Prescription Strike

The CIA’s use of vaccine programs as cover for covert operations in Pakistan has endangered aid workers and undermined the fight against polio

“We went into a camp to inoculate some children. We left the camp after we had inoculated the children for polio, and this old man came running after us and he was crying. He couldn’t see. We went back there, and they had come and hacked off every inoculated arm. There they were in a pile. A pile of little arms. And I remember ... I ... I ... I cried, I wept like some grandmother. I wanted to tear my teeth out; I didn’t know what I wanted to do! And I want to remember it. I never want to forget it ... I never want to forget. And then I realized... like I was shot... like I was shot with a diamond ... a diamond bullet right through my forehead. And I thought, my God... the genius of that! The genius! The will to do that! Perfect, genuine, complete, crystalline, pure. And then I realized they were stronger than we, because they could stand that these were not monsters, these were men ...”

—Walter E. Kurtz, Apocalypse Now

The fatal attacks on health workers vaccinating against polio push the limits of even the most ungenerous vision of a “barbaric” Pakistan. Understandably provoking disgust and awe, headlines announcing the murders reinforce faith in the sound judgment of Western intervention.

But you would have to be an almost quaintly classic racist to believe these attacks are simply the violence inherent to brown men with long beards rather than the product of a specific set of circumstances.  With the discovery of a covert CIA war operating behind their back, rural Pakistanis are ­increasingly wary of any kind of Western presence, including medicine. The real threat to Pakistan’s anti-polio campaign is a lack of immunity to the War on Terror.

There was a time when Pakistan’s mission to eradicate polio was thriving. In 2007, opposition to the vaccine declined in western Pakistan, home to the highest rates of polio. That year, a government-coordinated campaign, working with local religious leaders to inform locals about the vaccine, reached more than 30 million children. Compared with the 2006 immunization, recorded refusals were down almost 20 percent in North-West Frontier province. And in the Federally Administered Tribal Areas (FATA), nearly 50 percent of parents who had initially refused the vaccine opted to allow it.

Now, vaccine refusal is once again chronically high. For rural regions already skeptical of outsiders offering free medicine, U.S. foreign policy shrouds Western aid in suspicion. America is engaged in one war in Afghanistan, one in Iraq, and in a drone war in Pakistan. It regularly threatens a war in Iran and is home to a network of Islamophobia so potent, it inspired a massacre in Norway. It isn’t so surprising, then, that medicine even tangentially related to the U.S. is often assumed to be yet another American effort to kill Muslims.

At a recent conference on “Polio eradication in the light of Islam” hosted by the International Islamic University, Islamabad, and designed to dispel anxiety over the vaccine, scholar Samiul Haq told the crowd, “People of Pakistan, especially in the KP [Khyber Pakhtunkhwa] and tribal ­areas, assume that there must be some hidden interest of the West in the polio campaign because it is killing us through the drones and … giving us the vaccine on the pretext of eradicating polio.”

Both the vaccinations and the drones are foreign intrusions, and the violence of the latter undermines faith in the former. Last summer, Mullah Nazir, a Taliban commander in South Waziristan famous for signing a peace pact with the Pakistani military, issued a pamphlet declaring, “Polio and other ­foreign-funded vaccination drives in Wana subdivision will not be allowed until U.S. drone operations in the agency are stopped.” The pamphlet cited 2011’s CIA fake vaccination plot as evidence that “infidel forces are using media, education, and development as a tool to gag Muslims.” Many other Taliban Shuras, or councils, issued similar bans on anti-polio programs conditioned on the end of drone strikes. The pamphlet stated, “In the garb of these vaccination campaigns, the U.S. and its allies are running their spying networks in FATA which has brought death and destruction on them in the form of drone strikes.” In January, a drone strike killed Mullah Nazir.

Both the World Health Organization and the United Nations have halted vaccine campaigns after a series of fatal attacks on volunteers. Killed under suspicion of being covert operatives for the U.S., they’re victims of a precedent set by the CIA.

The vaccination plot Nazir referenced in his pamphlet was an intelligence-­gathering mission under the guise of a hepatitis B ­vaccine campaign that ended up being neither. In the poorer part of Abbottabad, children were given only one of the required three doses before workers were directed to move closer to Osama bin Laden’s compound. At this point the CIA already knew Osama bin Laden’s whereabouts but wanted to confirm his DNA. If and how the CIA managed to procure DNA samples through the administration of vaccines isn’t clear.

The CIA mission for bin Laden used Pakistani faces at every level of the plot except the actual kill. Shakil Afridi, a health official in the tribal area bordering Afghanistan, was paid to spearhead the hoax. He spread word of the campaign with posters advertising a Pakistani medicine manufacturer. He bought the cooperation of local government health workers. He trained Pakistani nurses to administer the vaccines. These nurses promptly lost their jobs after Pakistan’s investigation into the Osama bin Laden raid revealed the hoax. Defense Secretary Leon Panetta said that Afridi “was not in any way doing anything that would have undermined Pakistan.” After all, Pakistanis have never been a priority in America’s war on terror; they’re the collateral damage.

The U.S., desperate for closure, celebrated the death that supposedly justified two wars, and the Pakistani government bristled at yet another unilateral U.S. mission conducted without Pakistan’s consent or knowledge. To convict Afridi of treason would have meant calling the U.S. the enemy. Instead, Afridi was quietly charged under a tribal code for providing supplies to the militant group Lashkar-e-Islam. Secret proceedings found him guilty, and the U.S. Senate responded by cutting $33 million in aid to Pakistan—$1 million for every year of Afridi’s sentence.

U.S. Congressman Dana Rohrabacher introduced a bipartisan resolution in the House of Representatives to declare Afridi a hero, saying, “he paid a terrible price at the hands of our so-called allies—the Pakistani government.” Afridi became proof of everything Americans suspected about Pakistan’s loyalty and everything Pakistanis suspected about America’s honesty.


The fallout has been ongoing.  More than 30 health workers have died trying to administer polio vaccines in Pakistan since the CIA’s field trip into Abbottabad.

Javed Akhter is the executive director of Support With Working Solutions (SWWS), a Pakistani aid group dedicated to improving conditions for women and the poor. In January, his team of seven was shot down on their way back from working in Sher Afzal Banda, a village in Khyber Pakhtunkhwa where SWWS had built a clinic and a school. SWWS had been a presence in the region since 2010, and their list of successful social, economic, and educational projects is formidable. When I asked Akhter if he thought the attack was precipitated by the CIA’s covert war, he said “Yes, absolutely.”

In Pakistan, America’s War on Terror isn’t an abstraction for stump speeches, but a deadly reality. In the FATA province health workers find themselves in an undeclared war zone, one between “the Pakistan army, CIA, and over a dozen militant groups (some of which are at odds with one another),” says Middle East Institute scholar Arif Rafiq. “There is the fundamental absence of trust. Suspected CIA and ISI [Inter-Services Intelligence, Pakistan’s intlligence service] spies are executed in the streets.”

The paranoia isn’t unwarranted. In January 2011 CIA contractor Raymond Davis killed two allegedly armed Pakistani men in Lahore. When he phoned for backup, the American Consulate sent an SUV that then sped the wrong way down a one-way street, killed another Pakistani man, and drove off.

Immediately preceding the capture of Osama bin Laden, the Davis scandal confirmed what many Pakistanis were afraid of: that the U.S. had filled the country with covert operatives for dubious reasons, and they didn’t care if Pakistanis died. Pakistan’s alliance with the U.S. has meant tolerating a proxy war within its borders. Simultaneously, U.S. politicians and pundits have voiced constant skepticism about Pakistan’s status as an ally. It’s tempting to think America’s misgivings about Pakistan are at least partially rooted in the knowledge no other country would ­accede to
such a ­relationship without resistance.

When Pakistan was founded in 1947, tribes in the region now known as the FATA province pledged loyalty to the state on the condition that they would maintain their autonomy. “The Pakistan army entered the area for the first time ever after 9/11, under the pretext of combating al-Qaeda,” Rafiq explains. “The traditional system governing FATA was reliant on tribal leaders. It has been obliterated by over a decade of conflict. FATA is in disarray. Hundreds of thousands of locals in FATA have been displaced by conflict. Some have fled to nearby districts or have migrated all the way south to Karachi.”

Rafiq goes on to say that “attacks on polio workers have risen after former CIA director Leon Panetta admitted on 60 Minutes in January 2012 that Dr. Shakil Afridi worked for the agency … These attacks take place in Pashtun-populated areas throughout the country, and so it is in the context of the war on terror in which these workers are targeted.”

The stateside reports on the mounting deaths of health workers provide the ­number killed, with the cursory reference to the ­Taliban or local militants as likely perpetrators, and Western readers shake their heads in contempt. But what could the shadowed violence of a U.S. presence in Pakistan encourage besides more chaos, more violence? The attitude that Pakistani lives are expendable—Obama has yet to apologize for the hundreds of children killed by drone strikes—leaves Pakistanis resisting with the only targets available to them: health workers that symbolize Western money.

Each of the three countries left with endemic polio—Pakistan, Afghanistan, and ­Nigeria—endure sustained U.S. involvement. For each, security is the top challenge to humanitarian aid, and for each, myths about the goals of polio vaccines persist.

Chief among these myths is the idea of vaccines as a method of sterilization. Belief in such a conspiracy is encouraged by the U.N.’s keen and vocal interest in slowing Pakistan’s population growth, expressed most recently in Capturing the Demographic Dividend in Pakistan, a book launched last month at an event organized by the U.N. Population Fund. As much as Pakistani health workers try to convince families of the vaccine’s benefits, their efforts are undermined by the perception that the program may be U.S. funded. NGOs are often viewed as nothing more than support infrastructure for foreign agents.

The skepticism and fear exhibited in Pakistan’s autonomous areas are understandable for a region that found itself the unwitting host of a foreign war. Families refusing vaccines logically conclude that a country launching drones with one hand can’t be trusted to offer aid with the other. President George W. Bush has said, “You’re either with us or against us.” Rural Pakistanis can do little else but acknowledge they are not us and want nothing to do with us.

Identity is the primary resource in a war against an idea. The distrust “they” in Pakistan have for “us” reflects the distrust “we” have for “them.” How many drone attacks, CIA scandals, and covert operations does it take to cast vaccine workers as foreign threats? How many terrorist attacks did it take to warrant the search of every brown man at the airport, the spying on Muslim Americans, the launching of  two separate wars? We conflate large swaths of Asia into a single Muslim enemy that lurks in deserts and caves; we retroactively label every “military age” male killed by drone a militant. They conflate all Western initiatives into a single operation bent on their demise, every health worker a potential spy. Meanwhile, Pakistani children die of polio and Americans ask, “Why do Pakistanis hate us? We’re only trying to save them.”