Blowback and forth

Oral vaccine, Balochistan. Via Express Tribune Pakistan, 2011.

So in southwestern Balochistan last Wednesday, just outside the provincial capital of Quetta, a van carrying eight women and a boy working in Pakistan's polio vaccination program was attacked by a couple of men on a motorcycle, with guns, who just started shooting. They killed three of the women and a bystander and then sped away. The women screamed for help but there were no police around; there was a "security gap", according to Masood Khan Jogezai, Balochistan representative for the Bill and Melinda Gates Foundation:

“Definitely there was a security gap in the operational plan. The security people must have come to one of the areas, which is called the basic health unit, they should have come there, but they did not come,” he said.

The reason the Gates Foundation and the security people and the health care workers were tooling around Baluchistan was that polio, which has long been eliminated from most of the world, is still a calamitous problem in three countries: Nigeria, Afghanistan, and Pakistan. Pakistan has recorded 260 cases of polio so far this year, which is about 85% of all the cases in the entire world (306), making it kind of ground zero. Last year the big winner was Somalia, where polio had been fully eradicated by 2007, but suddenly returned, with 185 cases to Pakistan's 64, but their situation has been greatly improved this year, with just five cases to date.

The reasons for the outbreaks are not unconnected to the reason why the vaccinators need to travel with a security detail: Nigeria, Afghanistan, Pakistan, and Somalia, and Syria (38 cases since October 2013) are all in varying stages of civil war in which one of the parties is a reactionary Islamist army whose fighters likely believe that vaccination is a Western plot to spread disease, make men impotent or sterile, or spiritually pollute them (there's a theory that vaccines use substances derived from pigs), like Jenny McCarthy with AK-47s. These people are likely to forbid vaccination in areas under their control, and attempt to stop it by killing the medical workers who bravely fight the diseases.

What's special about Pakistan is the Central Intelligence Agency, which is there as a "secret" substitute for the US Armed Forces so that the Pakistani government can say it has refused to allow the USAF into the country, and which used to spend a lot of their time there trying to figure out where Osama bin Laden was, even after they had already found out.

In 2010, after one of bin Laden's sisters died in Boston, they worked out a baroque and senseless plan to verify that he was living in that villa in Abbottabad by means of a scam door-to-door program providing hepatitis B vaccinations: they figured bin Laden would be unable to resist the lure of free shots, giving him one would enable their local agents to collect his DNA, and that could be compared to the sister's for a positive identification.

The stratagem, which sounds like a discarded plot point for The Barber of Seville, didn't work, obviously, although since there were fortunately some people older than 11 working on the case, this failure did not stop them from storming the villa and killing bin Laden; but what it did do was to provide the Taliban forces with new reasons to stop vaccination from taking place, as was widely noted at the time (as in the Public Library of Science Speaking of Medicine blog, September 12 2011):

Taliban-circulated rumors that Western vaccines are untrustworthy and may contain pig products already contribute to the Afghan/Pakistan border’s low vaccinations rates. In July alone, such rumors led parents there to refuse vaccinations for more than 16,000 children, according to Pakistani media.2 The CIA’s decision to use the cloak of public health and medicine may lend further credence to specious claims of government conspiracies.

And so it did: more than 80 vaccinators and their police guards have been murdered in Pakistan, plus nine in Nigeria, in the past two years, quite a few more than those killed (as opposed to merely paralyzed) by polio. This seems to be a new phenomenon since the CIA program was exposed (there wasn't any solid data as late as December 2012), and the CIA is clearly to blame for that. DCI Brennan has directed the agency not to "make operational use of vaccination programs", but without directly acknowledging that that is what they had been doing in Pakistan, and without apologizing. I think I really need to hear an apology.