The New Republic, April 1, 2019
In August, the most important Islamic religious council in Indonesia, home to the world’s largest Muslim population, issued a public health opinion. The Indonesian Ulama Council, known as the MUI, decreed that observant Muslims in the country should consider the measles vaccine haram, or forbidden, because it contains gelatin derived from pork.
The fatwa represented a niche opinion—millions of observant Muslims accept vaccines every year—but it had the power of politics behind it: The head of the MUI, a religious hardliner, had recently agreed to appear on the ballot with Indonesia’s president when he runs for reelection in April. The ruling had disastrous consequences. Millions of parents in Indonesia refused to allow their children to be vaccinated, and the region of Aceh, which operates under religious law, blocked vaccination teams from entering. Outside of Java, Indonesia’s most populous island, the refusals pushed vaccine acceptance to just 68 percent of eligible children, when effective protection requires 95 percent. In Aceh, only 8 percent of children received the shot.
The opposition to the measles vaccine in Indonesia surfaced the same month that the Italian Senate voted to end all mandatory vaccinations for schoolchildren—for measles, tetanus, polio, and seven other diseases. By October, the occurrence of measles—one of the most contagious diseases on the planet and a widespread cause of blindness, deafness, and brain damage—began rising there. Simultaneously the disease soared across Europe, with 82,596 cases in 2018, compared to 5,273 two years earlier. Measles also crept back in Venezuela, just two years after the Americas had been declared free of the disease. At the end of November, an array of international health authorities—the World Health Organization, the Centers for Disease Control and Prevention, UNICEF, and Gavi, the Vaccine Alliance—jointly warned that measles was surging across the planet. “We risk losing decades of progress,” a WHO official said.
The worldwide effort to eliminate measles is not failing because the organism has changed significantly—the virus that infects a child today is largely the same one that sickened children 100 years ago—nor because the vaccine is faulty. Measles cases are multiplying across the globe for the same reason that the international campaign to eradicate polio has stalled, and that Ebola outbreaks continue, and that opportunistic new diseases like Zika take us by surprise: a rise in nationalist politics, which is causing countries to turn inward, harden their borders, and distrust outsiders. One hundred years after the influenza pandemic of 1918—the worst outbreak in recorded history, which killed as many as 100 million people by some estimates—the assumption that every nation owes an investment in health to every other nation no longer holds.
As nativist appeals undermine public health systems and cooperation among countries degrades, the potential for catastrophe increases. We are always at risk of a new disease breaking out, or a previously controlled one surging back. What’s different now is that the rejection of scientific expertise and the refusal to support government agencies leave us without defenses that could keep a fast-moving infection at bay. Pathogens pay no respect to politics or to borders. Nationalist rhetoric seeks to persuade us that restricting visas and constructing walls will protect us. They will not.
“Nationalism, xenophobia, the new right-wing populism in Europe and the United States, are raising our risk,” said Ronald Klain, who was the White House Ebola response coordinator for President Barack Obama and now teaches at Harvard Law School. “There’s a focus not so much on stopping infectious diseases as much as there is on preventing the movement of people to prevent the transmission of diseases. And that’s not possible, because no matter what you do about immigrants, we live in a connected world.”
Distrust of expertise, suspicion of immigrants, shunning of international cooperation—these all describe nationalist movements in Africa and Europe. But the place where official attitudes toward global public health have changed most sharply is the United States during the presidency of Donald Trump. It’s difficult to convey just how great the change has been over the past two years. The Obama administration wrote the first national strategy to tackle antibiotic resistance in 2014, launched with an executive order and a summit at the White House; created the Global Health Security Agenda, which drew 64 nations into a partnership to advance public health; and oversaw the largest foreign deployment of the CDC in the agency’s history, to the 2014–2016 Ebola outbreak in West Africa—which was accompanied by an emergency appropriation of more than $5 billion. The Trump administration has abandoned such commitments.
Trump’s first budget proposal included sharp cuts to the CDC, the National Institutes of Health, and the Environmental Protection Agency, which is responsible for addressing the health problems caused by climate change. The final budget passed by Congress reinstated much of the funding for these agencies, but Trump’s next budget proposal a year later included further cuts to health and science. Beyond the budget cuts, Trump also drastically reduced the scale of the CDC’s overseas outbreak-prevention work from 49 countries to ten and attempted to eliminate $252 million in funding left over from the Obama administration’s appropriation for Ebola. Moreover, Trump dismantled the National Security Council’s global health security team, leaving the United States with no clear channel to respond to global health threats.
Read full article at The New Republic (includes and audio version)