How the C.I.A. Hurt U.S. Health Diplomacy

The C.I.A. spared no effort in its relentless and ultimately successful campaign to locate and kill Osama bin Laden. But it has been revealed that the no-holds-barred inventiveness of C.I.A. operatives involved the recruitment of a Pakistani doctor to run a community vaccination program in Abbottabad as cover to try and obtain biological samples from occupants of the Bin Laden compound.

The scheme involved having the doctor gain entrance to the compound under the pretense of a hepatitis vaccination campaign, give shots to Bin Laden’s coterie, and perhaps extract a biological sample that could confirm the presence of Bin Laden from his children’s DNA.

The C.I.A.’s ploy to verify Bin Laden’s presence at his Abbottabad hideout through its “Trojan Needle” project, has sparked a firestorm of opposition from the public health community. And rightly so. To attach a political and intelligence agenda to a medical campaign is to breach trust between doctors and patients — the understanding that health care is provided solely for humanitarian purposes.

That chain of trust also extends to large public health programs, which depend on community and national leaders to gain access to remote villages and maintain complex supply chains for vaccines and medicines. Cooperation that makes possible the flow of aid between the United States and countries hit by disease and poverty has been built after years of negotiation and a track record of successful collaboration.

The revelation of the C.I.A.’s tactics now threatens to undermine a broad set of American global health initiatives. Even though the Abbottabad effort did not directly involve Americans, the hidden hand of the C.I.A. leaves current U.S. international health operations vulnerable to new scrutiny and suspicion, however unfounded and unwarranted they might be. The momentum generated by the Bush AIDS and malaria treatment initiatives as well as President Obama’s Global Health Initiative has mobilized billions of dollars and deployed thousands of people in dozens of developing countries. The State Department recently launched a developmental diplomacy campaign that promotes American good will through “civilian power.” Now, given the C.I.A.’s manipulation of the vaccination program, U.S. motives for that campaign may be met with skepticism and even mockery.

The trust invested in U.S. development assistance may become eroded, especially in regions where America’s geopolitical rivals exert pressure. American health operations and personnel working abroad could come under foreign intelligence surveillance and face politically motivated hindrance and harassment, potentially disrupting health supply lines to millions of needy people. Diplomats charged with coordinating U.S. aid may be put on the defensive. Especially vulnerable to foreign scrutiny are the U.S. military’s sponsored health programs, such as the Navy’s medical research bases in Peru and Egypt, and the Defense Department’s medical assistance programs to Ethiopia and Tanzania, where U.S. health teams provide direct care and advice on public health.

In the past, conspiracy theorists have accused the C.I.A. of helping to spread disease for its own nefarious purposes. In 2000, for example, South Africa’s then president, Thabo Mbeki, openly accused the C.I.A. of fostering the region’s H.I.V./AIDS pandemic. Such accusations were easily deflected by their sheer ludicrousness. But with the revelation of the agency’s Pakistan operation, the C.I.A. is vulnerable to renewed attacks over the misuse of legitimate programs.

How might the agency act to remedy the adverse side effects to U.S. health diplomacy? The incoming C.I.A. director, David Petraeus, ought to impose clear restrictions and prohibitions on medically oriented spy tactics so that the integrity and humanitarian purpose of U.S. health aid are affirmed and that current and future health aid operations will not be misused. Congressional oversight committees ought to investigate the Pakistan operation and determine whether agency leaders weighed broader policy sensitivities or the ethical implications of using a medical based tactic to gain intelligence.

However critical it was to target Bin Laden, the covert use of a legitimate health program threatens to make U.S. health and development aid an unintended casualty in the fight against terrorism. With millions of lives being supported with U.S. aid, it is vital that medical assistance to the needy continue without political hindrance and without cause for impugning American humanitarian motives.

Jack C. Chow, the U.S. ambassador on global H.I.V./AIDS from 2001-3 and the assistant director-general of the World Health Organization on H.I.V./AIDS, tuberculosis and malaria from 2003-5. He is currently a professor at Carnegie Mellon University, Heinz College of Public Policy.

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