Global polio eradication: espionage, disinformation, and the politics of vaccination.

In early 2011, a Pakistani doctor, Shakil Afridi, went door-to-door promising to deliver hepatitis B vaccines in Abbottabad, Pakistan. In reality, the CIA had recruited Dr. Afridi to gather DNA samples as a prelude to the assassination of Osama bin Laden, the Al Qaeda leader. (Dr. Afridi was later sentenced to prison for colluding with the CIA.) That deception fueled a widespread distrust of vaccine campaigns, critically damaging the global poliomyelitis eradication program. Shortly after bin Laden's assassination, senior Taliban commanders banned polio eradication in the most troubled areas of Pakistan—South and North Waziristan—until US drone strikes ended: “In the garb of these vaccination campaigns, the US and its allies are running their spying networks.”1 The Pakistani government, which seldom is a full and willing partner of the United States, waivered in its resolve to eradicate polio. It ordered Save the Children personnel to leave the country, leaving children unvaccinated. Public backlash has persisted, threatening foreign and community health workers. In March 2014, Salma Farooqi, a mother of 4, was abducted, tortured, and killed for offering polio vaccines—just one of the more than 30 female health workers killed in Pakistan since 2012. Scores of others have been murdered, leading the United Nations to temporarily withdraw its polio eradication staff in December 2012. Fearful parents are preventing health workers from vaccinating their children. (In a sign of hope, though, the Afghan Taliban last year renounced violence against vaccine workers, and earlier this year the Tehrik-i-Taliban Pakistan distanced itself from prominent attacks on polio vaccinators.) On May 20, 2014, the Obama administration formally declared an end to its use of vaccine campaigns as a ruse for spy operations. Responding 16 months after receiving a letter from American public health school deans, the White House said that since August 2013, US policy has not allowed the CIA to use vaccination programs, workers, or genetic materials gathered from immunizations for intelligence purposes. But the White House did not offer a public apology, despite violating the long-standing norm of strictly separating humanitarian assistance from military and intelligence operations. The harms already produced are palpable. Of the 115 polio cases reported this year (as of July 9), 90 were in Pakistan. (http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx). In addition, cases in Afghanistan, Iraq, and war-torn Syria are genetically linked to Waziristan, demonstrating the deep connections among terrorism, political instability, and public health. Nigeria, as well, is a polio-endemic area of global concern; in February 2014, the Islamist militant group Boko Haram shot dead at least 9 women administering polio vaccinations in northern Nigeria. The CIA's ploy created political cover for militants seeking to exploit preexisting fears. Disinformation campaigns, for example, have linked polio vaccination campaigns to Western plots to sterilize Muslims. Rumors also have circulated asserting that the vaccines contained porcine contaminants, which violate the Muslim faith. Indeed, the interconnection of immunization, ideology, and religion has created a toxic mix, for which poor children are most likely to suffer.