Thursday, September 22, 2011

A Shot in the Back

The CIA's fake vaccination program in Abbottabad is an outrage. But what's important to remember is that even Osama bin Laden wanted to vaccinate his kids.

It was bound to come out sooner or later. The CIA/Navy SEAL raid that took out Osama bin Laden was just too good, just too clean. But the news that the CIA created a fake vaccination program in Abbottabad, Pakistan -- an effort to capture DNA from Osama bin Laden's children and plant a recording device in the bin Laden compound -- is an ugly smear on the high-water-mark mission of the U.S. fight against terrorism. To be fair, there's much that is still murky: We don't know for sure whether the CIA actually gathered any DNA, and we don't know whether it managed to plant the listening bug. We do know, however, that it paid a Pakistani doctor to start a fake vaccination program, administered the first dose of hepatitis B vaccine to poor children in Abbottabad, and hired an apparently unsuspecting nurse to enter the bin Laden compound.

Get ready for a lot of outrage over this. Doctors, health-care providers, and medical organizations in general get angry when their ability to care for patients is threatened. And using medicine for non-healing purposes -- in this case for killing -- really rubs them the wrong way. First off, hepatitis B is a real worry in Pakistan, and one dose in a three-dose series will only provide a tiny amount of protection to those children. There's almost no chance now that these kids will even finish the vaccination series -- and many, many thousands more will likely steer clear of future programs of this sort, no matter how legitimate.

Promoting vaccination in the Muslim world is hard enough already. As recently as 2007, visiting health workers in Afghanistan ran the risk of being beaten when they arrived to provide vaccines. Local leaders assumed they were spies; it took a formal letter from Taliban leadership to make vaccination possible. We can assume that kind of diplomacy will come to an end now. And the consequences are real: When Muslim leaders in Nigeria rejected the polio vaccine over fears that it would lead to sterility, it led to a polio outbreak in eight African countries.

There's good reason for the outrage. People's faith in their doctors is critical to the ability to provide health care, and it's unconscionable that the United States would use the single most delicate health issue in the Muslim world as its cover. But we do need to be realistic. It's not the first time health services have been a cover for a security operation, and it won't be the last. The most recent high-profile example was in 2008, when the Colombian military used the Red Cross emblem to disguise an army team engaged in a hostage rescue operation of 15 people held by the Revolutionary Armed Forces of Colombia (FARC).

But there's another narrative to this story, besides the outrage. Medical care gets used as a cover because it works. People persistently trust health-care providers to have their best interests at heart. That trust is broad and often blind. Sometimes stupidly so. In April this year, 86 homeowners in southeastern Turkey obediently swallowed a blood pressure pill given to them by police officers dressed as doctors. The "doctors" hadn't showed any kind of identification, and the pill turned out to be a piece of candy. The purpose of the exercise was apparently to get people to be more careful about checking IDs. Brilliant. (I'm glad I'm not a Turkish taxpayer.)

But this is the heart of this CIA vaccination story. People believe in their medical care. They want to be healthy, and they want more than anything to have healthy children. Accordingly, they believe in their doctors and nurses. And it's the duty of health-care professionals -- and governments -- to return and protect this trust. It is not acceptable to weaponize health, to use Christopher Albon's brilliant turn of phrase. But it's clear -- and interesting -- that doing so is remarkably easy.

In a world where social cohesion is eroding rapidly, people still trust their health-care providers. Despite everything we know about medical care in much of the world -- poor care, discrimination, under-the-table payments, and doctors who put their own interests first -- people still open the door when you say "I'm a doctor, and I want to help."

Maybe this in an inside-out way of seeing things, but I think this widespread trust in health care is a sign that global health efforts are working. In 1978, in Kazakhstan, the Alma-Ata Declaration called for all governments, all health and development workers, and the world community to promote and protect all people in the world. It launched the global health movement as we know it. We don't have health for all yet, certainly, but we're making progress. And people everywhere are voting in favor of these global health efforts with their open doors.

It's clear that there should be a deeper investigation into the U.S. government's decision to set up the fake vaccination program in Abbottabad. Criticism is well warranted, and there is no shortage of that right now. But that's not the interesting part of the story; governments routinely use sneaky tactics to achieve their goals. To me, the interesting story is this: Everyone in the world knows how much health-care matters. Seriously, even evil terrorist masterminds know it's important to vaccinate their kids. Just think what we can do with that, if we use it the right way


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