By ROMEO F. QUIJANO, M.D.*
Vaccination is probably the most deceptive tool of imperialism that even anti-imperialists often fail to recognize. It displays a humanitarian face but has the soul of a beast. Its true character is that of a deceptive agent of imperialism. The romanticism of western medicine has masked the true nature and ethos of vaccination. However, using the anti-imperialist tool, pedagogy of the oppressed (1), a diligent and deeper study of the history of vaccination and the socio-political and cultural context of that history would reveal the true character of vaccination.
Vaccination is the process of introducing a vaccine into the body to produce immunity to a specific infectious organism. It is not the same as immunization (which has been mistakenly used interchangeably with vaccination), which is the process of conferring immunity, not necessarily through vaccination. Immunity is the capacity of the body to protect itself from the development of a disease due to exposure to an infectious organism. Imperialism is usually defined as expansion of economic activities, especially investment, sales, extraction of raw materials, and use of labor to produce commodities and services beyond national boundaries, as well as the social, political, and economic effects of this expansion. I would define Imperialism as: Intervention of Monopolistic Power Exploiting the Resources of Impoverished Areas Leading to Increased Social Misery (I-M-P-E-R-I-A-L-I-S-M).
If we look carefully into the history of vaccination, we will find that the development of vaccination coincided with the development of imperialism. Medicine and public health have played important roles in imperialism. With the emergence of the United States as an imperial power in the early twentieth century, interlinkages between imperialism, the business elite, public health, and health institutions were forged through several key mediating institutions. Philanthropic organizations sought to use public health initiatives to address several challenges faced by expanding capitalist enterprises: labor productivity, safety for investors and managers, and the costs of care (2).
In the early 1900s, the capitalist magnate Rockefeller already had a hand in the development of smallpox vaccine. Rockefeller’s pioneering virologist Tom Rivers (1888-1962) undertook to develop a safer vaccine by growing the virus in tissue culture. The result was an attenuated strain of virus that was better than the earlier vaccines produced in England. It was the first vaccine used in humans to be grown in tissue culture. Rivers’ interaction with Rockefeller Foundation scientists, who were then working to make a yellow fever vaccine in Foundation laboratories on the Rockefeller Institute campus, influenced Max Theiler to create an attenuated virus vaccine. Theiler later won a Nobel Prize for this work (3). Parke-Davis also was a pioneer in vaccine production. The company set up shop in 1907 in Rochester hills, Michigan, pitching a circus tent to house horses and constructing a vaccine-propagating building, a sterilizing room and a water tank(4). Parke-Davis was once America’s oldest and largest drug maker. It was acquired by Warner Lambert company in 1970, which in turn was acquired in 2000 by Pfizer, which is now the largest pharmaceutical company in the world(5,6). Pfizer claims that it was involved in the commercial production of a smallpox vaccine in the early 1900s, that it was the first to develop a heat-stable, freeze-dried smallpox vaccine as well as the bifurcated needle, the first to introduce a combined vaccine for preventing diphtheria, pertussis and tetanus and had produced more than 600 million doses of the first live trivalent oral poliovirus vaccine (7). These medical advances coincided with the emergence of what has been called “New Imperialism” when European states established vast empires mainly in Africa, Asia and the Middle East (8) and almost at the same period, the United States colonized the Philippines, Guam, Puerto Rico, Kingdom of Hawaii, American Samoa, Northern Mariana Islands, and for short periods, Haiti, Dominican Republic, Nicaragua and Cuba (9, 10).
Imperialism is driven by the pressure of capital for external fields of investment. The recurrent crises of overproduction and subsequent diminution of profits and stagnation of capital leads to ever-increasing pressure to expand markets and territories. The tendency for investors to work towards the political annexation of countries which contain their more speculative investments is very powerful. Imperialism is seen as a necessity by the capitalists so they can continue to accumulate wealth. Capitalist greed was hidden behind the curtain of “manifest destiny” and “mission to civilize colonized people”. It was the Robber Barons of the time, the likes of Rockefeller, Morgan, Carnegie, Cooke, Shwab, Fisk, Harriman and their ilk who actually needed Imperialism and who were fastening it upon the shoulders of the government. They used the public resources of their country for their capitalist expansion (11). Imperialism, therefore, was adopted as a political policy and practice by the government which was controlled by the business elite. The Government and private corporations sought ways to maximize profits. Economic expansion demanded cheap labor, access to or control of markets to sell or buy products, and extraction of natural resources. They met these demands through plunder and tyrannical rule.
However, the imperialists experienced excess diseases and deaths among their troops, civil servants and traders. They had to do something about it. With the advent of the “Germ Theory” of disease, it was believed that these diseases and deaths were caused by infectious organisms. This belief led to the development of drugs and vaccines that the colonial powers wholeheartedly embraced. That was the beginning of Big Pharma. Initially the advances in medicine were introduced for the protection of colonial troops and civil servants, then for the local people working for the colonial power and eventually for the whole population. Improved health care was also included with the provision of hospitals and, as for the other measures, these were initially for the military, then for expatriates and finally for the local people (12). The pioneer pharmaceutical companies of that time and the financial elite clearly saw the huge profits to be made from vaccination and the provision of pharmaceuticals. Among the most cited justification for colonial rule is the introduction of “modern health care” to the subjugated people. Thus, health became an instrument of pacification of the oppressed and the people were made to believe that colonialism was good for them. However, the introduction of health care technologies like vaccines and drugs are really not out of altruistic intentions of the colonial power but more for the satisfaction of the imperialist’s plunderous desires. In fact, systematic public health regimes originated as military programs in support of imperialist expansion. Private charities entered the field as colonial conquests were consolidated. The colonizer was more concerned with maximizing the exploitation of imperialized labor and extraction of the natural resources of the conquered people.
Since then, the elimination or control of disease in tropical countries became a driving force for all colonial powers. In the colonized world, public health measures encouraged by Rockefeller’s International Health Commission yielded increases in profit extraction, as each worker could now be paid less per unit of work, “but with increased strength was able to work harder and longer and received more money in his pay envelope”. Rockefeller’s research programs promised greater scope for future US military adventures in the Global South, where occupying armies had often been hamstrung by tropical diseases (13). The Rockefeller programs did not concern themselves with workers’ physical productivity alone. They were also intended to reduce the cultural resistance of “backward” and “uncivilized” peoples to the domination of their lives and societies by industrial capitalism. The Rockefeller Foundation discovered that medicine was an almost irresistible force in the colonization of non-industrialized countries. During the US occupation of the Philippines, Rockefeller Foundation president George Vincent was quite frank in saying, “Dispensaries and physicians have of late been peacefully penetrating areas of the Philippine Islands and demonstrating the fact that for purposes of placating primitive and suspicious peoples medicine has some advantages over machine guns” (14).
Mass vaccination emerged as a major imperialist program, notwithstanding the erroneous, reductionist concept behind it and despite the utter lack of proper safety and efficacy studies. Vaccination was hailed as the savior of colonized people from infectious disease despite clear evidence of adverse effects worse than the original disease. Many of these forced mass vaccination campaigns resulted in disastrous results. For example, in the Philippines, prior to U.S. takeover in 1905, case mortality from smallpox was about 10%. In 1905, following the commencement of systematic vaccination enforced by the U.S. government, an epidemic occurred where the case mortality ranged from 25% to 50% in different parts of the islands. In 1918-1919 with over 95 percent of the population vaccinated, the worst epidemic in the Philippines’ history occurred resulting in a case mortality of 65 percent. The lowest percentage occurred in Mindanao, the least vaccinated place, owing to religious prejudices. Dr. V. de Jesus, Director of Health, stated that the 1918-1919 smallpox epidemic resulted in 60,855 deaths. In Japan, after compulsory vaccination was mandated, there were 171,611 smallpox cases with 47,919 deaths recorded between 1889 and 1908, a case mortality of 30 percent, exceeding the smallpox death rate of the pre-vaccination period. At about the same time, in Australia, one of the least-vaccinated countries in the world for smallpox, had only three smallpox cases in 15 years. In England and Wales, between 1934 and 1961, not one death from natural smallpox infection was recorded, and yet during this same period, 115 children under 5 years of age died as a result of the smallpox vaccination. The situation was just as bad in the USA where 300 children died from the complications of smallpox vaccine from 1948 to 1969. Yet during that same period there was not one reported case of smallpox in the country (15).
Similar disastrous results also happened with the polio vaccine. The majority of polio cases actually do not cause symptoms in those who are infected. Symptoms occur in only approximately 5 percent of infections (16) with a case fatality rate of only about 0.4%. Even during the peak epidemics, poliovirus infection resulting in long-term paralysis, was a low-incidence disease that was falsely represented as a rampant and violent paralytic disease by fund raising advertising campaigns to fast track development and approval and release of the Salk vaccine with Rockefeller as the key supporter. Because of outside pressure, the US licensing committee in charge of approving the vaccine did so after deliberating for only two hours without first having read the full research (17). This hasty approval led to the infamous “Cutter disaster”, the poliomyelitis epidemic that was initiated by the use of the Salk vaccine produced by Cutter vaccine company. In the end, at least 220,000 people were infected with live polio virus contained in the Cutter’s vaccine; 70,000 developed muscle weakness, 164 were severely paralyzed, 10 were killed. Seventy five percent of Cutter’s victims were paralyzed for the rest of their lives (18). When national immunization campaigns were initiated in the 1950s, the number of reported cases of polio following mass inoculations with the killed-virus vaccine was significantly greater than before mass inoculations and may have more than doubled in the U.S. as a whole (19). Wyeth was also found much later to have produced a paralyzing vaccine. All other manufacturers’ vaccines released in the 1950s were sold and injected into America’s children and millions of vaccines were also exported all around the world (17). The “eradication” of smallpox and the seemingly dramatic decline of polio cannot be largely attributed to the vaccines. There never was valid scientific study that supported the claim that the vaccines caused the decline of the disease. The combined effects of social and environmental determinants of what was poliomyelitis at that time were the most likely reasons for the decline. The polio vaccine was propelled more into widespread use by economic, political and personal interests of imperialists rather than by science and public health interests. It is well established scientifically that the decline in mortality rates of infectious diseases was due largely to socio-economic determinants (improved nutrition, hygiene and sanitation, etc.) and the strengthening of natural immunity. Medical intervention using vaccines and antibiotics was late in coming and whatever contribution it made in the overall decline of mortality over time was miniscule at best. In fact, there is a large body of scientific and narrative evidence that the vaccines cause various acute and chronic adverse effects and likely resulted in delaying the decline of infectious diseases to a relatively insignificant and naturally manageable health problem. Vaccination, an invasive and un-natural induction of immune response, which was largely inappropriate, did not really help but instead, created more problems, among which is the emergence of highly virulent strains of microorganisms. One un-anticipated potentially disastrous adverse effect of vaccination is the disruption of natural immunity among the people in communities. Nevertheless, despite overwhelming contrary scientific evidence, the overwhelming power of the ruling elite successfully implanted the entrenched belief that vaccination had eradicated smallpox and dramatically reduced deaths from polio and other infectious diseases. This widely held belief allowed the global ruling class to hide behind humanitarian posturing and mask their true agenda of global dominance and maximizing profits for Big Business.
After World War II, public health philanthropy became closely aligned with US foreign policy as neocolonialism thrust “development” on Third World nations. The major foundations collaborated with USAID and allied agencies in support of interventions aimed at increasing production of raw materials while creating new markets for Western manufactured goods. The concept of “global health governance” (GHG) arose in the early 1990s, reflecting US confidence that the fall of the Soviet Union would usher in a unipolar world dominated by American interests. This was a vision of diffuse, omnipresent power to be exercised collaboratively by the institutions of global capitalism and guaranteed, in the last resort, by the US military. The Alma Ata principles became moot as structural adjustment programs decimated Third World government investments in public health. Corporate globalization intensified with neoliberal imposition of liberalization, deregulation and privatization. The new global health governance regime systematically bypassed or compromised national health ministries via “public-private partnerships” and similar schemes. To soften the resistance against imperialist interventions in health, “emerging infections” were hyped as inevitable and potentially catastrophic and the global health governance scheme was framed within the larger discourse of “security” that arose in the wake of the dubious 9/11 event. Worldwide alarm about bioterrorism provided an opportunity to link together health and national/international security. Not only would health-care workers open the funds for a medical front in the War on Terror, but also military forces would routinely be mobilized as a response to health disasters. Imperial interventions in the health field began to be justified in the same terms as recent “humanitarian” military interventions. Some analysts denounced the militarization of public health as worryingly authoritarian and strategically counterproductive, but to Bill Gates, the world’s second richest man, it was a welcome development. Gates’ endorsement was especially significant because his foundation had become the leading exemplar of philanthropy in the era of global health governance (13).
The Bill & Melinda Gates Foundation (BMGF) is now by far the world’s largest private foundation; with more than $50 billion in assets. The bulk of its activities are directed at the people of the imperialized world, where its ostensible mission involves providing birth control and combatting infectious diseases. BMGF exercises power not only by means of its own spending but also through steering an elaborate network of “partner organizations” including nonprofits, government agencies, and private corporations. As the second largest donor to the UN’s World Health Organization (WHO), it is a dominant player in the formation of global health policy. It orchestrates elaborate public-private partnerships and is the chief funder and prime mover behind the Vaccine Alliance (formerly GAVI), a public-private partnership between the World Health Organization and the vaccine industry. The chief beneficiary of BMGF’s activities is not the people of the Global South but the Western pharmaceutical industry. The Gates Foundation’s ties with the pharmaceutical and vaccine making industry are intimate, complex, and long-standing. Soon after its founding, BMGF invested $205 million to purchase stakes in major pharmaceutical companies, including Merck & Co., Pfizer Inc., Johnson & Johnson, and GlaxoSmithKline. BMGF’s interventions are designed to create lucrative markets for surplus pharmaceutical products, especially vaccines (13, 20).
The vaccine producing companies belong to the largest interlocking corporations controlled directly or indirectly by a few highly secretive business and power elite who effectively rule the world and impose imperialist policies. Large corporations have become more and more interrelated through shared directors and common institutional investors. In 2004, A team of Swiss systems theorists, utilizing a database of 37 million companies and investors worldwide, studied the share ownerships linking over 43,000 transnational corporations. They found that a core 1,318 companies, representing 20 percent of global operating revenues, “appeared to collectively own through their shares the majority of the world’s large blue chip and manufacturing firms – the “real” economy – representing a further 60 per cent of global revenues”. When the team further untangled the web of ownership, it found much of it tracked back to a “super-entity” of 147 even more tightly knit companies – all of their ownership was held by other members of the super-entity – that controlled 40 per cent of the total wealth in the network. In effect, less than 1 per cent of the companies were able to control 40 per cent of the entire network. Most were financial institutions. The top 20 included Barclays Bank, JPMorgan Chase & Co, and The Goldman Sachs Group (21). These business elite is intimately linked to the Council of Foreign Relations (CFR). The CFR, founded in 1921, is a United States think tank specializing in U.S. foreign policy and international affairs. The CFR runs the Rockefeller Studies Program and convenes government officials, global business leaders and prominent members of the intelligence and foreign-policy community to discuss international issues and make recommendations to the presidential administration and the diplomatic community (22). Some critics and political analysts have called the Council for Foreign Relations the “Shadow Government” (US) that is pulling the strings behind the scene.
The Vaccination Trojan Horse of Imperialism in recent years has become much bigger with the growing power of Bill and Melinda Gates Foundation which is the main driver of global health policy. It is now the second biggest donor to WHO. With the USA as the biggest donor, US imperialism’s hold over WHO has become almost absolute. Bill Gates is the first private individual to keynote WHO’s general assembly of member countries. One delegate remarked: “He is treated liked a head of state, not only at the WHO, but also at the G20” (23). BMGF has been compared to “a massive, vertically integrated multinational corporation (MNC), controlling every step in a supply chain that reaches from its Seattle-based boardroom, through various stages of procurement, production, and distribution, to millions of nameless, impoverished ‘end-users’ in the villages of Africa and South Asia”. It has a functional monopoly in the field of public health. In the words of one NGO official: “You can’t cough, scratch your head or sneeze in health without coming to the Gates Foundation” (13).
With his unprecedented power, Bill Gates was able to initiate an elaborate neoliberal financing scheme for vaccines that inevitably transfers public funds to private coffers. Ostensibly, the scheme is designed to help developing countries to fund their vaccination programs but in reality, these countries are caught in a debt-trap. This so-called “innovative development financing” is a debt-based mechanism that taps capital markets to subsidize vaccine buyers and manufacturers through an intermediary, the International Finance Facility for Immunization (IFFIm). Gavi floats bonds which are secured by the promise of government donors to buy millions of doses of vaccines at a set price over periods as long as 20 years. Capitalists take a cut at every stage of the value chain while poor countries are supposed to benefit from access to vaccines that might not otherwise be affordable. Bondholders receive a tax-free guaranteed return on investment, suited to an era of ultra-low interest rates. Pharmaceutical firms, meanwhile, are able to peddle expensive vaccines at subsidized prices in a cash-poor but vast and risk-free market. By creating a predictable demand pull, IFFIm addresses a major constraint to immunization scale-up: the scarcity of stable, predictable, and coordinated cash flows for an extended period. (13,24). Recent BMGF/GAVI activities in Sri Lanka offer a virtual case study in what has been called “pharmaceutical colonialism.” GAVI targeted the country in 2002, offering to subsidize a high priced, patented pentavalent DtwP-hepB-Hib vaccine. In exchange for GAVI’s support, the country agreed to add the vaccine to its national immunization schedule. Within three months of the vaccine’s introduction, 24 adverse reactions including 4 deaths were reported, leading Sri Lanka to suspend use of the vaccine. Subsequently, 21 infants died from adverse reactions in India (13).
The real underlying cause of deaths in epidemics is the dysfunctional health care system brought about by chronic socio-economic underdevelopment characteristic of a semi-feudal and semi-colonial society victimized by imperialism, not the loss of vaccine confidence due to the “Dengvaxia scare”. Corporate hijacking of the health care system with the complicity of government, international institutions, mainstream medicine and various cohorts deprived the people of their right to health. Profit has become the primary driving factor in addressing a public health problem, not public welfare. Deregulation, privatization and liberalization, the hallmarks of corporate globalization, the new face of imperialism, have practically wiped-out whatever remaining affordable basic needs and social services, especially health services, are available to the majority of the population. Worse, under the guise of economic development, big business juggernaut in mining, plantations, coal, dams and other environmentally destructive and socially disruptive mega-projects have devastated community-empowering and truly sustainable, poverty alleviating, health promoting and climate resilient initiatives. The concomitant and worsening assaults (including extrajudicial killings) on fundamental human rights have subjected marginalized people to extreme physical, biological, psychological and social stress and have repeatedly been forced to be displaced from their land, homes, crops and other means of survival. Under these circumstances, infectious disease epidemics and other serious health problems are bound to arise and worsen. The root cause of epidemics in this country is imperialism. Liberation is the answer, not vaccination.
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* The author is a retired professor of the Department of Pharmacology and Toxicology at the College of Medicine, University of the Philippines-Manila