By Tyler Sheets
Janice Flood Nichols
As a child in the early 1950s, Janice Flood Nichols lost her twin brother to polio. On the night of his funeral, she was admitted to the hospital with the paralytic form of polio herself. Her outlook was not promising. 58,000 Americans had contracted polio the previous year; of these, 3,000 died and more than 21,000 were left paralyzed.
Though polio is now a forgotten disease in the United States, it was the leading public health terror American families faced before April 12, 1955. On that date—ten years to the day after polio’s most famous victim, Franklin Delano Roosevelt, died— television broadcasts, loudspeakers in grocery stores, classrooms, and churches across the country announced that Jonas Salk, a Jewish immigrant researcher, had developed a polio vaccine. Even though no disease had ever been entirely eliminated, experts discussed polio’s eradication. Salk went on to win the first ever Congressional Medal for Distinguished Civilian service. Parades were proposed in his honor. Warner Brothers quickly bought rights to make a movie about his life. Most importantly to Dr. Salk, in a short time it seemed polio was forgotten in America.
Polio did not, however, forget Janice Flood Nichols. Though she received the vaccine and apparently conquered polio in the mid-1950s, during her first and only pregnancy, she discovered that her weakened internal muscles had not supported the structure of her sacrum. A caesarean section saved her son’s life, but her fight with polio was still not over. Nichols began to experience symptoms of post-polio syndrome, uncomfortable after-effects suffered by those who fought polio as children. Her body lives on as a relic of a disease that once terrified the most powerful nation on earth. Nichols calls polio “the disease that keeps on giving”.
Just as Janice Flood Nichols has never been completely free from polio, global eradication remains an elusive goal. Though Janice’s community suffered from a polio epidemic because of a lack of medical understanding, polio lives on today for purely political reasons. Polio’s most impenetrable fortress today is in the headquarters of international political problems: Pakistan.
Health or Security
Polio has tortured mankind for millennia. Even ancient Egyptian art depicts polio sufferers. But despite this long history, in early 2012 the World Health Organization declared that, after a year of a record-low number of cases of polio, polio was now a global health emergency. It did so because the end was in sight, and the declaration of a global health emergency freed up extra funding needed for a surge against the virus. It was a “now or never” strategy.
“Now” no longer seems likely. Three weeks ago, six public health workers involved in the eradication effort were killed while conducting immunizations of Pakistani children. Though this type of violence is not common, it was anticipated by many health workers in the region. Miseducation campaigns and general Amerophobia (fear of all things American) have led many in Pakistan to believe that the immunizations were an effort to sterilize all Muslim children. This idea has been around in Pakistan for some time. Similar paranoia has been a roadblock to immunization efforts in other countries as well. Less than a month ago, retiring congressman Dan Burton of Indiana, in an interview with C-SPAN, reaffirmed his belief that immunizations have a causal relationship to both autism and Alzheimer’s disease. His explanation was essentially that his grandson had several shots and also had autism, so the shots obviously caused autism. Though misinformation campaigns are ubiquitous and can be expected during any immunization campaign, one conspiracy about vaccinations particular to Pakistan has proven to be somewhat true.
Taliban leaders, the de facto authority in two of Pakistan’s three main polio transmission zones, have issued religious edicts (which can act as law in much of Pakistan) accusing U.S. intelligence agencies of using fake immunization campaigns to undermine local leaders. We now know that they were correct.
Now I want to be clear: The six health workers killed last month were almost certainly not involved in any CIA plot. Their murders should be condemned and their killers should be fully prosecuted. However, the CIA’s actions have made a significant impact on polio eradication and it should be held accountable for that impact.
The CIA made major headway in its hunt for Osama bin Laden when it tracked his courier to Abbottabad, a Pakistani city. The Guardian reported that the CIA then began to conduct surveillance on the compound, but wanted confirmation before infiltrating it. Their research revealed that the only people with previous access to the compound had been health workers delivering oral polio vaccines to the children living in the compound. Oral vaccines wouldn’t work because the CIA needed to match DNA samples of children in the compound with the DNA of bin Laden’s daughter, who passed away in Boston months earlier.
Agents contacted the head health official in the Khyber region, Shakil Afridi, about setting up a false Hepatitis B vaccination program. The doctor agreed. A sample was taken. The sample was matched. The man responsible for 9/11 was killed. In all the celebration, few considered the impact or legality of using a medical cover for a military operation in a country with an already ineffective health care system.
Some did, however. Michael Specter of the New Yorker called the plot a “stunning display of arrogance, stupidity, or both”. But support for President Obama surged and most health organizations were relatively quiet. Presumably nobody wanted to offer any negativity when so many were celebrating bin Laden’s death. Yet the CIA should not count this as a victory without drawbacks. Indeed, with victory over polio in sight and with victory in the war on terror a mirage, the CIA’s plot let us lose the former for the benefit of the latter.
Since May 2, 2011, the day bin Laden was shot and dropped into the sea, tensions have been increasing between the Taliban and health workers. The Taliban has made numerous threats against these workers’ well being. Now six health workers have been killed. As health work becomes more dangerous and requires more security, it becomes more expensive. Costs aside, fewer health workers will be willing to risk their safety. This is particularly true of women, who perceive themselves as especially vulnerable in Pakistan.
The more successful polio eradication programs have made female workers a critical element of their campaigns. UNICEF, one of the primary organizations responsible for eradication in India and elsewhere, conducts thorough interviews with parents who reject immunization. In India, results showed that many parents were uncomfortable letting men into their home or handling their children. A massive effort was made to recruit female health workers and the job was completed. Polio is no longer endemic in India.
As the situation has become more dangerous for health workers, polio is not slowing its effort to survive in Pakistan. Four primary factors make Pakistan an ideal last stronghold for polio, and many now are saying it will be the last country on earth where polio is endemic. First, for a variety of reasons Pakistanis have been on the move lately. Violence in some areas, floods in others, and general economic push/pull factors have meant that people, including people with polio, have been traveling. When they travel, polio travels.
Second, health care in Pakistan is poor. That is primarily because of corrupt local governments. The federal government has very little influence in the areas where polio is most often transmitted, and local leaders would prefer to hand health care jobs and financing over to friends and family rather than the health care worker most suited for success at the position. These corrupt local governments can be found in the same areas where polio is most common.
Not only is organized governmental health care poor, but health practices in the home are very poor as well. This is primarily because the people of these areas are poor and uneducated. In the Federally Administered Tribal Areas (FATA), a key polio transmission zone, female literacy is 3%. This lack of female education is perfectly partnered with the male involvement with the Taliban’s conspiracies to leave the children vulnerable to polio. Though these three factors will likely stick around, anti-American sentiment, the final catalyst for polio, can and should be stopped.
Anti-american sentiment should not play a role in the fight against polio, but it does. Though disliking the West is not an available option for refusing immunization on UNICEF’s interview sheet, it often is the reason. The CIA’s fake vaccination program did not do much to help. Furthermore, the “program” is indicative of something more deeply wrong with the United States’ current security philosophy. Too often leaders in the Pentagon and the CIA believe their military objectives take priority over objectives like public health, when in reality, the two objectives are linked. Choosing U.S. security over Pakistani health care will lead to negative outcomes for both.
Health and Security
An article in the current edition of Foreign Affairs entitled “Do Less Harm” discusses the apparent unwillingness of the Pentagon to understand that military success has been, is, and will continue to be linked to the well-being of the citizenry of nations, and the perception of the United States’ impact on that well-being. The author of the piece is primarily frustrated with the lack of a permanent policy mandating that the United States give money to families who have lost loved ones as “collateral damage”. The idea works here as well and is indicative of a poor understanding of the societies we fight among when the United States goes to war. Further evidence of this military-first ideology is that fact that drone strikes were once only a part of a larger strategy, but are now the entire strategy. The U.S. military is primarily concerned with killing easily replaceable Taliban leaders, even when this requires killing scores of civilians. Any philosophy that places military victory over all other victories will delay military victory and have an adverse effect on other victories such as the victory over polio.
Eradicating polio from Pakistan would have been a major increase in soft power for the United States; instead, bin Laden is dead. If the U.S. goal is to eliminate those who hate America, there is no better way to accomplish this than to provide a polio-free environment for children to be raised in. This undermines Taliban authority in the area and can help to mitigate the negative effects of collateral damage and other factors stoking anti-U.S. fervor. Instead of choosing to aid in the anti-polio campaign, America now has to deal with a Pakistan where many believe it is sterilizing their children and using doctors to kill off their leaders. Though I believe the world is a better place without Osama bin Laden, a more holistic approach could have allowed us to defeat both.
Finally, improving efforts to eradicate polio would have reaffirmed the United States’ effort to advance global and multi-lateral interests. Though the United States famously donates more foreign aid than any other nation, its image still suffers from decades of unilateralism. Choosing to kill bin Laden in a way that did not let the global medical world defeat only the third virus in history reaffirmed that notion.
The fight on polio is in trouble but is not lost. The United Nations has halted vaccination programs, as have several local leaders in Pakistan. If the security isn’t provided to allow them to return to work on this mission, polio will not stay where it is now. Donald McNiel, a New York Times reporter who is an expert on polio, has likened the virus to a campfire that will not settle until every spark is stamped out. This is an excellent opportunity for the United States to improve relations with the Pakistani government and more importantly its people. A fantastic effort is needed both in the media and on the ground to ensure that polio is eradicated in Pakistan, but the United States has made fantastic efforts to accomplish its goals in Pakistan before. Our leaders should take up this fight primarily because the war against polio is one that we can win.
Janice Flood Nichols “Twin Voices” 2007
Michael Specter “The C.I.A. and the Polio Murders” New Yorker 12/18/2012
Walsh & McNeil “Gunmen in Pakistan Kill Women Who Were Giving Children Polio Vaccines” New York Times 12/18/2012
McNeil “Deans Condemn Vaccine Ruse Used in Bin Laden Hunt” New York Times 1/7/2013
Leslie Roberts “Fighting Polio in Pakistan” Science Magazine 8/3/2012
Photo by Gates Foundation