Voice

Losing Polio

Did the CIA ruin our chance to eradicate one of the world's worst diseases?

Last week, a Pakistani doctor was sentenced by his government to three decades in prison for actions that helped the United States kill Osama bin Laden. Meanwhile, in far-off Geneva, the World Health Organization (WHO) declared a state of emergency in its decades-long battle to eradicate polio. That these two events are intimately connected speaks volumes about new challenges -- political ones -- that threaten to undermine extraordinary global health achievements.

A tribal court in Peshawar sentenced Dr. Shakil Afridi to 33 years' imprisonment for treason -- a penalty considered mild given that the nontribal Pakistani government courts would have ordered death by hanging for the same alleged crime. Afridi collaborated with the CIA's efforts to determine if the secretive family residing behind high compound walls in Abbottabad in 2011 was the bin Laden clan, as U.S. officials suspected. His role was to use a fake hepatitis-B vaccination campaign to gain access to the children in the compound, administer immunization, and retain the needles for use by CIA lab scientists to identify the youngsters's DNA.

Bin Laden was indeed inside the compound, which was raided by U.S. Navy Seals on May 2, 2011, resulting in the death of the al Qaeda leader. U.S. officials later told the New York Times that Afridi had failed to obtain the desired DNA samples, but the physician has publicly admitted to collaborating with the CIA in the vaccine ruse. A chorus of U.S. politicians and Obama administration officials have denounced Afridi's conviction, arguing that the doctor had not acted in betrayal of his country, but in opposition to al Qaeda. This week, tribal court documents were released showing that the doctor's ultimate "crime" was an alleged association with the militant Pakistani insurgent Mangal Bagh, a claim widely dismissed by human rights observers as false.

The same day Afridi received his sentence, leaders attending the Geneva meeting of the World Health Assembly (WHA), the WHO's governing body, declared a state of emergency in the global effort to eradicate polio. With a $1 billion shortfall and only the last 1 percent of polio to go, WHO chief Dr. Margaret Chan declared on May 24, "polio eradication is at a tipping point between success and failure. We are in emergency mode to tip it towards success -- working faster and better, focusing on the areas where children are most vulnerable."

In the 1980s, an estimated 350,000 children in 125 countries annually contracted polio; the WHO believes that this year, just 100 cases of the disease have surfaced worldwide. The end is so near that the Rotary Club, which has made eradication of polio one of its core missions, has champagne on ice. In February, the WHO declared that for 12 months India was free of polio for the first time in the known history of the massive nation, leaving just three countries in the world with endemic polio: Afghanistan, Nigeria, and Pakistan. Not coincidentally, all three have huge Muslim populations. Nigeria has struggled with polio control since 2003, when a group of imams in the country's Islamic north declared the vaccine was deliberately contaminated with either HIV or contraceptives, the result of an alleged CIA campaign to wipe out Muslim children. The conspiratorial view of polio control was shared by some imams and Muslim politicians in Pakistan and Afghanistan.

So last July, when it was disclosed that the CIA had used Afridi and a false vaccination campaign to gain access to the Abbottabad complex, I co-authored a warning with Dr. Orin Levine that the CIA had "destroyed credibility that wasn't its to erode." We wrote: "It was the very trust that communities worldwide have in immunization programs that made vaccinations an appealing ruse. But intelligence officials imprudently burned bridges that took years for health workers to build."

A year later, we have crossed a Rubicon, as WHO Assistant Director General Bruce Alyward told the World Health Assembly. Polio has been eradicated from all the world save those pockets least likely to have faith in Westerners, and the final assault on the virus is hampered by distrust that was in part sown by the CIA. Worryingly, religious leaders in Southern Sudan are reportedly now advising mothers to refuse vaccination for their babies. The WHO, the Rotary Club, and other leaders of the anti-polio campaign have enlisted support from top Muslim religious figures around the world to counter such vaccine apprehensions and conspiratorial views. But it's hard when the conspiracies prove true.

The tragedy is that we could be on the verge of a new outbreak, just as we are on the verge of success. The continued wild-type polio circulation -- the epidemiological term for various natural forms of the virus -- in neighboring Pakistan and Afghanistan causes grave concern in India, where any reintroduction of the virus carried by outsiders into Indian territory could be dangerous due to under-immunization of millions of babies, now children, in pre-2010 campaigns. Even as India changed vaccination tactics and was bringing its polio caseload down to zero, incidence soared in next door Pakistan last year. In late 2011, 10 cases of wild polio turned up in China, carried across its border from Pakistan into territory where health officials had eradicated the disease.

Alarm across Asia skyrocketed.

As cries of concern from New Delhi grew louder, earlier this year the WHO gave Islamabad a stern warning: Stop polio or face global health travel restrictions, which would be economically crippling. After two years of mishaps in its bungled immunization efforts, Pakistan's health leadership went overboard, stopping cars at tollbooths and dropping polio vaccine into every child passenger's mouth. By April, local polio trackers sent numbers to Geneva that the WHO interpreted as hopeful signs that the disease was finally coming under control. But recently, Pakistan's chief health commissioner Tariq Pirzada revealed that the numbers were faked by overzealous officials eager to please the WHO. In truth, rural immunization rates remain appalling.

The call for polio eradication goes back decades, and was initially backed by millions of members of the Rotary Club International, which raised much of the money used to eliminate the disease from the Americas, nearly all of Africa, and Southeast Asia. More recently, philanthropist Bill Gates jumped into the fray, donating billions of dollars to the effort. Combined with the WHO, UNICEF, and other organizations, these players eliminated 99 percent of the global burden of the disease, including cases of permanent paralysis caused by the crippling virus and deaths. But in mid-May, U.N. Secretary-General Ban Ki-Moon warned that the great achievements to date could collapse if polio efforts fail in Afghanistan, Nigeria, and Pakistan. 

"There is a looming danger that we could fall victim to our own success," he warned. "Here's why: The world is now populated by a generation that for the most part has never been exposed to polio. Additionally, many in this generation have been inadequately vaccinated. When the virus strikes under those conditions, the impact can be devastating. We saw that in the Republic of Congo and elsewhere in Africa in 2010, when an outbreak killed half of all who contracted the virus."

Eradication is tenuous. Since the early 1960s it has been known that the polio virus can be carried by higher primate species, including monkeys, chimpanzees, and gorillas. In the laboratory it is also possible to infect rodent and chicken cells with the virus, though there is no evidence of those species carrying polio in nature. Nevertheless,  unlike smallpox -- the only human pathogen ever eradicated -- polio isn't merely a Homo sapiens germ.

The virus, moreover, enters the human body in multiple ways, and after vaccination may continue to reside in the gastrointestinal (GI) tracts of infected individuals. Back in the 1950s, when scientists Jonas Salk and Albert Sabin competed to be the first to invent a vaccine, Salk created an injectable version that eliminated the virus from the individual's bloodstream, built up antibodies, and completely protected children from the disease. But Sabin showed that those children could still harbor viruses (harmlessly to themselves) in their GI tracts, and shed infectious microbes in their feces. Thus, Sabin said, oral vaccination was preferable, as it cleansed the intestines and built up local cellular immunity that protected not only the vaccinated individual, but the general public health by eliminating fecal passage of virus into water supplies, food, and untreated sewage systems.

Broadly speaking, this conflict between oral versus injected vaccination, public versus individual protection, and lifelong immunity versus temporary was at the heart of ongoing technical disputes regarding how best to target the disease, and whether eradication is even possible. While oral vaccination is easier than giving shots, its immunization impact is weaker and wanes with time -- even fairly recently immunized Indian children are showing signs of lost protection. Overcoming this requires giving a child as many as seven doses of polio vaccine droplets over a period of months -- a monumental logistics feat for poor countries, particularly in rural areas.

After years of struggle, India succeeded in vanquishing polio only when it switched its vaccine strategy to radically decrease the need for boosters. Instead of using an oral formulation that counters all three strains of polio viruses at the same time -- but weakly -- in 2009, India introduced a stronger vaccine that targets only the dominant two polio strains. The new vaccine gave children a 30 percent more powerful initial immune response, meaning that even without boosters, many Indian kids were protected. The impact was immediately felt, even in the poorest parts of the country. But this strategy may have rendered the children only temporarily protected, accounting for India's fears of Pakistani vaccination failure. Yet the government should also be concerned about its own population's anti-vaccine movement, which has has reached middle-class India, where some parents decline immunization under false grounds that it would contribute to autism.

The world is very close to victory, but the remaining challenges are more cultural and political than scientific. Last year, a team of experts was deployed by the U.S. Agency for International Development to Afghanistan, Nigeria, and Pakistan to ask  local villagers what the polio eradication effort was doing wrong. In village after village, they got the same astonishingly obvious answer: Stop sending teams of men to vaccinate our children. Even a rudimentary understanding of conservative Muslim culture should have taught the would-be disease vanquishers that under Islam a woman may not allow an unrelated male into her home without her husband's presence, nor should she allow the well-meaning gentleman to touch her female children. In all too many cases, vaccine failure boiled down to finally sending all-female health teams to Muslim-dominated villages.

Though the WHO says the final eradication effort is shy $1 billion, money is less likely to decide the fate of the great polio elimination campaign than governance, politics, and culture in three hotbed nations. Which is why the CIA's use of a phony vaccine campaign is so infuriating to health officials. It undermined the faith that many Muslims in vulnerable countries place in Western-inspired immunization and medicine. And with millions of children in India and some other countries now experiencing waning immunity, time is decidedly against us. If wild polio hasn't been eliminated from the final three countries by the end of 2012, the virus could well resurge in sites of alleged eradication, all over the world. And thousands will suffer.

MANAN VATSYAYANA/AFP/Getty Images

Argument

What the Hell Should We Do About Syria?

FP asked five smart observers to offer their solutions for the quagmire in Damascus.

Robin Yassin-Kassab: Arm the Guerrillas

Randa Slim: Talk to Iran

Bilal Y. Saab: Don't copy Yemen

Andrew J. Tabler: Cut off Assad's lifelines

Andrew Exum: Lock up the WMDs

***
 

Robin Yassin-Kassab: Arm the Guerrillas

There are some, perhaps many, Syrians who detest their government and are entirely aware of its treasonous nature -- yet wish for the demonstrations and the guerrilla actions of the Free Syrian Army (FSA) to stop and for President Bashar al-Assad's regime to regain control as soon as possible. They take this position out of a profound pessimism: They believe it is impossible to uproot the surveillance-and-torture state and its deep sectarian substructure, that more people will die the longer the unrest continues, that the economy will collapse further, and that nothing will alter the end -- Assad's inevitable victory. Some Syrians go so far as to say that the regime itself, or a branch of it, is surreptitiously encouraging demonstrations so as to have an "excuse" to teach the new generation an unforgettable lesson.

I can't agree with this defeatist perspective on principle -- the principle being my refusal to give in to despair, and my faith in the ability of human beings to change their circumstances. I understand it, however, and I understand that I might share it if I were living in the heart of the horror instead of in Scotland. But apart from principle, I think the assumption underlying the defeatist perspective is mistaken. Yes, the regime is still able to kill, and will continue or even intensify its killing. However, it has lost control of the country and won't be able to reestablish it.

The much-maligned United Nations observers have confirmed what news reports had already suggested: Large areas of the Syrian countryside and provincial cities are either under FSA control or nobody's. Regime forces are able to infiltrate and punish areas under the revolutionaries' sway, but they dare not linger. Sometimes, they are not even able to move in. When the Assad regime recently attempted to retake the eastern city of Rastan, the FSA destroyed a number of armored vehicles and killed 23 soldiers, forcing the military to retreat.

This is not the 1980s, when Bashar's father, President Hafez al-Assad, succeeded in crushing an Islamist-led rebellion. Back then, the regime succeeded in isolating its enemies in the city of Hama while the world's eyes were focused on a raging civil war and regional struggle for influence in neighboring Lebanon. That was before YouTube and citizen journalism, and before a generation of guerrillas learned lessons in insurgency from south Lebanon and Iraq.

Today, regime forces face roadside bombs from the Jabal al-Zawiya countryside in the north to the Deir ez-Zor governorate in the east and Deraa in the south. According to the most optimistic reports, about a third of the army has defected -- most men have gone home or fled abroad and are keeping their heads down, but many thousands have joined opposition militias. For the defectors, and for the civilian volunteers who fight for revenge or neighborhood defense, the regime's re-establishment of control would mean certain death. These men have no option but to continue resisting.

A few weeks ago, the situation for the resistance militias was dire. They were hopelessly outgunned and had run out of ammunition. But there has been a glimmer of light more recently: News reports suggest that greater quantities of improved weaponry have begun reaching some of the revolutionary forces. One sign of this is the FSA's increasing effectiveness at destroying regime tanks.

It's too early to be certain, but it does seem that Qatari and Saudi promises to arm the opposition, or at least to fund arms purchases, are being fulfilled. The United States is reportedly helping to "coordinate" this process. After 15 months of slaughter and sectarianism, I find myself in the novel position of welcoming this vague intervention.

The dangers of foreign-funded civil war are many and obvious. Saudi Arabia and Qatar are not democracies, and Saudi and Qatari "investors" will not willingly invest in democracy. Private Gulf and other Islamist investors are likely to channel money to groups that understand the conflict in nakedly sectarian terms. The United States, one would expect, will also be doing its best to cultivate clients friendly to American and Israeli interests in the region.

I doubt that any outside power will be able to impose its candidate at the end. The balance of power in the region is currently too contested to allow one side a conclusive victory. But it's almost certain that the country's future leaders will be not civilians but military heroes. That's because it's almost certain that the conflict will be settled not by talking, but by guns. To the victor goes the spoils.

The overbearing role of armed men has been one of Syria's curses since the foundation of the postcolonial state. A greater, and related, curse has been sectarianism -- a monster now well and truly out of the bag and prancing in all its naked ugliness. Just as the regime managed to project a veneer of intelligence before the uprising by deploying urbane spokespeople and co-opted "intellectuals," so it was long able to pose as the secular defender of Syria's delicate social balance. Beneath the surface lay the reality: Syria is just another Levantine postcolonial regime -- every bit as much a product of Sykes-Picot as the Zionist power structure. As the French appointed Maronites to rule Lebanon, they created "an army of minorities" that would rule Syria. The system has not been secularist but sectarian-secularist: Alawis overwhelmingly staff the upper ranks of the security and intelligence services, the most powerful branches of state whose permission is required for everything, from renting a building to opening a street stall. Though unfavored Alawis remain poor and marginalized, those with family connections to the security services are favored for jobs and other opportunities. The brooding social tensions this caused were set aflame when the regime began arming Alawi thugs and sending them into Sunni cities to kill, rape, and humiliate. Eyewitnesses from the town of al-Houla report that the people who cut the throats of children during the massacre were uniformed Alawis from a neighboring village.

In this context, the popular chant of the revolution -- "the Syrian people are one" -- sounds to many like an empty slogan. The damage is already done. It's already too late for a happy ending. The civil war is here, and the longer the stalemate lasts the deeper the trauma will be. This is why I support supplying weapons to the Free Syrian Army. Let's get it over with as soon as possible.

The regime deploys tanks, missile batteries, and helicopter gunships, and is aided and resupplied by Iran and Russia. Syrians have the right to defend themselves, and the right to the means to defend themselves. Most of the country, especially the Sunni heartland, has been reduced to something worse than Gaza. Syrians are fighting anyway -- not for ideology, but for survival. They won't stop fighting. Eventually they will win, although the field of their victory will be the smoking ruin of a poor and bitterly divided country. At some point before that, key sections of the military and the Alawi community will realize they have no hope of victory, and will either flee or switch sides. I would prefer this moment to come in a year's time or sooner, not in another decade. Arming Syria's guerrillas is the only way to bring about that result.

Robin Yassin-Kassab is author of The Road From Damascus and co-editor of the Critical Muslim. He is working on his second novel. He blogs at www.qunfuz.com.

FABRICE COFFRINI/AFP/GettyImages


Randa Slim: Talk to Iran

The massacre in al-Houla, where Syrian military forces and allied militiamen massacred more than 100 civilians in cold blood, leaves no doubt about the intentions of President Bashar al-Assad's regime: survival at any cost and through any means. Assad does not have a Plan B.

While the United States and its Western partners remain publicly wedded to a toolbox of diplomacy, sanctions, and pressure to force Assad out of power, he responds with escalating violence. And it will only get worse: As long as Assad remains in power, more horrific massacres will follow. As long as Assad and his military elites believe they can win this fight, they will not relent, and defections from the senior brass -- whether out of loyalty or fear -- will remain minimal. The steady flow of Russian weapons and Iran's financial and military assistance reinforce their calculus.

Assad is digging in for a long fight. As the struggle goes on, the regional implications of Syria's crisis will increasingly become a complicating factor. Sunni-Shia sectarian tensions are already at a boiling point next door in Lebanon.

The Syrian opposition is also becoming more militarized, and will grow increasingly lethal with time. Saudi Arabia and Qatar are providing the weapons that are transiting through Turkey. According to recent news reports, the United States is playing a coordinating role in this process, vetting rebel groups to make sure the weapons do not fall into the wrong hands.

But don't expect this influx of arms to be a game-changer: The weapons being shipped to the Free Syrian Army do not present a serious challenge to the regime's military arsenal. They will neither serve a deterrent function nor prompt the senior brass to recalculate the long-term costs of their support for Assad. At best, the weapons will help prolong this fight.

Nor does the international climate provide much reason for hope. Russia and Iran, Assad's two principal patrons, are not ready yet to abandon the Syrian regime; they do not yet believe Assad's rule is in danger. And though the West might be overestimating Russia's sway over the Syrian leadership, it is deliberately ignoring Iran's influence in Syria. For now, Supreme Leader Ayatollah Ali Khamenei stands firmly behind Assad.

Over the years, the Iranian leadership has nurtured contacts and relationships inside Syria's Alawite community, particularly with senior Alawite figures in the security and intelligence services. They have a good feel for the dynamics inside this community. Whether the Iranian regime is ready to be part of a deal to unseat Assad remains unclear, but the fact that an Islamic Revolutionary Guard Corps official has recently publicly admitted to the presence of elite Iranian forces in Syria is partly intended to send the message that a NATO-led military intervention in Syria will be costly. It is also a signal to the international community that any future deal in Syria must involve Iran.

During the recent discussions in Baghdad between the global powers and Iran, the United States rejected an Iranian proposal to add Syria and Bahrain to the discussion agenda. It might be worth pursuing this proposal at the next round of talks in Moscow. Time and again, Iranian senior officials have stressed the need for a political resolution to the Syrian crisis. They have been reaching out to different groups in the Syrian opposition. As the Western community keeps searching for a political solution in Syria, Iran might have some ideas about how to bring it about.

Rand Slim is an adjunct research fellow at the New America Foundation and a scholar at the Middle East Institute.

LOUAI BESHARA/AFP/GettyImages

Bilal Y. Saab: Don't copy Yemen

In an attempt to find a solution to the Syrian crisis, the United States and Russia appear to be discussing a diplomatic option, modeled on the U.S.-led political transition in Yemen, that ensures the departure of Syrian President Bashar al-Assad, his family, and perhaps a few of his close associates but keeps his regime intact. Let us save Washington and Moscow the trouble of having to think through this latest proposal, known in diplomatic circles as "the Yemenskii Variant": It is a very bad idea that will make things worse.

First, while this proposal, albeit with major modifications and conditions that guarantee a democratic future for Syria, could have been entertained during the first weeks of the uprising, 14 months and more than 13,000 deaths later is simply too late. The bloodshed is too extreme, and Assad must be held accountable. And any theory of him not being in charge or not having ordered this brutal crackdown is utter nonsense. Assad is the head of the Syrian government and -- as far as we know -- all major decisions, including management of the uprising, are made by him and members of his family.

Second, the Syrian people should be consulted first and foremost. It is one thing to try to stop the carnage and save lives in Syria, but quite another to do it without respecting the long-term aspirations of the Syrian people. Who said that the Syrian people would be on board with keeping a murderous regime that has massacred them on a daily basis? Of course, it is a challenge to know precisely how the Syrian people wish to achieve their goals of freedom, security, and prosperity. Those who speak for the people -- the Syrian opposition -- are hardly coherent or united. There may not be consensus or unanimity among Syrians on how to move forward. Nevertheless, there is something terribly wrong about the notion of foreign powers planning the future of a people they wish to rescue without their endorsement.

Third, the plan is highly immoral. Diplomacy should seek to end the violence in Syria, but certainly not at the expense of justice. History shows that diplomacy is most effective when it is just and rooted in morality. The Syrian people, like their Egyptian counterparts, deserve to see their tyrannical ruler stand before them and face punishment for his crimes. Without justice, there is no reconciliation, and thus any post-Assad political order that preserves the outgoing president's regime is a recipe for continued conflict. For Syrian society to be given a chance to heal, all sects and communal groups must come together and collectively build a better future.

Preserving an oppressive and minority-led regime means that the Alawites will retain their political dominance over others, a condition that is guaranteed to cause more sectarian violence and further alienate the Sunnis, who represent the majority of Syrian society. While former Yemeni President Ali Abdullah Saleh personified the state in his country, Assad is not the only problem in Syria. It is the fascist and security-oriented regime that the Baathists built in 1963 and Hafez al-Assad -- Bashar's father -- remodeled in 1970. Syria needs new leaders, but it also needs a new system and a new identity and role in international society.

Fourth, has anybody called Bashar and asked him if he is willing to play ball? Given the alliance between Damascus and Moscow, one would assume that Russian President Vladimir Putin has phoned his Syrian counterpart and asked him how he would feel about packing his and his family's bags in return for his life. Even if he did, there is reason to believe that Assad will reject this offer for one simple reason: He thinks he is winning. His regime has yet to face a significant security or political threat and the balance of power, despite the rebels' receipt of more modern weapons recently from neighboring countries, still tilts heavily in the government's favor.

One can understand why Russia would favor the Yemeni model for Syria. Moscow does not really need Assad to preserve its strategic interests in Syria and the Middle East. All it wants is a Syrian government that allows it to use the port of Tartous for access to the Mediterranean Sea, that purchases Russian arms, and that maintains trade relations. Assad is expendable as long as his successors stay the course on relations with Russia.

How could the United States even be thinking about this exit strategy, which does nothing to address the roots of the uprising or hold anyone accountable for the crackdown? The stakes in Syria are too high to resort to solutions on the cheap, especially when such solutions are more likely to make things worse and lead to the same unintended consequences that top U.S. officials have been warning about: a full-blown civil war that engulfs parts of the Middle East, further Islamist radicalization of Syrian society that could open new doors for al Qaeda, and a generally chaotic and violent environment in which chemical weapons -- suspected to be held in large quantities by the regime -- are either lost, used or both.

Kofi Annan's U.N.-backed plan has served its goal of exposing the Syrian regime before the world. But that was all anyone could realistically hope of Annan's mission. Now, the United States should pursue tough talks and bargain with Russia to find a solution that respects the hopes and interests of the Syrian people -- not a short-term solution that betrays the Syrian people and undermines U.S. strategic interests in the Middle East.

It's time for real and serious negotiations with Russia over not just Syria but a range of Middle Eastern issues of concern to both countries. But the Yemenskii Variant is not it.

Bilal Y. Saab is visiting fellow at the Monterey Institute of International Studies.

ATTA KENARE/AFP/GettyImages

Andrew J. Tabler: Cut off Assad's lifelines

Last week's massacre in the Syrian village of al-Houla, in which more than 100 civilians lost their lives, has called into question the conventional wisdom in Washington that intervention would make things worse on the ground. President Bashar al-Assad's disregard for the U.N. deadlines in early April to withdraw forces from populated areas and implement a ceasefire has further undermined whatever credibility anyone thought he had.

Without leadership from the United States, though, there is little hope that the many countries with a stake in Syria's conflict will support a negotiated solution. The only way Russia would be willing to help pressure the Assad regime to "step aside," as the White House has demanded, would be if Moscow assesses the regime is in terminal failure and Russia's interests in the Middle East are at stake. U.S.-led intervention sooner, rather than later, would help accelerate that process. The question, however, is how and when. Beyond the existing diplomatic isolation, the sanctions regime on Syrian oil exports and other designations of Assad regime figures and entities, a number of measures could be undertaken in the short run to weaken Assad's grip on power. Here they are, in order of most indirect to most direct:

1. Provide greater support to the opposition within Syria: The Obama administration is providing non-lethal assistance to the non-violent opposition in Syria. That assistance could be extended openly to all opposition forces as well, including providing them with vital intelligence about regime security and military formations headed for towns and cities. Working with these groups would help the United States understand them better, assess their reliability, and establish bonds of trust that could lead to provisions of lethal assistance as the conflict unfolds.

2. Encourage the Kurds and Arab tribes in eastern Syria to fully support the uprising: The Assad regime has broken its most reliable divisions into brigades as it continues its deadly game of "whack-a-mole" with the Syrian opposition. One way to further stretch Assad's forces and accelerate its demise is to expand the Syrian uprising to eastern Syria, where Syria's Kurds and Arab tribes hold sway. They also sit atop Syria's oil and gas producing regions. Sabotage operations on pipelines and other facilities would severely constrain the regime's ability to maneuver. In preliminary discussions with figures representing these communities, they have expressed interest in expanding their relationship with the Free Syrian Army, which has been active in eastern Syria. Now is the time to take the next step.

3. Help Syria's neighbors create safe zones on their territory: Official figures show Syria's border areas in Turkey, Lebanon, and Jordan hold around 70,000 displaced persons, with unofficial figures undoubtedly much higher. Washington could help all three countries create de facto safe zones that could serve as staging areas for the training and equipping of all aspects of the Syrian opposition, including military. This is a legitimate possibility in Turkey and Jordan (with U.S. backing), though it is highly doubtful that it is feasible in Lebanon given Hezbollah's influence. Sunni and Kurdish areas of Iraq could serve as future buffer zones as well.

4. Help create buffer zones within Syria: Safe zones and staging areas in Turkey and Jordan, once established, could be extended onto Syrian territory to protect civilians and allow the Syrian opposition to operate freely within Syrian territory. Turkey has already reportedly developed detailed contingency plans to establish such a zone or zones as a way to deal with refugee flows and to keep Kurdish militants, which the Assad regime supports, from entering Turkey and carrying out attacks. Establishing such zones would involve a long-term military commitment by Turkey and its allies that would only be sustainable with U.S. assistance.

5. Establish an arms quarantine off the Syrian coast: Iran and Russia are openly sending arms to the regime, and this needs to stop. The United States and its allies could establish a naval quarantine along Syria's coastline similar to the international patrols that intercept arms shipments to Lebanon destined for Hezbollah. This, however, would seem to require a U.N. Security Council resolution -- which Russia would likely veto. A possible way around that could be to establish a naval and/or air quarantine of Syria with legal support from the Arab League, akin to the legitimacy given by the Organization of American States to a similar measure during the Cuban Missile Crisis. The question, however, is what happens when Russia and Iran challenges it.

As Syria's conflict tragically unfolds, Washington may need to carry out surgical airstrikes or similar measures to stop regime forces from attacking civilians. If those strikes are to succeed in toppling the regime, however, Washington and its allies will need to have cultivated an alternative leadership from the fragmented Syrian opposition. Conflict will be the constant in Syria for the foreseeable future. But conflict does not necessarily have to set off a generalized civil war -- the opposition on the ground has come together over one issue: Assad must go at all costs. The question is how to get there.

Andrew J. Tabler is a Senior Fellow at The Washington Institute for Near East Policy and author of In the Lion's Den: An Eyewitness Account of Washington's Battle with Syria.

JUNG YEON-JE/AFP/Getty Images

Andrew Exum: Lock up the WMDs

There is little reason to expect a swift resolution to the Syrian conflict. For the moment, Syrian government forces enjoy a tremendous advantage in terms of both manpower and equipment, and the regime has no reason yet to think it will lose. The Alawi minority group -- which fears the loss of its political and economic power -- has strong incentives to act as a spoiler to any potential political settlement.

Which is not to say the United States is powerless. The Obama administration should press for a resolution to the conflict, promoting greater freedom and justice for the Syrian people without becoming mired in Syria's civil war. Working with the U.N. Security Council and the Friends of Syria, the contact group set up to aid the Syrian opposition, the United States should continue to publicize regime atrocities, attempt to establish coherence and inclusion in the Syrian opposition, and exert international pressure on regime officials to promote a political transition negotiated between the Syrian opposition and government. While the Pentagon will and should prepare military contingencies, without a more cohesive Syrian opposition, an international mandate, and a viable strategy for success, the United States should not rev up the B-52s. Under current conditions, military intervention in Syria would, in the words of Foreign Policy's own Marc Lynch, "alter but not end the dynamics of a long conflict, embroiling the United States directly in a protracted and bloody insurgency and civil war."

As the United States works to facilitate a transition, it must also recognize the limitations of its leverage over Syrian actors, prepare for the likelihood of a long conflict in Syria, and work to mitigate the effects of that war on U.S. interests. This means containing the conflict and discouraging human rights abuses while seeking a political solution. At the same time, the United States should counter efforts by other states, including those in the Friends of Syria coalition (think: Saudi Arabia), to empower surrogates with advanced weaponry or otherwise exploit the situation in ways that serve their own sectarian or narrow national interests.

The United States should worry about two particular consequences of the conflict in Syria: terrorism and the proliferation of chemical and biological weapons. The 2007 violence between Lebanese security forces and the Fatah al-Islam terrorist group, led by a militant released by Syrian authorities and resulting in the displacement of nearly 30,000 Palestinian refugees, is a harbinger of the kind of violence that might spill over from Syria. To mitigate the outbreak of limited, terrorist-led sectarian violence in Lebanon and other surrounding countries, the United States should provide security assistance and intelligence support to Syria's neighbors -- as it did in 2007 with arms and equipment, in addition to intelligence support. The United States has excellent relationships with the security services of each neighboring country, which will serve as a valuable asset in the event of a contingency.

The spread of chemical or biological weapons is more difficult to mitigate. None of Syria's neighbors has an interest in such weapons crossing its borders. But the ease with which people and weapons have been smuggled during the conflicts in both Syria and Iraq points toward how porous the Syrian borders with Iraq and Lebanon can be. Both countries have maintained relationships with the Assad regime, and each country should lobby the regime to safeguard its chemical and biological weapons stockpiles. The United States must work with the security services of each neighboring country, meanwhile, to develop plans to halt the movement of such weapons outside of Syria. The last thing this combustible region needs is weapons of mass destruction on the loose.

Andrew Exum is a senior fellow at the Center for a New American Security. This commentary is excerpted from a longer report written with Bruce Jentleson, Melissa Dalton, and J. Dana Stuster to be published in June.

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