Protecting the Heir: Assessing how Household Gender Composition Compounded Shocks of the CIA Vaccine Ruse in Pakistan

Abstract Book of the 11th International Conference on Research in Management and Economics

Year: 2026

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Protecting the Heir: Assessing how Household Gender Composition Compounded Shocks of the CIA Vaccine Ruse in Pakistan

Humna Rehan

ABSTRACT:

This study examines the gendered impacts of the 2011 CIA vaccination ruse in Pakistan, targeted at the capture of Osama Bin Laden. My research builds on the initial findings of Martinez-Bravo & Stegmann’s paper: In Vaccines We Trust? The Effects of the CIA’s Vaccine Ruse on Immunisation in Pakistan (2022). Specifically, I examine the gendered impacts of the ruse by focusing on intrahousehold composition. By isolating homes into families with only daughters, I run a Triple Difference (DDD) Specification model to observe the impact of the CIA ruse on families with only daughters when there is a change in Islamist support. Therefore, this paper focuses on three observatory variables: the CIA ruse, Islamist support (voter share), and household gender composition. I find that households with only girls see a whopping 9.8 percentage point drop (p<0.01) in full polio immunization for a one standard deviation (SD) increase in Islamist support compared to households with at least one son. This is double the effect found in previous studies. Such a drastic drop can be referred to as a daughter penalty and is rationalized by studying primary sources on targeted Taliban propaganda, claiming the ruse was a mass sterilization campaign. Our discussion in this paper focuses on decisions made at the margin and how having even one boy in the home skews the trade-off made by families when considering vaccine uptake. This study illustrates an important argument: the Global South is not intrinsically patriarchal nor anti-health, and such a characterization would be isolated from context. Rather, the position of women’s health in these regions must be contextualized with the historical background of foreign intervention and its localized implications.

Keywords: Pakistan, Vaccination, CIA, Healthcare, Gender, Polio, Islamist, Son Preference, Ruse, Daughter Penalty, Intra-Household Bargaining