The use of health programs by the United States Agency for International Development (USAID) to recruit political activists in Cuba is reprehensible and unacceptable. Using health care as a cover for political activities goes against the internationally accepted principle of medical neutrality and is harmful to the wider practice of providing medical aid in countries around the world.
An investigation by the Associated Press has revealed that USAID has sent nearly a dozen young people from Latin America to Cuba over the last two years to support democratic reform by recruiting political activists who are against the Castro government. These individuals used an HIV-prevention workshop as a ploy to find political activists within groups of patients. USAID documents referred to the HIV-prevention workshop as a “perfect excuse” to conduct political activities.
Health workers are protected under the international principle of medical neutrality, which specifically outlines that governments must not interfere with the duties of medical professionals, especially in times of national and international armed conflict and civil unrest. Political goals should never enter the trusted relationship between a doctor and a patient, and health facilities should never be used for covert political operations.
The concept of espionage runs directly against the notions of honesty and trust, which are essential to doctor-patient relationships and form the foundation of successful medical care. When health care workers have ulterior motives, such as political interests, the trust between doctor and patient is compromised and the broader reputation of public health programs is called into question.
Such activities jeopardize the credibility of the United States and put other USAID programs around the world at risk – programs that, when implemented properly, can significantly improve health care and other essential services. The recent operation has the potential to negatively affect the credibility of USAID health programs not only in Cuba, but around the world.
Similar methods have been employed to gather intelligence in the past, including the CIA’s use of a polio vaccination program in Pakistan to assist in locating Osama bin Laden. After the program was revealed in 2011, widespread distrust for health programs and vaccination campaigns in Pakistan followed, leading to the persecution of health workers and the resurgence of polio in the country. After condemnation by public health experts, President Barack Obama also denounced the CIA operation and vowed to never again use vaccination programs to gather intelligence. President Obama should make a similar decision to ban all subversive activities that interfere with important public health interventions, such as the program in Cuba.
Disease outbreaks around the world, from cholera to Ebola, demonstrate that disease management and eradication require global cooperation. When the credibility of these efforts are undermined, the potential risks to the global and local communities can be devastating. Health care efforts and medical facilities must remain refuges for medical care that strengthen, not erode, the trust between the health workers and communities they serve.