In early 2011, a CIA-recruited Pakistani doctor, Shakil Afridi, entered Osama Bin Laden’s compound posing as a Hepatitis B vaccination worker. His real intention was to gather samples of the Bin Laden family’s DNA to aid the CIA in locating the Al Qaeda leader. Although Dr. Afridi was apparently unsuccessful, the CIA’s actions would have dire consequences for vaccine workers—and for the fight against vaccine-preventable diseases.
On Tuesday, the Obama administration indicated it would no longer employ vaccination programs in its intelligence efforts. This announcement came in response to a letter, sent by the deans of twelve U.S. schools of public health, condemning the practice.
The damage, however, has already been done.
In March, Salma Farooqi, a thirty-year-old mother of four, was abducted from her home, tortured and killed for distributing polio vaccine in Pakistan. She is just one of thirty Pakistani “Lady Health Workers” killed since 2012 for their work on vaccination programs. Scores of other vaccinators and support staff have also been murdered. After the CIA deception was uncovered, the Taliban began a systematic program of attacks, leading the United Nations to temporarily withdraw its staff supporting the polio eradication program.
All this has seriously impaired polio vaccination efforts. Even before the Bin Laden ruse, vaccination programs were deeply distrusted in many parts of the world. The disclosure of the fake program has spread such fears—and given them a measure of legitimacy. This has contributed to the sad reality that polio, a disease that recently seemed on the path to eradication, is now experiencing a resurgence, with Pakistan among the worst affected countries. This alarming spread led WHO Director-General Margaret Chan last month to declare wild poliovirus a Public Health Emergency of International Concern under the International Health Regulations (IHR) – making it only the second disease so designated. The CIA’s deception alone can hardly be blamed for this new crisis, but it is an important contributing factor.
What does the future hold? While reassurances that the U.S. government will not repeat its mistake are of course welcome, it is doubtful that a U.S. government statement will do much in the short-term to quell fears among Pakistanis (and others) that vaccination programs are a front for espionage. It is seems that only time and broader improvements in trust between the United States and Pakistan will be able to undo the damage caused. A formal apology, while unlikely, could also help to mend relations.
The aftermath of the U.S. government’s clumsy actions in Pakistan should provide important lessons for U.S. government intelligence programs. First, the devastating results reinforce the dangers of a myopic view of national security that focuses on eliminating immediate threats by any means possible, without taking into account the longer-term implications. The spread of polio, attacks on health workers, and deeper distrust between the United States and the Pakistani people are all long-term threats to U.S. security. The broader and more important concern, however, is one of morality and social justice—concerns that pervade U.S. counterterrorism efforts. Whether or not it is the government’s intention, too often the United States seems willing to endanger foreign civilians’ lives and health to protect U.S. citizens. Such actions are both morally wrong and deeply counterproductive. Let’s hope that the U.S. intelligence community’s most recent foray into public health is its last.
The views reflected in this expert column are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.