Fake vaccine campaign in Pakistan could threaten plans to eradicate polio

Public health and medical aid organisations around the globe have condemned a fake vaccination operation reportedly run by the US Central Intelligence Agency as part of a ruse to capture and kill Osama bin Laden.

The charity Médecins Sans Frontières issued a statement on 14 July saying that the operation constituted a “dangerous abuse of medical care, which threatens the trust essential for health agencies and humanitarian aid workers.” The charity, a number of whose doctors have been killed in conflict zones, also said that “using medical cover for military purposes “endangers those who provide legitimate and essential health services.”

The criticisms come after reports that the CIA attempted to obtain DNA samples from the children living in a compound in Abbottabad, Pakistan, where the CIA suspected that Osama bin Laden was living. The agency planned to compare the children’s DNA with that of a sister of bin Laden who died in Boston in 2010. It is not clear whether the operation succeeded in terms of obtaining DNA evidence.

The scheme, which involved vaccinating children against hepatitis B, was launched in the Nawa Sher neighbourhood of Abbottabad, where children were reportedly given only the first of three doses, leaving them potentially vulnerable to hepatitis B infection, said a report in the Guardian newspaper (www.guardian.co.uk/world/2011/jul/14/cia-fake-vaccination-medecins-frontieres).

The CIA has not responded to news organisations’ inquiries about the scheme.

Orin Levine, executive director of the International Vaccine Access Center and associate professor of international health at Johns Hopkins Bloomberg School of Public Health, Baltimore, and Laurie Garrett, senior fellow for global health at the Council of Foreign Relations, wrote in a commentary in the Washington Post that the “CIA’s reckless tactics could have catastrophic consequences” (www.washingtonpost.com/...cias-vaccination.../gIQASu12GI_story.html).

Responding to an unnamed US official who reportedly said, “People need to put this into some perspective . . . If the United States hadn’t shown this kind of creativity, people would be . . . asking why it hadn’t used all the tools at its disposal to find bin Laden,” Mr Levine and Ms Garrett wrote, “Those searching for perspective should consider some facts about global health. To start, the CIA’s actions may have jeopardized the global polio eradication program . . . Pakistan is the last place on Earth where wild polio still spreads in local outbreaks.” They also expressed concern that efforts to improve maternal health and drinking water “could be imperilled.”

In response to an inquiry by the BMJ, the US Centers for Disease Control and Prevention in Atlanta deferred to the World Health Organization, stating that, “WHO is taking the lead for many in the global public health community in responding to questions about the alleged vaccine campaign and any effects on public acceptance of vaccine.”

WHO said, “This is not the first time that allegations and conspiracy theories related to immunisation have arisen. On several occasions such allegations have led to an erosion of public trust in immunisation—and consequently resurgence of diseases that the vaccines aim to prevent. These negative consequences have affected both industrialised and developing countries.”

Despite this history, WHO said that the effect of the current allegations “is yet to be determined.” It was confident that the incident would not have “a major impact.”

WHO emphasised that, in the programmes it supports, “routine immunisation is never given in house to house campaigns” but in health centres. The only vaccines given in programmes supported by WHO are oral preparations.

Other organisations and bioethicists are less sanguine. Arthur Caplan, director of the Center for Bioethics and professor of bioethics at the University of Pennsylvania in Philadelphia, told the BMJ that the alleged fake vaccine operation could undermine the entire global vaccination programme because “vaccination programmes depend on public trust.” Already, said Dr Caplan, “people in Nigeria worry that vaccine programmes are actually secret sterilisation plots, and in India they worry that the vaccines are unsafe.”

Dr Caplan added, “This just fuels every conspiracy theory out there.” Unfortunately, trust was already undermined in Nigeria, said Dr Caplan, when a US drug company conducted a “hugely controversial” clinical trial in Kano, Nigeria. After that trial the incidence of polio in and around Kano rose, as families refused to have their children vaccinated against the disease.

The reported CIA scheme, said Dr Caplan, “just plays into the fears, worries, and distrust of international vaccine efforts that run deep in many places. Distrust is absolutely toxic to eradication efforts.”

Dr Caplan said that in terms of the global vaccination programme “the CIA probably didn’t even know they were playing with fire.”