The article introduces the special issue by mapping the field of pertinent scholarship and situating the articles with regard to the special angles and contributions they have to offer. As our five articles present case studies from Bulgaria and the GDR, both state socialist countries and their health care systems are portrayed here to provide context. The introduction locates each of the contributions and the overarching aims of the special issue within current scholarly discussions and demonstrates the issue’s innovative potential.

This article deals with the tuberculosis policy in Communist Bulgaria from the 1940s to the end of the 1950s. The focus is on the BCG vaccination as the major preventive tool. The article’s reconstruction of decision-making draws on evidence from archive records produced by the Bulgarian Ministry of Health. The main question guiding the research is how past Bulgarian experiences on the one hand, and international traditions, on the other, influence medical opinion and state policy towards tuberculosis and patients with tuberculosis. How did the Cold War context shape BCG vaccination policy? The author presents the story of the ‘Bulgarian’ BCG strain, which was made possible by the international research networks and travels of the Bulgarian scientist Srebra Rodopska (1913–2006). Her story has recently been rediscovered and made popular in Bulgaria, in the context of debates about COVID-19. This article aims to correct the public history narrative, which has thus emerged by placing the story of the BCG vaccine within its Cold War context. The author pays attention to dependencies between medicine and politics, and to the role of the state. Despite the popular story of Rodopska as the inventor of a ‘Bulgarian’ BCG strain and vaccine, what actually happened was that in Bulgaria of the 1950s and 1960s, the Soviet strain and vaccine production technique were used. This was also due to Soviet pressure to follow the Soviet model of public health infrastructure.

Following the decisions of the scientific session ‘For the further flourishing of Pavlov’s doctrine’ of the Academy of Sciences and the Academy of Medical Sciences of the USSR in 1950, important reforms were introduced under political control in the USSR and the Eastern Bloc countries. Research plans of science institutions and medical university curricula were changed according to these decisions. Scientists and university professors were forced to adopt courses in Pavlovian doctrine. The reforms affected the work of hospitals and sanatoriums, whose staff was instructed to reform the everyday practice. Regarding the clinical work, the session had two main consequences: the introduction of the so-called Curative-Protective Hospital Regime and the introduction of sleep therapy for the treatment of psychiatric diseases, hypertension, ulcers, rheumatism, and other diseases. As a widespread therapeutic method, it was established in the 1950s in the USSR and in the countries of the Eastern Bloc as a general reform of health politics. Political (Soviet influence), ideological (dialectical materialism), theoretical (Pavlovian teaching), and practical medical considerations intersected in the implementation of the therapeutic methods which made patients objects of this treatment. This study explores the process of dissemination and establishment of sleep therapy in Bulgarian hospital practice based on the hospital documentation of the Pediatrics Clinic at the Medical Academy and the Clinic of Cardiac Diseases in Sofia in 1952–1953.

Addiction was considered ‘alien to Socialism’. At least, that was the narrative upheld by the socialist East German state, which thus followed the traditional argumentation of socialist and social democratic movements since the turn of the century. While the state clung to this ideological claim, the consumption and abuse of beer, spirits, and benzodiazepines continued to increase. However, there was never a central strategy for the treatment and prevention of addiction in the German Democratic Republic (GDR). The hesitation and ignorance of the state authorities created a vacuum that was filled by local initiatives and expert discussions aimed at improving the situation of people with addictions. In this article, I analyse the introduction of new treatment methods in a psychiatric hospital in the GDR and show that doctors, psychologists, patients, and local officials had certain freedoms to test new approaches, many of which originated in the West. Even though they had to adapt concepts such as the ‘therapeutic communities’ of British reformer Maxwell Jones to the specific socialist and East German context to avoid restrictions by state authorities, the Berlin Wall did not prevent the transfer of knowledge. This article, therefore, paints a nuanced picture of the therapeutic methods used to treat people with addiction in the GDR. From condemning individuals as outcasts of socialist society for socially deviant drinking behaviour and relying exclusively on aversion therapy and moral accusations, there was a shift towards a mixture of treatments that became increasingly specialised and individualised, especially in the 1970s and 1980s, comparable to Western standards.

When kidney transplantation evolved from an experimental into a clinical treatment of end-stage renal disease (ESRD) in the 1960s, it was conceptualised as a collaborative therapy. Before specific immunosuppressants were introduced in the 1980s, the best chances for patient and graft survival were expected from finding ‘good’ matches between donor and recipient tissues. Therefore, the pioneers of clinical transplantation in Europe started to recombine their growing patient pools. They created trans-border organ exchange organisations such as Eurotransplant and Intertransplant, based on shared patient databases.

The article traces international and transnational co-operation in kidney exchange using the example of state-socialist Germany. How did the German Democratic Republic (GDR) get involved with the interconnected networks of knowledge, data, and organ exchange in ESRD treatment? In what ways did the domestic system of kidney transplantation depend on intra- and trans-bloc exchange? How did the GDR profit, and what did it have to offer on an international scale, both in the First and the Second World? The article sheds light on the under-explored transplantation history of the socialist East and thereby investigates the possibilities and limits of trans-bloc collaboration in Cold War Europe.

The article focuses on the export of cadaveric pituitary glands from communist Bulgaria in the 1980s, used for the production of human growth hormone. The case is explored in the broader context of practices and transnational networks for the supply of pituitaries. Special attention is paid to the changes resulting from the turn to the production of recombinant growth hormone in the mid-1980s, which put an end to the international ‘market’ of pituitary glands. In the last sections, different perspectives are explored to make sense of the case under scrutiny: those of bioethics and biolaw, on the one hand, and of bioeconomy in a globalising world, on the other.