Public health’s evolving role promoting U.S. military interests

The seal of the U.S. Department of Defense, representing seven branches of the U.S. military.
The seal of the U.S. Department of Defense, representing seven branches of the U.S. military.

The U.S. Department of Defense (DoD) remains one of the most sophisticated media production machines on the planet. Its ubiquitous advertising filters into every aspect of our lives, from public schools to product placement in the lucrative gaming industry to traditional online ads.

In 2007 alone, according to a Rand Corp. study, the total recruiting budget for the Army, Navy, Air Force, and Marine Corps exceeded $3.2 billion. Rand Corp. analysts also deemed those investments as successful as measured by recruitment, even during two ongoing wars in Afghanistan and Iraq.

Events with military personnel always feature sophisticated press and social media coverage. One of the more nuanced and I think effective messages I have seen from the DoD is how the military is not just about defense, but about a more deeply and morally resonant “good.” The U.S. Navy’s very slick videos call the branch a “a global force for good,” and show Navy SEALs in action carrying that message.

This clip from a U.S. Navy recruiting video shows a successful branding effort by the U.S. Department of Defense to promote its global activities as a moral good, including special ops efforts by U.S. special forces
This clip from a U.S. Navy recruiting video shows a successful branding effort by the U.S. Department of Defense to promote its global activities as a moral good, including special ops efforts by U.S. special forces.

Helping to prop up that messaging is the country’s long-standing integration of public health services into the DoD and overall military readiness. The military is successfully integrating public health activities, and it is branding these as part of its global efforts, including on the new battlefield in Africa.

Through contracting opportunities that support these efforts, many U.S. based firms who specialize in development and traditional public health activities are actively supporting these initiatives, in order to monetize their own business models.

Chasing contracts serving two masters: public health and defense

I recently stumbled on a job posted on the American Public Health Association (APHA) LinkedIn page by a company called the QED Group, LLC. The position was similar to ones I see posted on their job site now, for work on a “monitoring and evaluation” project in Africa.

This is one of many government-contracting agencies that chase hundreds of millions of contracts with U.S. government agencies and the major public health funders like the Bill and Melinda Gates Foundation.

In this case, the company was specifically targeting those in the public health community, who are entering the field or currently have positions with backgrounds in public health, economics, science, and health. The 15-year-old company itself actually began as a so-called 8(a) contractor, which means it could win no-bid and lucrative government contracts that are now the center of an ongoing and intense controversy over government waste. (These companies were created by the late Alaska Sen. Ted Stevens, who created the provision to steer billions in government contracting to Alaska Native owned firms that partner with companies like Halliburton and the Blackwater overseas and in the United States.)

QED Project in NorthAfrica
The company QED Group showcases its recent work evaluating anti-terrorism-related efforts in North Africa.

Today, QED Group, LLC claims “it is full-service international consulting firm committed to solving complex global challenges through innovative solutions” by providing clients “with best-value services so they increase their efficiency, learning capacity, and accountability to the public in an ever more complex and interconnected world.” It lists standard international development and public health contract areas of health, economic growth, and democracy and governance.

QED Group is not the only multi-purpose public health and development agency chasing military and global health contracts in Africa.  Another health contracting company called PPD boasts of its “long history of supporting the National Institutes of Health, the nation’s foremost medical research agency,” and that it was “awarded a large contract by the U.S. Army.” It claims its is also a “preferred provider to a consortium of 14 global health Product Development Partners (PDPs), funded in part by the Bill & Melinda Gates Foundation.”

As a public health professional, QED Group looks like a great company to join. However, if one scratches deeper, one learns that this company also uses its public health competencies with the U.S. military, which is spearheaded in Africa by U.S. Africa Command, or AFRICOM.  This raises larger questions of the conflicting ethics of both promoting human health and public health and also serving the U.S. Department of Defense, whose primary mission is to “deter war and to protect the security of our country.”

AFRICOM’s emerging role flexing U.S. power in Africa

AFRICOM’s demonstration of “hard power” is well-documented through its use of lethal firepower in Africa. AFRICOM is reportedly building a drone base in Niger and is expanding an already busy airfield at a Horn of Africa base in the tiny coastal nation of Djibouti. On Oct. 29, 2013, a U.S. drone strike took out an explosives expert with the al-Qaida-linked al-Shabaab terrorist group in Somalia, which had led a deadly assault at a Kenyan shopping center earlier that month.

One blog critical of the United States’ foreign policy, Law in Action, reports that the AFRICOM is involved in the A to Z of Africa.  “They’re involved in Algeria and Angola, Benin and Botswana, Burkina Faso and Burundi, Cameroon and the Cape Verde Islands. And that’s just the ABCs of the situation. Skip to the end of the alphabet and the story remains the same: Senegal and the Seychelles, Togo and Tunisia, Uganda and Zambia. From north to south, east to west, the Horn of Africa to the Sahel, the heart of the continent to the islands off its coasts, the U.S. military is at work.”

U.S. efforts in Africa require health, public health, and development experts. As it turns out the company, QED Group,  won a USAID contract examining U.S. efforts promoting “counter-extremism” programs in the Sahel. That study evaluated work using AFRICOM-commissioned surveys, all designed to promote U.S. national security interests in the unstable area.

The area is deeply divided between Christians and Moslems. It is also home to one of the largest al-Qaida based insurgencies known as al-Qaida in the Islamic Maghreb, which has similar violent aspirations as the ultra-violent Boko Haram Islamic militant movement of violence-wracked northern Nigeria. Al-Qaida in the Islamic Maghreb military seized control of Northern Mali in 2012, which ended when U.S.-supported French military forces invaded the country and routed the Islamic extremists in January 2013.

Public health’s historic role with U.S. defense and national security

“Hard power” and “soft power” are tightly intertwined in U.S. overseas efforts, where health and public health personnel support U.S. interests. This is true in Afghanistan and is certainly true in North Africa. This particular QED-led program used the traditional public health method of a program evaluation of an antiterrorism program to see if a USAID program was changing views in Mali, Niger and Chad—all extremely poor countries that are at the heart of a larger struggle between Islamists and the West.

That research methods used in public health–and which I have used to focus on health equity issues in Seattle–can be used equally well by U.S. development agencies to advance a national security agenda is not itself surprising.

However, faculty certainly did not make that case where I studied public health (the University of Washington School of Public Health). I think courses should be offered on public health’s role in national defense and international security activities, because it is nearly inevitable public health work will overlap with some form of security interests for many public health professionals, whether they want to accept this or not.

U.S. Public Health Service Corps members proudly serve their country and wear its uniforms.
U.S. Public Health Service Commissioned Corps members proudly serve their country and wear its uniforms. This photo published on the corps’ web site demonstrates that pride.

Public health in the United States began as a part of the U.S. armed services, as far back as the late 1700s. It was formalized with the military title of U.S. Surgeon General in 1870. To this day those who enter the U.S. Public Health Service Commissioned Corps wear military uniforms and hold military ranks.

A good friend of mine who spent two decades in the Indian Health Service, one of seven branches in the corps, retired a colonel, or “full bird.” He always experienced bemusement when much larger and far tougher service personnel had to salute him when he showed his ID as he entered Alaska’s Joint Base Elmendorf Fort Richardson looking often like a fashion-challenged bum in his minivan (he frequently had to see patients on base, and was doing his job well).

The U.S. Public Health Corps' web site shows the different uniforms worn by their members.
The U.S. Public Health Service Commission Corps’ web site shows the different uniforms worn by its members.

The U.S. Army’s Public Health Command was launched in WWII, and it remains active today. One of its largest centers is Madigan Army Medical Center at Joint Base Lewis McChord, in Pierce County, Washington. Public Health activities are central to the success of the U.S. Armed Services, who promote population-based measures and recommendations outlined by HealthyPeople 2020 to have a healthy fighting force.

AFRICOM charts likely path for the future integration of public health and defense

Africom photo
This screen snapshot of an AFRICOM media file highlights the public health and health related efforts AFRICOM personnel undertake in the region, where military efforts are also underway to suppress and disrupt Islamic extremist groups.

Today, the U.S. military continues to use the “soft power” of international public health to advance its geopolitical interests in North Africa.  In April 2013, for example, AFRICOM hosted an international malaria partnership conference in Accra, Ghana, with malaria experts and senior medical personnel from eight West African nations to share best practices to address the major public health posed by malaria.

At last count, the disease took an estimated 660,000 lives annually,  mostly among African children.

At the event, Navy Capt. (Dr.) David K. Weiss, command surgeon for AFRICOM, said: “We are excited about partnering with the eight African nations who are participating. We’ll share best practices about how to treat malaria, which adversely impacts all of our forces in West Africa. This is a great opportunity for all of us, and I truly believe that we are stronger together as partners.”

I have reported on this blog before how AFRICOM and the United States will increasingly use global health as a bridge to advance the U.S. agenda in Africa. And global health and public health professionals will remain front and center in those activities, outside of the far messier and controversial use of drone strikes.

It is likely this soft and hard power mission will continue for years to come. Subcontractors like QED Group will likely continue chasing contracts with USAID related to terror threats. Global health experts will meet in another African capital to discuss major diseases afflicting African nations at AFRICOM-hosted events. And drones will continue flying lethal missions over lawless areas like Somalia and the Sahel, launching missiles at suspected terrorist targets.

Oregon’s smallpox legacy in a state celebrated for vaccination deniers

Smallpox remains the only human disease that has been successfully eradicated. Its scourge has been global, impacting nearly every great civilization from the time of the Pharaohs onward.

Smallpox helped the Spanish invaders conquer the Aztecs in the 1500s; nearly 3 million persons were killed.

In Europe, it reportedly claimed 60 million lives in the 1700s. In the 1500s, up to 3 million Aztecs died after being infected by the conquering Spanish, bringing about the collapse of their culture and civilization more effectively than the violent conquistadores could have ever dreamed. The last reported case occurred in the 1970s. Since that time, the virus has existed only in two highly guarded labs.

Smallpox is also tragically rooted in the meeting of European and Native American cultures, and its horrific impact on the continent’s first peoples underlies the nation’s historic narrative as much as political and economic developments from colonial expansion to industrialization to slavery.

The pilgrims, like the Spanish, brought the dreaded scourge, which immediately took a toll on Native tribes on the Eastern seaboard. The first outbreak claimed 20 of the white settlers’ lives. Founding Father Ben Franklin lost a son to smallpox in 1736. But smallpox more than any army, particularly in the Pacific Northwest in the Oregon territory, made it possible for the young American nation to conquer Native areas, many totally wiped clean of their Native inhabitants. I will talk more about the impacts in Oregon shortly, but first some background on the killer virus.

Smallpox’s enormous role in North American and Native American history

There are two smallpox variants, Variola major, the more severe form, and the less severe Variola minor. Its symptoms include fever and lethargy about two weeks after exposure, followed by a sore throat and vomiting. For those afflicted, a rash would then appear on the face and body, and sores in the mouth, throat, and nose. Infectious pustules would emerge and expand. By the third week, scabs formed and separated from the skin. The virus is spread by respiratory droplets, and also by contaminated bedding and clothes. This was how many historians suspect the disease may have been transmitted to Native Americans in North America.

French Jesuits in Canada in 1625, according to an account by Ian and Jennifer Glynn in The Life and Death of Smallpox, received great hostility from Natives because of the link made between the disease and contact with Europeans. The missionaries reported the local people “observed with some sort of reason that since our arrival in these lands those who had been the nearest to us had happened to be the most ruined by [smallpox], and that whole village of those who had receive us now appeared utterly exterminated.”

The first recorded use of smallpox as a weapon was during the siege of Fort Pitt in 1763, when Native tribes during Pontiac’s uprising during the French and Indian war were reportedly given infected blankets by a British general, possibly with the goal of infection, even though scientific knowledge at the time did not fully understand germ theory or microbial infections. However, there was an understanding of how the disease might be spread based on experiences.  Reports also exist of the British attempting to infect colonial areas during the Revolutionary War–all early cases of germ warfare.

Smallpox was reportedly used against the 10,000-man contingent of the Continental Army that invaded British-held Quebec. Of that force, half were stricken by smallpox, and it was theorized the British commander may have intentionally spread it by sending infected persons to Continental Army camps. That army’s commander died, and the force retreated in 1776, keeping the Canadian territories intact and thus giving birth to Canada. Noted John Adams, “Our misfortunes in Canada are enough to melt the heart of stone. The smallpox is 10 times more terrible than the British, Canadians and Indians together.”

Abraham Lincoln supposedly contracted it during the height of the Civil Ware in 1863—the outcome of which could have turned the course of U.S. and global history, had he died. (I for one am glad he survived this.)

The first vaccine, developed in 1770, was derived from cowpox by Edward Jenner. He had observed how a milk maid  was inoculated from the impacts of the more deadline Variola major and minor by a previous exposure to cowpox. It was not until 1947 when a frozen vaccine was introduced globally. After a costly global campaign, smallpox was declared eradicated in 1980.

The College of Physicians of Philadelphia has published an extremely useful illustration and timeline of the history of smallpox in the United states and globally.

A man who caught smallpox in Milwaukee is shown in this 1925 photo.
It was less than 100 years ago smallpox wreaked havoc. A photo provided by Dr. Bennet Lorbar shows a man with pox marks on his body, among the victims of the 1925 Milwaukee outbreak that claimed 87 lives.

Today, many people in the United States, particularly those born after routine smallpox vaccinations were ended in 1972, have no memory of how awful such a disease can be. (The CDC has a plan to vaccinate the entire country should the virus ever break free from its labs.)

This may be a contributing factor to the rise of the anti-vaccination movement. It should noted opposition to smallpox vaccination in the United States dates to the 1920s, and opposition even as far back as the first vaccine of Jenners.

Ex-Playmate McCarthy and the vaccination deniers

The most famous case of modern day vaccination denialism is linked to controversies surrounding the measles, mumps, and rubella (MMR) vaccine, and its alleged link to autism and autism spectrum disorder. This bogus claim was completely based on a widely discredited study published by the British medical journal the Lancet in 2004, and then formally retracted in 2010. It was further debunked by extensive population based studies.

Facts, of course, have still not stopped former 1994 Playmate of the year Jenny McCarthy, and the “Green our Vaccines” campaign, from claiming toxins in vaccines cause autism.

Would anyone care what Jenny McCarthy has ever said if she did not have large breasts and have been a Playmate of the Year in 1994?
Would anyone care what Jenny McCarthy has ever said if she did not have large breasts and was not the Playmate of the Year in 1994?

Her campaign of disinformation just got a boost when she was given a national stage by Walt Disney Co.-owned ABC News, which hired the vaccination extremist to its show called The View in mid-July 2013. She begins her post in September.

As expected a chorus of worried public health advocates and policy wonks decried ABC’s crass capitalistic gesture. This made no impact whatsoever on the parent corporation, Disney—all of which might lead a rational person to ask when the Disney-owned ABC News might hire a blond, big-boobed Holocaust denier to co-host a lively, unscripted talk show, so long as she boosted ratings.

Smallpox wiped out Native Americans in state that now has the highest rates of vaccination exemptions

It seems particularly and painfully ironic that the state with the highest rate of parents opting out of childhood vaccinations is Oregon. This is a major public health concern, because when there are fewer people receiving vaccinations, herd immunity is reduced, making it easier for a disease to spread.

Oregon currently has the highest rate of unvaccinated children in the nation, well above the national average of 1.2%.

As of 2013, Oregon schools had the highest rate of non-medical–meaning religious–immunization exemptions for kindergarten age children. An all time high of 6.4% were exempt. That same year the state also recorded the highest rates for pertussis (whooping cough) cases in the United States, for the past 50 years, according to the Centers for Disease Control and Prevention (CDC).

According to the newsletter called the Lund Report: “In 2013, rates also showed that 17 counties have now surpassed the common 6 percent threshold whereby herd immunity may be compromised for some vaccine-preventable diseases such as pertussis and measles. In 2012, 13 counties were above 6 percent.”

Thanks to a new law signed in July 2013 by Gov. John Kitzhaber (D), himself a doctor, it will now be harder for Oregon parents to get exemptions from mandatory immunizations for children enrolling in schools.

Now, flash back more than two centuries, when the scourge of smallpox was first recorded in the Northwest due to trade with Europeans. A smallpox epidemic, starting in the upper Missouri River country, swept through current day Oregon to the Pacific Ocean in 1781–82 with horrific effects. Another scourge of “fever and ague,” likely malaria, ravaged Oregon in 1830–31. Other diseases as tuberculosis, measles, and venereal infections also took a huge toll. Epidemics in fact took an estimated nine of 10 lives of the lower Columbia Indian population between 1830 and 1834.

A rest stop on the Columbia River Gorge provide historic background on the dessimation of Native residents in Oregon due to disease in the 1800s.
A rest stop on the Columbia River Gorge provides historic background on the dessimation of Native residents in Oregon due to disease in the 1800s.

In 1834, Dr. John Townsend, in the area that would become the Oregon Territory, wrote of a mass extermination of Native residents, similar in scope to what one today only knows through zombie or science fiction films of recent years like World War Z and I am Legend.

Townsend wrote: “The Indians of the Columbia were once a numerous and powerful people; the shore of the river, for scores of miles, was lined with their villages; the council fire was frequently lighted, the pipe passed round, and the destinies of the nation deliberated upon . . . Now alas! where is he? –gone; —gathered to his fathers and to his happy hunting grounds; his place knows him no more. The spot where once stood the thickly peopled village, the smoke curling and wreathing above the closely packed lodges, the lively children playing in the front, and their indolent parents lounging on their mats, is now only indicated by a heap of undistinguishable ruins. The depopulation here has been truly fearful. A gentleman told me, that only four years ago, as he wandered near what had formerly been a thickly peopled village, he counted no less than sixteen dead, men and women, lying unburied and festering in the sun in front of their habitations. Within the houses all were sick; not one had escaped the contagion; upwards of a hundred individuals, men, women, and children, were writhing in agony on the floors of the houses, with no one to render them any assistance. Some were in the dying struggle, and clenching with the convulsive grasp of death their disease-worn companions, shrieked and howled in the last sharp agony.”

An image the young then-U.S. officer Ulysses S. Grant, during his tour of duty on the Pacific Coast, where he saw the devastation of smallpox firsthand.
An image shows the young then-U.S. officer Ulysses S. Grant, during his tour of duty on the Pacific Coast, where he saw the devastation of smallpox firsthand.

While stationed in Fort Vancouver on the banks of the Columbia River in 1852 and 1853, future Union General and President Ulysses S. Grant recorded similar devastation: “The Indians, along the lower Columbia as far as the Cascades and on the lower Willamette, died off very fast during the year I spent in that section; for besides acquiring the vices of the white people they had acquired also their diseases. The measles and the small-pox were both amazingly fatal. … During my year on the Columbia River, the smallpox exterminated one small remnant of a band of Indians entirely, and reduced others materially. I do not think there was a case of recovery among them, until the doctor with the Hudson Bay Company took the matter in hand and established a hospital. Nearly every case he treated recovered. I never, myself, saw the treatment described in the preceding paragraph, but have heard it described by persons who have witnessed it. The decimation among the Indians I knew of personally, and the hospital, established for their benefit, was a Hudson’s Bay building not a stone’s throw from my own quarters.”

(For those interested in this topic, they may wish to buy, download, or borrow a study of smallpox’s impact on Native North Americans called Rotting Face: Smallpox and the American Indian. One reviewer wrote that smallpox “claimed more lives from the Northern Plains tribes in one year than all the military expeditions ever sent against American Indians.”)

Where is the statue or monument pointing out this critical event in Oregon’s history?

Yet, I could find no record of any statue or memorial in Oregon today that notes this historic tragedy, which depopulated a region and left it wide open for white settlers to inhabit in the mid-1800s. Perhaps if such physical reminders were present, and educational programs to accompany them, there might be a more lively debate in Oregon. But as of now, it is state celebrated for its vaccination deniers and for denying the benefits of community water fluoridation for residents of its major urban center, Portland, for a fourth time since the 1950s.

Maybe a statue honoring ghost villages, dead tribes, and forgotten cultures on the banks of scenic Multnomah River in downtown Portland, could kick off with a special celebrity ceremony. The organizers could host a live broadcast of The View with Jenny McCarthy, in a revealing dress, describing why the state’s residents should keep their children from getting vaccinated from diseases such as pertussis.

I would be sure this event included representatives of the remaining tribal groups who managed to survive the wholesale disease-driven extermination of their brethren not many decades ago, many due to illnesses now controlled through childhood immunizations. Now that would be an attention-grabbing event that might just propel the discussion in a new direction.