The news that the Central Intelligence Agency had been running a fake vaccination program in Pakistan first surfaced in 2011 and quickly ignited fears that the covert operation could compromise the global campaign to eradicate polio. Late last month, a handful of vaccine workers, including a teenage girl, paid the price for the CIA's deceit: They were gunned down as they tried to give the polio vaccine to children living in the Pakistani city of Karachi and other areas.
No one has taken responsibility for the attacks, although the Pakistani Taliban has threatened vaccine workers in the past. But many worry that the violence will continue unless the U.S. government takes steps to rebuild trust in Pakistan and ensure that the CIA can never again infiltrate efforts to fight global health problems that affect all of us, from residents of Karachi to people living here in Baltimore.
Authorities in Pakistan shut down the vaccine drive briefly to prevent additional attacks and just this week resumed the campaign in high-risk polio zones. Still, the wave of violence represents a setback for the Global Polio Eradication Initiative, a public-private partnership established to stamp out this crippling and potentially fatal illness. The campaign has been largely successful in the past and has reduced new polio cases from 350,000 in 1988 to just 650 cases in 2011.
But wild polio virus still lurks in three countries: Afghanistan, Nigeria and Pakistan. And as long as the virus survives in just one location, it can spread. This virus, like other communicable diseases, can infect someone living in Karachi and then travel via jet to Baltimore or any city in the world.
Yet this massive vaccination effort could stall out just at a time when eradication of polio is within our reach. That's why the CIA deception delivered not just one shock but a series of aftershocks that are still reverberating in Pakistan today. When the CIA enlisted a Pakistani doctor to run a fake vaccination program as part of an effort to hunt down Osama bin Laden, it stoked fears that vaccine workers are all potential spies.
Health workers, paid the equivalent of $2 per day, already had a hard time convincing parents in distressed neighborhoods that the vaccine could protect children from polio, and the CIA's deception made that job harder. On top of that, when Pakistan dissolved its Ministry of Health, the vaccine workers were left to deal with the local tribal leaders — people who were already deeply suspicious of the campaign's motives.
This is not the first time that fear and deception have resulted in violent attacks and a stymied public health effort. In 2007, extremists in Pakistan said that the polio vaccine was being used as a cover to sterilize Muslim children. As a result, an estimated 24,000 families refused to allow health workers to administer the vaccines. And then, as now, the mistrust was followed by threats and violent attacks on health care clinics and health workers.
A massive vaccination effort like this one requires a bond of public trust, one that was broken by the CIA. The U.S. took the first step toward repairing the atmosphere of mistrust by admitting to the sham vaccination effort. Now, the president and Congress must take the next step by erecting a firewall between public health programs, like the global polio initiative, and espionage or other covert operations conducted by the CIA.
They should follow action taken by former Peace Corps director Sargent Shriver, who in 1961 won assurances from President John F. Kennedy that they would not infiltrate the ranks of the Corps. Shriver believed ties to the CIA could jeopardize the Peace Corps' mission and put young volunteers at risk, especially in countries that were already suspicious of the program.
In addition, the United States, the World Health Organization, partners in Pakistan and others must work together to create an atmosphere of trust and safety. We can and must do more to shield vaccine and other public health professionals from acts of violence so that they can continue to do their job. They are, after all, protecting all of us from newly emerged infectious diseases, as well as killers that could rebound in the future if not stamped out.
Dr. Lynn R. Goldman is dean of the George Washington University School of Public Health and Health Services in Washington, D.C. Dr. Michael J. Klag (firstname.lastname@example.org) is dean of the Johns Hopkins Bloomberg School of Public Health in Baltimore.