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A War on Health?

Predatory. Lethal. An elusive rapidly-evolving threat developing into a global insurgency. A scourge that exploits poverty, conflict, climate change, and urbanisation, claiming lives in its wake.  An enemy that must be rooted out.

These phrases are being used to describe not only the war against ‘terrorism’ but also the war on certain viruses, such as Zika.[1] Beyond the fact that this kind of description is de-humanising and reduces patients to fearsome bio-threats on two legs, it is more than simple rhetoric that links the two. National self-interest and security concerns have driven the response to both terrorism and epidemics, with disastrous consequences on both patients and the act of providing healthcare itself. Applying national security strategies used against terrorism to fight viruses is fundamentally flawed and may only amplify epidemics rather than contain them.

Stripped of any individual relevance, the patient is instead cast as a human shield against the terrorist virus. Health provision becomes an act of war. Patients are dealt with only insofar as they are host to the terrorist virus and thus a threat to the self-interest of wealthier nations.

We saw this in West Africa. When Ebola struck, national health workers and MSF teams bore the brunt of caring for patients for six months despite repeated appeals for help. Yet none was offered until the realization dawned that the virus could cross the ocean via air passengers, and wealthy nations felt under threat.  Thousands of lives might have been saved if the priority from the onset had been to care for those suffering at the heart of the epidemic first, instead of waiting until it threatened the national security interests of powerful states.

The response to public health crises seems to continue down the same path. Once Zika cases began appearing in the US, more than $1 billion materialised, some of which was stripped from the US Ebola fund intended to help rebuild the crippled health systems in West Africa.

All eyes are now on Zika as it threatens the wealthy nations, while a mostly unnoticed outbreak of yellow fever in Angola and the Democratic Republic of Congo has been spreading since last December. Scaling up the response has been slow due to the usual blockages: slow lab results, poor surveillance, and logistical issues. And now the virus has reached Kinshasa, a city of 10 million people. The city is due to be vaccinated in mid-August, but the authorities must now use 1/5 of a dose per person, due to the unusual scale of the epidemic and the need to conserve the vaccine stockpile. While studies have shown that using a reduced dosage will give protection against yellow fever, albeit possibly not for life, it is the first time a mass vaccination campaign will take place using a partial dose.

If yellow fever had appeared in Europe or the US we would almost certainly have seen a very different response. Yet this outbreak garners scarce attention as it poses little threat thus far to wealthy nations. Equating viruses to terrorists means that states are spurred to action only when their direct national security interest is at stake.

The link drawn between the fight against terrorism and that of epidemics is not simply a crafty analogy. It is a chilling indicator of how far healthcare has been intimately intertwined in the prevailing national security logic in the war on terror era, with a deadly cost.

The most obvious example of how healthcare has been co-opted in the war on terrorism was the use of a vaccination campaign to locate Osama Bin Laden. But labelling viruses and terrorists interchangeably raises other subtler and unsettling questions. Does the analogy of viruses being terrorists work the other way around? Are terrorists also considered viruses? For example, if a wounded terrorist is brought to a hospital, does that mean the hospital is contaminated and no longer protected? Does the hospital itself therefore need to be eradicated? If that’s the case, then hospitals can be used to entrap patients and arrest them from their hospital beds, or hospitals become fair game to be attacked full stop.
A person suffering Ebola, Zika or yellow fever is a patient that has the right to be treated for their own sake, not for the sake of national security. Just as a fighter wounded on the battlefield is a patient entitled to treatment, no matter who they fought for before. And the job of MSF doctors is to provide treatment on the basis of medical need alone. We cannot accept that the ability to care for our patients depends on the national security interests of the most powerful.

If the response to public health crises like Zika is conceptualised along the same national security lines as the war on terror, then the likely result will be the same: more Zika.

By Heather Pagano and Jonathan Whittall. Photo by Phil Moore © MSF, 2014.

[1] Gary Frandsen, the ex-chief of staff of the US Stabilization Operations after 9/11, argued in a Reuters article in May that the World Health Organization and the US government “should apply crucial lessons learned from the evolving fight against terrorism” to combat the threat of Zika.

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