Humanosphere

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One of the chronic problems the international community has with almost every disease-fighting campaign has been the need to overcome mistrust — mistrust of government, of foreign health workers or outsider do-gooders in general.

This is, for a variety of reasons, especially true of vaccines.

So many worry that such global health efforts will suffer from the revelation, reported first in The Guardian and later by the New York Times and others, that the Central Intelligence Agency (CIA) set up a fake vaccination program in Pakistan in order to collect DNA samples. Says The Guardian:

The CIA organised a fake vaccination program in the town where it believed Osama bin Laden was hiding in an elaborate attempt to obtain DNA from the fugitive al-Qaida leader’s family, a Guardian investigation has found.

The CIA has refused to confirm or deny these reports.

Most of the media reports tend to focus on issues of terrorism, foreign policy and the increasingly strained relationship between the U.S. and Pakistan. There was little attention, initially anyway, given to the possibility that this CIA ruse could also seriously undermine a key tool in the worldwide battle against disease.

As anyone who has worked in the field in a foreign country on a vaccination campaign or other such project will tell you, establishing and maintaining trust is critical to success in public health.

Pakistan is one of those corners of the world where polio continues to spread. The infectious disease has been especially hard to stamp out despite a massive vaccination campaign because of gaps in immunization coverage in a few remaining polio-endemic countries.

With this news, it is perhaps not much of a stretch for many to predict that the polio campaign in Pakistan will have an even harder time reaching people in remote communities hostile to outsiders.

Beyond the impact on the polio campaign, some are concerned this CIA ploy is almost certain to fuel broader conspiracy theories and mistrust around any number of global health or humanitarian endeavors. Lives of health workers may be put at risk.

From the news reports, it appears the CIA didn’t follow through with the required number of doses needed for its own vaccination program — which was focused on preventing Hepatitis B — to be fully effective. In that sense, the CIA project was fake on a number of levels.

The damage done here will be hard to measure.

It’s not clear what the impact this revelation will have on the many efforts now underway in global health. But some in the aid/development blogosphere regard it as a major setback.

Mark Leon Goldberg at UN Dispatch specifically worries about the impact this could have on the polio campaign:

One of the great barriers to vaccination campaigns in these countries has been a stubbornly persistent rumor that the polio vaccine is a western plot to sterilize Muslim children…. This CIA ruse seems to confirm all the darkest fears that vaccination campaigns–particularly against polio–are part of some insidious American plot.

Brett Keller, a prolific global health blogger and grad student, describes the CIA project as “despicable” and calls for widespread condemnation:

Assuming the early reports are confirmed, this plot should be condemned by everyone. If US officials who support global vaccination efforts are going to control the damage as much as possible — though it’s likely much of it has already been done — then there need to be some very public repercussions for whoever authorized this or had any foreknowledge. What tragic stupidity: a few branches of the US government are spending millions and millions to promote vaccines, while another branch is doing this.

Chris Albon, who writes at Conflict Health, similarly says:

If true, the CIA’s actions are irresponsible and utterly reprehensible…. The simple fact is that the health of the children of Abbottabad has been put at risk through a deceptive medical operation by the Central Intelligence Agency.

Seth Mnookin, author of a book examining the anti-vaccine movement, The Panic Virus, calls this episode a horrible move with potentially dangerous consequences for global health.

It’s early days, but we have yet to hear anything from members of Congress or the Obama Administration about the strategy of using a public health campaign as a disguise for covert intelligence. Is this an acceptable trade-off in the war against terror? Or is it too potentially destabilizing to global health?

Will the global health community, especially those like Bill Gates who so vigorously promote vaccination as a “miracle” weapon against disease, speak out on this?

Clearly, many believe national security depends not only on winning the fight against the bad guys. Global stability and security depends upon many things, including maintaining a working level of trust and good will around the world — at least so we can collaborate when fighting common enemies like infectious disease.

Even the CIA has reported in the past on the benefit of promoting global health as a means to improve national security. The question now is if this episode will be regarded as an aberration or lead to further mistrust of U.S.-sponsored efforts in global health.