Reuters recently published the bombshell report that in the spring of 2020, the US military began a social media disinformation campaign in the Philippines that aimed to undermine China’s influence in the country by casting doubt on the effectiveness of the COVID-19 relief aid China had delivered.

Under the pithy slogan #Chinaangvirus (#ChinaIsTheVirus), these fake accounts explicitly and repeatedly doubted the effectiveness of China’s Sinovac COVID-19 vaccine, in some cases calling the vaccine “fake.” In others, it suggested that the virus’s origin in China was all the evidence needed to be suspicious of the vaccine, whose origin was also in China.

The logic may be elusive, but the sentiment seemed to resonate. At least, the Philippines struggled mightily with vaccination uptake initially, with only about a third of the population taking up the vaccine over the first eight months of its distribution.

This wasn’t the only such campaign. From its operations hub in Tampa, Florida, the military psychological operations team reportedly expanded its horizons to the Middle East and Central Asia. In these cases, it amplified the rumor that the COVID vaccines from both China and Russia contained pork gelatin. More than 150 Facebook and Twitter accounts repeated variations on the same message: Sinovac and Sputnik V were not halal. Do not get the vaccine.

As expected and, indeed, as appropriate, nearly everyone asked to comment on this story condemned the action, citing both the immediate deleterious effect this campaign may have had on COVID illness severity and death rates during the pandemic and its wider effect of fomenting vaccine hesitancy more broadly.

Though some expressed shock that the US would opt for such a campaign, others pointed out that we’d seen this scenario before – and recently.

NOT THE FIRST TIME
In 2011, a CIA-run operation was launched intending to confirm the whereabouts of Osama bin Laden by collecting DNA from his family compound in a suburb of Abbottabad, Pakistan. But it was so poorly disguised as a hepatitis B vaccination campaign that suspicions were immediately raised.

Not only did vaccinators fail to return with the vaccine’s required second dose, but the campaign quickly moved on from a relatively poor area of the city, where hep B vaccination was a reasonable undertaking, to the wealthier suburb where Bin Laden lived, an altogether unlikely locale for a hepatitis B vaccination drive.

Scenarios like these surely drive vaccine hesitancy. Sometimes they even seed violence.

In the wake of the CIA’s sham vaccination campaign, the Taliban issued a fatwa against vaccination programs, and various localities in their jurisdiction prevented vaccination teams from entering.

As Lawrence Gostin, an American law professor, has described, vaccination campaign workers in the area (often women) were attacked and even killed.

Under pressure from public health leaders, the CIA agreed in 2014 never again to use vaccine programs as a cover. Perhaps the Pentagon didn’t get the memo. Although, even if it had, it seems likely that those directing the COVID vaccine disinformation campaign would have gone ahead, anyway.

According to military news outlets, the Pentagon “stands by”  its activities. Its justification is that the campaign was merely a response to China’s own disinformation campaign, which suggested that America was responsible for the virus’s spread.

This admission makes clear a context that is crucial to understanding the significance of such interventions. Globally, vaccines have long had a political significance that is so potent that it almost trumps their significance as agents of health prevention.

From the days of the 19^th century European empires, vaccines were lauded for their effectiveness as agents of colonialism. They afforded an easy way to introduce “western” medicine into colonial holdings, displacing indigenous health traditions as they also reinforced a dependency between colonizer and colonized.

VACCINE DIPLOMACY
By the 20^th century, and especially during the cold war period, “vaccine diplomacy” rendered a similar relationship, now not between colonized and colonizer but between so-called “client states” and the behemoths of the geopolitical order – chief among them the US and Soviet Union.

Though vaccine diplomacy has positive valences, as an antidote, for example, to vaccine nationalism, it has an explicit dark side, where the price for receiving vaccines on the part of a client state is “policy concessions and favorable geopolitical reconfigurations.”

During the 1958 smallpox epidemic in Pakistan, both the US and USSR rushed to provide aid. No doubt humanitarianism played a role, but at stake were also the geopolitical advantages that a foothold there would bring. Vaccines often came with a hefty price tag.

And that’s what we’ve seen over the COVID era as well, as Russia and China especially raced to supply vaccines “in exchange,” as one commentator put it, “for favorable foreign-policy concessions.”

This is quite clearly the context that best explains the Pentagon’s actions in the Philippines, where the US read China as courting the Philippines with COVID aid. As a critical military base of operations for the US, precisely for its nearness to China, this was deemed unacceptable.

The heightened attention to dis- and misinformation in recent years has rendered the significance of the Pentagon’s disinformation campaign, like the CIA’s sham vaccination drive, too narrowly. Vaccine hesitancy is poorly defined in these contexts when it is glossed in terms of dis- or misinformation, in terms of conspiracy theories and in terms of science or medical literacy.

The long history of vaccines in the global context has instead established vaccines as just one more potent example of the injustices that the yawning power imbalances of the global order have wrought.

After all, vaccine hesitancy in Pakistan didn’t begin with the CIA’s sham campaign just as vaccine hesitancy in the Philippines did not start with America’s disinformation campaign. If we want to start to make a dent in global vaccine confidence, we need to take a much longer view.

THE CONVERSATION VIA REUTERS CONNECT

Caitjan Gainty is a senior lecturer in the History of Science, Technology and Medicine, at King’s College London. She has received funding from the Wellcome Trust.