When reports leaked in 2011 that the CIA had hired a Pakistani doctor to vaccinate the children of Osama bin Laden in a ruse to capture their DNA, global public health experts were quick to condemn the action. They feared that the tactic, aimed at confirming the terrorist mastermind’s presence through genetic evidence, would undermine legitimate efforts to eradicate diseases. These concerns, reiterated in a Jan. 7 letter to President Obama by 12 public-health school deans including Harvard’s Julio Frenk, are proving prescient. International health workers in Pakistan have come under suspicion, sometimes with deadly consequences.
The deans are right to highlight the “unintended negative public health impacts” of clandestine programs, including the one used to ensnare bin Laden. But it’s crucial to remember that bin Laden had vowed to strike on a massive scale against the United States; normal restrictions shouldn’t necessarily apply when investigators are seeking to prevent potentially catastrophic attacks.
Still, the United States should agree, as a rule, to avoid using public health programs as cover for investigations; if such a ploy is ever utilized again, it should be only in cases involving imminent threats, and only with prior presidential approval.
It isn’t clear whether Obama himself knew the vaccination ruse was part of in the bin Laden investigation and could therefore consider whether the tactic was necessary. But there were competing considerations worthy of the president’s attention — including the threat of harming the global campaigns to eradicate polio and measles.
Sadly, the CIA vaccination ruse has had serious consequences that continue to jeopardize public safety as well as public health. The Pakistani government retaliated against American aid programs, even forcing the staff of the nonprofit Save the Children out of the country. Nine public health vaccination workers have been shot and killed in Pakistan since the bin Laden raid, and public resistance to vaccination programs has surely exacerbated a measles outbreak that has killed hundreds of people in the Sindh province.
The relationship between Pakistan and the United States has been marked by mutual suspicions that are deeper and more complicated than any single intelligence effort. Some distrust of American public health initiatives would have existed even without the bin Laden vaccination ruse. Nonetheless, global policy makers need to recognize that promoting public health is a security issue in itself: Stable populations are less likely to be radicalized and to pose a threat.
In light of these considerations, the use of public health campaigns for intelligence purposes should be allowed only if approved by the official best positioned to balance the needs of security and health: the president.