Authors: Todd Summers and J. Stephen Morrison, May 28 2014 - In early January 2013, a dozen deans from America's premier public health schools wrote President Obama a letter protesting the CIA's use of a faked vaccination campaign in the hunt for Osama bin Laden. Sixteen months later, on May 16, 2014, Lisa Monaco, the top White House terrorism expert, responded to the deans with a short letter indicating that since August 2013 the policy of the United States has been that the CIA will no longer use vaccination programs, workers, or genetic materials obtained through immunizations for intelligence purposes. In that same letter, she reaffirmed that the United States "strongly supports the Global Polio Eradication Initiative (GPEI) and efforts to end the spread of the polio virus forever."

Monaco’s letter is an important step, though long overdue. Implicitly, it is also an acknowledgement of the dangers and high costs of not respecting the red line between humanitarian programs and covert operations. That is especially poignant in acutely sensitive areas such as Pakistan, where polio and terrorism remain endemic, and where U.S. national interests stretch from drones to child survival and GPEI, among many other complex issues.

Prior to the 2011 assault in which bin Laden was killed, the CIA used a local doctor to fake a door-to-door vaccination campaign in Abbottabad, Pakistan to acquire DNA samples from family members. This ruse subsequently became public, igniting multiple disturbing reactions. The Pakistani government ordered Save the Children expatriate personnel to depart, even though they had no role in the CIA effort and were supporting over two hundred thousand Pakistani children. The resolve of the Pakistani government to complete the elimination of polio - never a certainty - wavered, as did public confidence. Access for polio vaccinations in the northwest FATA [Federally Administered Tribal Areas] region ended abruptly in June 2012, leaving in isolation a quarter of a million children. Terrorists began murdering polio vaccine workers, mostly women volunteers, as the Taliban banned immunizations in the areas under its control. This raised the specter of armed Islamic militants worldwide seizing upon the global polio eradication campaign as a ripe "western" target.

Polio in Pakistan resurged in 2013 and into 2014. On May 4, WHO [World Health Organization] Director General Margaret Chan declared the spread of polio to be a global health emergency, with Pakistan cited as one of the principal hot spots both for rising circulation within the country and for export of the virus back to areas where it had been eliminated. This may have caused the White House to go public with the May 16th letter, trying to contain damage done as the U.S. mistake in Abbottabad continued to haunt responses to polio in Pakistan and elsewhere.

Time will tell whether this damage can be repaired, trust restored, and polio eradication efforts put back on track. What also remains to be seen is whether President Obama’s broader efforts to bring an end to a "cycle of suspicion and discord" between Islam and the West can also be reclaimed. He committed, in a 2009 speech in Cairo, "to seek a new beginning between the United States and Muslims around the world" as well as announcing "a new global effort with the Organization of the Islamic Conference to eradicate polio."

To have health worker lives and vaccination efforts threatened by the introduction of doubt as to the legitimacy of their purpose is unacceptable. The new administration policy is a positive move, restoring the bright line that must separate our covert and humanitarian activities. It will also help restore the integrity of U.S. leadership on global health, which like so much in the world, depends on faith and trust.
Click here to access this Smart Global Health blog, originally posted May 27 2014 on the Center for Strategic and International Studies (CSIS) website. Image credit: CSIS