs to deliver in these short electoral cycles. So of course when it suits him, he will appropriate the legitimacy of experts.”
An ANO spokesman rejected as “completely absurd” any suggestion that the party had used the fight against cancer for political gain. “The only people who should have profited from the entire project were Czech citizens,” spokesman Martin Vodicka told BIRN in an e-mailed statement.
Andrej Babis was accused of sidelining institutional channels and placing himself at the centre of public health messaging during the pandemic. EPA-EFE/MARTIN DIVISEK
‘A fantasy from Scandinavia’
As Babis rallied support for his proposal, the Masaryk Memorial Cancer Institute and its employees would feature prominently in content produced by the ANO party’s social media channels, and by mainstream media outlets owned by Babis’ trust. Over a 12-month period before the October 2021 election, the two nurses who were featured in Finance Minister Alena Schillerova’s video were also interviewed at length by Idnes, an online outlet owned by Babis’ Mafra media group; credited for guest op-eds in Share It Before They Delete It, a campaign book authored by Babis; and photographed on at least four occasions attending events alongside Schillerova or party colleagues.
Over the same period, the director of the Masaryk Memorial Cancer Institute, Marek Svoboda, was interviewed twice by publications owned by Babis’ Mafra group. He also contributed an op-ed to a brochure on cancer prevention that was launched by Babis and his health minister at the time, Adam Vojtech, less than a month before the election. Svoboda told BIRN that his media activity fell firmly within his official remit. He dismissed any suggestion that he had allowed himself, and the Masaryk Institute, to serve as props for Babis’ re-election campaign. “I am a loyal director of a state institution and if any democratically elected politician approaches me… I cannot refuse to co-operate,” he said.
As well as providing the model for Babis’ envisaged new hospital in Prague, the Masaryk Institute was among the beneficiaries of his government’s cancer strategy. Some 250,000 euros of the 330 million euros of EU funding for oncological resilience had been allocated for the completion of a new wing of the Institute, dedicated to cancer screening and prevention. Svoboda emphasised that the Institute had not felt any obligation to help the government. “The prime minister may have highlighted the issue of cancer prevention… but I really refuse to be part of any political campaign,” he said. “I don’t feel guilty, as though we did something wrong,” he said. “We did our best for the patients.”
Svoboda said the two nurses from the hospital who had appeared in ANO campaign videos had done so in a private capacity, rather than as representatives of the Institute. “It was clearly their personal activity,” he said. “I am hardly going to fire someone for what they do in their free time.” The nurses, Michaela Prikrylova and Petra Absolonova, were contacted by BIRN for comment. Prikrylova did not respond. Her colleague, the head nurse of the gastro-enterology department, Petra Absolonova, said in a brief statement that she had collaborated with Babis because she shared his belief in “cancer prevention and early diagnosis”.
Former Finance Minister Alena Schillerova, in the green dress, was filmed with nurses from the Masaryk Memorial Cancer Institute in campaign videos released on Instagram. Photo: Instagram
As he approached re-election, Babis was coming under mounting criticism over his management of the Covid pandemic. The caution shown in the handling of the first wave had given way to complacency. Faced with highly infectious new variants, the government was slow to impose restrictions, seemingly failing to grasp that infectious diseases grow exponentially. When curbs were eventually imposed, they came too late to prevent the Czech Republic from developing some of the highest infection rates in the world. The official messaging was often contradictory, health ministers were sacked within weeks of being appointed, and according to critics, the institutional response was bypassed in favour of personal messages from Babis and his favoured experts. Months away from a parliamentary election, in February 2021, Babis would admit that “far too many mistakes” had been made.
Babis’ cancer strategy was also coming under fire, with questions being raised about the planned site for the new institute. The government wanted to develop a vacant plot of land adjoining the University Hospital in Vinohrady, central Prague. The site had previously been earmarked for a trauma centre – but that project had to be abandoned because of a lack of funds.
Maria Maco, a haematologist at the University Hospital, told BIRN there was little discussion about the new institute among staff, despite the media fanfare around the government’s announcement. “If you don’t have enough money to cover the day-to-day costs of an ambulance service, how are you going to hire a professional team to move into a new building?” she said. “It sounds like a fantasy from Scandinavia, and nothing at all like the Czech reality.”
A senior doctor at the University Hospital said that the announcement was largely met with shrugs from his colleagues, with a few questions about the sudden change of plan. “Some people wondered how management had been talking about a trauma centre for years, and now within a few weeks, there was a completely different project in the works,” the lead doctor from the support and palliative care team, Adam Houska, told BIRN.
Addressing journalists three months before the election, Babis accused the press of trying to sabotage his plans. He referred to the Masaryk Memorial Cancer Institute by its nickname, Zlutak, given after the hill where the hospital is sited. “This is the place for the Zlutak of Prague,” he told a press conference at the University Hospital in Vinohrady. “I have a feeling the media has a problem with that. Do you have a problem with Europe’s most modern cancer hospital being built here? That’s how it works in the real world.”
‘Healthcare is politics’
After its defeat in the October 2021 election, the ANO-led government was replaced by a centre-right coalition. The new health minister, Vlastimil Valek, initially declared that he was scrapping Babis’ plans for the Masaryk-style hospital in Vinohrady, emphasising the need for improving cancer services across the board rather than concentrating them in a single location. However, as the proposal submitted to the EU had envisaged the construction of a new hospital, the funding could be jeopardised if a new facility were not built.
Andrej Babis has gone on trial in Prague on accusations of EU subsidy fraud. He denies the charges and is widely expected to be planning a run for the presidency next year. EPA-EFE/MARTIN DIVISEK
The government duly announced that a portion of the funds sought by Babis would indeed be spent on a new cancer centre in the capital – but it would not be built in Vinohrady. Instead, it would be housed in the renovated wing of another teaching hospital in Prague, in the western district of Motol. The new centre would reportedly use two-thirds of the funds allocated for the abandoned scheme in Vinohrady, with the remainder of the money allocated to upgrading existing cancer services.
The task of managing the planned new centre in Motol was assigned to the doctor who had led the opposition to Babis’ proposal for a Masaryk-in-Prague – Jana Prausova, the head of the Czech Society of Oncology. In a press conference last summer, Andrej Babis seemingly anticipated her appointment when he took a swipe at his loudest critic. “And as for Mrs Prausova,” he said, “she too would like to have an oncology centre – for four billion in Motol.”
Prausova told BIRN in an e-mailed statement that she had not been opposed to any new construction. Rather, she said, she had specifically opposed Babis’ plan to build a stand-alone cancer institute “outside the reach of one of the large teaching hospitals”. The decision to build a cancer centre as an extension of the Motol hospital had been backed by an independent feasibility study, she added.
Experts say a degree of politicisation in public health strategy is inevitable, irrespective of who is in government. “Look at the way healthcare crops up in every election,” the director of the Masaryk Memorial Cancer Institute, Marek Svoboda, told BIRN. “Healthcare is indeed politics.”
Adam Houska, the doctor from the University Hospital in Vinohrady, said the Czech healthcare system was based on links between experts and politicians. “There is a shortage of experts in oncology so if a politician has a personal connection to an expert with an interesting project, they will prefer that expert over someone else.”
While Babis’ plans for a Masaryk-in-Prague may have been scuppered by electoral defeat, he can still claim credit for having secured EU funding to improve cancer care when the new hospital takes shape in Motol. The former prime minister’s healthcare credentials are likely to be emphasised if, as many expect, he chooses to contest the presidential election next January. “If he can convince people that he can deliver good healthcare, whether it is true or not, he will be unbeatable,” said Professor Lenka Bustikova from the University of Oxford.
ANO spokesman Martin Vodicka confirmed to BIRN that healthcare – and cancer care in particular – was a priority for the party, citing statistics that indicated the disease could become the biggest cause of death for Czechs by 2035. “The fight against cancer, and the prevention of this insidious disease, remain major themes of the movement,” he said, in an e-mailed statement.
Eva Kubaniova is a reporter with the Prague-based investigative outlet, investigace.cz. This story was edited by Neil Arun. It was produced as part of the Fellowship for Journalistic Excellence, supported by the ERSTE Foundation, in cooperation with the Balkan Investigative Reporting Network.