Shadow Government

Loose Lips at the White House Created a Polio Crisis

There is a tragic story unfolding in Pakistan, which is the only country in the world where polio infections increased last year. According to the Centers for Disease Control there were 416 reported cases in the world last year. Ninety-three of them were in Pakistan. So far this year there have been 128 recorded cases. Ninety-nine have been in Pakistan. Pakistan saw a 60 percent increase from the prior year despite the availability of a licensed polio vaccine since 1962. The problem is that the Taliban is shooting the doctors administering the vaccine and has banned the vaccine outright.

The reason the Taliban is suddenly against the polio vaccine isn't because of Jenny McCarthy-led anti-vaccine lunacy. Rather, it's because the Taliban and tribal leaders fear that it is a CIA plot. They have drawn this conclusion because the CIA famously used a hepatitis vaccine program to confirm the location of Osama bin Laden.

The operative word in that sentence isn't "CIA" but "famously." In other words, the problem isn't that the CIA used that tactic -- it's that President Obama bragged about it for political gain. After the May 2011 raid of Osama bin Laden's compound, the Democrats leveraged positive PR to help win re-election -- a welcome distraction from a lethargic economy and a weak foreign policy. Administration and CIA officials were spread to the four corners of Hollywood to spread the Good News about the Pakistan raid.

The easy response to this is that such a momentous event as the killing of Osama bin Laden was bound to become public. Of course it was. He was the most wanted man in the world and someone who had instigated both the worst terrorist attack on U.S. soil and the longest war in U.S. history. Even exposure of the crash of a top-secret MH-60 during the raid was inevitable. The Pakistanis have cameras, after all. However, the degree to which this administration disclosed details and shamelessly fogged the story was unprecedented. The administration leaked so much that Democratic Senate ally Dianne Feinstein even called for a criminal investigation. The raid leaks followed many others, among them leaks about drones, Yemen, and Iran, meant to show some semblance of foreign-policy success.

It was even rumored that Leon Panetta, the then-director of the CIA, was behind many of the leaks for the movie Zero Dark Thirty.

With the deluge of leaks it was not difficult for the Pakistanis to discern the role of Shakil Afridi, a senior Pakistani doctor who was recruited by the CIA to run a door-to-door hepatitis B immunization drive in an effort to collect bin Laden DNA. The administration leaked how they had tracked bin Laden's courier to the compound, how many times SEAL Team 6 had violated Pakistani airspace in the past (presumably to show President Bush had made similar decisions to lesser effect) and even gave a lengthy New Yorker interview with then-Counterterrorism Advisor John Brennan and Deputy National Security Advisor Ben Rhodes giving a blow-by-blow of the details of the operation.

The rank political opportunism was pretty obvious, and even understandable to a certain extent. However, the divulgence of "sources and methods" used by the intelligence community was troubling. Because it involved such a momentous event as the killing of Osama bin Laden, any complaints were taken as partisan bickering and even labeled "Swift Boating."

There is no doubt the revelation is having an impact. According to Pakistani officials there are 250,000 children without their vaccines -- all to avoid a CIA plot. Pakistan was well on its way to eradicating polio until the Taliban learned how the CIA operated. As Elias Durry, head of the World Health Organization's eradication efforts in Pakistan, told NPR, "The whole thing just then got reversed when vaccinators started to be targeted and killed."

U.S. officials opportunistically spilled classified operational details for the sake of spinning a political yarn. Because the Obama administration chose to take a national security issue and use the classified operational details to tell a political story there are now kids in Pakistan missing their polio vaccines. It is a direct relationship.

Had the administration kept classified information, well, classified, the Taliban would never think to ban the polio vaccine. Yes, the Taliban does horrible things like banning little girls from going to school to learn to read, for example. But the Taliban didn't make this decision by twisting Islam into knots. They made it because they learned CIA operational details from the Obama administration's self-congratulatory fanfare.

The administration's shameless leaking literally created a public health crisis. The fight against polio has gone on for decades and cost billions of dollars. It is a worthy goal and attainable. Yet it's a fight that would have been met with a little more success had there been a little more discretion and less political opportunism from President Obama.


Shadow Government

Three Lessons the White House Should Learn from the Ebola Outbreak

We are pleased to welcome Michael Miller to the Shadow Government team -- and just in time.  With the headlines talking about pandemic scares and health screening of VIPs visiting the White House, it is obvious that health matters have profound implications for foreign policy and vice-versa.  Michael has just the right background and perspective to make sense of these issues and to help our leaders manage them more wisely. Welcome aboard.

- Shadow Government Eds.

The news coverage of the Ebola outbreak in West Africa has left Americans reasonably unsure whether the threat is real or hype. In fact, it is both. The outbreak's startling spread and high mortality rate is indeed a real crisis, but it is unlikely to pose a serious threat to Americans at home. Stark differences in natural, cultural, and capacity factors between West Africa and the United States, and the way the virus is transmitted among humans make it extremely unlikely that the United States will face the kind of crisis that has swept through Guinea, Sierra Leone, and Liberia.

The low likelihood of a serious threat to us from Ebola, however, does not mean we should be unconcerned. Though the story is becoming part of a hype-and-fizzle news cycle that contributes to dangerous complacency and even cynicism about the very real threat of a global pandemic, such as from H5N1 influenza ("bird flu" or "avian flu") that could mutate and become readily transmissible among humans, it still carries important lessons.

Like bird flu, Ebola is an animal virus whose novelty among humans makes it highly pathogenic. But Ebola is spread only through direct contact with body fluids of an infected person, and a person directly exposed to Ebola is not contagious if he or she shows no symptoms, which makes travel possible and screening and response relatively straightforward, if admittedly challenging, for competent authorities.

By contrast, a traveler infected with a mutated bird flu could be asymptomatic yet contagious for days, giving no indication of the acute public-health threat they represent and rendering global point-of-entry-focused security measures dangerously ineffective. This scenario is the most common one discussed regarding a potential global pandemic -- it's not far-fetched and should be added to the growing list of things that keep a president up at night.

For its part, the Obama administration has responded to Ebola appropriately thus far, and has not treated the situation as a crisis it shouldn't waste. That said, a bit of "good crisis" thinking is perhaps in order to improve our ability to prepare for and respond to a future pandemic threat. Instead of allowing the "lessons learned" process around Ebola to default to a recommendation to simply spend more money -- a typical Washington impulse -- this crisis should be an opportunity to also honestly examine potential systemic weaknesses and advance policies that could be the difference between life and death for millions of people.

First, the White House should provide clarity about roles and responsibilities among U.S. government departments and agencies involved in health-security, both at home and abroad. Earlier this year the administration unveiled a Global Health Security agenda that sets the right tone and goals, but at least publicly is unclear about authorities, responsibilities, and accountability. In this case, the National Security Council (NSC) process of interagency refereeing and policy development cannot suffice for clearly established authorities and responsibilities at the department and agency level. A lack of clarity in this case can be dangerous, and someone has to be in charge and accountable to the public. There is no room for considerations of fairness or equity among agencies, and parochial rivalries should be dealt with forcefully.

Second, if ever there's an area in which the United Nations system should work, it is to address global public-health threats. The World Health Organization (WHO) is bloated, politicized, and inconsistent in fulfilling its essential role. It is impossible to see how the necessary reforms could ever happen in the absence of forceful U.S. leadership. The president and his new secretary of health and human services have a sometimes-willing reform partner in current WHO leadership, and they should exploit the opening as fully as possible.

Third, the president should use this opening to champion the International Health Regulations (IHRs) and explain importance of these un-sexy, "one world"-sounding commitments that spell out countries' obligations to each other on health-security. Adoption and adherence is voluntary, and the entire system is only as strong as the weakest links. It should be no surprise that three of those weak links are now battling Ebola. Now that the agenda for this week's U.S.-Africa Leaders Summit has been overshadowed by Ebola, the president should direct the discussion toward an honest assessment of the failures around the outbreak, why adherence to the IHRs could make a difference, and how and under what circumstance we can help.

In cases of "lessons learned," the default course for government tends to be one that leads only to a plea for more spending -- doing something different will take a commitment of effort and discipline that seem in short supply in Washington these days. By using the Ebola crisis as an opening for honest evaluation and real reforms, the president has the chance to address some critical deficiencies in our government and the weak global health-security system upon which we all depend.

Michael Miller is a Washington, D.C.-based consultant and an adjunct associate professor at the Duke Global Health Institute. Previously, he was Republican Policy Director at the Senate Foreign Relations Committee, and served as senior advisor in the office of the secretary of health and human services, deputy assistant administrator for global health at USAID, and director for Africa at the National Security Council.

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