Global Vaccine Programs: Health Security not National Security
White House Responds to Plea from Public Health Schools
In January 2013, deans from 13 schools of public health sent a letter to the White House declaring that it was dangerous and unethical to use public health workers for military intelligence gathering of any kind. This concern was prompted by the discovery that the Central Intelligence Agency (CIA) used a sham vaccination campaign against Hepatitis B in 2011 to gather DNA samples in Pakistan for the purpose of finding Osama bin Laden’s hiding compound.
After the fictitious campaign was discovered, the fragile trust that public health workers had managed to build, particularly those providing vaccines, was completely shattered in Pakistan and elsewhere. The Taliban banned health workers, villagers kept them away from their children, and some volunteers were even killed out of fear that they were spies or were attempting to sterilize young girls.
The letter emphasized the effect this operation had on the progress that had been made in the eradication of polio, a disease that can cause paralysis in children:
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.
On May 16, 2014, Lisa Monaco, Assistant to the President in Homeland Security and Counterterrorism, finally responded to the letter. She assured the deans that the CIA was directed in August 2013 to discontinue operational use of vaccination programs in the U.S. and worldwide.
However, the damage had already been done. Polio cases have risen in Pakistan, with 66 cases reported already this year. There were 93 cases in Pakistan in all of 2013, and 58 in 2012. More than 60 workers have been killed since news of the phony vaccination program broke in Pakistan.
“It is important to note that militant groups have a long history of attacking humanitarian aid workers in Pakistan and those attacks began years before the raid against the Bin Laden compound and years before any press reports claiming a CIA-sponsored vaccination program,” said CIA spokesman Dean Boyd.
Global Vaccine Programs: Building Trust
Building trust in a community for a public health intervention like vaccinations is difficult at domestically and internationally, but securing this trust is essential for the campaign’s success. UNICEF advises that health workers in vaccination campaigns utilize the community’s religious groups to build trust, mobilize support, and tailor the intervention in a way that is both efficient and effective.
- First impressions are key in delicate situations, so before approaching a community religious group, assess the situation: do your homework on the beliefs and practices in that particular locale. Understand the available resources in the community and anticipate potential resistance to the intervention and be prepared to work with community groups to ameliorate fears and correct misinformation.
- Then, make an initial contact with the religious group. Choose an appropriate person to make the initial visit—for example, someone who speaks the language or is member of that religious group. During the meeting, facilitate dialogue and honor differing points of view.
- Begin group work by acting as a resource for information while focusing on building relationships. Encourage participation and informality.
- Finally, facilitate the planning process. This includes organizing workshops, identifying resources, and clarifying roles and responsibilities. Develop a clear message with the facts about your intervention.
For a vaccine program to succeed, it must maintain motivation and commitment. The program must encourage continual community participation in problem solving and give out positive feedback. Remember that sustainability is a priority, so be responsive to the group’s desire to expand to other areas of intervention.
Polio: Disease Facts
- Polio, also called infantile paralysis, is caused by a virus called poliovirus. There are three naturally occurring types of poliovirus: Type 1, type 2, and type 3. Type 2 has been eliminated, with the last case detected in India in 1999. Type 1 is the most common strain of poliovirus.
- Polio can cause paralysis, encephalitis, and apnea. It is highly contagious and is often spread in temperate climates and unsanitary conditions. There is no cure for polio.
- Dr. Jonas Salk developed the injectable polio vaccine in 1955. Dr. Albert Sabin developed the oral vaccine in 1961.
- Despite the success of the vaccine in the high income countries, polio continues to affect children worldwide. In the 1980s, polio paralyzed more than 1,000 children every day. Today, thanks to many vaccination programs including the Global Polio Eradication Initiative, 2.5 billion children have been immunized against the virus.
- The polio vaccine comes in both an oral form and an injectable forms. Vaccination is important to prevent paralysis, which can occur from the polio infection. In Pakistan and many low-income countries, the oral polio vaccine is most often used because it is easier to transport and administer.
Report written by Farah Kudrath