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Originally published July 9, 2012 at 6:54 PM | Page modified July 10, 2012 at 4:00 PM

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CIA vaccine ruse may have harmed war on polio

The CIA sent a vaccination team into the bin Laden compound in Pakistan to collect DNA samples and information. When the subterfuge was revealed a year ago, angry citizens chased off legitimate vaccinators in one of the few places where polio has not been eliminated.

The New York Times

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Did the killing of Osama bin Laden have an unintended victim: the global drive to eradicate polio?

In Pakistan, which remains one of the few places where polio has never been eliminated, the CIA's decision to send a vaccination team into the bin Laden compound to gather information and DNA samples clearly hurt the national polio drive.

After the ruse by Dr. Shakil Afridi was revealed by a British newspaper a year ago, angry villagers, especially in the lawless tribal areas on the Afghan border, chased off legitimate vaccinators, accusing them of being spies.

"There could hardly have been a more stupid venture, and there was bound to be a backlash, especially for polio," said Dr. Zulfiqar A. Bhutta, a vaccine specialist at Aga Khan University in Pakistan.

And then, late last month, Taliban commanders in two districts banned polio-vaccination teams, saying they could not operate until the United States ended its drone strikes. One cited Afridi, who is serving a 33-year sentence imposed by a tribal court, as an example of how the CIA could use the campaign to cover espionage.

"It was a setback, no doubt," conceded Dr. Elias Durry, the World Health Organization's polio coordinator for Pakistan. "But unless it spreads or is a very longtime affair, the program is not going to be seriously affected."

The two districts, North and South Waziristan, are in sparsely populated mountains where transmission is less intense than in urban slums. Only about 278,000 children younger than 5 — the vaccine target population — live there. By contrast, in northern Nigeria, where polio is being beaten after years of public resistance to the vaccine campaign, children number in the millions.

Also, Durry said, vaccinators reached 225,000 Waziristan youngsters in early June, before the ban. All will need several doses to be fully protected, but each dose buys time.

The impact of the mistrust won't emerge until the summer spike of polio cases tapers off in the fall. The virus likes hot weather, and the summer monsoons flood the sewage-choked gutters where it lurks.

Paralyzed children may also be found in neighboring countries with better surveillance, as they have been before just over the China and Tajikistan borders. Genetic testing would show whether the strains are Pakistan-based.

By contrast, if the eradicators are winning, local paralysis cases would slowly shrink to zero, as they have in India, a former epicenter that has not had a case in almost a year and a half. And the virus would no longer be found in sewage samples from Pakistani cities, as it is now.

The setback was just one more in the endless war on polio, which was supposed to have been over by 2000. The fight is against the last 1 percent of cases. Paralysis cases worldwide have shrunk from 350,000 in the 1980s to about 600 now.

Victory gets tantalizingly close and then recedes, forcing health authorities to appeal for another $1 billion, as they did recently in Geneva.

Nigeria had only 62 cases last year; Pakistan had 198. For every known case, there are about 200 carriers with no symptoms, experts believe. Thus far in Pakistan this year, only 22 confirmed cases have been found. But the virus is still in sewage samples, meaning people are still shedding it.

Paradoxically, Afridi was not offering polio vaccine, but hepatitis B vaccine.Hepatitis vaccine is injected, while polio vaccine is oral drops. If the objective was to gather DNA — which Afridi's team apparently failed to do — it would be easy to aspirate a little blood into each needle. But polio is the vaccine with a long history of controversy in predominantly Muslim countries, including Nigeria, so Pakistanis who were not familiar with the difference turned on polio vaccinators.

Rumors about polio vaccine abound: that it is a Western plot to sterilize girls, that it is unclean under Islamic law, that it contains the AIDS virus.

Pakistan's polio failures, however, started long before a Navy SEAL team killed bin Laden. A "mafia" of local leaders was pocketing gasoline money, putting children on the payroll, fielding ghost teams and faking statistics, Durry said. More than 300,000 children lived in areas considered too dangerous to enter.

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