Deans of public health schools in the United States have sent the following letter to President Obama, in which they criticize the use of a vaccination campaign by the Central Intelligence Agency in Pakistan to hunt for Osama bin Laden. I wonder if he will reply.
January 6, 2013
Dear President Obama,
In the first years of the Peace Corps, its director, Sargent Shriver, discovered that the Central Intelligence Agency (CIA) was infiltrating his efforts and programs for covert purposes. Mr. Shriver forcefully expressed the unacceptability of this to the President. His action, and the repeated vigilance and actions of future directors, has preserved the Peace Corps as a vehicle of service for our country’s most idealistic citizens. It also protects our Peace Corps volunteers from unwarranted suspicion, and provides opportunities for the Peace Corps to operate in areas of great need that otherwise would be closed off to them.
In September Save the Children was forced by the Government of Pakistan (GoP) to withdraw all foreign national staff. This action was apparently the result of CIA having used the cover of a fictional vaccination campaign to gather information about the whereabouts of Osama Bin Laden. In fact, Save the Children never employed the Pakistani physician serving the CIA, yet in the eyes of the GoP he was associated with the organization. This past month, eight or more United Nations health workers who were vaccinating Pakistani children against polio were gunned down in unforgivable acts of terrorism. While political and security agendas may by necessity induce collateral damage, we as an open society set boundaries on these damages, and we believe this sham vaccination campaign exceeded those boundaries.
As an example of the gravity of the situation, today we are on the verge of completely eradicating polio. With your leadership, the U.S. is the largest bilateral donor to the Global Polio Eradication Initiative and has provided strong direction and technical assistance as well. Polio particularly threatens young children in the most disadvantaged communities and today has been isolated to just three countries: Afghanistan, Nigeria and Pakistan. Now, because of these assassinations of vaccination workers, the UN has been forced to suspend polio eradication efforts in Pakistan. This is only one example, and illustrates why, as a general principle, public health programs should not be used as cover for covert operations.
Independent of the Geneva Conventions of 1949, contaminating humanitarian and public health programs with covert activities threatens the present participants and future potential of much of what we undertake internationally to improve health and provide humanitarian assistance. As public health academic leaders, we hereby urge you to assure the public that this type of practice will not be repeated.
International public health work builds peace and is one of the most constructive means by which our past, present, and future public health students can pursue a life of fulfillment and service. Please do not allow that outlet of common good to be closed to them because of political and/or security interests that ignore the type of unintended negative public health impacts we are witnessing in Pakistan.
Sincerely,
Pierre M. Buekens, M.D., M.P.H., Ph.D.
Dean, Tulane University School of Public Health and Tropical Medicine*
James W. Curran, M.D., M.P.H.
Dean, Rollins School of Public Health, Emory University*
John R. Finnegan Jr., Ph.D.
Professor and Dean, University of Minnesota School of Public Health*
Chair of the Board, Association of Schools of Public Health*
Julio Frenk, M.D., M.P.H., Ph.D.
Dean and T&G Angelopoulos Professor of Public Health and International Development
Harvard School of Public Health*
Linda P. Fried, M.D., M.P.H.
Dean, Mailman School of Public Health, Columbia University*
Howard Frumkin, M.D., Dr.P.H.
Dean, School of Public Health, University of Washington*
Lynn R. Goldman, M.D., M.P.H.
Professor and Dean, School of Public Health and Health Services, George Washington University*
Jody Heymann, M.D., M.P.P., Ph.D.
Dean, UCLA Fielding School of Public Health*
Michael J. Klag, M.D., M.P.H.
Dean, Johns Hopkins Bloomberg School of Public Health*
Martin Philbert, Ph.D.
Dean, School of Public Health, University of Michigan*
Barbara K. Rimer, Dr.P.H.
Dean and Alumni Distinguished Professor
UNC Gillings School of Global Public Health*
Stephen M. Shortell, Ph.D.
Dean, School of Public Health, University of California Berkeley*
*Institutional affiliation is provided for identification only.
cc:
Regina M. Benjamin, United States Surgeon General
Hillary Rodham Clinton, Secretary of State
Thomas Frieden, Director, Centers for Disease Control and Prevention
Howard Koh, Assistant Secretary of Health
Michael J. Morell, Acting Director of the Central Intelligence Agency
Janet Napolitano, Secretary of Homeland Security
Kathleen Sibelius, Secretary of Health and Human Services
I think you need to dedicate an episode or two on this Polio issue (both the CIA issue and the vaccine concerns). Your listeners will be very intrigued if you walk them through the history of Polio vaccination and why we need to change our current thinking. The crystal structure of Polio is one of the best ever for a virus structure….I’d love if your listeners could appreciate the decades of basic virology that was gained from this little RNA virus. Personally I don’t think Polio will ever be vanquished, there will always be flare ups.
Yeah… Eliminating Bin Laden is more important than eradicating polio, even assuming this subterfuge has a lasting impact above the normal regional resistance to vaccines that existed before the ruse and will exist for years to come (for reasons both ancient and complex). Just because we’re virologists doesn’t mean every issue needs to be about virology.
This operation was an appalling misjudgement and grossly negligent not only of the lives of those living in polio-endemic areas, but also of ALL healthcare workers who rely on the trust they must build in difficult circumstances. I just wish there was greater media coverage and outrage so we could be assured this will never happen again.
Eliminating polio > executing a terrorist
Especially since they aren’t mutually exclusive.
The operation undermined global health, the health care workers who were senselessly murdered in retaliation but also, ultimately harms the population of Pakistan as a whole, its health care providers, the innocent people who will develop the paralytic disease and those who will silently spread Polio.
In addition, the radical Islamists have been given an argument on which to base their recruitment and evidence to justify impeding vaccination campaigns further. We should never help them perpetuate paranoia, mistrust and chaos. In the end this will have extremely costly consequences and should not have been allowed.
Bravo deans of public health schools!
It is an outrageous abuse of public trust. In Pakistan there were 173 cases of polio reported in 2011. (Actual counts may be considerably different.) If the vaccine program is held back that could easily rise by orders of magnitude. Polio in Pakistan could quite easily become blowback into the USA since so many mothers here are convinced that vaccination of their children is wrong, will cause autism, weaken their immune systems, etc. We have a lot of travel between the USA and Pakistan, and the amount of time it takes is well under the polio incubation period of 3-35 days.
I don’t believe there is any reason to compromise immunization programs. It is all about saving lives, not destroying them. If, for example, we cannot eradicate polio from Pakistan because of the CIA ruse, then the remainder of the world will have to keep immunizing against the virus to prevent spread. This is one example of an unacceptable potential consequence of what the CIA did.
I agree with their conclusion: this absolutely shouldn’t become a routine tactic in covert ops. However, as I’ve said before and will undoubtedly have to point out again, this story is part of a much larger, far more complicated set of issues that defies pat responses. When debating things like this, I think it’s helpful to put ourselves in the President’s position, and ask if we honestly would’ve done otherwise, given all the facts.
The polio eradication campaign’s problems extend way beyond one PR disaster in one country. Look at what’s happening in Nigeria (which still has more polio cases than Pakistan). Look at what’s happened in places like Hispaniola, where polio was “eradicated” only to pop back up again in vaccine-derived form because public health authorities stopped paying attention to it. It takes a breathtaking degree of naiveté to assert, as some appear to do, that the CIA’s ruse completely derailed a perfectly-functioning public health program. I have no doubt that it did some damage, but this setback was neither absolute nor unique.
Meanwhile, Osama bin Laden, a prolific mass murderer whose influence continued to destabilize the already-volatile Middle East, is now dead. That’s not nothing. I certainly would’ve preferred to have the CIA accomplish its mission without dragging public health through the mud, but if the other option was having this mission fail, well … it becomes a much harder call. I ignore the Monday-morning quarterbacks who sit in comfortable chairs and say that this particular intelligence-gathering effort failed. While true, it completely misses the point: the people who made the decision to do it didn’t have the luxury of hindsight.
So back to my initial suggestion: you’re the President of the United States. You have preliminary reports that suggest Osama bin Laden might (or might not) be at a particular house in Pakistan, and your military advisers tell you the Navy SEALs could probably get him if he is. Do you do set that as a top priority and pull out all the stops, with everything that entails, or do you go half-assed into a covert military action on foreign soil? Both choices have serious consequences. Neither is ideal. Do you honestly think the other option was better?
A few additional thoughts. First, I’m not sure that President Obama had to approve the immunization ruse. Second, the main issue is whether the potential risks of the operation to vaccination programs were ever balanced by the CIA against what information was to be obtained. From my ignorant position it seems highly unlikely that this operation would provide useful information. Do we really believe that members of bin Laden’s family would stand in for HBV immunization? I think this was an operation very unlikely to yield useful data, which on the other hand could have a big impact on immunization programs. There is no evidence that such an evaluation of cost:benefit was ever done by the CIA.
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President Obama did not take the decision to withdraw all foreign staff, the Pakistani government did. A democracy can’t be taken for responsible for all of the retributions from an almost terrorist country. As soon as the CIA decided to operate in Pakistan, they knew the extremist would be reacting strongly against doctors, orphan’s adoption or any foreigners. Sadly the vaccination had to take the fall. There is always collateral damage during a war and only a fool believe he can predict who will suffer the consequences. It is anyway much easier to criticize right after.
PS: I’m a foreign student so I apologize for the probable mistake
Shame CIA SHAME. YOU will sell your mothers for your operations. the real terrorist organization . No terror before 9/11 inside job. I called it inside job and it is the american term for 9/11. CIA spread terrorism in whole world. and now they are trying to destablize pakistan but God will never succeed them . we will destroy u like we destroyed russia and u saw it. SHAME ON CIA
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I am not privy to all that information, but from what I know: yes. Polio is a much greater threat than bin Laden (at that point).
Well we have found various health care programs in the world that are quite beneficial for us; in order to promote the concept of global health care America used to deliver quality health care service in the world and through which many under developed countries are getting positive benefits. But in terms of CIA vaccine we have found a controversial note arises in which American’s vaccine and health care campaign in Pakistan would be in its last stage. In my point of view I don’t think that global health would be found better through these acts.
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