As the world turns a hopeful eye toward coronavirus herd immunity, public health officials everywhere face the challenge of swaying people to get a COVID-19 vaccine.
The hesitancy can stem from political, moral or religious views; concern over vaccine safety or fear of side effects; inconvenience; or a basic lack of information. In Pakistan, however, things could be further complicated by a tangled legacy of vaccine distrust following reports of a 2011 CIA-led vaccination campaign ruse designed to locate al-Qaida leader Osama Bin Laden.
Shortly after a US military special operations unit killed Bin Laden on May 2, 2011, a Guardian article reported the CIA had organized a fake vaccination campaign in the town where it believed Bin Laden was hiding. The goal was to obtain DNA samples from children who were likely closely related to the fugitive leader, under the guise of administering hepatitis B vaccines.
Revelations of the scheme caused an uproar, with extremists launching an intense propaganda effort against vaccines. And the campaign worked, according to a new study that appears in the Journal of the European Economic Association. It finds a significant decline in the vaccination rate in the country followed.
The study doesn’t directly correlate the Central Intelligence Agency’s vaccine ruse and current rates of COVID-19 vaccine adoption in Pakistan. Rather, it uses the dramatic events of a decade ago to explore how false information discrediting vaccines affects immunization rates and other forms of health-seeking behavior. The findings seem particularly relevant given how crucial public acceptance of COVID-19 vaccines is to halting the pandemic.
“We were interested in how anti-vaccine rumors and conspiracy theories are sometimes fueled by true pieces of information,” said Monica Martinez-Bravo of Spain’s Center for Monetary and Financial Studies, and one of the authors of the paper. “The CIA vaccine ruse seemed to be one such instance.”
The CIA didn’t immediately respond to a request for comment, but in 2013, then-CIA Director John Brennan issued an order forbidding the use of vaccination programs in its operations.
Martinez-Bravo said the team couldn’t find another instance where health services were used to cover up espionage activities. But the study does cite other cases of medical malpractice that appear to have eroded trust in the medical sector, like the high-profile Tuskegee experiment. In it, public health workers in the US denied medical treatment to Black men suffering from syphilis so they could investigate the effects of the disease. Later, Black men living close to Tuskegee in Alabama developed lower levels of demand for formal medicine.
After the Guardian article came out, Pakistani doctor Shakil Afridi was sentenced to 33 years in prison for treason for colluding with Americans on the scheme. And members of the Taliban accused health workers of being CIA agents, claimed polio vaccine campaigns were a conspiracy to sterilize the Muslim population and even unleashed violence on health care workers administering vaccines. One Pakistani Taliban commander banned polio vaccinations in an area of the tribal belt days before 161,000 children were scheduled to be inoculated.
Following the Taliban’s campaign, the researchers involved in the new study estimate that the vaccination rate declined between 23% and 39% in Pakistani districts with higher levels of electoral support for an alliance of parties espousing political extremism. They used data from the Pakistan Social and Living Standards Measurement on children born between January 2010 and July 2012. The records indicated whether newborn babies had received vaccines for diphtheria, tetanus and pertussis (DTP), polio and measles.
“Our findings highlight the importance of safeguarding trust in health systems, particularly in contexts with some underlying level of skepticism in formal medicine,” the study says. “Events that cast doubt on the integrity of health workers or vaccines can have severe consequences for the acceptance of health products such as vaccines, that are characterized by having large positive externalities.”
A remaining question, the researchers say, is if and how the public’s trust can be regained.
The World Health Organization in 2019 identified vaccine hesitancy as one of the top 10 global health threats. “Vaccination is one of the most cost-effective ways of avoiding disease,” the WHO wrote at the time. “It currently prevents 2-3 million deaths a year, and a further 1.5 million could be avoided if global coverage of vaccinations improved.”
While the findings have implications beyond Pakistan, they could help inform public health officials in the South Asia country, where vaccines have so far been limited to health care workers and people over 50.
Surveys show general vaccine hesitancy is growing in Pakistan. The country has vaccinated just 0.8% of its total population against COVID-19. The percentage of vaccinations per 100 people also stands at just 1.53%, compared with the global average of 16.44%, according to German news agency DW.
“Some studies suggest the degree of confidence in the vaccines against COVID-19 in Pakistan is low — 30% of the population indicates that they would not get the vaccine,” Martinez-Bravo says.
According to Johns Hopkins University’s coronavirus resource center, Pakistan has recorded more than 864,000 COVID-19 cases, with over 19,100 deaths. According to United Nations data, the country has a population of more than 224.5 million.