The Killing of bin Laden and the Undermining of Public Health

(A modified version of the following has been submitted to an unnamed journal for publication.  Republication or redistribution without the permission of the author is forbidden.  However, links and references may be made to this specific post.)

In May of 2011, after a decade-long international manhunt, Osama bin Laden was shot dead by US special forces in Abbottabad, Pakistan (1).  It was later reported that bin Laden’s presence, or at least that of his family members, was likely confirmed via the comparison of DNA samples from bin Laden’s dead sister to samples taken from individuals –predominantly children– in the Abbottabad neighbourhood.  The samples were obtained through the inception of a childhood Hepatitis-B immunization program that was devised and implemented by US Intelligence for the sole purpose of locating Osama bin Laden (2).  To appear as authentic as possible, the sham vaccination campaign even started in the poorer part of town, before making its way to the wealthier bin Laden neighbourhood (3).

While acknowledging that the Hepatitis-B campaign was implemented for reasons unrelated to public health, the CIA nonetheless insists that the actual injections were real and can therefore be considered a genuine and valid public health intervention (4).  While the so-called “bin Laden vaccine” might have been a real formulation, reports suggest that the duplicitous nature of its delivery did not allow for provision of the follow-up dosages required for proper conferral of immunization against Hep-B (5).  This means that the inoculated children do not in fact have full immunity, and that their health has therefore been compromised in the wake of this covert military operation.  Future related cases of morbidity and mortality are unlikely to appear on anyone’s ledger of collateral damage caused by the Abbottabad raid.

Concern has been voiced in the international public health community about the damage that this operation has done to the image and effectiveness of genuine current and future public health campaigns.  The concerns can be summarized into two themes: fear of greater distrust of public health campaigns, leading to reduced treatment compliance and vaccination coverage, and fear of backlash, perhaps violent, against individual health care workers.

Public health campaigns, particularly vaccination programs, already suffer from public distrust.  This is particularly true in Pakistan, where a 2007 polio vaccination program famously failed to immunize 160,000 children due to rumours that the campaign was “a conspiracy of the Jews and Christians to stunt the population growth of Muslims” (6) or an “American conspiracy” to cause widespread sexual impotence (7).  Similar stories arise from other parts of the developing world, such as Nigeria, where accusations of a population control agenda were also laid against the polio vaccine (8).  In such areas, the success of an immunization campaign depends strongly on the cooperation of local religious and community leaders. With public admission now that at least one such campaign was in fact a CIA operation, the chances of such future cooperation in that region –and others– are greatly reduced. In wealthier countries, of course, the anti-vaccination movement is similarly driven by conspiratorial sentiments, usually with pharmaceutical companies, rather than government agencies, typically painted as the villains.

Unsurprisingly, with distrust of the vaccination campaigns has come distrust of the workers.  The 2007 anti-vaccination scare in Pakistan involved cases of violence against the clinicians tasked with giving the inoculations (9).  Violence against health care workers is a growing issue worldwide, as in the attacks on caregivers during the political demonstrations in Bahrain earlier this year (10).  By undermining the legitimacy of health development programs, the Abbottabad raid has possibly increased the likelihood of violence against public health caregivers abroad.

American international health and development efforts have long been accused of being fronts for American political, intelligence or military purposes.  According to William Blum, a few decades ago USAID (the United States Agency for International Development) maintained “a close working relationship with the CIA, and Agency officers often operated abroad under USAID cover” (11).  And well before the Abbottabad raid, the media reported on Pakistan’s suspicion that USAID efforts in that country were thin cover for CIA activities (12).  Health care and development workers engaging in what they assume to be altruistic foreign endeavours are often unknowingly tainted and burdened by the weight of a history of official duplicity.

Steps must be taken immediately to assuage the damage to public health that the Abbottabad raid and similar operations have wrought upon workers’ ability to protect both themselves and the populations in need.  While most international health workers have become experienced in helping to diffuse anti-vaccination propaganda, now is the time for more official and systematic steps to be taken.  There are rumours that WHO and UNICEF are devising special identification procedures for vaccination workers, to make it harder for them to be infiltrated by intelligence agents (9).  While this is unlikely to deter infiltrations that have official state sanction, it is at least a first step in restoring public confidence.

What is truly needed is for key agencies — e.g.,WHO, UNICEF, USAID, CIDA—to issue individual and joint public statements, first to condemn the use of public health as cover for an act of military violence, and second to make assurances that despite whatever activities might have been permitted in the past, in future all public health activities and interventions will be free from any type of political or intelligence-related duplicity.

In fact, this shameful affair presents a unique opportunity for Canada in particular to adopt a leadership role in the return of honour to international public health.  A declaration in Parliament, followed by a renewed formal statement in policy, that no Canada-funded public health endeavour will be provided under false pretences, would be a bold and needed declaration to the world that Canadians take the health of populations seriously, and that our projects and our workers are to be trusted.

REFERENCES

1. BBC.  Osama Bin Laden, al-Qaeda leader, dead – Barack Obama. BBC News, May 2, 2011.  Available at: http://www.bbc.co.uk/news/world-us-canada-13256676.  (Accessed Aug 30, 2011).
2. Shah S.  CIA organized fake vaccination drive to get Osama bin Laden’s family DNA.  The Guardian, July 11, 2011.  Available at:  http://www.guardian.co.uk/world/2011/jul/11/cia-fake-vaccinations-osama-bin-ladens-dna. (Accessed Aug 30, 2011).
3. Shen S.  (July 28, 2011).  CIA Vaccination Program to Catch Bin Laden Makes Middle-East Even More Suspicious of Vaccinations.  Foreign Policy in Focus, July 28, 2011.  Available at:   http://www.fpif.org/blog/cia_vaccination_program_to_catch_bin_laden_makes_middle-east_even_more_suspicious_of_vaccinations.  (Accessed Aug 30, 2011).
4. Ukman J.  CIA defends running vaccine program to find bin Laden.  The Washington Post, July 13, 2011.  Available at: http://www.washingtonpost.com/world/national-security/cia-defends-running-vaccine-program-to-find-bin-laden/2011/07/13/gIQAbLcFDI_story.html.  (Accessed Aug 30, 2011).
5. Chambers A.  (July 13, 2011).  Was Bin Laden vaccine plot worth all the risk?  The Guardian, July 13, 2011.  Available at:  http://www.guardian.co.uk/commentisfree/2011/jul/13/bin-laden-vaccine-plot-cia.  (Accessed Aug 31, 2011).
6. Albon C.  The hidden perils of covert action.  Foreign Policy, July 13, 2011.  Available at:  http://afpak.foreignpolicy.com/posts/2011/07/13/the_hidden_perils_of_covert_action.  (Accessed Aug 30, 2011).
7. Yusufzai A.  Impotence fears hit polio drive.  BBC News, Jan 27, 2007.  Available at:   http://news.bbc.co.uk/2/hi/south_asia/6299325.stm.  (Accessed Aug 30, 2011).
8. Mckenna M.  File Under WTF: Did the CIA Fake a Vaccination Campaign?  Wired, July 13, 2011.  http://www.wired.com/wiredscience/2011/07/wtf-fake-vaccination.  (Accessed Aug 31, 2011).
9. Reardon S.  CIA’s Fake Vaccination Drive Angers Public Health World.  Science, July 13, 2011.  Available at: http://news.sciencemag.org/scienceinsider/2011/07/cias-fake-vaccination-drive-angers.html.  (Accessed Aug 31, 2011).
10. Friedrich MJ.  Human rights report details violence against health care workers in Bahrain.  JAMA.  2011 Aug 3;306(5):475-6.
11. Blum W. Killing Hope: U.S. military and CIA interventions since World War II.  London, UK.   Zed Books. 2003;142, 200, 234.
12. Ditz J.   Concerns in Pakistan that USAID Officials Are CIA Spies.  Antiwar, April 29, 2011.  Available at:  http://news.antiwar.com/2011/04/29/concerns-in-pakistan-that-usaid-officials-are-cia-spies.  (Accessed Aug 31, 2011).