Fighting for the right to vaccinate

By Daniil Davydoff and Scott Rosenstein

Reports from the Guardian and the New York Times about the CIA’s ruse to use a vaccination program to swipe DNA from Osama bin Laden’s family in Pakistan (and thereby confirm his whereabouts) have sparked outrage from the public health community. Critics charge the U.S. government with compromising the sanctity of medical missions and endangering the global immunization push, which, despite bestowing substantial benefits, has already seen its share of controversy. 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.

The CIA’s scheme seems to have used actual hepatitis B vaccine. But only one out of the three required shots was reportedly delivered, undermining arguments that the CIA was simultaneously trying to boost public health and find Osama. Either way, the Pakistani media and blogosphere have picked up on the story, and other accounts of troubled vaccination drives have resurfaced. The most famous is probably the 2003 polio eradication campaign in northern Nigeria, which was derailed by Nigerian imams’ claims that "Western imperialists" wanted to sterilize Muslims. Today, Pakistan remains one of only four countries where polio is considered endemic. Cases there are trending upward, and because of political instability and local mistrust of the Pakistani and U.S. governments, as well as the United Nations, many public health officials believe that Pakistan is the biggest obstacle standing in the way of global eradication.

Suspicion of government-sponsored health programs could also impede progress in the war on terror. In Afghanistan, where the counterinsurgency (COIN) strategy relies heavily on trust between locals and allied forces, an arrangement with Taliban leaders has allowed government volunteers to conduct polio vaccinations in militant-held areas. Word of the CIA’s activities in Pakistan could lead to such agreements being revoked and stymie the effort to boost the state’s legitimacy. Gains made in areas not dominated by the Taliban could also be reversed if confidence in the nascent Afghan government is sapped.

In addition to potentially undermining U.S.-led state-building efforts, the CIA’s leaked ploy presents opportunities for radical non-state actors. Public health authorities in unstable countries tend to rely on agencies not connected to the government. In Yemen, for example, Doctors Without Borders administers polio and measles vaccinations in the northern Sa’ada governorate. Humanitarian organizations aren’t the only ones overseeing immunizations, though. In Pakistan, complicated webs of charities tied to militant Islamic groups stage similar campaigns. One such organization is Jamaat-ud-Dawa, which recently earned notoriety for holding mass prayer sessions in honor of Osama. Widely thought to be an off-shoot of the militant Lashkar-e-Taiba, Jamaat-ud-Dawa has more than 150 medical centers and several hospitals across the country. From 2007-2008, it is thought to have vaccinated as many as 850,000 people for unspecified forms of hepatitis. In this environment, immunization could turn into a zero-sum game between governments and terrorists. And a patient lost to the state might be one gained for the militants.

Daniil Davydoff and Scott Rosenstein are members of Eurasia Group’s global health practice.