Militarizing Global Health

Below is an excerpt from Alex de Waal’s essay, “Militarizing Global Health,” the full essay is available on the website of The Boston Review, where it was published on November 11, 2014. 

Using troops in a humanitarian crisis or to stop an epidemic is a seductive idea. Indeed, President Barack Obama dispatched the 101st Airborne Division to “fight” Ebola and the UN Security Council declared West Africa’s Ebola epidemic a threat to international peace and security. And on November 4, Sierra Leone’s President Ernest Bai Koroma declared a “military approach” to fighting Ebola, appointed his former defense minister, a retired army major, as head of the National Ebola Response Centre, and urged citizens to use force against those who resist public health directives.

This is worryingly authoritarian, bad for public health, and strategically counterproductive. Despite its impressive logistics, the army makes only a marginal contribution to international disaster relief—and often makes things worse. Nor do soldiers “fight” pathogens—and the language of warfare risks turning infected people and their caretakers into objects of fear and stigma. But, because of America’s politics of public finance, the army is the only tool we have. If civilian health programs were properly funded, they could have prevented the disaster.

Infectious Disease Is Not a National Security Threat

After the end of the Cold War, President Bill Clinton instructed national security analysts to focus on non-traditional threats to U.S. security. Vice President Al Gore focused on climate change. Another major theme was epidemics, spurred by the finding that infant mortality was one of the top three variables predicting state failure, and by the growing HIV/AIDS pandemic. In January 2000 the National Intelligence Council reported that “the persistent infectious disease burden is likely to aggravate and, in some cases, may even provoke economic decay, social fragmentation, and political destabilization in the hardest hit countries in the developing world.” That same month, at the initiative of the United States, the UN Security Council held a historic debate on HIV/AIDS, the first time it had ever discussed a disease.

Then came 9/11 and the anthrax scare. Rattled, the Bush administration began a $6-7 billion annual program for defense against bioterrorism. It is instructive to look into what the experts on smallpox, anthrax, and other potential weaponized germs did with that money. They already knew that a naturally occurring epidemic is much more probable than a bioterrorist attack, and that epidemics and bioterrorism require exactly the same response. So when the Centers for Disease Control was allocated $17.4 billion over ten years, it “put the vast majority into bolstering an underfunded public-health infrastructure. The rationale is that the nation has little chance of fighting a bioterror attack without a strong system for detecting, reporting and treating any emerging infectious disease.” The consensus was that spending for general population health is useful, but funds solely targeted at anticipated terrorist use of biological weapons are wasteful.

Public health advocates were grateful for the security alarm because it brought much-needed attention and funds. And they adopted martial language themselves. Calling for a Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria, Kofi Annan said, “The war on AIDS will not be won without a war chest.” International donors have increased their assistance to health fourfold since 2001, and in 2012, $28 billion was spent annually on global assistance programs for public health, with the U.S. government as the largest contributor.

Over the same period, researchers explored every connection between health and security in the history of disease. They found that modern epidemics do not cause security crises. For example, the influenza pandemic that followed World War I killed many more people than the war, but its political impact was negligible. John Barry concludes his account of the pandemic, “The fear, not the disease, threatened to break the society apart.” Many observers—including this author—predicted that Africa’s epidemic of HIV and AIDS would have far-reaching governance and security impacts—but those feared consequences failed to materialize. In fact, a human rights–based response to AIDS strengthened civil society and improved governance. Ebola may kill thousands of people and impoverish hundreds of thousands, but a nightmare of a new plague tearing down the pillars of social order is just that—a nightmare. Newly evolved pathogens are a constant threat, but a rerun of the near-total devastation of the native American populations by diseases entirely new to them is far-fetched for the simple reason that there are no longer any large populations wholly isolated from, and therefore at risk of major infections.

Read the full essay at The Boston Review.