The term "smart power" was new to me when I encountered it recently in a British Medical Journal blog as part of the new-speak vocabulary of J Stephen Morrison 'senior vice president at the Center for Strategic and International Studies and director of its Global Health Policy Center". Morrison's article is interesting both because it discloses explicitly how 9/11 was made an opportunity to draw health into the global security agenda of the United States while failing to understand how such a move might result in the shattering of "consensus" and the post war "Western post-war liberal order": "smart power" even if it is smart is not "liberal" and will not lead to consensus. But it also spells out that the global vaccine program has become a covert instrument of US power. If Morrison by any chance laments the passing of the centre-left government in Italy, then perhaps the White House putting Italy and its health minister, Beatrice Lorenzin, in charge of global vaccine strategy was an error.
Morrison thinks it is a paradox but it is scarcely so if a government is seen to pursue coercive health measures over its citizens at the behest of a foreign power - even those who favor vaccination could be concerned at the state's new found powers over their bodies (which might also be indefinitely extended). If that was not so smart a political move perhaps the technology is not so smart either - as I remarked to Steven Salzberg a few years ago: "The unwelcome news is that the “cruise missiles and drone helicopters” of the war on disease often hit the wrong target, and the more cruise missiles and drone helicopters you unleash the greater the risk".
Frankly, no one knows what they are going to be injected with next. Smart bombs become too easily the agents of international chaos and mistrust: just so the smart bombs of the war on disease, both for what they can do to your body and what they can do the political landscape, including destabilizing friendly governments. “Smart power” is also duplicitous: Italy is just the surrogate of the US. Why could the citizens of the world not have it directly from the mouth of Obama saying in effect your bodies are not your own and we inject into them what we like?
To make measles a key issue in global security is an unforgivable distortion of policy. It really is not clear why we are at more risk from disease now (apart from by the sinister development of viral technology) than at any time since the end of the Second World War, we are simply being gripped by a new manipulative rhetoric. Nor could we be further from the consensus that gave rise to the Nuremberg Code 70 years ago. Everything we have learnt has been stood on its head.
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Below is a letter I recently wrote to British Medical Journal (unfortunately not so far published):
"Smart power": reasons for disaffection in Italy, and the destruction of the post-war liberal order and consensus
Owen Dyer presents a rather incomplete background to recent political events in Italy . The is is not to say that I have any insight into what Giulia Grillo - the Italian Health Minister - intends, but there are some gaps in the narrative regarding the defeat earlier this year of the governing centre-left coalition, in which Grillo's predecessor - Beatrice Lorenzin - was a key player over several years. This is to say that there are reasons for discontent which apart from anything else fall well short of outright rejection of vaccination.
In the first place we seldom if ever hear mention in mainstream reports of the appointment of Lorenzin, and Italy, to head global vaccine strategy by the Obama administration in September 2014. An Italian government press release states :
"Washington, 29 September 2014 - Italy will lead vaccination strategies and campaigns in the world over the next five years. This was decided by the Global Health Security Agenda (GHSA) held last Friday at the White House. Our country, represented by the Minister of Health Beatrice Lorenzin, accompanied by the President of the Italian Medicines Agency (AIFA) prof. Sergio Pecorelli, has been commissioned by the Summit of 40 Countries, at which also spoke US President Barack Obama...."
Equally, demonstrators against mandated vaccinations in Summer 2017 will likely have been aware of the statement by GSK's Italian administrator - Daniele Finocchiaro in 2015 :
"Recently I accompanied our global CEO, Andrew Witty, to Matteo Renzi. The premier told us clearly that he considers - and rightly so - the pharmaceutical sector as strategic for Italy. Further, he said that the pharmaceutical is precisely the future of our country ... I then met also Minister Lorenzin and other members of the government who reiterated the sensitivity of the government to those who invest, create jobs and opportunities for young people. So we started on the right foot. To find such sensitivity in Roman palaces is not to be discounted. As for us, Andrew Witty asked few things: certain rules and stability in the face of very strong investments in advanced research and production equipment. We understood each other."
Citizens may also have been sceptical of Lorenzin's claim that 270 children had died in a recent outbreak of measles in London [3,4], and they may have wondered why ten vaccines had to be mandated to protect against one disease.
It is interesting in this light to view the complaint of J Stephen Morrison (senior vice president at the Center for Strategic and International Studies and director of its Global Health Policy Center) in BMJ Opinion that post-war consensus has broken down :
"Global health is a product of the Western postwar liberal international order—an order that is today besieged, says Stephen Morrison"
"In the past two decades, we have witnessed an expansion of investments into global health that have been rooted in humanitarianism, the rule of law, and democracy. Underlying this action have been the principles of multilateralism, alliances, and partnerships. It has been consistently argued that investments outside home borders will not only save and improve lives but also promote economic growth and the stability of communities.
"In surprising and unforeseen ways, global health also benefited enormously from the post 9/11 counter terror doctrine that came to dominate the security strategies of the major Western powers. That doctrine aggressively advanced the argument that uncontrolled infectious diseases pose major transnational threats. It put a spotlight on smaller countries beset by weaker governance and fragile infrastructure, where grave health challenges can fuel armed, internal violence. Counter terror gave rise to the belief that focused investments—“smart power”—would achieve concrete results in improving lives while also winning hearts and minds in a global struggle."
But there is a paradox here that "smart power" is necessarily what everyone wants, or that the consensus is any longer "liberal". The Italian people were in effect being told that they must cede rights over their bodies and those of their children to the state because of the demands of global security strategy (starting apparently in the White House). Even if they accepted ten vaccines where would this end in principle? Could it be that the global strategists are themselves smashing the consensus, by arrogating extraordinary rights over ordinary people? Morrison assumes this is a benefit of 9/11, but if so it was not one that the citizens of the world were consulted about, it was something which happened within US and global hierarchies and we were all just supposed to do as we were told.
 Owen Dyer, 'Italy’s health minister fires country’s top health board', BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k5158 (Published 05 December 2018)
 John Stone, 'Re: MEPs devise strategy to tackle vaccine hesitancy among public -Echoes of WMD', 26 March 2018, https://www.bmj.com/content/360/bmj.k1378/rr
 John Stone, 'Re: Too many vaccine mandates subvert measles vaccine update', 24 August 2018, https://www.bmj.com/content/362/bmj.k3596/rr-6
 John Stone, 'Re: Compulsory vaccination and growing measles threat - Prof Melegaro's response', 21 October 2017, https://www.bmj.com/content/358/bmj.j3429/rr-7
 J Stephen Morrison, 'Global health disruptors: Decay of the postwar multilateral Western order', BMJ Opinion 29 November 2018, https://blogs.bmj.com/bmj/2018/11/29/stephen-morrison-decay-of-the-postwar-multilateral-western-order/
John Stone is UK and European editor of Age of Autism