When it comes to a Sophie’s Choice sort of prioritizing, I tend to value national security over minor setbacks in other fields. This is not a popular sentiment in the field of public health, where evangelists are evangelists and the US government is a happy target frequently accused of, god forbid, acting on its own interests. In terms of bulk cost calculations – why spend billions on aircraft carriers when that same money could go to treating malaria? – I also think that Givewell types tend to undervalue hegemonic stability and underestimate, or have perhaps forgotten, the dangerous down stream flailings of a wounded giant. I am One of Those Democrats, and I’m not sorry for it.
But foreign aid, and particularly well-designed health assistance, is in the interest of national security. Unrest results from lack of satisfaction with the state of affairs; extreme dissent emerges in hungry, impoverished, and desperately ill populations where people have the balls to get angry (that is to say, in a less crude manner, societies where women possess limited rights – but that’s another post). And here are a few True Things:
1. Maintaining public health programs abroad is a critical part of the ability of the United States to influence policy abroad in a subtle, effective, and generous way.
2. Vaccination is unparalleled as far as things in our toolbox go. They save money – something entirely uncommon in international aid. This may sound very simple, but it’s extraordinary: a successful vaccination program allows us to prevent lengthy courses of treatment for expensive diseases in difficult-to-access areas.
3. The vaccination “scandals” in the US – such as Andrew Wakefield’s ridiculous shenanigans – have resulted in an inexplicable amount of damage. Accusations of vaccines causing autism in a nation where most people are literate, where 70% graduate from high school after completing a basic biology courses, have been crippling: as an example, one of the most conservative governors in the nation was bullied into not mandating a Gardasil vaccine. The amount of damage associated with something most people don’t understand is amplified as the education of the general population plummets. So when a rumor starts up that US vaccines are intended to render Muslim children infertile in Nigeria? People believe it, and consequently have their children die from preventable diseases.
In attempting to use DNA samples obtained from needles to confirm Osama Bin Laden’s presence in the compound, we did not give the Pakistani children in Abottabad the full 3 courses of the hepatitis B vaccine necessary to ensure functionality. Those kids are not going to have access to the full course – and if they do, why should they trust it?! Why on earth should they, when a legitimate ruse has been constructed against them in which vaccination was hardly considered a fringe benefit? I don’t see what this should have to do with the political sympathies of the children involved, or of their parents; when the United States lies abroad, when we conduct ineffective schemes in places where our word is already compromised, we make enemies. When we do a good thing poorly, we make enemies. Let’s stop doing that right now.