A fake vaccination program reportedly orchestrated by the CIA in Abbottabad, Pakistan, may have helped the United States gather information about the compound where Osama bin Laden was killed in May 2011. But it also breached a principle of global health, that the workers who provide relief in the form of food, water, or vaccines against preventable illnesses such as polio, operate outside the realm of politics and national interests to meet basic human needs, Dr. Michael VanRooyen, director of the Harvard Humanitarian Initiative, and a colleague write in a perspective piece published by the New England Journal of Medicine Wednesday.

Following the raid, Pakistan officials forced out workers from an aid organization that had been operating in the country for decades. Since December, at least 11 polio vaccination workers have been killed there in a series of attacks, including one on Tuesday, the Los Angeles Times and other outlets have reported.

VanRooyen, who is a Brigham and Women’s physician, and Columbia University epidemiologist Les Roberts write that vaccination programs supported largely by the United States and the Bill and Melinda Gates Foundation have helped to eliminate polio in all countries but Afghanistan, Nigeria, and Pakistan. With the end of the disease in sight, the CIA’s actions are especially concerning, they write:

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Although some U.S. policymakers consider immediate national security concerns a higher priority than long-term global health efforts, the CIA’s false vaccination campaign in Pakistan may cause collateral damage with profound long-term implications for national security. If every aid worker with a syringe is suspected of being a spy, the children, families, and communities of the world will no longer have protection against our greatest killers. Ultimately, if the neutrality of public health efforts is undermined, the world will become a more violent and unhealthy place.

Their sentiments echo a letter sent to the Obama Administration last month by deans of several of the country’s top public health schools, including Dr. Julio Frenk of the Harvard School of Public Health.

Here’s the text of the letter, dated Jan. 6:

Dear President Obama,

In the first years of the Peace Corps, its director, Sargent Shriver, discovered that the Central Intelligence Agency (CIA) was infiltrating his efforts and programs for covert purposes. Mr. Shriver forcefully expressed the unacceptability of this to the President. His action, and the repeated vigilance and actions of future directors, has preserved the Peace Corps as a vehicle of service for our country’s most idealistic citizens. It also protects our Peace Corps volunteers from unwarranted suspicion, and provides opportunities for the Peace Corps to operate in areas of great need that otherwise would be closed off to them.

In September, as a result of a CIA sham vaccination campaign used to hunt for Osama Bin Laden in Pakistan, Save the Children was forced by the Government of Pakistan (GoP) to withdraw all foreign national staff. This action was apparently the result of CIA having used the cover of a fictional vaccination campaign to gather information about the whereabouts of Osama Bin Laden. In fact, Save the Children never employed the Pakistani physician serving the CIA, yet in the eyes of the GoP he was associated with the organization. This past month, seven or more United Nations health workers who were vaccinating Pakistani children against polio were gunned down in unforgivable acts of terrorism. While political and security agendas may by necessity induce collateral damage, we as a society set boundaries on these damages, and we believe this sham vaccination campaign exceeded those boundaries.

As an example of the gravity of the situation, today we are on the verge of completely eradicating polio. With your leadership, the U.S. is the largest bilateral donor to the Global Polio Eradication Initiative and has provided strong direction and technical assistance as well. Polio particularly threatens young children in the most disadvantaged communities and today has been isolated to just three countries: Afghanistan, Nigeria and Pakistan. Now, because of these assassinations of vaccination workers, the UN has been forced to suspend polio eradication efforts in Pakistan. This is only one example, and illustrates why, as a general principle, public health programs should not be used as cover for covert operations.

Independent of the Geneva Conventions of 1949, contaminating humanitarian and public health programs with covert activities threatens the present participants and future potential of much of what we undertake internationally to improve health and provide humanitarian assistance. As public health academic leaders, we hereby urge you to assure the public that this type of practice will not be repeated.

International public health work builds peace and is one of the most constructive means by which our past, present, and future public health students can pursue a life of fulfillment and service. Please do not allow that outlet of common good to be to be closed to them because of political and/or security interests that ignore the type of unintended negative public health impacts we are witnessing in Pakistan.

Sincerely,

Pierre M. Buekens, M.D., M.P.H., Ph.D.

Dean, Tulane University School of Public Health and Tropical Medicine*

James W. Curran, M.D., M.P.H.

Dean, Rollins School of Public Health, Emory University*

John R. Finnegan Jr., Ph.D.

Professor and Dean, University of Minnesota School of Public Health*

Chair of the Board, Association of Schools of Public Health*

Julio Frenk, M.D., M.P.H., Ph.D.

Dean and T&G Angelopoulos Professor of Public Health and International Development

Harvard School of Public Health*

Linda P. Fried, M.D., M.P.H.

Dean, Mailman School of Public Health, Columbia University*

Howard Frumkin, M.D., Dr.P.H.

Dean, School of Public Health, University of Washington*

Lynn R. Goldman, M.D., M.P.H.

Professor and Dean, School of Public Health and Health Services, George Washington

University*

Jody Heymann, M.D., M.P.P., Ph.D.

Dean, UCLA Fielding School of Public Health*

Michael J. Klag, M.D., M.P.H.

Dean, Johns Hopkins Bloomberg School of Public Health*

Martin Philbert, Ph.D.

Dean, School of Public Health, University of Michigan*

Barbara K. Rimer, Dr.P.H.

Dean and Alumni Distinguished Professor

UNC Gillings School of Global Public Health*

Stephen M. Shortell, Ph.D.

Dean, School of Public Health, University of California Berkeley*

*Institutional affiliation is provided for identification only.