Amanda and I wrote before the New Year about the tragic violence against vaccination workers in Pakistan who were doing vital work in the struggle to completely wipe out polio worldwide. Their deaths were linked to allegations that the CIA had used a vaccine campaign as part of intelligence gathering operations in the country. I’d like to propose a specific policy action by the US government that might marginally reduce the risk of such attacks –and their knock-on effect in terms of more kids dying, stalled progress in the battle to wipe out infectious diseases worldwide and sickness in the United States.
It is a vital moment for the world community to do everything it can to encourage vaccination, especially against polio. The last few decades have seen massive global progress against infectious disease thanks to vaccine programs. Worldwide, 16% of infants were vaccinated against measles in 1980 compared to 85% in 2010. In 1980, the disease killed 2.6 million people a year; that number was down to 139,000 in 2010. And we are on the very cusp of completely wiping out polio worldwide –that disease may follow smallpox onto the ash-heap of defeated human scourges. Only a couple of generations back, tens of thousands of Americans were left paralyzed by polio while three thousand died. Global eradication would free Americans from that threat for ever.
But the sad events in Pakistan and Afghanistan are only the latest in a line of setbacks for the battle against infectious disease linked to allegations of US intelligence services using vaccination programs as part of operations. Not least, efforts to contain a polio outbreak in Kano, Nigeria in 2003 that might have put us on the path to global polio eradication by now were derailed when imams and local political leaders called for a boycott of the polio vaccination campaign. They claimed (without evidence) that the vaccine program was part of a U.S. sterilization plot.
Given that, a declaration by the US that public health interventions will not be used to gather intelligence could play a vital role in tipping the balance towards successful polio eradication –and enhance US national security. Such a declaration has been proposed in a letter sent to President Obama this Monday signed by the deans of America’s top public health schools. I suggest this could be modeled on –and inserted into-- Executive Order 12333 which mandates that “No element of the Intelligence Community shall sponsor, contract for, or conduct research on human subjects except in accordance with guidelines issued by the Department of Health and Human Services,” and bans engagement in or conspiracy towards assassination and actions intended to influence United States political processes, public opinion, policies, or media.
It is of course doubtful that many of those in infected communities would know of any constraint on US intelligence service use of vaccination programs, or that the knowledge would be sufficient to reverse a decision against vaccination in any particular case. However, the constraint could be advertised to local politicians and community leaders as part of vaccination campaigns, potentially reducing the risk of a boycott. Furthermore, the decision to vaccinate is made by many millions of parents every year, so there is scope for even a marginal shift in the decision calculus for or against vaccination at the individual level to impact many thousands of children worldwide, with knock-on impacts on a lower overall disease burden amongst those who remain unvaccinated.
So why not amend Executive Order 12333 to add a paragraph that would read: “2.14 No person acting on behalf of elements of the Intelligence Community may join or otherwise participate in any activity directly related to the provision of child public health services on behalf of any element of the Intelligence Community.” Such an order might help restore confidence in vaccination programs in areas where the communicable disease burden remains high -- benefitting people in those communities, but also helping to ensure the health of Americans here at home. The proposal is outlined in a little more detail here.