Antibiotics as a symbolic framework for articulating healthcare attitudes and legitimising parental choices in narratives of vaccine-hesitant parents

Abstract

This article explores the role of antibiotics as a symbolic tool in the narratives of vaccine-hesitant parents in the Czech Republic. Based on in-depth interviews with 53 parents, the study examines how references to antibiotics and antibiotic prescribing are incorporated into vaccination strategy narratives and explores the interlinkage between attitudes towards vaccination and antibiotics and how antibiotics are positioned by vaccine-hesitant parents as a powerful marker for articulating health-related beliefs and parental medical authority. Three distinct ways in which references to antibiotics were incorporated into vaccine-hesitant narratives were identified during the analysis. First, antibiotic prescribing was framed as a measure of healthcare quality, influencing how parents evaluated and selected paediatricians for their children. Second, antibiotics functioned as a symbolic marker for communicating the superiority of vaccine-hesitant health strategies, with parents contrasting their cautious, self-reliant approach with conventional biomedical practices. Finally, antibiotics were used as a reference point for legitimising vaccine hesitancy, reinforcing broader critiques of pharmaceutical interventions and mainstream medical authority.

Introduction

Antibiotics and vaccines both hold a distinct place in the history of modern medicine, with this distinction extending to their privileged status in societal perceptions of medical success. They represent transformative breakthroughs in medicine which have had a significant impact on our understanding of medical prevention and treatment, as well as on reducing mortality and infection risks. Despite the critical role they play in public health, challenges to their use are growing: antibiotic resistance threatens the efficacy of these life-saving drugs, while vaccine hesitancy undermines immunisation efforts. These parallel trends not only jeopardise individual health but also pose broader challenges to global public health.

Although antimicrobial resistance (AMR) represents a natural evolutionary response to antimicrobial exposure (Holmes et al., 2016), the acceleration of such mutation is significantly influenced by social processes, particularly the misuse and overuse of antimicrobials in humans, animals and plants (Larson, 2007; WHO, 2023). Vaccine hesitancy can be conceptualised as a social phenomenon with more immediate roots in public attitudes and beliefs. Peretti-Watel et al. (2015) emphasise that vaccine hesitancy arises from varying degrees of personal commitment to self-responsibility for health and perceived control over risk, alongside different levels of confidence in health authorities and biomedicine. In addition to attitudes towards vaccination, research indicates that other health-related experiences, such as negative encounters with healthcare providers (Decoteau and Sweet, 2024; Nurmi and Jaakola, 2023; Scavarda et al., 2025) or health beliefs, especially those related to complementary and alternative medicine (CAM) (Souček et al., 2025; Ward et al., 2023), can shape vaccine hesitancy. This suggests that vaccine decision-making is not made in isolation but is embedded within broader health worldviews and social experiences.

This study examines the attitudes of vaccine-hesitant parents, defined as those who refuse some or all vaccines for their children, deliberately delay vaccination or express ongoing uncertainty about immunisation. Specifically, I explore how parents spontaneously discuss antibiotics within their narratives of vaccine decision-making, situating these discussions within the context of diverse vaccine-hesitant attitudes. Building on sociological debates concerning the ways in which individuals construct their identities through their engagement with medical products and the meanings these products acquire (Collin, 2016; Fox et al., 2005; Williams et al., 2008), the analysis explores how antibiotics are positioned within parents’ accounts and how their references to antibiotic treatment are used to inform and legitimise vaccine hesitancy.

While existing research has tended to examine individuals’ relationships with single drugs or therapeutic categories (e.g. Fox and Ward, 2006), this article extends the discussion by considering the interrelationship between attitudes towards antibiotics and vaccines. Analysing these domains together offers insight into how people construct coherent frameworks of health and immunity across different pharmaceutical contexts. Attitudes towards vaccination are thus approached not simply as opinions about specific medical interventions, but as reflections of a broader set of moral and social orientations (Lermytte et al., 2024; Peretti-Watel et al., 2015; Reich, 2014). Within this perspective, vaccination and antibiotic decisions become meaningful sites through which parents articulate their understandings of good care, health and appropriate engagement with biomedical authority.

Vaccines and antibiotics as social symbols: exploring attitudinal overlaps

Amid the increasingly critical context of antibiotic misuse as a significant contributor to AMR (Chokshi et al., 2019), a substantial amount of attention has been directed towards mapping people’s knowledge of antibiotic treatment principles (Anderson, 2020; Salm et al., 2018; Zilinskas et al., 2019) and their awareness of the antibiotic resistance process (Mason et al., 2018; Mazińska et al., 2017). However, less focus has been placed on examining how individuals create meanings around antibiotic use, the role antibiotics play in their health strategies, and how their attitudes towards antibiotics intersect with other health-related beliefs and practices (Davis et al., 2023).

AMR is a multifaceted challenge that underscores the interdependence of human and animal health, agriculture and the environment. As Davis et al. (2023) highlight, AMR is an effect of biosocial assemblages that include, among other aspects, human individuals, a thriving and diverse collection of microbes, the pursuit of animal health, the economic rationalities of public health and the pharmaceutical industry. However, efforts to address AMR frequently emphasise individual behavioural change as a pivotal solution (Chandler, 2019), as seen in public health campaigns that employ nudging strategies to encourage prudent antibiotic use and in antibiotic stewardship programmes promoting rationalised prescribing and consumption (Goossens et al., 2006; Huttner et al., 2010). Just as antibiotic stewardship campaigns and nudging strategies encourage individuals to make responsible choices about antibiotic use, vaccination discourses similarly position parents as rational decision-makers tasked with evaluating risks and benefits. Research on vaccine hesitancy highlights the impact of the neoliberal health paradigm, which prioritises individual autonomy and informed choice (Borozdina, 2025; Reich, 2014; Ward et al., 2017). The current anti-vaccine discourses are primarily motivated by the desire to be a good parent and to choose the best strategies for the child’s health (Berman, 2020: 212). As Reich (2016) highlights, vaccine-hesitant parents often reject passive compliance with medical authority and instead embrace the role of critical consumers who must navigate complex health decisions. This positioning reinforces the idea that responsible parenting requires active engagement in health choices, with vaccination framed as just one option among many, rather than a public health necessity.

Both vaccination and antibiotic use share an important social dimension: in each case, individuals’ decisions have consequences that extend beyond their own health to affect the well-being of the wider community. Although both AMR and vaccine hesitancy are often cited together as major challenges to contemporary public health, as seen by their joint presence on the WHO’s list of threats to global health in 2019 (WHO, 2019), public health campaigns tend to address these issues separately, with content focusing on minimising “irresponsible” antibiotic use and maximising vaccine uptake (Anderson, 2022: 3039). Despite these differences, both policy discourses are underpinned by a shared moral imperative of individual responsibility, which is demonstrated through distinct yet parallel moral logics. In vaccination discourse, responsibility is expressed through participation and compliance, while in antibiotic discourse, it is conveyed through restraint and self-control. Both, however, reinforce a citizen-consumer model of health, which rests on the assumption that individual behaviour is the primary locus of intervention, thus locating the governance of collective health risks within the domain of personal ethics (Broom et al., 2021).

Despite the growing body of research on vaccine hesitancy and AMR, the connection between attitudes towards vaccination and antibiotic use remains underexplored. Studies examining the social context of these two phenomena are somewhat rare, although the available partial evidence suggest that attitudes towards vaccination may intersect considerably with attitudes towards antibiotics: a quantitative UK study identified that members of the public who had a negative perception of vaccination (in regard to side effects and the efficacy of vaccines) were also more likely to have a less accurate understanding of antibiotics as a treatment for bacterial infections and not for viral infections (Anderson, 2022).

The perspective of parents of young children is particularly significant, as they are the primary decision-makers regarding their children’s vaccination. Simultaneously, overprescription in paediatric care plays a prominent role in addressing the issue of excessive and “irrational” antibiotic prescription (Murray and Amin, 2014). The observed higher rate of paediatric prescribing, especially in cases of respiratory tract infection, is often interpreted in the context of the vulnerability of children (Cabral et al., 2015) that may result in clinicians feeling pressured by parents and/or opting for “just in case” antibiotic prescriptions (Lucas et al., 2015; Stivers, 2002). The vulnerability of children also plays a significant role in the dynamics of vaccine-hesitant attitudes. Vaccine hesitancy is often deeply rooted in parental responsibility for managing children’s health (Lermytte et al., 2024; Ward et al., 2017), reflecting a broader discourse that constructs children as vulnerable and (especially) mothers accountable for managing their children’s exposure to risk (MacKendrick, 2014). Vaccine-hesitant parents often construct an opposition between natural and artificial immunity and see vaccines as unnatural tools that may actually undermine natural immune capabilities (Reich, 2016), and articulate their responsibility to strengthen the child’s immunity naturally (Lermytte et al., 2024). The opposition between “natural” immunity and medical interventions that have the potential to disrupt it, which is a significant, though not necessarily inevitable, part of vaccine-hesitant discourses, may also affect vaccine-hesitant parent’s attitudes towards antibiotic treatment. As Nurmi’s (2021: 106) ethnographic study on the perception of human-microbe relations in vaccine-refusing families highlights, antibiotics are positioned by vaccine-hesitant parents, similarly to vaccines, as a disruptive technology for human-nature connection, with participants often emphasising practices aimed at nurturing the microbiome and avoiding interventions perceived as potentially harmful to it, including both vaccines and antibiotics.

Methodology

This study is based on data collected in the Czech Republic (CR). Childhood immunisation in CR operates within a compulsory vaccination system embedded in the country’s statutory public health framework. All vaccines included in the national immunisation programme are fully covered by public health insurance. The programme mandates vaccination against nine diseases for all children and adolescents up to 19 years of age, with administration primarily overseen by paediatric general practitioners. Compliance is legally enforced under Act No. 258/2000 Coll. on Public Health Protection, with non-compliance subject to administrative fines of up to approximately €400. Unvaccinated children may be excluded from nursery or preschool facilities unless they are medically exempt (for a detailed discussion regarding the role of sanctions in the Czech context, see Hasmanová Marhánková, 2025). CR has long reported relatively high vaccination coverage, with vaccination rates for mandatory diseases exceeding the EU average as recently as 2018 (OECD, 2019). However, despite this strong institutional framework and public health infrastructure, vaccination rates have gradually declined over the past two decades—from 98.4% for diphtheria, pertussis and tetanus (DPT) and 97.1% for measles in 2000 to 93.7% and 90%, respectively, by 2022 (OECD Health Statistics, 2025). CR lost its “measles-free” status in 2018 following a measles outbreak that year, and a decline in vaccine confidence has been observed over the preceding decade (Larson et al., 2019).

In CR, the consumption and prescription of antibiotics are tightly regulated, and antibiotics can be obtained only with a medical prescription. Only around 2% of antibiotics in the CR are taken without a prescription, compared to an average of approximately 8% across the EU (Eurobarometer Data, 2022). Overall, the CR reports an average level of antibiotic consumption among EU countries (Bruyndonckx et al., 2021). General practitioners are the primary prescribers in this system, accounting for roughly 77% of all antibiotic prescriptions in primary care (Krenželok, 2022). However, recent data indicate that diverging from medical recommendations is not uncommon: 10.6% of citizens report self-medicating with antibiotics (often using leftovers from previous prescriptions), and 7% have refused to take antibiotics prescribed by their general practitioner (Hasmanová Marhánková and Petrúšek, 2025).

Research design and data collection

This study integrates data from two projects that examined the experiences of vaccine-hesitant parents, from which a total of 53 in-depth interviews were analysed. The interviews were conducted in two waves. The first wave took place in 2012 and 2013 as part of a study focusing on the anti-vaccine movement in the CR. A total of 23 parents (22 mothers and 1 father) participated, all of whom had refused some or all mandatory vaccinations for their children. The parents were contacted primarily through an advertisement included in a questionnaire survey posted on the Facebook page and website of Rozalio, a non-governmental organisation, or they were directly approached at events organised by this NGO. Rozalio is an association of parents who are critical of vaccination and advocate for a shift to a voluntary vaccination system. The organisation regularly hosts debates for parents on critically evaluating vaccination, engages in lobbying efforts and publishes accounts of families’ negative experiences with vaccination on its website. In addition, it provides support for parents seeking to delay or refuse vaccinations for their children.

The second wave of 30 interviews was conducted between December 2021 and April 2022 as part of the international VAX-TRUST project. Several members of the project team participated in data collection in this case (see also the acknowledgement section for more details). While the first wave focused on parents who had refused at least one of the vaccinations classified as mandatory in the CR, this phase targeted a broader spectrum of vaccine-hesitant attitudes. Participants were recruited through social media advertisements on platforms such as Facebook, particularly in groups focused on parenting and community support. In addition, announcements were published in newsletters and on the websites of organisations specialising in maternity care and parenting. Recruitment efforts also included using email to target students at Charles University who had accessed parental support services. A smaller group of participants were recruited through snowball sampling (for a comprehensive discussion of the recruitment process, see Hilário et al., 2023). Notably, only mothers responded to our recruitment efforts in this wave. Throughout the recruitment process, we emphasised that we were looking for individuals who had either intentionally delayed or refused vaccination or had experienced conflicts, disagreements or challenges related to vaccination in the CR. Compared to the first wave interviews, this phase included a more diverse group of parents, ranging from those who refused some or all of the mandatory vaccinations to those who expressed relatively high vaccine confidence but chose to delay certain vaccinations or follow an alternative vaccination schedule. The primary selection criterion was experience with vaccine hesitancy, which we conceptualised as a continuum of attitudes (see Vuolanto et al., 2024). Approximately one-third of the interviews were conducted in person, while the remaining two-thirds were conducted online.

Although the interviews were conducted at different times using different recruitment procedures, the characteristics of the participants remained broadly similar. The majority were women with an average age of 35 years and a university degree. Each interview lasted approximately 50 minutes and was recorded with participants’ consent before being transcribed verbatim. The specific topics covered in the interviews varied across the first and second waves of data collection, reflecting the distinct original focus of each project. However, the overall structure remained consistent, centring on participants’ attitudes towards vaccination. The interviews began with a request for participants to chronologically map their decision-making process regarding childhood vaccination, emphasising aspects they personally considered significant. This was followed by additional questions that explored key factors and experiences influencing their views, decision-making processes, interactions with healthcare professionals and perceptions of vaccination practices in the CR.

Data analysis

The analysis presented in this article is based on two waves (2012/2013 and 2021/2022) of data collection conducted with vaccine-hesitant parents. There were no substantial changes in the organisation of the compulsory childhood immunisation programme during this period. However, the second wave of data collection began during the last COVID-19 lockdown in CR and shortly after the introduction of the public vaccination campaign. The period was marked by an emotionally charged public debate over vaccination mandates, though the discussions focused primarily on COVID-19 vaccines. Nevertheless, the intensity of these debates brought the topic of vaccination more prominently into public discourse, even though the existing mandates and organisational structure of childhood immunisation were not directly challenged. Given the pandemic’s significant impact on public discourse around vaccination (i.e. Langbecker et al., 2024; Wagner et al., 2024), I was attentive to the possibility that these shifting narratives might be reflected in participants’ responses. To account for possible temporal influences, the two datasets were first analysed separately. However, no substantial differences were found in how references to antibiotics were incorporated across the interviews. Consequently, I combined the two samples for the final analysis.

The topic of vaccine-hesitant parents’ attitudes towards antibiotics and their experiences with antibiotic treatment was not explicitly included in the interview topic guide of any of the studies. However, participants frequently spontaneously brought up antibiotics and their views on antibiotic treatment during the interviews. These references did not appear in every interview, and antibiotics were only briefly mentioned in some cases. To explore how antibiotics featured in parents’ accounts, I identified all passages in the interviews in which participants mentioned antibiotics. Particular attention was paid to the context and meaning of these spontaneous references in interviews with vaccine-hesitant parents, as well as to the potential role antibiotics played in shaping their broader narratives about vaccination. All relevant excerpts were extracted and coded in NVivo^®. The analysis followed Braun and Clarke’s (2021) approach to thematic analysis. This approach enabled me to move towards a deeper understanding of how parents construct meanings around antibiotics and how these meanings intersect with their perceptions of vaccination and trust in medical authority.

Results

The findings highlight the heterogeneity of vaccine-hesitant attitudes, revealing that similar behaviours, for example, postponing vaccination, can be driven by distinct underlying motivations. I identified two predominant argumentative repertoires in the narratives that shaped how the parents justified their attitudes towards vaccination. The first type centres on risk–benefit calculations: vaccines are not rejected outright but viewed as potentially risky biomedical interventions requiring individual assessment and careful timing. Parents who employed this discourse emphasised its adverse effects and argued for postponing or selectively vaccinating as a strategies to minimise harm. Their critique is directed less at vaccines per se and more at rigid vaccination schedules and a perceived lack of individualised care. Parents employing such arguments accepted the general benefits of vaccination; however, they contested their benefit and/or the recommended vaccination schedule for their own children.

I wanted a postponement of up to a year. It was somehow important to me that at that point, I would already know how the child was doing health-wise (. . .) So I felt that it (vaccination) was simply too much, that I did not want to put six different diseases in the little baby at the same time, and that there is no alternative for us. Otherwise, I might choose a vaccine against just one illness, and we would vaccinate only for this one. Maybe we would create some sort of individual plan and not include so many vaccines. I saw it as too brutal an intervention (Iva).

The second repertoire constructs vaccines as unnecessary or even harmful. Within this repertoire, the parents’ attitudes towards vaccination were closely embedded in their subjective concept of health. Vaccination was described in opposition to how they view health and healthcare, and how they view practices beneficial for health:

I don’t see illness as something really bad that one should definitely protect oneself from, because I simply think that if this one illness doesn’t come, another one will, and one has to go through some kind of experince (Ester)

I am not afraid of diseases, therefore, I see no reason to vaccinate against them. At the same time, I think it can disrupt the natural body, which works well. And I don’t see it as a help, but rather as harm (Edita).

Parents questioned the necessity of vaccines, emphasising the role of “natural” immunity and lifestyle-based prevention. The spontaneous references to antibiotics and antibiotic treatment were more frequent in this type of argument. In the following section, I explore this further and present three distinct ways in which spontaneous references to antibiotics were integrated into these narratives, examining how antibiotics and vaccines are symbolically and conceptually linked in the accounts of vaccine-hesitant parents.

Attitudes towards antibiotics as a reflection of reflexive health responsibility

Antibiotics play a central symbolic role in modern biomedicine, representing the triumph of scientific advancement over infectious disease. They exemplify the power of targeted pharmaceutical intervention and reinforce the biomedical model of disease treatment. As such, they hold a unique position in public perception, often viewed as both life-saving medicines and, in some cases, overused agents contributing to broader health concerns such as antibiotic resistance (Lohm et al., 2020). During the interviews, parents reinforced the specific role of antibiotics as the embodiment of modern medicine. Through their experiences with antibiotic treatment and perception of antibiotics, parents articulated attitudes towards biomedicine that they saw as integral to their vaccination decisions. Individuals’ views on antibiotics were used to reflect on their perspectives on vaccines, reinforcing a consistent approach to medical decision-making. In their narratives, the parents referenced the doctors’ approach to antibiotic treatment to express their criticism of the biomedical approach, a stance they extended to vaccination. The overuse of antibiotics was used, especially within the narrative of unnecessary or even harmful use of vaccines, as a means of articulating the limitations of modern medicine, which was depicted as focusing primarily on symptomatic treatment rather than comprehensive problem-solving. These narratives often referred to illness as a phenomenon with more complex causes than, for example, bacterial infections. The topic of over-prescribing and the non-reflective use of antibiotics by doctors often brought about a critique of biomedicine as a system incapable of seeking holistic solutions and of doctors who treat only the symptoms of disease but do not consider the individuality of the person. The parents who used arguments oriented on the unnecessary or even harmful use of vaccines responded to the question of what had influenced their current approach to vaccination with narratives about a change in their own approach to health, and in which their own previous experience with antibiotic treatment was frequently mentioned.

I myself have problems with immunity, conventional medicine never helped me, and finally, when I got pregnant at twenty-nine, I just didn’t want to take antibiotics and started trying other ways. I suddenly found out that things were different. So my kids, like, just the oldest one had antibiotics one time because she had cystitis, and otherwise we just deal with everything with herbs, homoeopathy. Conventional medicine is great when there’s an injury or just when something is acute. But it doesn’t take a holistic approach, it doesn’t respect that everything is connected to everything (. . .) So it wasn’t until I got pregnant that I was like, now I can’t keep taking antibiotics. I can’t eat antibiotics all the time because I was eating antibiotics like three times a year, like four times, so I started looking into other ways (Darina).

Parents often interpreted their vaccine hesitancy in the context of their own experiences with the limitations of biomedicine in addressing their health problems. Their narratives regarding attitudes towards vaccination were interlinked with their conviction that we need to change our approach to health, illness and healing. Daniela described her own long history of periodically appearing illnesses requiring antibiotic treatment.

I used to be quite sick in the past. I had the flu, tonsillitis, and colds that took me out of work a lot. I was unable to open the computer and work, and it was just a common cold. I took antibiotics, and I saw how they affected me. After the last antibiotics, which was sometime in 2009, I remember, I spent a few years getting my digestion together, and then, around that time, I started to pay more attention to healthy living and prevention, and I saw how that radically transformed my life (Daniela).

Daniela associated her newfound interest in prevention and healthy living with being healthier. This led her to believe that health did not require what she called “something external,” such as medicine or doctors. This change in her perspective also prompted a change in her attitude towards vaccination: “So my approach to vaccinations has changed from a great fear of both vaccinating and not vaccinating, to trusting that we can handle it if something comes up.”

Vaccines were used in the parents’ arguments to convey the belief that individuals can maintain their health without relying on pharmaceutical interventions. A similar logic was evident in her approach to antibiotics: Daniela not only avoided their use but also framed this refusal as contributing to her family’s overall health. While vaccines and antimicrobials address fundamentally different medical phenomena, both occupy analogous roles within narratives of modern biomedical success, serving as touchstones for parental judgements about responsibility and care. In Daniela’s account, the deliberate management of health without antibiotics complemented her vaccine hesitancy, reinforcing a broader ethic of active, informed decision-making.

Much like vaccine-hesitant attitudes, the reluctance or even refusal to take antibiotics was constructed by parents primarily as an expression of a responsible approach to parenting and healthcare. As Reich (2020) shows in a study of parents who refuse vaccinations, these parents may not categorically reject all pharmaceutical agents, but what is specific to their health strategies is their sense of being able and empowered to choose if, and in which cases, pharmaceutical interventions are useful for their children. Barbara described her approach to healthcare and her relationship with her children’s paediatrician by recounting her experience with the antibiotic treatment offered to her children, which she always refused.

She (the paediatrician) was used to prescribing antibiotics for everything. And I just didn’t want them, and I was like, “what if we wait?”. I never took the prescription, and I think that’s really important to always do it openly because it’s actually educational, I don’t want to sound pretentious, but it’s actually educational when you do things openly, when you don’t throw the drugs in the bin behind someone’s back and just make it clear that you want to deal with it in a different way (. . .) Today, it’s getting better, and I meet a lot of people who are just responsible for themselves. Lots of people are like “I wouldn’t take that responsibility”, for example, in some vaccination issues, birth issues, not giving the baby antibiotics and stuff like that. They don’t understand that everything is their responsibility, that whatever they decide, it’s always their decision, they’re responsible for it, and then they’re going to take care of a child who, for instance, gets an infection because it was unnecessarily treated with antibiotics in the beginning (. . .) So I think that’s kind of the main problem, the belief that somebody’s gonna figure it out for us (Barbara).

Much like vaccine hesitancy, a cautious or outright refusal of prescribed antibiotics was primarily framed as an assertion of personal responsibility for health management. In both instances, Barbara perceived herself as an active agent in health-related decision-making rather than a passive recipient of medical guidance. The ability to manage a child’s health without resorting to antibiotics and to assert parental authority in determining the necessity of antibiotic treatment was, therefore, another expression of the broader attitudes underpinning her vaccine-hesitant stance.

Antibiotics as a symbolic marker for communicating the superiority of vaccine-hesitant health strategies

In their narratives, participants implicitly made salient the symbolic significance of antibiotics as a cornerstone of modern biomedicine, often attributed with exceptional therapeutic efficacy. The ability to replace antibiotic treatment with alternative health practices served as a means of reinforcing the perceived superiority of their own health strategies. In this context, Sonia recounted an instance where her son was diagnosed with an infection. The doctor advised that suppressing the infection without antibiotics would likely not be feasible. Nevertheless, Sonia chose to administer homoeopathic remedies instead, rejecting conventional medical intervention in favour of her preferred approach.

So he got one homoeopathic dose the first morning, a second dose in the afternoon, and a third dose on Tuesday morning, and he was healthy. And that was a really quick recovery for me. And so I called my homeopath, and she laughed so hard and said, “well, first of all, he’s (the son) never been chemically treated before, so actually his body is working the way it’s supposed to, and by knowing him from birth, from a little boy—I know what to give him, right”. So I had this terrible urge to take him to the doctor to show him and then I thought there’s no point. So that’s my experience with homeopathy, we’ve actually only dealt with everything homeopathically since then, and I’ve only had a course on aromatherapy, so at the most—you know what, for me a cold or a cough is not a disease. So I’ll mix up some oil, put it on him, and in three days it’s gone. The power of oils (Sonia).

In her story of her son’s “miraculous” recovery, Sonia linked the experience of being cured without antibiotic treatment to the fact that her son “was not chemically treated,” which, in the context of the interview, referred primarily to the fact that he had not been vaccinated. These anecdotal stories, in which parents demonstrated their ability to cope with their children’s health problems without the use of antibiotics, also served as a powerful legitimising tool for their decision not to vaccinate. In these cases, parents mobilised the symbolic position of antibiotics to demonstrate the superior status of their health strategies.

Simultaneously, references to antibiotic treatment were used to draw a contrast between either the lifestyle and health status of other (vaccine-confident) families or to communicate a contrast between their own health status before they began practising CAM and now.

I don’t give him (her unvaccinated younger son) any medication; he’s never had any medication. He’s much healthier than my daughter, who was vaccinated. She was so sick all the time until she was six before we started doing alternative medicine; she had one antibiotic after another, just plain congestion all the time, runny nose, coughing, bronchitis and on and on. With my son, even when he’s got sick, the course is, basically, I can’t jinx it, he’s healthy. He’s healthy, but I just treat him differently (Alena).

In the interviews, Alena compared the health of her older, vaccinated daughter with that of her younger son, who was born after she became more invested in CAM and had not been vaccinated at the time of the interview. Parents interviewed in our research often mentioned the number of antibiotic treatments they had had in the past (“I last had antibiotics when I was in primary school,” Marina) or listed the number of times their children had had antibiotics compared to (vaccinated) children from other families in their neighbourhood (“my daughter never took antibiotics and is completely healthy, unlike her friends who take antibiotics all the time,” Alena). Parents spontaneously included those comparisons to explain their decision not to vaccinate or postpone vaccination. Those stories could be considered an example of the “unhealthy other” construction that Attwell et al. (2018) identify as a vital component of the discourse used by vaccine-hesitant and rejecting parents. By constructing the other (families or vaccinated family members) as regularly burdened by illness, those parents created a positive self-identity as healthy, and enlightened parents. I identified the reference to antibiotics as an important symbolic tool through which parents communicated the distinctiveness (and superiority) of their health strategies. Antibiotic treatment acted as an easy-to-understand comparative tool to communicate the different approach to health and its quality, and through which the parents also legitimised their attitudes towards vaccination.

Antibiotic prescribing as a measure of healthcare quality: vaccine-hesitant parents’ strategies for choosing a paediatrician

In the CR, children’s immunisation is the responsibility of general practitioners for children and adolescents, more commonly known as paediatricians. ¹ Under the Czech healthcare system, parents can choose their child’s paediatrician. Parents typically find a suitable paediatrician during pregnancy, and the child is registered immediately after birth and may remain in their care until the age of 19. Selecting a child’s paediatrician represents a crucial point in parental decision-making. Although the proximity of the paediatrician’s office to home was articulated as important across all interviews, parents simultaneously stressed their effort to gather information in regard to the attitude of particular paediatricians to immunisation and other aspects of healthcare, for example, some paediatricians have a reputation of being “benevolent” in terms of mandatory vaccination, enabling parents to modify the vaccination schedule.

The paediatrician’s approach to antibiotic treatment became one of the clues parents used to navigate the selection and quality assessment of the paediatrician. When answering the question on what basis they chose a paediatrician for their child, they often mentioned the paediatrician’s approach to prescribing antibiotics, in addition to their possible benevolence regarding the vaccination schedule. Parents perceived a less frequent and more careful approach to antibiotic prescribing by the paediatrician as one indicator of possible compliance with their approach to health. For parents who already had hesitant attitudes towards vaccination, the paediatrician’s attitude towards antibiotic prescribing was perceived as an indicator (or accompanying feature) of open-mindedness towards delaying or refusing vaccination. At this point, it is essential to note that the CR has a compulsory vaccination system, and vaccine hesitancy therefore poses a considerable challenge to the doctor–parent relationship. In this regard, the paediatrician’s attitude towards antibiotic treatment may be a less controversial initial indicator of benevolence towards vaccine-hesitant attitudes and therefore one that parents use to navigate the choice of a paediatrician.

When we were choosing a paediatrician, we searched for one in our area, did some research on Facebook, and had a stipulation that the doctor doesn’t automatically give antibiotics for everything and is open to postponing vaccination as well (Gizelle).

I was happy with this one (the paediatrician she chose for her daughter). There were about three options (in the locality), and I chose this one with my first baby because I had done some research among other mums on how the doctors worked. So, for example, I learned about this one that she minimally prescribes antibiotics. On the other hand, the other one is like, “Do we have a fever? Antibiotics, of course, of course.” So, I intuitively chose her, and she never pushed me to do anything like, “You have to do this” (Kamila).

Parents used antibiotic prescribing practices to communicate their ideas about what constitutes good paediatric care. In this context, Irene spoke of “antibiotic doctors” as the prototype of the “bad” doctor who automatically provides antibiotic prescriptions even in cases of minor health problems. She contrasted this type of “antibiotic doctor” with her children’s paediatrician, who always performs a C-reactive protein test (which helps determine the need for antibiotics by indicating the likelihood of bacterial infection) and recommends that the temperature also be brought down by non-pharmacological means and prescribes pharmaceuticals only in extreme cases. Monika talked about her reasons for changing her doctor, whom she described as someone who “pressured” her too much to have her children vaccinated, even though she did not want to. She related her final decision to eventually register her children with another paediatrician to her experience with antibiotic treatment.

So then we somehow lasted there (registered with her daughter’s previous paediatrician) for about a year, or until we were a year old, but then she just pushed us too much, and I wasn’t happy with her anymore because she just treated us with such strange methods. My daughter had a rash, and she gave her antibiotics right away. However, it was clear that the rash was caused by the baby formula; if I had just cut back a little, the rash would have gone away. And the doctor said, “It can’t be from that” and stuff like that, so then we looked for another doctor and we found a great one who does homeopathy, and she’s like tolerant to people who don’t vaccinate (Monika).

For many parents, access to antibiotic treatment represented a significant means of articulating their ideas about what constitutes good paediatric care. A low level of openness to vaccine-hesitant attitudes, coupled with a perceived overreliance on antibiotics as a solution to a wide range of health issues, was employed to communicate expectations regarding appropriate paediatric care. These expectations extended beyond vaccination or antibiotic use, encompassing broader critiques of what parents perceived as a paternalistic approach by some doctors and a tendency to follow standardised solutions rather than individualised approaches that might better serve a child’s health.

For some vaccine-hesitant parents, particularly those who viewed vaccination as unnecessary or potentially harmful, the prescribing practices of paediatricians in regard to antibiotics were perceived as closely linked to their stance on vaccination. The frequency with which a paediatrician prescribed antibiotics was interpreted as an indicator of their openness to accommodating parental decisions to delay or refuse vaccination. A clear parallel was drawn between a cautious approach to antibiotic prescribing and a similarly measured stance on vaccination. Furthermore, a reluctance to prescribe antibiotics was regarded as a key marker of paediatric competence. This highlights the significant role that attitudes towards antibiotic treatment play in shaping vaccine-hesitant parents’ perceptions of healthcare quality and in legitimising their health-related decision-making. No other biomedical intervention or medication has held such a central position in articulating these perspectives.

Conclusion

Although antibiotics and vaccines function on fundamentally different biomedical principles, they share common features regarding their social meaning. Both are pharmaceutical interventions that play a central role in the narrative of modern biomedicine’s achievements, embodying its core principles and promises. References to antibiotic treatment were spontaneously incorporated into the narratives of vaccine-hesitant parents when they communicated their attitudes and experiences with vaccination. This suggests that future research on vaccine hesitancy could be enriched by a broader analytical lens, one that extends beyond vaccination alone. As Reich (2020: 125) notes, “public health advocates would benefit from considering vaccines as not distinct from other pharmaceutical products.” My findings support this view, indicating that attitudes towards various pharmaceutical interventions often intersect and are used to express broader perspectives on biomedicine as a whole. The spontaneous incorporation of references to antibiotics and antibiotic treatment into the narratives of vaccine-hesitant parents regarding their attitudes towards immunisation, especially among parents who expressed more critical or strongly negative views towards vaccination, suggests that antibiotics and vaccines may occupy a comparable symbolic and conceptual space within the perceptions of these parents.

In the stories of vaccine-hesitant parents, critical evaluation (or outright rejection) of vaccines and antibiotics functioned as a way to symbolically demonstrate their active responsibility for managing the health of family members. Rather than treating these two forms of medical intervention as separate issues, parents often positioned their refusal as part of a broader moral stance, through which they asserted autonomy over health-related decisions and reflexive engagement with health, that challenged the dominant biomedical approach. By distancing themselves from what they perceived as the overreach of institutional medicine, these parents constructed an alternative model of care, in which informed refusal signified both empowerment and the fulfilment of parental duty. In this context, the capacity to manage children’s health without pharmaceutical interventions, whether vaccines or antibiotics, was constructed as a source of pride and an expression of competent parenting.

This study also indicates that a doctor’s antibiotic prescribing practice plays an important role when vaccine-hesitant parents are navigating the healthcare system. While vaccine hesitancy is widely problematised by health professionals, particularly within the context of the CR’s mandatory vaccination system, a cautious approach towards antibiotics is generally seen as a sign of good medical practice and responsible antibiotic stewardship. For many vaccine-hesitant parents, however, these two positions seem closely connected. Even when vaccination views were not openly discussed, parents often interpreted cautious antibiotic prescribing as a subtle indicator that the doctor might be more respectful of their concerns, thereby influencing how parents navigated the healthcare system and selected medical professionals in the context of their vaccine-hesitant attitudes.

This study underscores that vaccine-hesitant attitudes among parents are far from homogeneous. The analysis identified two broad repertoires that illustrate this diversity. In the first approach, vaccination is evaluated through risk–benefit calculations, where vaccines are not rejected outright but are treated as potentially risky biomedical interventions that require individual evaluation, careful timing and, in some cases, postponement or selective uptake. In the second repertoire, vaccines are constructed as unnecessary or harmful, with attitudes towards immunisation closely embedded in parents’ subjective understandings of health and healthcare, often framed in opposition to biomedical intervention. While antibiotics appeared in both repertoires, they assumed a more central role in the latter, reflecting how broader conceptualisations of health shape orientations not only towards vaccination but also towards pharmaceutical interventions more generally. Nevertheless, regardless of the predominant argumentative repertoire employed, vaccine-hesitant parents framed their relationship to antibiotics as an expression of responsible parenting, emphasising caution, restraint and attentiveness to their child’s well-being. This suggests that shared moral understandings of good parenthood cut across otherwise divergent forms of vaccine hesitancy.

Much of the scholarship on pharmaceuticalisation has focused on the growing incorporation of pharmaceutical products into everyday life, highlighting how medications have come to function as “magic bullets” for a range of everyday life problems (Fox and Ward, 2006). The case of vaccine-hesitant parents illustrates how non-consumption can be just as constitutive of selfhood as consumption itself. Parents’ engagement with antibiotics and vaccines reflects not only scepticism but also a wider moral project of responsible care. Through selective refusal or restraint, they construct themselves as informed and ethically engaged parents who manage their children’s health.

Paradoxically, antibiotics and vaccines are thematised within contemporary public health discourse as interlinked pharmaceutical products, bound together through the shared concern with AMR. Vaccines have been described as “powerful tools to fight antibiotic resistance” (Jansen and Anderson, 2018: 8), since their prophylactic use reduces the incidence of infectious diseases, thereby decreasing the need for antibiotic treatment and slowing the development of resistance (Micoli et al., 2021). Although the precise impact of vaccine hesitancy on antibiotic resistance remains uncertain, Hernando-Amado et al. (2019) caution that the spread of vaccine-preventable diseases due to declining immunisation rates could, paradoxically, lead to greater antibiotic consumption.

The attitudes of vaccine-hesitant parents towards antibiotics highlight the ambivalence of health strategy outcomes that are grounded in similar assumptions and beliefs about health. Critical perspectives on pharmaceutical interventions, reflections on their negative side effects and concerns about their overuse in medical practice represented key frameworks of the vaccine-hesitant parents’ attitudes towards both vaccines and antibiotics. Both attitudes were often rooted in an emphasis on cultivating “natural” immunity and a critique of pharmaceutical interventions, particularly when they were perceived to replace or overshadow lifestyle-based approaches to health promotion (see also Dubé et al., 2016). However, strategies emerging from these shared frameworks can paradoxically lead to radically different outcomes for public health. Vaccine hesitancy is widely recognised as a significant threat to public health, with hesitant parents often portrayed as “free riders” of herd immunity: benefitting from collective protection while opting out of contributing to it (Buttenheim and Asch, 2013). In contrast, public health campaigns to reduce antibiotic use actively discourage behaviours aligning with pharmaceutical overuse, with critiques framing the reduction of community-level antibiotic consumption as a public good. These campaigns frequently use changes in prescribing rates, particularly for viral illnesses, along with public knowledge of AMR, as key outcome measures (Gilham et al., 2024). The parents interviewed in this study embody many of the principles promoted by these campaigns: they expressed a commitment to minimising antibiotic use, avoiding unnecessary prescriptions, and reflected critically on the overuse of antibiotics in outpatient, particularly paediatric, care. However, at the same time, their vaccine hesitancy presents a challenge to public health efforts. Both the cautious approach to antibiotics and the rejection of vaccines stem from the same broader processes of responsibilisation, yet, despite sharing a common origin, they have markedly different implications for public health.