Months after the Navy SEAL raid that killed Osama bin Laden in Abbottabad, Pakistan, in May 2011, The Guardian reported that the CIA had organized a fake, door-to-door vaccination drive in the city. They were hoping to recover DNA that would help locate bin Laden's family members and confirm his presence there and, while the plot never yielded useful DNA, it did help the CIA obtain a cell phone number connected to bin Laden's messenger.
Scientists and public health officials were outraged and predicted that the ruse would be a propaganda victory for the Taliban, helping to undermine legitimate vaccination efforts. New Scientist declared using health workers as spies was a "violation of trust [that] threatens to set back global public health efforts by decades."
A new study, currently under review in advance of publication, tries to quantify that setback, and finds that, in regions with high support for Islamist groups—likely those most amenable to the Taliban's anti-vaccine propaganda—vaccination rates dropped dramatically after the CIA's plan was exposed.
The study authors, Monica Martinez-Bravo and Andreas Stegmann of the Center for Monetary and Financial Studies (CEMFI) in Madrid, Spain, note that the success of vaccines uniquely depend upon patients' trust in the medical establishment. "Herd immunity," the idea that vaccinations prevent outbreaks by increasing immunity within the group, is a medical abstraction that's hard to demonstrate precisely because it's preventive. "Trust is critical for the demand of preventive medicine, such as vaccines," Martinez-Bravo told Tonic via email. "It takes a very long time to build trust in medical institutions, but it takes very little to damage it."
People don't think they're at risk of getting viruses like polio or measles because no one around them gets sick (thanks to vaccines). From a patient's perspective, it's a lot different than, say, seeing a bandage help heal a wound. That's why, they note, the infamous, discredited study connecting vaccines with autism was so damaging: It eroded trust, creating a "debate" where one shouldn't have existed. From there it's not a far walk to conspiracy theories.
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Erosion of trust exactly what happened in Pakistan. Well before bin Laden's killing, the Taliban had argued that Islam forbid vaccines; it also claimed government efforts to eradicate polio were part of a "conspiracy of Jews and Christians to make Muslims impotent and stunt the growth of Muslims." But the revelation that the CIA had used fake vaccination programs to further its own ends added credibility to those claims. (After facing intense blowback, the United States officially pledged it would never again use the technique.) The Taliban and local warlords pointed to the case when they began intimidating health workers in mid-2012. A Taliban fatwa issued in June 2012 demanded an end to the polio vaccination program, saying "polio agents could also be spies." Soon enough, health workers were being killed.
Vaccination rates, though, had begun to drop before the Taliban violence. That suggests propaganda—not just intimidation—had an effect. To test that hypothesis, the study authors used voting data to gauge the population's support for Islamist groups, which would include the Taliban. Populations with high support for Islamist groups, the thinking goes, would be more open to their anti-vaccination views.
Next they mapped that voting data compared to vaccination rates, specifically looking for an effect after news of the CIA's ruse broke. They found that in places where support for Islamist parties was low, there was little change in vaccination rates. Regions with high support for Islamist groups, however, saw a decline.
The connection was significant: a single standard-deviation increase in support for Islamist groups led to vaccination rates falling between 9 and 13 percent for polio, measles, and DPT (diphtheria, pertussis aka whooping cough, and tetanus). A standard deviation is a statistical measure; in this case it corresponds to a 11 percent vote share for Islamist parties. That means for every 11 percent increase in vote share for Islamist parties within a given area, vaccination rates fell between 9 and 13 percent for those three immunizations. After the ban, cases of polio increased from 58 in 2012 to 93 the next year, and spiked to 306 in 2014. They've since gone way down."
The pattern is sadly familiar: Facts (and pseudo-facts) get weaponized to turn people against vaccines, leaving them more exposed and vulnerable to illnesses like polio, a disease virtually eradicated in the developed world. And it's a pattern the CIA—no stranger to blowback—could and should have foreseen. Now we know just how much its fake-vaccination gamble cost.
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