By Sally McBride

On Midnight of May 2, 2011, in the small province of Abbottabad, Pakistan, a team of US Navy SEALs raced to the top floor of a three-storey compound and killed Osama bin Laden.^[1] It seemed the CIA would stop at nothing to identify and capture bin Laden and his family, launching a fake hepatitis B vaccination campaign as an attempt to collect DNA samples in the neighbourhood he was believed to be hiding.^[2] The fraudulent campaign failed, and Pakistan’s trust in the United States withered. This threatens the integrity of the international community’s efforts to promote public health in poorly developed countries like Pakistan. This article will analyse the cultural and political implications of the fake hepatitis B vaccination campaign on the current polio immunisation operations in Pakistan and the collateral consequences for local community healthcare programs due to a perceived western threat.

In Pakistan, polio workers have been administering vaccinations without substantial interference for the past fifteen years. As a restult, the global polio campaign had entered what should have been its final stages. Between 1988 and 2011 global cases were down from 350,000 to 650,^[3] most significantly in the majorly affected countries – Afghanistan, Pakistan and Nigeria – where polio is still endemic. Disrupting these vaccination efforts could result in the resurgence of the debilitating disease around the world. The situation involving the US has bred suspicion in Pakistani society, particularly with the rise of anti-polio campaigns by Islamic leaders and the subsequent accusation of polio workers for pursuing a western political agenda^[4]. Already, since 2012, forty health workers and escorting police have been killed and many more chased off by villagers, who accuse them of being government and/or foreign spies.^[5]

Objections by Muslim fundamentalists, particularly in the Federally Administrated Tribal Areas (FATA) in Pakistan, have driven suspicions about the polio vaccine, falsely arguing that it is an American ploy to sterilise Muslim populations and an attempt to avert Allah’s will. The FATA currently have the highest percentage of polio cases in Pakistan. Religious and cultural suspicions have been large contributors to this phenomenon, leading to a rejection of modern medicines in tribal regions of Pakistan. Militant groups such as the Pakistani Taliban are openly hostile towards vaccinations. Taliban anti-vaccination propaganda and attacks on polio workers have lead to a rise in fear, distrust and anti-western values which have provoked terrorist attacks targeting polio workers and vaccination campaigns, as well as innocent local people. To serve as an example, in March this year thirteen people working as part of a Polio vaccination team were killed by two targeted roadside bombs and heavy automatic rifle fire in the Khyber tribal district.^[6]

In 2012, militant leaders from North Waziristan in the FATA banned the vaccination efforts arguing that it was a conspiracy to allow American spies to penetrate the region.^[7] This attitude has clearly developed from the prior hepatitis B campaign, which has been negatively publicised in local newspapers in North Waziristan. A maximum of three vaccination doses, six weeks apart, are required before a child is immune. The issuing of a fatwāagainst vaccinations will leave many children under five vulnerable and will  negate the effects of previous campaigns.^[8] In provinces where religion reigns supreme and, there are low literacy rates for women, decisions on children’s health are strongly influenced by traditional leaders. The level of distrust and inequity sowed by the US mock hepatitis B campaign coupled with the aggressive US drone program over north-west Pakistan could consequently postpone polio eradication for up to twenty years, or until it is safe for health workers to operate in the Pakistani provinces, leading to thousands more infections and deaths.

Political turbulence between the Taliban and Pakistani Government has resulted in a decade of war and civil unrest. While the Pakistani government aligned itself with the White House in the war on terror, it was furious about being kept in the dark over the breach of sovereignty in the assassination of Osama bin Laden. The US was suspicious (to the point of disbelief) that the Pakistani investigation somehow missed the fact that the al-Qaeda leader was able to live in Abbottabad for five years and not be found. Following this, as punishment for Pakistan’s perceived lack of cooperation, the US announced a cut of $US800m worth of military aid.^[9] The heavy reliance on US cooperation during the conflict diminished the Pakistani Government’s will to retaliate politically against the superpower for fear of losing its ally and financial backer.

The 2011 fake hepatitis B vaccination campaign further complicated the already complex US–Pakistan relationship. A poll in 2012 by the Pew Research Centre’s Global Attitude Project revealed that seventy-four per cent of Pakistanis consider the US an enemy,^[10] making it increasingly difficult for health workers to deliver the vital polio vaccine. Aggressive anti-polio campaigns by the Taliban terrorise local people and stop the house-to-house movement of health workers. This hostility originated due to suspicions of surveillance activities by the west against the Taliban, combined with America’s elusive drone surveillance program and the infamous hepatitis B campaign. This has left many innocent families without access to the life-saving vaccine due to the hostility of the political environment that surrounds them.

Relations between the US and Pakistan have deteriorated considerably since the Bin Laden operation and the prior hepatitis B campaign. To ensure that children are immunised against this avoidable disability, efforts need to be made to educate religious leaders and local people, particularly by raising female literacy rates. There is a need to convey the message that the eradication of polio is a social and cultural problem and to encourage local people to take ownership of health inequality. Working directly with in the community, trust needs to be built and the ‘western link’ associated with immunisations removed to eradicate the rumours of Western ‘sterilisation’ through polio injections. Increasing pressure on governments in polio-infected areas to impose vaccinations will help to increase coverage and access to health and so improve trust between governments and local people.

It took the CIA sixteen months to respond to a letter from the Deans of twelve US public health schools protesting against the precedent set by the hepatitis B campaign. In their response, the CIA informed that they would no longer conduct such campaigns.^[11] However, whether the CIA have taken responsibility for the multiple lives they have put in danger and current polio outbreaks as a consequence of their actions is questionable. Pakistan still remains an area of escalating violence and the polio vaccination program may have to wait until a political agreement or permanent cease-fire is reached. Unfortunately, the polio virus won’t wait.

Sally McBride is completing her Bachelor of Science majoring in Pathology with a concurrent Diploma in Global Issues at the University of Melbourne. Sally plans to continue studying in the field of Medicine with a particular interest in global health and rural medicine.

^[1]  Washburn, Sam (2013) “How the CIA’s fake vaccination campaign endangers us all” in Scientific American, Vol. 308, No. 5, p. 12

^[2]  Shah, Saeed, “CIA organized fake vaccination drive to get Osama bin Laden’s family DNA” in The Guardian, London, July 11, 2011, p. 1

^[3]  Global Polio Eradication Initiative Data (2012) http://www.Polioeradication.org/Dataandmonitoring/Poliothisweek/Poliocasesworldwide.as, Accessed on 7^th April 2014.

^{[4]  ,}IRIN Humanitarian News and Analysis, (2007)Pakistan: fighting disinformation in Polio campaign  http://www.irinnews.org/report/69975/pakistan-fighting-disinformation-in-Polio-campaign , Accessedon 9^th April 2014.

^[5]  Herrmann, Steve (2014) Pakistan Polio workers shot dead in Karachi, http://www.bbc.com/news/world-asia-25823154 , Accessed on the 9^th April 2014.

^[6]  Watkins, Tom & Zahir Shah, Sherazi (2014) Attack targets Polio workers in Pakistan, http://edition.cnn.com/2014/03/01/world/asia/pakistan-attack/, Accessed on 7^th April.

^[7]  IRIN Humanitarian News and Analysis (2013) Battling militants’ ban on Polio vaccines in Parkistan’s North Waziristan, http://www.irinnews.org/report/97743/battling-militants-ban-on-Polio-vaccines-in-pakistan-s-north-waziristan , Accessed on 3^rd April 2014.

^[8]  Washburn, Sam (2013) “How the CIA’s fake vaccination campaign endangers us all” in Scientific American, Vol. 308, No. 5, p. 12.

^[9]  Shah, Saeed, “CIA organized fake vaccination drive to get Osama bin Laden’s family DNA” in The Guardian, London, July 11, 2011, p. 1.

^[10]  International Human Rights and Conflict Resolution Clinic (Stanford Law School) and Global Justice Clinic (NYU School of Law) (2012) Living Under Drones: Death, Injury and Trauma to Civilians from US Drone Practices in Pakistan, www.livingunderdrones.org/ Accessed on 12^th April 2014.

^[11]  Sun, Lina (2014) “CIA no more vaccination campaigns in spy operations”, in The Washington Post, May 20, p. 4.