In the years before U.S. forces killed Osama bin Laden, CIA handlers in Pakistan secretly hired a doctor to conduct a fake vaccination campaign. The intelligence agency told the doctor to conduct the program to obtain DNA from bin Laden’s children in order to confirm the al Qaeda leader was in Abbottabad, Pakistan. The information the doctor gathered was used in the ultimately successful effort to kill bin Laden in 2011.

Now, in the wake of years of criticism of that fake vaccination program, the U.S. is vowing to stop exploiting healthcare for intelligence operations. The White House has promised that the Central Intelligence Agency will no longer use vaccination campaigns as a front for conducting covert operations.

But the damage has already been done. Polio, for instance, is on the rise around the world, including in Pakistan. Vaccinations have become tainted by their past association with the United States.

Last week, Obama administration counter-terrorism advisor Lisa Monaco sent a letter to the heads of 13 public health schools that announced a new CIA policy to spurn the use of vaccination campaigns in intelligence efforts. Monaco said that CIA director John Brennan had issued a directive saying that the agency would “make no operational use of vaccination programs, which includes vaccination workers. Similarly, the agency will not seek to obtain or exploit DNA or other genetic material acquired through such programs.”

Monaco’s letter came in response to concerns raised by the deans of public health universities. They charged that the CIA’s fake hepatitis vaccination program in Pakistan had severely undermined healthcare efforts in the country. Save the Children, a prominent NGO, had been run out the country because of the “CIA sham vaccination campaign” and “seven or more United Nations health workers who were vaccinating Pakistani children against polio were gunned down in unforgivable acts of terrorism,” the deans said in their letter. (Save the Children was accused of facilitating the CIA’s meetings with the doctor who ran the vaccination campaign, though they strongly deny this.)

In 2009, the CIA contacted Dr. Shakil Afridi, a Pakistani healthcare worker. He agreed to work for them while working at a hospital. Afridi set up a hepatitis B vaccination program in Pakistan. But it was actually a ruse. The end goal of the effort was to get inside the bin Laden compound in Abbottabad and take a DNA sample of one of bin Laden’s children to confirm that Osama bin Laden was actually in there. The effort continued as the Obama White House fiercely debated whether to launch a Navy SEAL raid in Abbottabad—a risky ordeal they didn’t want to undertake if they weren’t confident bin Laden was in the Pakistani city.

It’s unclear whether Afridi ever did make it into the bin Laden house. Both the U.S. and Pakistan say his fake vaccination campaign was crucial to the success of finding and killing bin Laden. Whether he, his partners in the vaccination campaign, or a separate social worker got the DNA is disputed, as investigative reporter Matthieu Aikins wrote in GQ Magazine. Whatever the story, the U.S. did kill Osama bin Laden, setting off a crisis in U.S.-Pakistani relations and leading to the jailing and alleged torture of Dr. Afridi, who will remain in prison for years.

But the collateral damage also extended to vaccination campaigns in Pakistan. The Taliban in Pakistan went on a rampage against health workers in the country. While it’s true the Taliban and other Pakistan militant groups have long targeted internationals in Pakistan and Afghanistan, radical Islamists have exploited the CIA ruse to try to run healthcare workers out of the country.

Militant groups have killed 30 members of vaccination teams over the past two years. One of the latest attacks came in late March, when armed men kidnapped and murdered a polio worker in Peshawar, Pakistan. This has affected the availability of polio vaccinations, fueling the rise of a disease that was once almost fully eradicated.

This year, health experts have warned that polio, a crippling disease prevented by vaccination, is increasing around the world. Pakistan is the leading culprit. Fifty-nine cases have been reported in the country, amounting to 80% of the global total. The World Health Organization warned earlier this month that Pakistan, Cameroon and Syria needed to institute emergency measures to prevent the disease’s spread.

Speaking to Democracy Now!’s Amy Goodman earlier this month, journalist Rafia Zakaria laid out why polio has become such a problem in Pakistan.

“The central issue, is the issue of public trust. You know, it is unimaginable that in the Western industrialized nations of the world, that a public health program would be allowed to be used as a front to—you know, to essentially forward a strategic interest in capturing one or another person. But this is what has happened in Pakistan,” Zakaria said. “There is a rumor that says that Pakistani children are being sterilized by this vaccine, and then you have the truth of the fact that the CIA did use the program, it’s very, very difficult to convince people, even educated people, that the vaccine that their children are going to get is one that hasn’t been tampered with.”