Confronting Public Health Imperialism: A Transnational Feminist Analysis of Critical Nurse Responses to the National Smallpox Vaccination Program of 2002

Small acts of resistance: gender and imperialism

The juggernaut of US empire known as the "War on Terror" is by now a familiar, ubiquitous part of the twenty-first century. Less familiar to most is one of its early missteps, namely, the National Smallpox Vaccination Program (NSVP), a biodefense program that the Bush Administration devised to protect the US from a bioterror attack. From late 2002 to mid-2003, the federal government, arguing that a potential attack might occur from the likes of Al Qaeda or Iraq, attempted to recruit the health care field into a preemptive vaccination program against smallpox. Nurses were among the prominent occupational categories targeted, and more important, among the leading groups who challenged the program on the grounds of its health risks and role in the Iraq war. In this article I chronicle the multilayered intervention that US nurses made in the NSVP, specifically their reworking of hegemonic scientific and national security discourses.

Nurse intervention into the NSVP is significant for two reasons. First, nurses reclaimed their centrality as decision makers in the NSVP, a prominent public health campaign that, as I show, exploited their labor and marginalized their medical expertise. Feminist scholars have analyzed nursing as a feminized labor domain long beset with the historical character of "women's work"—for example, low wages and devalued expertise.¹ I demonstrate that nurses' defiance of the NSVP contributes significantly to a legacy of resistance to these conditions. Second, nurses challenged the NSVP based on its connection to the US program of aggression in Iraq and the War on Terror during a period of extreme "patriotism," when it was difficult to wage criticism of the US national security apparatus. Remarkably, US nurses linked their struggles for better safety and protections to a broader critique of US imperialism. In doing so, I argue, they enacted a model of transnational feminist praxis wherein women in global north and imperial nations hold their governments accountable for perpetrating oppressive practices of imperialism and other forms of structural violence against less powerful nations in the global south.

Transnational feminist theory builds on the intersectional analysis forwarded by feminist theorists such as Kimberle Crenshaw² and Patricia Hill Collins,³ who analyze women's struggles through a gendered lens that considers how race, class, nation, and other socio-structural positions determine gender relations and social power. Transnational feminist theorists focus on the intersection between gender and nation, noting that women across the globe are not only connected by their commonalities but also severely divided, particularly along the axis of colonialism and imperialism. They have noted that many feminist movements in imperial countries have been insufficiently critical of their government's expansionist foreign policy and imperialist practices globally, at times even joining forces to further them. Transnational feminist scholars have criticized the US-based Feminist Majority Foundation, for instance, for aligning itself with the US government's war on Afghanistan and its paternalistic rescue mission to save Afghani women, in the process marginalizing Afghani feminists' work and leadership.⁴

Transnational feminist theorists espouse that women in imperial nations should attend to their complicity in the actions of their governments. In the context of the most recent bouts of US imperialism targeting Afghanistan and Iraq, transnational feminist scholars such as Chandra Mohanty have challenged global north feminists to be self-reflexive about their political praxis (politically informed theory and action):

What role have US feminists who supported the Bush administration's war in the name of "rescuing" Afghan and Iraqi women played in [the] narrative of empire and imperialism? This is one of the questions we need to pose to address the politics of complicity and dissent within contemporary feminist projects.⁵

In addition to calling for feminists in imperial and global north nations to reexamine their role in US imperial violence, she also highlights US imperialism as a key site for transnational feminist engagement:

The militarized US State and its imperial projects are thus a crucial site of feminist struggle both in terms of the violence...