David Heymann
Head and Senior Fellow, Centre on Global Health Security

There were media reports this week that the CIA created a vaccination drive in the Pakistani town of Abbottabad in an attempt to collect from the needles DNA samples from residents of a compound it suspected Osama bin Laden of living in. This is a setback for immunization programmes and for the wider effort to fight disease in developing countries.

It makes no difference whether the reports are true or not. The mere rumour that vaccines have been used as a front to further the foreign policy goals of a foreign government is enough to erode trust in vaccination campaigns, whether in Pakistan or elsewhere. This is not the first time that rumours have put vaccination programmes at risk, and each such incident decreases confidence further.

Vaccines are one of the most effective interventions in public health, preventing an estimated 2.5 million deaths a year worldwide. The Abbottabad incident could cause a setback that global health can ill afford. It plays into pre-existing fears, and even if its immediate impact on immunization efforts in Pakistan turns out to be minor, it provides ammunition for those wishing to exploit those fears, not just in Pakistan, but across the world. There is a risk of it feeding into a increasing culture of vaccine refusals in some industralized countries, as occurred in the UK after discredited research in 1998 raised unfounded concerns about MMR vaccine links to autism.

Gaining and maintaining trust is crucial to the successful delivery of health-related aid, and healthcare in general, and this is especially true for vaccination programmes, which have previously been the target of conspiracy theories that have wreaked significant damage. Media coverage of the CIA story has been extensive in Pakistan and the World Health Organization is now rallying on the ground to head off an escalation and minimize the impact such rumours can have.

For instance, by 2003, polio had been tightly corned into four remaining countries. However, as a result of rumours that the vaccine contained ingredients that could sterilize girls, the local government in some states in northern Nigeria suspended immunizations for a year, sparking an outbreak that spread throughout the Horn of Africa and on to Indonesia, reinfecting scores of countries and setting back the global eradication effort.

Similarly, in 2007, 24,000 parents in northern Pakistan refused to let their children be vaccinated against polio after extremist clerics spread rumors that the vaccine was an American plot to sterilize Muslim children. Paralysis from polio spiked and health workers and clinics were attacked, illustrating how such rumours can also put the security of aid workers at risk when doubt is cast on their neutrality.

The actions reportedly being taken in Pakistan to manage the risk, including the crafting of public health messages reassuring the population and community leaders of the safety of vaccines, and the furnishing of vaccination teams with identification cards, letters from health authorities and special jackets, will help, but the longer the rumours persist, the harder it will be to maintain trust.

The CIA vaccine plot highlights how decisions aimed at achieving foreign policy goals such as national security can threaten our global health security.