The hidden perils of covert action

United States-Pakistan relations have been in free fall since the successful raid by Special Operations Forces on May 2nd  killed Osama bin Laden and several others in Abbottabad, Pakistan. Now an investigation by the Guardian has revealed details of an intelligence operation in the months prior to the raid that attempted to use a fake vaccination campaign to confirm the terrorist leader’s whereabouts. The operation, which reportedly failed, attempted to use the pretext of a free Hepatitis-B vaccination to collect DNA on those living inside Bin Laden’s suspected compound, hoping to match it with the DNA of his relatives. However, while few details about the operation are known, one thing is certain:  its existence will cause serious damage to legitimate domestic and international health campaigns in Afghanistan and Pakistan. 

Immunization programs in Pakistan already have a hard time convincing many to get vaccinated. In 2007, a polio-vaccination campaign in northern Pakistan failed to immunize 160,000 children, due to rumors that the vaccine was an American attempt to sterilize children. The rumors were at least partially spread by local clerics, who claimed that the polio-immunization drive was "a conspiracy of the Jews and Christians to stunt the population growth of Muslims." Some vaccination teams were even beaten after locals heard the rumors. In another case, a Pakistani doctor was killed in 2007 after working to fight anti-vaccine propaganda in Bajaur agency. And the risk to health workers has increased drastically in recent years. According to the Aid Worker Security Database, which tracks attacks against national and international humanitarians, only two aid workers working in Pakistan reported being the victim of attacks in 2004,  while by 2010 that number had risen to 28. Furthermore, the Red Cross claimed this month to have observed a spike in attacks against humanitarians, fueled in part by anger over the Abbottabad raid. Simply put, it has never been more dangerous to be a health worker in Pakistan.

Similar distrust towards health workers exists in Afghanistan. Taliban fighters have always had an uneasy relationship with vaccination teams and aid workers, suspecting they are government or Western spies. In 2007, Taliban fighters kidnapped one vaccination worker in Uruzgan province during a polio-vaccination campaign. They beat him and only released him after he promised to stop vaccinating children. It is not just vaccination efforts that are harmed by the rumors: less than a year ago a group of international and Afghan aid workers were hiking back from a three-week medical mission in the Hindu Kush mountains when they were captured and executed by gunmen. A Taliban spokesman took credit for the attack, claiming that the aid workers were spies.

Insecurity has a serious negative effect on health care in rural communities. The greater the personal risks, the greater the appeal for both national and international health workers to stay within the safety of major cities, venturing out only in large convoys. This so-called "bunkerization" diminishes the ability of health campaigns to target rural communities — often those most in need of primary health care. The best way to overcome bunkerization is through building relationships with communities and local elites, allowing for the free movement of health workers in a region — exactly the kind of thing undermined by the CIA’s apparent operation.

Given the precarious relationship between health workers, militants, and civilians in many areas of both Afghanistan and Pakistan, the existence of a fake vaccination program ran by the CIA is likely all the evidence many need to accuse all vaccinators and health workers of spying. The end result will be fewer families willing to have their children vaccinated, and more attacks on health workers providing any manner of medical care to communities. Some people will no doubt say that the operation was a reasonable and necessary attempt to confirm bin Laden’s location, and that nobody was directly put at risk as a result. Tell that to the next vaccination team in Abbottabad.

Christopher R. Albon is writer and researcher on public health in armed conflict, health diplomacy, and human security. Writes at Conflict Health, UN Dispatch, the US Naval Institute, and elsewhere.