you’re not helping: seriously, CIA, we have enough problems convincing people to get vaccines, polio and otherwise

“At the behest of CIA officials, Afridi reportedly launched a fake polio vaccination campaign in Abbottabad last year, using it as a front to gather DNA samples from people thought to be relatives of the elusive Osama Bin Laden. This elaborate scheme would later contribute to the frenetic manhunt for and subsequent assassination of the Al Qaeda leader.

“(Before this) happened, one could brush aside negative perceptions about the polio vaccine, terming them baseless and ‘agenda-driven’, but not this time,” Fazal Shah, a development sector professional based in the northern district of Mardan, told IPS.

Religious leaders and tribal elders who had hitherto been highly successful in generating public support for the polio vaccine – by breaking myths about the vaccine being life-threatening, made of haram (forbidden) ingredients or causing infertility among both male and female recipients – found their efforts seriously hampered by Afridi’s hoax vaccination drive.”

Rest of article. (h/t KFF)

Update 6 March 2012 (h/t KFF)

“The CIA’s use of the cover of humanitarian activity for this purpose casts doubt on the intentions and integrity of all humanitarian actors in Pakistan, thereby undermining the international humanitarian community’s efforts to eradicate polio, provide critical health services, and extend life-saving assistance during times of crisis like the floods seen in Pakistan over the last two years,” the InterAction coalition wrote to the CIA director, David Petraeus.

Update 18 Oct 2012 (h/t Humanosphere)

“News reports out of Pakistan on the polio efforts there vary wildly, saying two very different things. Some say the efforts to vaccinate against polio are moving forward despite opposition from the Islamists, and from locals still mistrustful of health workers thanks to an ill-conceived fake vaccine ploy by the CIA… This report seems to indicate things are actually getting worse.”

Update 24 December 2012

“Yesterday, a male polio worker was fatally shot, and today four women were killed within about 20 minutes of each other in three apparently coordinated attacks in poor Karachi neighborhoods, including Gadap, where the July shootings occurred. Another woman was killed in Peshawar. Taliban insurgents have repeatedly threatened campaign workers, but so far no one has claimed responsibility for the current or previous attacks.”

Nice editorial 3 Jan 2012

“Pakistan now has a three-fold responsibility: addressing systemic polio eradication impediments, getting vaccination back on track with appropriate security cover for more 90,000 vaccinators, and reaching out to the masses with the right information to ally mistrust. At a minimum this would demand the will to prioritize action, the intent and ability of political factions to work collaboratively, and the ongoing injection of resources. With parliamentary elections forthcoming, all these will be in short supply.”

Further comment on recent polio worker killings via the lancet 4 Jan and time.com 4 Jan.

Nice post from Amanda Glassman and Charles Kenny (19 Dec 2012).

This situation unfortunately follows allegations that US security agencies used a Hepatitis B vaccination campaign as a vehicle for intelligence gathering (see here).  And it is clear that such allegations have had a chilling effect on vaccination programs—for example in Nigeria (see here)–even when completely baseless.

Given that, it is in our own interest to make crystal clear that the US supports global public health programs to improve global health alone and that US-backed public health interventions will not be used to gather intelligence. While far from a panacea, it might help persuade a few more parents to get their kids vaccinated, or a few more local leaders to back down from a boycott.  In the battle against global communicable diseases like polio and measles, every little bit helps.

Wired update 11 January 2013 (h/t humanosphere)

Worldwide, the polio campaign depends on the efforts of volunteer and low-paid vaccinators who work solo or in small teams, and there are signs that the Taliban intimidation has kept those teams at home. In Pakistan, both The News and The Frontier Post are reporting that “lady health workers” are staying home out of fear or as a result of family pressure… The crisis in Pakistan is not just about the changeable fortunes of the polio campaign, which has waxed and waned in public opinion since its launch in 1988. It is specifically in response to the admitted-to ruse by the CIA

Fake drugs for all!

“Most Americans don’t question the integrity of the drugs they rely on. They view drug counterfeiting, if they are aware of it at all, as a problem for developing countries. But the latest incident, which follows the appearance of other fake drugs in the U.S.—including counterfeits of the weight-loss treatment Alli and the influenza treatment Tamiflu—suggests it is a growing risk.”

(More.)

If it doesn’t kill them, it makes them stronger (I)

Gonorrhea increasingly drug-resistant (use drugs right; be careful)

Further comment, offering caution about freaking out.

Dr. Weil on household disinfectants (use less)

Development effects of piracy in Somalia (as studied by day & night satellite images)

Can I come up with a reason to study the health impacts of piracy? Ideas welcome!

“Piracy has created employment and considerable multiplier effects in the Puntland economy, even if a significant proportion of the proceeds is invested in foreign goods or channelled to foreign financiers. The distribution of ransoms follows traditional patterns in Somalia, involving considerable redistribution and investment in urban centres rather than coastal villages. Piracy-related gains have been largely offset, however, by the rise in international food prices. While Puntlanders are relatively better off than the rest of the country as a result of piracy, the poor are no better off in absolute terms.”

“The total cost of piracy off the Horn of Africa (including the counter-piracy measures) was estimated to be in the region of US$7–12 billion for 2010, while ransoms were said to be in the region of US$250 million. Even if Somali communities received all of the ransom money, replacing this source of income (for example with a combination of a foreign-funded security forces and development aid) would be considerably cheaper than continuing with the status quo. A negotiated solution to the piracy problem should aim to exploit local disappointment among coastal communities regarding the economic benefits from piracy and offer them an alternative that brings them far greater benefits than hosting pirates does. A military crack-down on the other hand would deprive one of the world’s poorest nations of an important source of income and aggravate poverty.”

Full report: Treasure Mapped: Using Satellite Imagery to Track the Developmental Effects of Somali Piracy

h/t: Alex Evans

Am I a pirate or a bandit? quick check

Technically, piracy is an act directed at a private sea/air craft that occurs outside the jurisdiction of any one state (international waters or airspace). Once you have committed such an act, however, you can be declared a pirate for acts within a state that would otherwise be considered kidnapping or banditry. This out-of-state definition means pirates (as “common enemies of all”) can be arrested and detained universally – that is, by any country. Though any one country should be able to prosecute pirates by the same logic, the actual legal logistics are unclear – in part because of freerider, capacity, and diplomacy problems related to the work of bringing a potential pirate to trial and jailing him/her if necessary. “One proposal is to form a regional legal center that would be able to apply its own laws to the cases, interact with foreign navies, and have the capacity to incarcerate convicted pirates in a prison system and to return others safely to their home nations. The US supports such a “piracy chamber,” Mr. [Andrew J.] Shapiro [assistant secretary of state] said.”

World Cancer Day: PP & SGK

This seems like as good a day as any to write about the PP/Komen controversy (Komtroversy?). And it seems like a reasonable place to start is agenda-setting theory, riffing on Michael Reich’s riff on Kingdon’s agenda-setting streams. My basic understanding is this as follows. Kingdon identifies three agenda-setting streams: problems, policy, and politics. The political stream includes events, opinions and symbols to which problems can be attached or detached by stakeholders to raise or lower the priority of a problem.  Reich has identified four currents that run within this stream — organizational, scientific, symbolic, and economic.

As far as I can tell, symbolic and organizational politics have trounced science, with economics being a bit of a wash in setting priorities — or in this case, “winning” a debate.

A basic issue seems to be that the organizations – Susan G. Komen Foundation (SGK) and Planned Parenthood (PP) – have both set themselves up to represent women: Komen by pink-washingeverything in sight (also here) and PP by being a major provider of reproductive health care — and primary care in general. Simplistically, women funding women makes sense; women de-funding women seems bad. Whether one group seems to represent a (toothless? intolerant?) feminist approach while the other has “declined…into a parody of conventional femininity” is another argument – though an important one in teasing out the symbolism of the debate. Still, the women v. women gloss may help explain why this debate seemed more explosive than, e.g., Congress voting to de-fund PP.

The background politics don’t help, namely, the political stances of the head of SGK and SGK in general and the politics of abortion (George Karlin on abortion, fyi). It’s silly to pretend that this “just” became political or that only one side of the political spectrum is responsible for this. It seems that SGK’s CEO has given ample amounts of money to GOP campaigns and that Ari Fleisher was instrumental in the hiring of new head of communications at SGK — and that PP was key in the hiring decision and has been to SGK’s internal politics for some time. It is also true that, as a small set of a wider suite of services, PP (proudly) provides abortions (not with public money, although that is the crux of the federal investigation in question, which itself seems to be a political stunt.)

The reality of the funding seems to be that SGK was always going to honor existing grants through their end-dates (end-2012) but then not take any more applications from PP – or any organization under federal investigation (of which PP was really the only one — this must have seemed like such a good storyline at some meeting). Now, SGK says PP can still apply for funding and have tried toclarify the investigation criterion.

What I really don’t understand is why SGK took the route they did to distance themselves from PP and pro-choice-ness (which does seem to be the underlying intent). Another bizarre approach, which was suggested, would have been for SGK to say that they were going to cut-off PP because they wanted to remain apolitical and opt-out of any abortion debate. Things were already plenty political.

But is unclear if, given a goal of cancer detection, PP is the objectively best place to give money and this seems that it could have been a reasonable argument to make to redirect funding streams. First, the US government no longer endorses clinical breast exams or breast self-exams (or says it is an individual decision) and recommends mammograms for women aged 50 and over. Meanwhile, about 85% of PP’s clients are aged 35 or under. While many organizations (including PP) still support clinical breast exams, from a resource allocation perspective and focusing on mammograms – which PP refers-out to do – it may well make sense for SGK to move funds to organizations providing mammograms directly (and, indeed, this was the second storyline they tried on, though who knows if they will actually reallocate that money to mammogram services). Also, SGK funded less than 5% of clinical breast exams performed by PP over the last 5 years and less than 10% of mammogram referrals in the same period. Not all PP affiliates received SGK money for their services. So, losing SGK money might curb services but it is not going to end breast cancer screening and referral at PP. And, in the backlash of this blow-up, PP has already made up enough money to replace lost SGK funds.

If the goal is not merely breast cancer detection but accessible and affordable primary health care (for women) and ‘saving women’s lives,’ and doing things that are ‘in the best interest of women’ – then giving money to PP or other community health clinics makes sense and SGK pulling their money makes less sense. It is true that a lot of women rely on PP for comprehensive health care.

In part, the problems with symbolism represent a fundamental problem with disease-specific funding streams, especially when they have no obligation to engage in systems-strengthening or capacity-building. However, I suppose, this whole thing also represents the potential dangers of a disease– (or body part)-specific organization engaging with the wider health system — you’ll eventually be pulled into debates about what health and health care should entail and you’ll have to be ready to deal with them.

I’d be curious:

  • based on what we know about breast cancer detection, should money (in general) go to clinical breast exams? that is, is scientific recommendation being trounced by symbolism in this case?
  • should we – and how should we – be moving away from disease- and body-part-specific funding? is it different for funding research versus funding screening/care?

(update: 13 Feb, speaking of symbolism)

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