By Professor Mike Toole AM
The US government has told a group of local health educators that it will no longer use immunisation programs as a cover for espionage.
But the damage from previous such programs is difficult to undo, and distaste for the US, exacerbated by drone strikes, means the announcement has more symbolic value for Western audiences than impact on the ground. Luckily, local efforts and leadership in affected areas are making progress.
Three regions – Somalia, Nigeria and Pakistan – have armed groups openly hostile to public health efforts, especially immunisation. But only in the latter is this due to the CIA’s actions.
Radical groups in Pakistan
The most radical threat to public health by armed extremists is by anti-government elements in north-west Pakistan. Attacks on health workers and security personnel protecting them have led to more than 60 deaths over the past three years.
The escalation in assaults and murders of vaccinators can be traced directly to the May 2011 U.S. Special Forces assault on the Abbottabad compound inhabited by Osama bin Laden and his family. Three months after the raid, in which bin Laden was killed, the Guardian revealed the CIA had used a Pakistani doctor to carry out a fake hepatitis B vaccine effort to get DNA samples from children living in the compound.
Combined with anger about continuing drone attacks, this episode led to a ban by the Pakistan Taliban in July 2012 on all forms of immunisation in areas they control in the Federally Administered Tribal Areas (affecting mainly North and South Waziristan districts).
Around 350,000 children in contested areas are unable to access immunisation and other public health services. And there’s been a spike in paralytic polio cases in Pakistan this year, with 66 cases reported so far (compared with only 14 in the same period last year).
But this spike is merely the most visible impact of the Pakistan Taliban’s ban on vaccinations; polio surveillance is very effective compared with surveillance for other diseases.
Other negative health impacts include women health workers (the bedrock of Pakistan’s community health services) being unable to work for fear of violence. This means the coverage of health programs for women and children is now very low. And the government has closed 450 community health centres in FATA since 2010 due to the unwillingness of personnel (especially women) to work in the region.
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Professor Toole also spoke to Jonathan Green at Radio National’s Drive Program about the issue.