Is there ever a justification for a fake vaccination program?

by Salman Hameed

I have had several posts about the challenges of polio eradication in Pakistan (for example, see here and here). Part of the problem was the mistrust that many have of NGOs working in the northern areas of Pakistan. But then we got the reports that a doctor - working for the CIA - was conducting a fake-vaccination program to get the DNA sample of Osama bin Laden. Now, whatever importance one places on bin Laden, the fake-vaccination effort is despicable - and it sows mistrust for hundreds of authentic health-related efforts in the region. In one of its less proud moments, the prestigious science journal Nature responded to this news with an editorial titled, Don't Blame the CIA (From July 2011, it is available free of cost). No seriously. It pointed to other problems in Pakistan's healthcare system, but the editorial did not find a reason to raise any questions about the ethics of a medical doctor running a fake vaccination program. Shame on Nature.

Now Salim H. Ali brings up this issue in an excellent article for the Huffington Post, Why Pakistanis Don't Trust America:  

In mid-February, Californian Congressman Dana Rohrabacher announced his desire to nominate Pakistani doctor, Shakil Afridi, for the Congressional Gold Medal -- the highest civilian honor bestowed by our legislature. The deed which merits this accolade is his supposed assistance to the CIA in finding Osama bin Laden in Pakistan last year. Dr. Afridi is now languishing in a Pakistani prison under indefinite detention on charges of treason. Congressman's Rohrabacher's efforts to stand by the man who risked his life for this mission, and perhaps for monetary rewards and relocation to the United States, are understandable. Most Pakistani-Americans, including myself, are certainly relieved that a maniac like Osama bin Laden is no longer able to plan further acts of terrorism.

However, what is missing from this narrative is the method that was used by the CIA to glean the information about bin Laden's whereabouts. A fake hepatitis vaccination campaign was carried out by Dr. Afridi at the behest of the CIA to go door-to-door and ascertain who was residing in particular homes. If actual vaccine was administered, one might even consider the operation to have derivative health benefits. However, Dr. Afridi's mission from the CIA was not to incidentally deliver immunity but rather to collect blood samples from the children residing in the bin Laden compound for DNA confirmation of the culprit.

There are conflicting reports about whether or not Afridi's nurse was actually able to get the blood samples. U.S. officials can claim that this strategy was pursued to ensure they hit the correct target and to minimize collateral damage. Yet, most accounts of the bin Laden raid suggest that the decision to attack was largely based on tracking bin Laden's courier rather than any biological proof of his family's residence there.

So consider the episode from the perspective of a Pakistani. The trust that the public usually gives medical professionals on public health campaigns is being used as subterfuge to gather biological intelligence. There was complete disregard for the negative impact this action would have on the perception of future health campaigns in a country which is already paranoid about conspiracy theories regarding vaccination. Polio and other rare and obsolescent infectious diseases are making a rude comeback in the country because of such fears of vaccination. According to the World Health Organization in 2011, Pakistan led the world's tally in polio cases with 83, followed by Nigeria, which had 23 cases, and Afghanistan, with 12. Out of the children diagnosed, 50 had vaccination offered to them but their parents refused due to conspiratorial fears.

When actions like the CIA's fake vaccine campaign vindicate conspiratorial beliefs, one begins to see why even educated Pakistanis have begun to deeply distrust the United States.There were further revelations of U.S. complicity in co-opting humanitarian goals in Pakistan for "security objectives" in a recently published book by Marc Ambinder on U.S. Intelligence (The Command). During the devastating Kashmir earthquake of 2005 in which 90,000 people were killed, Arbinder notes that: "Using valid U.S. passports and posing as construction and aid workers, dozens of Central Intelligence Agency (CIA) operatives and contractors flooded in without the requisite background checks from the country's Inter-Services Intelligence (ISI) agency."

You add regular attacks to the mix and you have the recipe to loose the support of even the most liberal and left-leaning Pakistanis. 

The very basis of trust between nations is assistance in times of need. When trust between nations is violated during such times of humanitarian urgency, a great disservice is done to the principles and ideals which we as Americans are so proud to preach to the world. Such acts also make it subsequently more difficult to have genuine travel for citizen diplomacy since visa regimes get even more rigid and insurmountable. The willingness of the U.S. government to discount the impact of intelligence operations on long-term humanitarian goals is deeply disturbing. At the end of the day, we will only find collective security in South Asia and the United States when both Americans and Pakistanis feel that their lives are equally precious.

Read the full article here.