Global health community condemns CIA vaccine plot in Pakistan

Monday, 18 July 2011 13:22

Written by Kaiser Family Foundation

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[Updated August 16] After the Guardian broke the story that the CIA organized a vaccination program in Pakistan in an effort to confirm the location of Osama bin Laden and obtain DNA from his family members, several writers and health experts reacted to the situation, noting the possible implications for future health efforts.

"Spying is a messy business that necessarily involves deceit, and U.S. intelligence operatives need latitude to do their work. In this case, however, the planners and approvers of the CIA [vaccine] operation didn't appropriately calculate the possible consequences of their actions on an agenda that is as important to the world as fighting al-Qaeda," a Bloomberg editorial states. "Eradication of smallpox saves the world more than $1 billion a year, according to the WHO. If polio transmission can be stopped by 2015, the net benefit from reduced treatment costs and gains in productivity will be $40 billion to $50 billion, according to a recent study," the editorial notes, highlighting other benefits of eradicating the disease. "These are goals worth investing in, and the U.S. government has done just that. Its share of the $9 billion in contributions and pledges to the polio eradication effort through 2012 is $2 billion. That investment needs to be protected. Future U.S. intelligence schemes should take it into account," the editorial concludes (July 28).

"Before the betrayal devolves into a public health crisis, President Obama and leaders in Congress should acknowledge the damage to global health efforts and commit to repairing the trust. They should begin where the need is most urgent: Pakistan. They should make clear to regional leaders that despite cuts in foreign aid and U.S. support for the Pakistani military, Americans will not walk away from their region's poor, their needy children, or commitments to stopping the spread of deadly diseases," Orin Levine, executive director of the International Vaccine Access Center, and Laurie Garrett, author and senior fellow for global health at the Council on Foreign Relations, write in a Washington Post opinion piece (July 15).

"The incoming C.I.A. director, David Petraeus, ought to impose clear restrictions and prohibitions on medically oriented spy tactics so that the integrity and humanitarian purpose of U.S. health aid are affirmed and that current and future health aid operations will not be misused," Jack Chow, a former U.S. global AIDS ambassador and assistant director-general of the WHO, writes in a New York Times opinion piece. Chow also recommends that Congress "investigate the Pakistan operation and determine whether agency leaders weighed broader policy sensitivities or the ethical implications of using a medical based tactic to gain intelligence." He concludes, "However critical it was to target Bin Laden, the covert use of a legitimate health program threatens to make U.S. health and development aid an unintended casualty in the fight against terrorism. With millions of lives being supported with U.S. aid, it is vital that medical assistance to the needy continue without political hindrance and without cause for impugning American humanitarian motives" (July 26).

"The revelation will likely feed conspiracy theorists and set back a range of humanitarian operations. But that's just part of the problem. Talk of the phony vaccination drive could also strengthen terrorist networks that use public health initiatives as a way to gain the trust of local communities," Daniil Davydoff and Scott Rosenstein, members of Eurasia Group's global health practice, write in Foreign Policy's "The Call" blog (July 15).

"The revelation that the CIA used a covert vaccination program to attempt to obtain DNA from the bin Laden compound in Pakistan could have a profound impact on NGOs, vaccination drives and indeed on global healthcare policies. It politicizes medical aid and will fuel anti-vaccination conspiracy theories, which risk rolling back the successes in programs such as the multibillion-dollar polio eradication initiative," Andrew Chambers, a former aid worker, writes in the Guardian (July 13).

"It's clear that there should be a deeper investigation into the U.S. government's decision to set up the fake vaccination program in Abbottabad. Criticism is well warranted, and there is no shortage of that right now. But that's not the interesting part of the story; governments routinely use sneaky tactics to achieve their goals. To me, the interesting story is this: Everyone in the world knows how much health-care matters. Seriously, even evil terrorist masterminds know it's important to vaccinate their kids. Just think what we can do with that, if we use it the right way," global health consultant Alanna Shaikh writes in a Foreign Policy opinion piece (July 13).

The Guardian's Sarah Boseley writes on her "Global Health Blog": "I'm hoping the Abbottabad ruse will not have such widespread and dire consequences. There has been no suggestion that the vaccine was anything other than the real one for hepatitis B and the key figure in the plot was a senior Pakistani medical doctor, who is now paying for his duplicity at the hands of the Pakistani security services. I'm hoping it will be seen for what it was – a black day for medical ethics and a one-off crazy scheme to locate bin Laden, which failed" (July 13).

Health writer Maryn McKenna writes on her Wired "Superbug" blog: "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" (July 13).

"Vaccine program workers, who sometimes struggle to gain public trust and governmental cooperation in the first place, are furious about the deception" of the CIA in establishing a vaccination program in Pakistan in an attempt to gather DNA from Osama bin Laden's family, ScienceInsider reports. "Aid workers also say that news of the vaccination plot may undermine their ability to work with the public and with developing world governments," the news service writes (Reardon, July 13).

"This fear is especially pronounced because of the rising problem of polio. Pakistan was the only country to record an increase in cases of the crippling disease last year and now has the highest incidence of polio in the world," the Associated Press reports (Abbot/Apuzzo, July 13).

"Neither the White House nor the CIA would speak about the program. A senior U.S. official, speaking on condition of anonymity because the program remains secret, said the decision to use vaccinations as a cover was a rare move that reflected the seriousness of the hunt for bin Laden," according to the Associated Press/NPR (July 13).

On the "Global Health Policy" blog, Charles Kenny, a senior fellow at the Center for Global Development, points out that Pakistan "is in the midst of another polio outbreak, battling to stamp out the disease by next year as a vital part of the global eradication program" (July 12).

"I am glad we got bin Laden. But doesn't the CIA have enough credibility problems? Was adding to the frenzied fear of conspiracy, not to mention the doubts people have about their leaders or the burdens of physicians who spend endless hours trying to convince reluctant parents to vaccinate their children, genuinely necessary here?" writer Michael Specter writes on the New Yorker's "News Desk" blog (July 12).

"I think this is a horrible move with potentially dangerous consequences," author Seth Mnookin writes on the PLoS blog, "The Panic Virus." He adds: "We've already seen polio eradication efforts hindered by rumors that the polio vaccine is being used by Western imperialists to sterilize Muslims. Now, anti-vaccine activists have been given a legitimate reason to question the motives behind grass-roots vaccination campaigns" (July 12).

"What is most concerning to me about this ruse is the wider context in which this operation was conducted. Yes, I am glad that bin Laden is no longer of this earth, but I wonder how many parents in Pakistan will now refuse to get their children vaccinated – particularly against polio?" Managing Editor Mark Goldberg writes on "U.N. Dispatch" (July 12).

"The phony vaccination program is a grim reminder of the complexity of international relations as well as the interrelatedness of the world. The local doctor leading the program, Dr. Shakil Afridi, 'used a team of nurses and other health workers to administer hepatitis B vaccinations throughout Abbottabad.' He since has been imprisoned by the Pakistanis for his complicity with the American ruse," Kent Sepkowitz, an infectious disease specialist, writes in the Daily Beast. "Yet one could argue that our attention has been focused on the wrong enemy: in the year 2000, 620,000 people died of complications related to hepatitis B, something Dr. Afridi's vaccinations (were they real) could have prevented. Hepatitis B – now that is a real evil-doer" (July 12).

Reporter Tom Paulson also rounds up some commentary on the situation on KPLU's "Humanosphere" blog (July 12).

Source: Drawn from a number of articles from the Kaiser Daily Global Health Policy Report.