To End Polio, the U.S. Needs to Do More Than Get Spies Away From Vaccines

A Pakistani health worker administers polio vaccine drops to a child carried by a tribal resident fleeing military operations as they arrive in the town of Bannu, Pakistan on Feb. 25 Photograph by Karim Ullah/AFP via Getty Images

When the White House announced that the CIA would no longer use vaccination campaigns as cover for intelligence gathering, it came as good news for the renewed global fight to eradicate polio. The effort has been bogged down in Pakistan, where vaccination workers face assassination from the Taliban and widespread suspicion that vaccines are part of a Western plot. The challenge for the U.S. now is to build confidence that vaccinations aren’t part of its clandestine programs—or risk seeing the dream of a polio-free world fall victim to terrorists and the global war against them.

Polio is a disease that can paralyze or even kill. By destroying the nerve that drives the diaphragm, it can cause a slow suffocation. Once a global menace, the world has been on a path toward the eradication of polio thanks to a massive vaccination effort. Between 1980 and 2003, the number of polio cases worldwide fell from 400,000 to 784—a 99.8 percent decline. But the past few years have seen new outbreaks and a rising polio burden.

This month, the World Health Organization declared the renewed spread of polio an international public health emergency. Up until the end of April, there had been 68 confirmed polio cases worldwide. The total for the first four months of 2013 was just 24. Worse, the cases are spread across 10 countries when in recent years the disease appeared in only three: Afghanistan, Nigeria, and Pakistan. Given these setbacks, Donald Henderson, who was in charge of the successful global campaign to wipe out smallpox in the 1970s, has even suggested we abandon the $1 billion-a-year global effort to eradicate polio altogether.

Pakistan is home to the majority of polio cases this year, and has been the source of much of the disease’s recent spread to Syria, Iraq, and Egypt. This should come as no surprise given the war the Taliban and its allies are waging against the vaccination effort. The violence against vaccination workers began in 2007 with the assassination of the head of polio eradication in northern Pakistan—victim of a conspiracy theory that the vaccination campaign was designed to sterilize Muslim girls. But both boycotts and violence dramatically picked up in 2012, and more than 60 polio workers and security personnel have been killed since December 2012.

The escalation in violence against polio workers can be directly linked to 2011 reports that the CIA had used a fake vaccination campaign as part of a failed effort to collect DNA from the bin Laden family compound in Abbottabad. Taliban leaders subsequently called for a jihad against all immunization workers, and vaccine coverage fell. Alongside the impact on the global polio eradication effort, lower vaccination rates will have been one factor behind a measles outbreak in the country that killed more than 300 children in 2012-13. Taliban leaders in Waziristan are still banning polio workers until drone strikes come to an end, on the grounds that the vaccinators could by spying out targets.

There is good news, however, for the global fight against polio and other vaccine-preventable illnesses. It has been CIA policy since August 2013 to make no operational use of vaccination programs, according to U.S. Assistant to the President for Homeland Security and Counterterrorism Lisa Monaco. And the drone program appears to have been completely halted since the beginning of the year, a New America Foundation analysis found.

For a president who campaigned on the idea that health care is a right, ending gross interference in some of the most basic and effective health care known worldwide should have been a quicker step, and is only a first one. U.S. credibility on this issue surely remains limited, especially among those people to whom it would matter most: parents refusing to vaccinate their kids in Pakistan and Afghanistan. The White House could do considerably more to increase that credibility.

Not least, it could make more noise about the new policy against CIA use of vaccination programs, with senior officials declaring the change—and it could be given greater force as a presidential executive order banning the CIA from conspiring in assassination attempts rather than just a simple policy change within the intelligence agency. The Obama administration could also lead efforts to internationalize the new U.S. rules, backing a treaty that would give vaccine workers similar protections to those enjoyed by medical personnel in wartime (PDF) under the Geneva Conventions—including that such personnel must not be used for purposes outside their humanitarian role. And the U.S. could increase its support for vaccination efforts through organizations like the Global Alliance for Vaccines and Immunization.

The U.S. should also widen the scope of the ban on intelligence operations to cover humanitarian efforts more broadly. There are widespread allegations that CIA agents posed as relief and constriction workers to enter Pakistan after the 2005 Kashmir earthquake. That put all aid workers in Pakistan under suspicion and potentially in harm’s way. It doubtless reduced the goodwill generated (PDF) for America for what appeared at the time like an act of simple humanitarian generosity. Permanently ending the drone-strike program in Pakistan while reining in the global program, as President Obama proposed last year, would be another key step—and one that is increasingly plausible given ongoing peace negotiations between Pakistan’s government and the Taliban. Global opinion is strongly opposed to the drone strikes and they are approved by only 5 percent of Pakistan’s population, according to Pew polling.

Still, the White House does deserve credit for (belatedly) doing (some of) the right things. And for all of the confusion sowed by the leaked Abbottabad intelligence operation, there is no evidence that the polio campaign or the World Health Organization in particular has ever been used by Western intelligence services. Going forward, if the Taliban continue targeting polio vaccination workers, it is using a form of biological warfare against innocent children with no possible justification. The U.S. is slowly recovering from a stumble that threatened innocent lives by stoking fears over vaccination. But the global defeat of polio will still take peace of some sort in northern Pakistan.

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