Humanosphere

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New Action Thriller: From UNICEF with Love?

Now that the CIA has acknowledged running a deceptive, if not totally fake, vaccination program in Pakistan as part of the effort months ago to hunt down Osama bin Laden, here are three reasons why this episode is prompting an angry response by those who work against global poverty and disease:

1. This isn’t just about vaccines — about fighting terrorism vs fighting polio.
2. Health workers and aid workers overseas have to be seen as neutral and independent if they are to operate effectively and safely.
3. National security isn’t achieved just by hunting and killing bad guys. It’s also achieved through humanitarian efforts, aid efforts and other forms of international collaboration based on mutual trust.

So let’s review where we are so far with the strange case of “The Immunizer of Abbottabad.”

After The Guardian on Monday first revealed this bizarre scheme aimed at collecting DNA from bin Laden family members, the CIA apparently has confirmed to the Washington Post that it did set up the vaccination program in northern Pakistan. Here’s what some anonymous official reportedly told the newspaper:

A senior U.S. official said the vaccine campaign was conducted by medical professionals and should not be construed as a “fake public health effort.”

“People need to put this into some perspective,” said the official, speaking on condition of anonymity because of the sensitivity of the issue. “The vaccination campaign was part of the hunt for the world’s top terrorist, and nothing else.”

“If the United States hadn’t shown this kind of creativity, people would be scratching their heads asking why it hadn’t used all tools at its disposal to find bin Laden.”

Actually, many seem to be scratching their heads asking how the Central Intelligence Agency (given its middle name) came up with such a far-fetched scheme — it doesn’t appear to have worked — and how it can argue with a straight face that this was, in addition to a covert op, a legitimate vaccination program.

To begin with, just giving kids a real Hepatitis B vaccine doesn’t mean it’s not fake public health.

A number of reports have said the children in Abbottabad did not receive the full course of vaccination (three doses) against the disease. Since it was a covert operation, and the Pakistani doctor recruited by the CIA has been arrested for cooperating with the spy agency, there is no reliable documentation on the immunizations.

As Alanna Shaikh says in her article for Foreign Policy A Shot in the Back:

First off, hepatitis B is a real worry in Pakistan, and one dose in a three-dose series will only provide a tiny amount of protection to those children. There’s almost no chance now that these kids will even finish the vaccination series — and many, many thousands more will likely steer clear of future programs of this sort, no matter how legitimate.

So, based on what we know, it was indeed a fake immunization program since the goal appears not to have been to make these kids immune to this infectious disease that causes a lot of liver failure, cancer and other problems in poor countries (or anywhere, for that matter).

After perhaps a few days representing stunned silence, or waiting for the story to be confirmed, many leading organizations or individuals within the global health and aid community are beginning to react and speak out.

The primary concerns expressed are that this episode will make it harder to get kids immunized, especially in the difficult fight to wipe out polio in Pakistan.

Sarah Boseley of The Guardian writes, in Collateral Damage from the hunt for Bin Laden about what happened years ago in northern Nigeria and how mistrust of the vaccine there caused polio to explode:

In that northern, Muslim region of Nigeria, there was a dramatic loss of confidence in the polio vaccine after rumours spread that it was part of a plot by the US to make Islamic children infertile. It took a huge effort to rebuild trust, aided by senior Muslim clerics and scholars who visited Kano to reassure people that the vaccine was entirely benign.

Similarly, Maryn McKenna in Wired warns that the CIA ruse could actually do more than just cause harm in Pakistan. The rumors in Nigeria were false, McKenna notes, while what the CIA has now admitted doing is material evidence for the conspiracy theorists and anti-vaccine crowd:

The accusations that polio vaccination was a Potemkin cover for anti-Islamic activities almost ruined the international eradication of polio when they were false. Now, on the basis of the CIA’s alleged appalling ruse in Pakistan, they may be made again. And they will be much more believable, because this time they might be true.

With the perhaps unintentionally humorous headline, Fact Check: Vaccination not a CIA front usually, this AP article notes that the Obama Administration in 2009 actually had to reassure three Muslim nations that immunization was not a CIA plot in order to gain acceptance for our foreign aid programs pushing against polio and other infectious diseases.

But the move directly contradicts the administration’s own message to the Muslim world. And health experts say maintaining confidence in vaccination drives is far more important than even the hunt for bin Laden…. The expanded polio vaccination effort was seen as a key to success for the Obama administration’s Global Engagement Directorate, which is run out of the National Security Council.

As I wrote earlier, it will be difficult to assess just how much this CIA escapade damages immunization programs worldwide, or global health projects in general. There’s no simple way to diagnose and track mistrust. But many, like Doctors Without Borders, predict mistrust will increase and humanitarian efforts — if not the humanitarians themselves, as suspected spies — will suffer.

And many others, like James Fallows in The Atlantic, predict the potential damage could reverberate well beyond the global health or vaccination arena:

Around the world this will touch the very deepest sources of mistrust, fear, and hatred of the big, technological United States. We will (in this narrative) lie to people about basic questions of family health; we will prey on parents’ concern for their children to lure them into situations where we can take samples of their tissues and fluids; we will say one thing and do another — under white medical-technician jackets and a humanitarian guise. We will suggest that no aspect of our international presence is immune to penetration by spies.

The global health and aid community is beginning to speak out, largely to condemn this CIA project as ill-conceived and potentially damaging to immunization and international health efforts. Some see it, like Fallows, as having much broader, destabilizing consequences.

So far as I can tell, we have yet to hear from many in Congress or anyone in the Obama Administration, which frequently says it sees foreign aid and specifically these kind of global health efforts as critical to our national interest, on this episode.

Was this an acceptable compromise — of the integrity and independence of public health, not to mention the personal safety of aid workers — or a terrible mistake with many unforeseen consequences to come?