Mistrust and polio in Pakistan

By James Carroll

IN THE thick of the Ebola crisis, memories of another plague intrude. Tomorrow is the centenary of the birth of Jonas Salk, the doctor whose 1955 vaccine defeated polio. (1952 saw 57,000 U.S. cases of the disease; 1962 saw less than one thousand.) Because of what Salk began, health experts expected that by now polio — like smallpox — would be eliminated. It did not happen and not only because of the vagaries of nature.

There is an upsurge of polio in several countries today, but only in Pakistan is the virus uptick extreme. It was announced last week that for the first time in 14 years, the number of known infections there now exceeds 200, and many other Pakistanis are certainly infected.

Hundreds of thousands of children are unvaccinated, not least because a primitive Taliban leadership, controlling large sections of territory, regards polio vaccination programs as an American plot aimed at deliberate infections or at intelligence gathering related to drone strikes.

Vaccination workers have been targeted, and 50 of them have been killed since 2012. The Taliban threatens to kill parents who have their children vaccinated.

This is nuts, right? In 2003, certain Islamic leaders in Nigeria condemned polio vaccination programs as a US plot to spread AIDS, but that pernicious lie was overcome because there was no basis to it. Polio is almost eliminated from Nigeria, which records less than 10 cases this year.

But, alas, the story is different in Pakistan. Insane Taliban paranoia about the vaccination program is based in fact: In 2011, the CIA notoriously used a vaccination program as cover to obtain DNA samples from people in and around Osama bin Laden’s compound in Abbottabad in hopes of confirming his presence there. When the ruse was eventually exposed, an uproar of protest from nongovernmental organizations and public health experts followed, but the damage was done. American intelligence operatives had corrupted one of the most important — and benign — activities humans can undertake.

In Washington, the jubilation over the killing of bin Laden trumped any expression of regret about the counterfeit health operation then or later. It was only last May that an unapologetic White House announced that the CIA would cease using vaccination programs as cover. After bin Laden’s death, a chest-thumping CIA director, Leon Panetta, crowed, “Few events in recent history have carried the same impact.” Given the comeback of polio that his agency helped stimulate, Panetta’s claim turns out to be truer than he thought.

One of the most striking things about the tragic outbreak of Ebola is the way in which fear, escalating into panic, can undercut the trust that is essential to individual treatment of those who fall ill, as well as to broader prevention strategies that might slow the spread of the disease. Without social trust, there can be no effective treatment at the micro level, and no real mitigation at the macro level. Yet anguish can put people at the mercy of the worst sort of paranoid fears, as is obvious in the United States with its Ebola terrors far more imagined than real. The effect of public hysteria in America is to further undermine a sense of commonality with the human family. So, for example, when a politician like Scott Brown says that Ebola “underscores the need to secure our borders,” he manifests what Susan Sontag called “the language of political paranoia, with its characteristic distrust of a pluralistic world.”

But in Liberia, Sierra Leone, and Guinea, another sort of vulnerability is at play. Those impoverished countries — at actual and present risk of being decimated by Ebola — already had prior reason to regard the affluent world with suspicion. The global economy normally cares nothing for such nations, which can make current expressions of concern ring hollow. As infected individuals can hand themselves over to caretakers only by believing in their good will, so desperately poor post-colonial nations can accept intrusions on sovereignty, like the presence of US soldiers building health care facilities, only by assuming that international intentions are benign.

That is what was at stake when the CIA, with breathtaking cynicism, turned a vaccination program into a violent tactic of revenge. Because the United States, with its many heroic health care workers at risk today, is on a true mission of healing in West Africa, the Obama administration should more fully reckon with its recent crime against Jonas Salk’s children in Pakistan, and against the fragile tissue of trust on which the world’s health depends.