A child receives the polio vaccine. Demotix/Rajput Yasir. All rights reserved.

A couple of years ago, it seemed as if polio was on the verge of eradication, thanks to the Global Polio Eradication Initiative launched in 1988. Much has changed in the last three years. In May of this year, the World Health Organization declared a public health emergency (only the second time the agency has made such an extraordinary declaration) regarding the spread of the polio virus. It identified Pakistan, Syria, and Cameroon as three countries which posed maximum danger in this regard.

Consequently, it slapped travel restrictions on all residents and long-term visitors (not merely children who are most susceptible to it) from these countries, who are now required to receive a dose of a polio vaccine prior to their international travel. Even more worryingly, this emergency was declared towards the end of polio’s ‘low transmission season’.

A large portion of those infected by polio do not even know it and experience no symptoms, although they can still pass the disease to others. Those who are affected by it suffer from anything ranging from sore throats, fever, and vomiting to severe muscle weakness, loss of reflexes, and flaccid paralysis. Pakistan is one of the biggest sources of the polio strains, containing about 80 percent of all the newly infected. While Pakistan used to have a well-functioning polio immunization programme, this programme has suffered a severe downturn. In no small part, the hunt for Osama bin Laden has contributed to it.

Bin Laden was killed by US Navy Seals in May 2011. A crucial element in this operation was the setting up of a fake polio vaccination program. The CIA used the services of Dr. Shakil Afridi, a doctor from Khyber, to gain entrance into the Abbottabad house of Bin Laden and collect DNA samples from his family members. Dr. Afridi obliged (without the knowledge of the Pakistani government) and this allowed the CIA to match the collected DNA with DNA samples from Bin Laden’s sister (who died in Boston in 2010). The positive DNA match boosted the CIA’s confidence that Bin Laden was living in the Abbottabad compound, and contributed to the decision to launch the high-risk operation without the knowledge of the Pakistani government.  The discovery and killing of Bin Laden brought ridicule upon the Pakistani military establishment, which had vehemently denied his presence.  The establishment struck back by charging Dr. Afridi with various crimes. He is now imprisoned.

A more serious issue pertains to the consequences of revealing information about the fake polio vaccination programme. This has allowed various militant organizations to violently oppose it, including by murdering polio vaccination teams. The world is now suffering the consequences of the derailment of Pakistan’s polio programme.

The hunt for Bin Laden required the intelligence agencies to deploy all kinds of resources. There is a rich history of US intelligence agencies using American foundations focused on humanitarian work for intelligence gathering. But it is well known that public health programmes often encounter scepticism from the publics that they are trying to aid. This is true across the world. And this scepticism is partially rooted in misconceptions about vaccination. But the actions of the US fatally undermined the credibility of all humanitarian programs, as an alliance of 200 US humanitarian aid groups noted in a letter to the CIA director David Petraeus in March 2012.

There are clear rules in the conduct of war. Medics and Red Cross personnel are not supposed to be fired upon and, at the same time, are not supposed to be used for combat tasks. We need similar rules for intelligence gathering, specifically rules which prohibit the use of humanitarian efforts for intelligence purposes. Otherwise, humanitarian efforts will begin to be viewed as partisan affairs, and face local opposition.

The killing of Bin Laden was a significant achievement for the US intelligence agencies. Yet, they must recognise and learn from its unanticipated consequences as well. Public health crises contribute to state failures. In turn, such states may well provide havens for terrorist groups, and the latter will eventually return to haunt US security.