Last week, a Pakistani doctor was sentenced by his government to three decades in prison for actions that helped the United States kill Osama bin Laden. Meanwhile, in far-off Geneva, the World Health Organization (WHO) declared a state of emergency in its decades-long battle to eradicate polio. That these two events are intimately connected speaks volumes about new challenges -- political ones -- that threaten to undermine extraordinary global health achievements.
A tribal court in Peshawar sentenced Dr. Shakil Afridi to 33 years' imprisonment for treason -- a penalty considered mild given that the nontribal Pakistani government courts would have ordered death by hanging for the same alleged crime. Afridi collaborated with the CIA's efforts to determine if the secretive family residing behind high compound walls in Abbottabad in 2011 was the bin Laden clan, as U.S. officials suspected. His role was to use a fake hepatitis-B vaccination campaign to gain access to the children in the compound, administer immunization, and retain the needles for use by CIA lab scientists to identify the youngsters's DNA.
Bin Laden was indeed inside the compound, which was raided by U.S. Navy Seals on May 2, 2011, resulting in the death of the al Qaeda leader. U.S. officials later told the New York Times that Afridi had failed to obtain the desired DNA samples, but the physician has publicly admitted to collaborating with the CIA in the vaccine ruse. A chorus of U.S. politicians and Obama administration officials have denounced Afridi's conviction, arguing that the doctor had not acted in betrayal of his country, but in opposition to al Qaeda. This week, tribal court documents were released showing that the doctor's ultimate "crime" was an alleged association with the militant Pakistani insurgent Mangal Bagh, a claim widely dismissed by human rights observers as false.
The same day Afridi received his sentence, leaders attending the Geneva meeting of the World Health Assembly (WHA), the WHO's governing body, declared a state of emergency in the global effort to eradicate polio. With a $1 billion shortfall and only the last 1 percent of polio to go, WHO chief Dr. Margaret Chan declared on May 24, "polio eradication is at a tipping point between success and failure. We are in emergency mode to tip it towards success -- working faster and better, focusing on the areas where children are most vulnerable."
In the 1980s, an estimated 350,000 children in 125 countries annually contracted polio; the WHO believes that this year, just 100 cases of the disease have surfaced worldwide. The end is so near that the Rotary Club, which has made eradication of polio one of its core missions, has champagne on ice. In February, the WHO declared that for 12 months India was free of polio for the first time in the known history of the massive nation, leaving just three countries in the world with endemic polio: Afghanistan, Nigeria, and Pakistan. Not coincidentally, all three have huge Muslim populations. Nigeria has struggled with polio control since 2003, when a group of imams in the country's Islamic north declared the vaccine was deliberately contaminated with either HIV or contraceptives, the result of an alleged CIA campaign to wipe out Muslim children. The conspiratorial view of polio control was shared by some imams and Muslim politicians in Pakistan and Afghanistan.
So last July, when it was disclosed that the CIA had used Afridi and a false vaccination campaign to gain access to the Abbottabad complex, I co-authored a warning with Dr. Orin Levine that the CIA had "destroyed credibility that wasn't its to erode." We wrote: "It was the very trust that communities worldwide have in immunization programs that made vaccinations an appealing ruse. But intelligence officials imprudently burned bridges that took years for health workers to build."
A year later, we have crossed a Rubicon, as WHO Assistant Director General Bruce Alyward told the World Health Assembly. Polio has been eradicated from all the world save those pockets least likely to have faith in Westerners, and the final assault on the virus is hampered by distrust that was in part sown by the CIA. Worryingly, religious leaders in Southern Sudan are reportedly now advising mothers to refuse vaccination for their babies. The WHO, the Rotary Club, and other leaders of the anti-polio campaign have enlisted support from top Muslim religious figures around the world to counter such vaccine apprehensions and conspiratorial views. But it's hard when the conspiracies prove true.
The tragedy is that we could be on the verge of a new outbreak, just as we are on the verge of success. The continued wild-type polio circulation -- the epidemiological term for various natural forms of the virus -- in neighboring Pakistan and Afghanistan causes grave concern in India, where any reintroduction of the virus carried by outsiders into Indian territory could be dangerous due to under-immunization of millions of babies, now children, in pre-2010 campaigns. Even as India changed vaccination tactics and was bringing its polio caseload down to zero, incidence soared in next door Pakistan last year. In late 2011, 10 cases of wild polio turned up in China, carried across its border from Pakistan into territory where health officials had eradicated the disease.
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