Crisis of legitimacy

Medico: As an observer of the far-right in your home country in Great Britain and in the US, too, do you see far-right ideas of health politics already translating in societies and in what way?

Sophie Harman: Far-right ideologies around health tend to be about anti-elite, anti-science, anti big pharma, big food, big tech. How that is embedding itself within societies? I think that was already there. And they are tapping into a concern that people already have. That's what's effective about it., In the US for example the Make America Healthy Again (MAHA) movement, is tapping in with certain mum-fluencers. They had some concerns about what they were feeding their children. They had some concerns about what elites were telling them to do or they felt ignored by those elites. In my country, in the UK, you can see this rhetoric around the abortion reform. Finally, the anti-vaccines rhetoric. It taps into some concerns people have around vaccines anyway. And that whole idea that no vaccine is 100 percent safe, really just goes to people's anxieties about their children and the health of the future. They think that governments and elites don't respond to their lives. 

Doesn't the libertarian ideology of the right, which is based on deregulation and individualism, contradict the rhetoric directed against the pharmaceutical industry?

If you look at some of the MAHA movement, it's actually about taking individual good choices, being individually responsible, optimizing your own body to be healthy. So the neoliberal individuals, which are responsible for their own body and their own welfare are actually still there. But also as a society, you're responsible for you and your family. So this kind of conservatism allies with traditional neoliberalism against governmental regulations: A Socialized medicine is in their eyes not the answer because it becomes captured by elite forces telling us what to do. But I also think this is the core of where the MAHA movement falls apart. What we will see in the US midterms coming up next year, some of the MAHA movement telling the government, well, hang on a second, you haven't really clamped down as much as you said you would. So that's when Trump comes out with his nonsense about paracetamol when you're pregnant or regulating pharmaceutical companies from abroad, that kind of thing. So there are tensions and contradictions.

You write in your Book that the control of women's bodies and the fact that women's health is exploited is at the core of power relations in societies. Have the struggles around sexual and reproductive rights gained momentum with the rise of the global far-right movement?

Firstly, I just really want to be clear that the science and evidence around sexual and reproductive health particularly around abortion is not contested. It is clear that comprehensive sex education comprehensive sexual reproductive health rights do save lives. So it’s a solely political contestation. What we are seeing now has been building since the 1970s. At that time more progressive international regulations came in to protect and advance sexual and reproductive health rights as well as domestic changes such as the passing of “Roe v Wade” in the United States. This has prompted some forces that were anti-abortion or anti-comprehensive sexual and reproductive rights to take action globally. The idea behind it was: We've lost the argument domestically so we're going to start to think about how we influence this in other countries to then sort of boomerang back to our own countries. So these issues never went away they were always contested, particularly in the global south in aid dependent countries. There you saw this sort of tension emerging and so this is where you start to see the kind of Here a global phenomenon started to emerge, which is now swinging back to the US and increasingly also to parts of Europe. What's particularly notable about this current moment is how the global far right on sexual and reproductive health has adopted progressive language. When you look at their arguments they tend to appeal to a decolonial idea, to traditional values in certain countries in the global south by saying that it is about protecting the sovereignty of these countries. The far-right movement has filled a space that a lot of parts of more progressive global health movements have not been able to deal with. Most European countries have colonial histories and as part of that colonial project predominantly women of color were subjected to testing and experimentation. There's never been an apology for that. In the US you see the same with forced sterilization practices as well particularly of African American communities. Because those haven't been fully reckoned with situations arise in which the slogans of the extreme right find resonance: “Resist these international actors who are trying to forcely sterilize your women.” You can say well yes because that did happen and they haven't acknowledged it. Global health institutions themselves are very quiet about it. Because of this you can see this kind of hesitancy arising around international involvement in sexual and reproductive health. You can also see it in vaccine hesitancy as well, where the same pattern appears and I think the global far right has been very good at capturing that and using it to their own ends. Progressive global health groups have not been able to talk about eugenics in former colonies. You would never even hear about that in the world health summit. A lot of the time we think about what the global far right is breaking within terms of global health but we need to focus more on what they are building and when it comes to sexual reproductive health this is a core part of their foreign policy.

How does the far rights policy affect global health multilateralism in the global south?

It’s not just about cutting funding or ending membership of WHO, but it's also who's the next Director General of the WHO going to be? They want someone who represents the interests of the global right. Just as Robert Kennedy is undermining the system from within as US Secretary of Health, similar attempts are being made globally. This is resonating with a real crisis of legitimacy in global health. The Gates foundation is a really good example. If you think about all the conspiracy theories about Bill Gates and vaccines. But at the same time, the Gates Foundation, one of the biggest funders of global health around the world, is not accountable to anyone. You can see all of this backlash coming from real questions of legitimacy.

At the same time with the lack of public funding private actors and also philanthropic entities like the Bill Gates foundation are becoming even more important to fill the gap and not just on a global level but also nationally. Is the private sector eventually not only in terms of ideology but also materially one of the winners of this development? 

We already see an increase in philanthropic contributions, at the Gates foundation and also in the announcement of Melinda French Gates to invest about 100 million pound in women's health. In the past states have been very keen on public private partnerships. The principle is well known, the public taking on all the liabilities putting all the money in and actually the investment from companies wasn't really there. What's going to be really interesting is how key philanthropists navigate their relationships with states now and whether they are going to be more outspoken on some of these political issues.

The Interview was conducted by Felix Litschauer und Andreas Wulf

Transcription and Translation: Laura Höh