The reaction from public health workers was understandably fierce when the Guardian reported last week that the CIA had staged a vaccination campaign in an attempt to confirm Osama bin Laden's location by obtaining DNA from his family members. We recognize the importance of the mission to bring bin Laden to justice. But the CIA's reckless tactics could have catastrophic consequences.
The CIA's plot — recruiting a Pakistani doctor to distribute hepatitis vaccines in Abbottabad this spring — destroyed credibility that wasn't its to erode. It was the very trust that communities worldwide have in immunization programs that made vaccinations an appealing ruse. But intelligence officials imprudently burned bridges that took years for health workers to build.
A U.S. official was quoted last week as saying that “People need to put this into some perspective” and that “If the United States hadn't shown this kind of creativity, people would be . . . asking why it hadn't used all tools at its disposal to find bin Laden.”
Those searching for perspective should consider some facts about global health.
To start, the CIA's actions may have jeopardized the global polio eradication program, which has saved thousands of lives and in which billions of dollars have been invested. Americans could one day be at risk again from re-imported polio.
Many Pakistani communities suffer from preventable infections, including ones that have been brought under control or eradicated elsewhere. Pakistan is the last place on Earth where wild polio still spreads in local outbreaks. Only a handful of places elsewhere in the world have sporadic cases, and vaccine campaigns are vigorous in those areas. But if the Rotary Club, the Bill and Melinda Gates Foundation, governments and others working to eradicate polio realize their aspirations, Pakistan is where victory will be pronounced.
Complicating matters is the fact that Pakistan recently dissolved its Ministry of Health, which has left international programs to negotiate directly with local leaders. Many such leaders may be inclined to distrust doctors or to believe that vaccination programs are CIA ploys designed to hurt their communities.
Few issues have proven as historically sensitive for global health practitioners as building trust around vaccines, especially for polio, within Muslim communities. About eight years ago in northern Nigeria, mass refusals of polio vaccines led to a resurgence of cases locally. The infection then spread beyond Nigeria's borders. Distrust in the vaccine stemmed from Internet rumors that the vaccine was sterilizing people or spreading HIV; some of these claims were fueled by local religious leaders. It took years of negotiation and education for the World Health Organization, UNICEF and other health agencies to counter the conspiracy theories and regain trust about childhood vaccination.
Trust is both fragile and essential for successful global health outcomes. In Afghanistan, where colleagues of ours are helping to rebuild the national health system, locals often link trust in health services with security — in other words, they trust clinics because they believe they are safe places. But health workers there and in Pakistan may now be suspect or seen as spies. People throughout the region may reject vaccines out of politically derived fear. Health efforts beyond vaccination, including those aimed at reducing maternal mortality rates and bringing safe drinking water to millions of rural residents, could be imperiled.
Criticism of the CIA's actions is justified, but a continued focus on condemnation serves no one. Before the betrayal devolves into a public health crisis, President Obama and leaders in Congress should acknowledge the damage to global health efforts and commit to repairing the trust. They should begin where the need is most urgent: Pakistan. They should make clear to regional leaders that despite cuts in foreign aid and U.S. support for the Pakistani military, Americans will not walk away from their region's poor, their needy children, or commitments to stopping the spread of deadly diseases.
Orin Levine is executive director of the International Vaccine Access Center and an associate professor of international health at Johns Hopkins Bloomberg School of Public Health. Laurie Garrett is a senior fellow for global health at the Council on Foreign Relations and the author of “Betrayal of Trust: The Collapse of Global Public Health.”