In June, Reuters reported on a previously undisclosed U.S. information campaign against China during the COVID-19 pandemic. From the spring of 2020 until the spring of 2021, the U.S. Department of Defense conducted covert operations through social media to sow mistrust about Chinese vaccines and other forms of health assistance among populations in Central Asia, Southeast Asia, and the Middle East. Reuters stated that the Defense Department acknowledged the operations.
Reuters included criticism of the U.S. clandestine use of disinformation to hurt a rival country during a killer pandemic. Aid and health-care workers in the Philippines expressed anger about the campaign. Daniel Lucey, an American infectious disease specialist, shared his dismay about the U.S. anti-China propaganda. New York Times columnist David Wallace-Wells argued that the justification for the campaign was "flimsy" and "pretty sick." Government officials and lawmakers in the Philippines have questioned the campaign, one Filipino senator condemning it as "evil, wicked, dangerous, unethical."
The U.S. information operation shines a harsh light on the ways in which today's international politics affect foreign policy thinking about global health. Reuters' reporting underscores how the competition for power, influence, and ideological advantage among nations drags health into the zero-sum vortex of geopolitics. That dynamic batters rhetoric about solidarity and equity as guiding principles in global health and raises hard questions about how countries can mitigate the damage that realpolitik inflicts on collective action against health threats.
The Information Campaign
According to Reuters, the U.S. military launched the information operations in the spring of 2020 in response to Chinese propaganda blaming the COVID-19 pandemic on the United States and China's "ambitious COVID assistance program" in Southeast Asia and beyond.
The U.S. military feared that the propaganda and assistance could draw the Philippines and other countries closer to China and enhance China's regional and global ambitions. The U.S. information operations used hundreds of fake social media accounts, including on Facebook, Instagram, and X.
The operations sought to highlight that COVID-19 began in China and to undermine confidence in the safety and quality of Chinese health products, including masks, personal protective equipment (PPE), and vaccines.
In Central Asia and the Middle East, the campaign stoked fears among Muslims by amplifying rumors that Chinese vaccines contained pork gelatin and, as a result, potentially contravened Islamic law.
Muddy Machinations
Reuters quoted a senior U.S. military official who observed that the information campaign had no "public health perspective" because its purpose was to "drag China through the mud." That objective arose from U.S. pre-pandemic fears about China's growing global influence, Chinese efforts to increase such influence by offering countries COVID-19 assistance, and China's own mud-slinging strategy that blamed the United States for the pandemic.
The rapidity with which a pandemic became a balance-of-power battleground, with disinformation weaponized by rivals, demonstrates how comprehensively geopolitical calculations can dominate foreign policy. Before COVID-19, the U.S. government had identified China's rise as a strategic threat and embraced stronger countermeasures, including covert information operations. Prior to the pandemic, the return of geopolitics in the 2010s contributed to global health's decreasing foreign policy importance. The coronavirus crisis saw the priority of strategic competition prevail over the imperative for collective action against a shared pathogenic danger.
The Gravity of Geopolitics
In its story, Reuters recounted opposition, based on geopolitical calculations, to the COVID-focused information operations against China from officials at the Department of State. Aware that U.S.-Philippine relations had deteriorated before COVID-19 emerged, U.S. diplomats warned that "stooping lower than the Chinese" through clandestine information operations could jeopardize "Washington's diminishing influence" in Manila and worsen a "withering partnership" already "hanging by a thread." State Department officials preferred a geopolitical do-no-harm approach in responding to China's disinformation and pandemic diplomacy.
Authorized by the White House and Congress to engage in secret information operations against rival nations without State Department approval, the Defense Department proceeded with the campaign. It interpreted the troubled U.S.-Philippines relationship as a "call to action" against China's exploitation of the pandemic to gain geopolitical leverage in Southeast Asia and elsewhere. The contrasting positions of the Defense and State Departments illustrate the powerful pull of geopolitical thinking in foreign policy, even amid a once-in-a-century pandemic.
The disagreements between military and diplomatic officials also expose that, in 2020, the United States could not compete with China's ability to provide masks, PPE, and other products or equipment (for example, ventilators) to COVID-affected countries. The United States itself depended on Chinese-centric supply chains for masks and PPE and had a domestic shortage of ventilators. The United States chose not to compete with China's promise to share its vaccines globally because the U.S. vaccine development program, Operation Warp Speed, was an "America First" endeavor.
During 2020, the United States proved unable and unwilling to mount a foreign policy response to a pathogenic and geopolitical event, leaving the U.S. government—as a senior U.S. military officer explained to Reuters—with little more than the option "to throw shade" on China. The political and diplomatic poverty underneath the clandestine information operations is astonishing, especially considering that the United States spent the prior 20 years touting its unrivaled global health leadership.
In those years, the United States provided health assistance to the Philippines through bilateral programs, such as the President's Emergency Plan for AIDS Relief (PEPFAR), and U.S.-supported initiatives, including the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund). Before 2020, the Global Fund had disbursed approximately $500 million to the Philippines. In 2020, PEPFAR announced new funding to help the Philippines address COVID-19's impact on HIV/AIDS programs.
Even so, the Defense and State Departments agreed that the U.S.-Philippine relationship was in dire condition and vulnerable to Chinese influence—a sobering lack of confidence about what decades of U.S. global health engagement mean in a geopolitical world.
Et tu, Biden?
Reuters reported that the Joe Biden administration ended the covert information campaign in the spring of 2021 and ordered a review, which found that poor tradecraft and inadequate oversight by military leaders characterized the campaign. The termination and review provide a way to interpret the campaign as an artifact of the Donald Trump administration's foreign policies on China and COVID-19. President Biden attempted to reassert U.S. global health leadership, but his foreign policy on global health also bears the imprint of geopolitics.
President Biden continued President Trump's hard line against China, including on the pandemic and the origin of the deadly coronavirus. As U.S.-developed vaccines became available, Biden did not abandon vaccine nationalism until the U.S. government had enough to vaccinate the U.S. population. Biden then engaged in vaccine diplomacy in sharing supplies in ways cognizant of geopolitical competition.
The new U.S. global health security strategy makes no claim that it will deliver geopolitical benefits
In rethinking U.S. foreign policy, Biden administration officials have acknowledged that decades of global health leadership did not provide geopolitical traction against Chinese and Russian efforts to increase their global influence.
The new U.S. global health security strategy makes no claim that it will deliver geopolitical benefits, sharpening questions about what the foreign policy benefits of the strategy are. In addition, the strategy noted that U.S. global health spending is not well aligned with U.S. health security objectives. The administration is also developing U.S. industrial policy on health to secure supply chains for health products and technologies and reduce U.S. dependence on rivals, especially China.
Between Domino Theory and Germ Theory
The Reuters story connected U.S. covert information operations against Chinese pandemic diplomacy with the "aggressive clandestine propaganda operations" that the United States and the Soviet Union conducted during the Cold War. A pandemic as deadly as COVID-19 never rattled U.S.-Soviet relations, but disease threats did not escape superpower competition.
In the 1980s, the Soviet Union began a disinformation campaign that pinned the emergence of HIV/AIDS in Africa on the United States. A 1987 assessment by the U.S. Central Intelligence Agency (CIA) of the HIV/AIDS pandemic in sub-Saharan Africa warned that Soviet disinformation, combined with reluctance by Western countries to increase health aid to Africa, could adversely affect U.S. influence in Africa. Given the dangers posed by Soviet disinformation, the assessment stressed the need for a "vigorous counter to such propaganda."
The Cold War ended two years after the CIA's assessment, leaving the HIV/AIDS pandemic to be managed in a world that was devoid of balance-of-power competition for two decades. But echoes of Soviet and U.S. behavior can be heard in American and Chinese actions during COVID-19. In both episodes, geopolitical considerations bent policy thinking on disease threats away from prioritizing science, epidemiology, and multilateralism in countering dangerous pathogens.
The similarities and differences between the Trump and Biden administrations demonstrate that U.S. foreign policy on global health has to navigate between the paranoia of geopolitical domino theory and the piety of apolitical germ theory. The United States is only a few years into reorienting its foreign policy on global health after COVID-19. But the controversies associated with the Reuters story show that it has not achieved meaningful consensus on the way forward.
