Last week, Lisa Monaco, a senior counterterrorism and homeland security adviser to the White House, promised that something that happened in 2011, would never happen again.
The incident cited by Monaco occurred in 2011, when the CIA sent a senior Pakistani doctor to collect DNA samples under the ruse of a vaccination drive in a town thought to be harboring Osama bin Laden.
“The Director of the Central Intelligence Agency directed in August 2013 that the agency make no operational use of vaccination programs, which includes vaccination workers,” wrote Monaco in the letter, in response to a letter sent by the deans of 12 public health schools criticizing the CIA’s action.
“Similarly, the agency will not seek to obtain or exploit DNA or other genetic material acquired through such programs. This CIA policy applies worldwide and to U.S. and non-U.S. persons alike.”
While this pledge has been helpful in enforcing the promise of greater transparency in the intelligence community, it has also helped to reinforce a perceived stereotype that has, in the past, served to stall or slow the rate of polio vaccination in the world. As the rate of polio transmission has increased globally — due to the spread of the disease from nations such as Pakistan and Nigeria — the international community is moving to stop a potential international epidemic. However, resistance to global vaccination efforts threatens to derail the process.
In northern Nigeria, for example, difficulties in immunizing residents have been compounded by fighting between Islamic militants and the Nigerian military that has blocked access to immunization sites and by an active immunization ban by the militants, who have publicly denounced the immunization drive as a cover for espionage and part of a Western conspiracy against Muslims, among other things. In Libya, accusations that the CIA may be behind a cluster of HIV infections have effectively shut down Western medical intervention.
Throughout the Islamic world, this has created the impression that the United States is using the CIA to spy and interfere with these nations’ sovereign right to be left alone. The concerns further reflect a history of Western malefeasance toward the Islamic world and a difficulty in letting go of past wrongs.
Understanding the hesitation to vaccinate
The Nigerian misinformation campaign, similar that in Libya, manifested due to multiple causes. First, Boko Haram — the principal militant group in northern Nigeria — felt that the West was complicit in a war against Muslims via the U.S. invasion and occupation of Iraq and Afghanistan.
“The U.S. invasion of Iraq and Afghanistan — which caused deaths and destruction — is seen by many Muslims here as a war on their brethren. They wonder how the same countries responsible for this colossal carnage can now turn and save lives elsewhere. To them, it doesn’t make any sense that you offer to save my children from a crippling disease yet are killing my brothers,” said Sheikh Nasir Muhammad Nasir, imam of Fagge Juma’at Mosque in Kano, Nigeria.
“How could I be so naive as to allow my children to be given polio drops by people who go door-to-door giving the vaccine free while the government has failed to provide medication for the most urgent diseases affecting us, such as malaria and typhoid?” a Kano resident said in 2013.
Second, concerns about the purity of the polio vaccine — fueled by suspicions voiced by some Muslim clerics — led to questions and allegations about whether the vaccine could make a person sick or even sterile. As the polio vaccine is developed using animal products not considered halal (it is typically produced using cell cultures from monkeys), these suspicions gained traction, despite the fact that several Muslim scholars and clerics defended the vaccines as in keeping with Muslim law and traditions. Analysis of the oral vaccine found traces of estrogen and progesterone — two primary female sex hormones — during a joint investigation by the Kano State and the Nigerian federal government in 2003, bolstering the sterility claims.
However, as estrogen and progesterone both occur naturally in the male body, the argument was proven to be invalid. Additionally, the amounts of sex hormones found in the vaccine were too minute to have any measurable effect on a human.
Third, there is the Pfizer meningitis trial, which created a sense of distrust of vaccinations among Nigerians — especially among the people of the Kano State. In 1996, American pharmaceutical company Pfizer conducted a trial of its meningitis drug Trovan on 200 children at the Infectious Diseases Hospital in Kano. With Kano, at the time, being hit with the triple threat of meningitis, measles and cholera — which had killed about 12,000 residents — Pfizer placed half of the test subjects on Trovan, an antibiotic, and half on the antibiotic ceftriaxone. Eleven of the children in the test poll died, while many others suffered paralysis, brain damage and affected speech.
Trovan would later be pulled from the market due to the risk of liver damage. While Pfizer would argue that the complications were due to meningitis, it settled out of court with the families of children who died in the drug trial in 2005.
Finally, vaccination attempts have conjured images of the British colonial occupation of Africa. “Almost a century after the introduction of Western education, there are still parents who don’t enroll their children in school because they believe it is a ploy to convert them to Christianity, and the suspicion has its roots in the British conquest. It is the same sentiment playing out with the polio vaccine,” said Aminu Ahmed Tudun-Wada, head of the Kano State Polio Victims Trust Association.
Residents of the north offer an example of the dangers of Western intervention: the introduction of cigarettes to Nigeria from England 50 years ago. Initially, money was included in each pack, encouraging people to buy the harmful inhalant. Eventually, the money included would be reduced as the Nigerian people grew addicted and encouraged to buy cigarettes on their own. This created the impression that persists today that the West is unwilling to do anything for Africa for free.
While Nigeria was unique in its particular reasons for rejecting the vaccinations, suspicions of Western motives and questions reflecting on the Western colonization of the Islamic world were common among the communities that resisted vaccination.
As Sona Bari, spokesperson for the World Health Organization’s Global Polio Eradication Initiative, told MintPress News, the key behind breaking the Nigerian ban was education and persistence. Despite the threat to lives, health workers continued to go door-to-door, educating about the effectiveness of the vaccines and vaccinating those willing. Eventually, as the rate of polio transmission dropped, the negative propaganda about immunization collapsed, rendering the ban unenforceable.
As the average cost of vaccines has been increasing at a nearly exponential rate — from $1.38 per child in 2001 to almost $39 in 2013 — many of the poorer countries in Africa may only be able to vaccinate their children with the help of the West. With a measles outbreak spreading throughout Chad, Benin, Cameroon, Guinea, Nigeria, the Democratic Republic of Congo and the Central African Republic — despite a weak vaccination campaign by the nations, which all have weakened or compromised health infrastructures coupled with high rates of chronic malnutrition — the need for international relief, such as Doctors Without Borders and the United Nations’ Children’s Fund, to take the lead in vaccinations may be pressing.
The continuing fight
While the vaccination bans in Africa have been resolved, the same hesitations and doubts that have plagued northern Nigeria about Western-administered vaccinations seem to have emerged in Islamic-held North Waziristan, located in northeast Pakistan.
In 2014, the WHO has discovered new cases of polio in Equatorial Guinea, Iraq, Cameroon, Syria and Ethiopia. All of the cases have been shown to originate from polio strains native to Pakistan, Nigeria and Afghanistan.
“Any case of polio represents a global emergency,” Bari, of the WHO, said. “Polio is a very travel-prone, epidemic-prone virus. It likes to travel, it’s very good at finding unprotected children. It will continue to do so until it is eradicated. It can’t be controlled in any single country.”
Libya and HIV
This phenomenon is reflected in Libya. In 2007, five Bulgarian nurses and one Palestinian doctor were sentenced to face a firing squad in Libya on suspicions that they introduced HIV into a children’s hospital in 1999. Due to a lack of information from the administrators at the Al Fateh Children’s Hospital in Benghazi, parents were left to speculate that the infections arose from a blood transfusion.
At the time of the discovery of the virus, Benghazi was a hotbed for the resistance against Col. Moammar Gadhafi, with Islamic militants attacking government posts at the periphery of the city on a regular basis. Concerned about the possibility that the HIV crisis would raise awareness of other health and social issues — and simultaneously weaken his grip on power — Gadhafi closed down the Libyan Writers Association’s magazine Laa, arrested both foreign and Libyan health workers, and started a smear campaign against foreigners, particularly Americans. The U.S. had long been an antagonist to the Gadhafi regime, and allegations of the CIA introducing infection fit nicely into the regime’s already-existing propaganda.
The international community denounced all of this, stating that the infections arose due to the failings of the Libyan health system. A 2002 report from the Italian National Institute for Infectious Diseases indicated that of the 402 children identified as contracting HIV as of the spring of 1999, all had received potentially contaminated intravenous fluids, antibiotics, steroids or bronchodilators between February and September 1998. It was determined that a single strain of HIV was involved in the infections. A 2003 report from Professor Luc Montagnier, co-discoverer of HIV, argued that “patient zero” — the host of the original strain — was in the hospital in 1997, before the accused medics worked for the hospital.
The 2007 verdict was actually a retrial. In the original death verdict, the Libyan government consented to the release of the medics for $10 million per infected child. The Libyan government would hold the medics until it received these funds. In 2006, however, a new trial was ordered based on a confession that was allegedly coerced from one of the medics.
It has been argued that this event — which occurred around the same time as the trial on the December 1988 attack on Pan Am Flight 103 over Lockerbie, Scotland — offered counterbalance for the Gadhafi regime. It has been alleged that the arrests of the medics, for example, gave political cover for Gadhafi to surrender Abdelbaset al-Megrahi and Al Amin Khalifa Fhimah — two Libyan citizens — to the United Kingdom to be tried for their involvement in the hijacking. The medics were captured within weeks of the surrender of the two men. Additionally, the $4 billion ransom was seen as counterplay to the 2003 $2.7 billion Libyan settlement with the U.S. and the U.K., as $10 million — the amount Gadhafi asked for for each affected child — matched the payoff amount for each family of the Lockerbie dead.
The West is far from blameless in this situation, as Western nations muted their outrage with the medics’ condemnation due to the fact that, at the time, Libya’s oil was being opened to outsiders for the first time since Western sanctions were imposed in 1981, but blaming the CIA was a stretch. However, in the aftermath of the 2012 attack on the U.S. consulate in Benghazi, it would be revealed that the CIA’s role in Libya was suspect. While many allegations against the West cannot be taken at face value, most are based on some level of truth.
A growing world health crisis
This level of mistrust is having disastrous ramifications.
Despite the fact that the global polio eradication program has eliminated more than 99 percent of cases of polio in the last 25 years, the disease remains endemic in Nigeria, Afghanistan and Pakistan. Of the three, only Pakistan currently has a rate that is increasing. The situation has grown to a point that the WHO has declared an international public health emergency. It has also recommended that Pakistanis travelling to other countries should have an immunization certificate to show officials abroad.
“In most of these countries [the developing world], the vast majority of people are extremely accepting of vaccines, much more so than people in the Western world, because they can see the results of the vaccine-preventable disease — measles kills children in these countries still,” Bari, the spokesperson for the WHO’s Global Polio Eradication Initiative, told MintPress. “Except for these small parts of these three countries, vaccinations have helped to erase the 350,000 new cases of polio that occurred every year when the initiative started.”
North Waziristan is semi-autonomous from Pakistan. Because of this, there is a high level of suspicion in the region toward Pakistan’s national authority. There is also a suspicion that the vaccination ban may be being used as a bargaining chip in negotiations with the national government.
The current situation in Pakistan mirrors the situation in Nigeria two years ago. Fighting between Boko Haram and the Nigerian military made the distribution of vaccines to the Islamic-held north nearly impossible. Conspiracy theories — including allegations that the vaccinations were an attempt by the U.S. to sterilize males — fueled misinformation that directly threatened health workers, leading to the killing of 10 vaccinators in 2013 in Kano. In 2012, Nigeria had 122 cases of polio — more than half of the world’s total cases.
“Vaccine refusal in Pakistan — at less than 1 percent — is lower than it is in Western Europe,” Bari continued. “In some parts of these countries, there are communities that are marginalized and are left behind. They are not given any kind of service by the government for a number of reasons — they can be ethnic minorities, nomads or even sometimes migrant populations. These communities tend to isolate themselves from the mainstream and tend to be suspicious of government program, and polio eradication is a government program.”