A new kind of biological warfare may be emerging. Terrorists are increasingly exploiting vulnerabilities in our global vaccine systems and denying vaccines for preventable diseases. This terrorism-disease nexus has the potential to not only be a humanitarian crisis in places rife with radicalization, but also serve as a potential source for radicalization to gain a stronger foothold in new recruits.
It’s time to take this formidable challenge seriously. This is not just a potential public health emergency; this is potentially a threat to global security.
Currently, in violent extremist-occupied areas in Afghanistan, Nigeria, Pakistan and Somalia, fatwas supporting vaccine bans have been instituted. Suspected bans also exist in parts of Iraq, Syria, Yemen, Equatorial Guinea, Cameroon and Ethiopia. In effect, violent extremists are using biological warfare against their own people. In some cases radicals have even suggested that children who die or become paralyzed from vaccine bans are to achieve the status of martyrs.
If this practice continues it could pose a huge security challenge. By withholding vaccines from their own people violent extremists claim a rationale for further recruitment both in local populations and overseas, and the possibility of introducing the risk of transmission into populations by reducing herd immunity or population health resilience. While the second outcome may or may not be an articulated tactic of violent extremists such as al-Qaeda, al-Shabaab, Tehrik-i-Taliban, and Boko Haram, the impact poses a very tangible and trans-boundary security threat. The confluence of a humanitarian crisis, public health emergency, and cross-border conflict pose a looming security disaster.
Vaccine bans appeared in extremist circles following the CIA-led plan to use a polio eradication health care worker in Pakistan as an extension of the American national security apparatus when trying to get closer to Osama bin Laden. The result was a popular uprising against vaccinations, resulting in withholding polio inoculation and likely additional vaccines, such as Measles, Mumps, and Rubella, or MMR, and declining population health and resilience, and not only in countries where the bans are enforced.
Fatwas against vaccines pose a potential security threat, and here is why: A vicious recruitment cycle is created. The West is perceived to be duplicitous and looking to murder Muslim children thru the guise of immunization and drone attacks, and this assignation provides fodder for extremists to rationalize allowing their children to die. Despite the logic flaw, the effects are real.
Further complications have arisen from persistent conflict zones, e.g., Syria. Access to these areas rendered destabilized has also contributed to a spike in new cases due to immunization schedule disruption or inaccessibility. For Europe, not only do European passport-holding jihadists returning from battle pose a threat, but refugees seeking asylum or immigrants may be bringing infected children with them. While previously, this had not been a concern for a Polio-free and Measles, Mumps, and Rubella-eliminated Europe, recent unfounded reticence and faulty logic blaming the effective MMR for autism have drastically reduced the number of families choosing to inoculate their children. Consequently, transmission and reintroduction of these diseases into the European population is a real possibility. Furthermore, since the EU does not have mandatory vaccination requirements, the migrational patterns, particularly in Schengen countries, could prove to be “transmission highways.”
With respect to measles in the United States, previous smaller outbreaks and the recent, large Disneyland outbreak have been attributed to either unvaccinated Americans returning from foreign travel or from foreign visitors. In the U.S., however, this outbreak was significantly affected by ignorance and political extremism of a small but vocal part of the population refusing to have their children vaccinated. Should deference continue to be given to political expediency over evidence-based public health systems the result could be that the U.S. is making itself more vulnerable to crude and unsophisticated attacks through intentional weakening of our public health system and herd immunity, all under the guise of personal choice and freedom.
Innocent travelers, however, also can be the source of disease outbreaks in supposedly immune populations, posing another potential problem: the possibility that non-radicalized immigrants may be blamed as being human disease vectors. Persons who may have been exposed and can be carriers or transmitters of a contagious disease should not be viewed as disease terrorists. During the Black Death or plague epidemic of the 13th and 14th centuries the charges leveled against European Jews as poisoners of Christian wells fomented anti-Semitic violence not to be seen on the same scale again until the 20th Century under Hitler’s Third Reich. In some areas, Arabs—Christians and Muslims—were also bestowed the dubious honor of being labeled as harbingers of doom. Just a few short months ago the same was occurring here in the U.S. over Ebola where, through ignorance and political cynicism the public’s health was put in jeopardy by leaders who trumpeted for quarantine and isolation of people who never posed a threat. The result was not only the loss of civil liberties, but actual death threats.
Violent extremists, in addition to intentionally denying their populations access to vaccines for preventable diseases, have also gone so far as to kill teams of health care workers dedicated to promoting community health. This violence has also been witnessed during the early days of the Ebola epidemic in West Africa.
While one suicide bomber can kill dozens, or even hundreds, of people, and 19 suicide attackers killed more than 3,000 in the 9/11 attacks, should public health and vaccine programs become ineffective due to denial, ignorance or degradation millions may die. Those that live may suffer chronic illnesses, disability and infertility. Attempting to weaken the resolve of “the West” and other alleged “apostates” through the use of such asymmetric tactics, must not be allowed to continue.
So, what is needed to identify opportunities for mitigating the impact of vaccination bans and long-lasting negative public health effects administered in geopolitical settings with a high-prevalence of radicalization and violent extremism? In working towards identifying strategies whereby trust and confidence in the public health system can be repaired, the hope is to counter radicalized or extremist narratives. Who should lead the effort is open for debate. Imams, expatriate Muslim communities and Islamic leadership may be instrumental in identifying strategies to overturn such an asymmetric risk to global public health. But public health and international security have never had an easy alliance. To effectively combat this threat, however, these two communities must begin to work together and cooperate against a common foe, led by the U.S., Europe and other countries plagued by extremist ideologies.
Public health must be recognized and respected as a full partner at the table of international security and become part of, not a minor side issue to, our counter-radicalization and counter-terrorism strategies.