The Anthrax Vaccine Controversy Questions about its Efficacy, Safety and Strategy

Although all U.S. Armed Forces personnel have been ordered to receive the anthrax vaccine, questions remain concerning its efficacy and safety and its intended use to counter a biological weapons threat. Since published data on the anthrax vaccine are scarce, it is difficult if not impossible to evaluate claims on its effectiveness and safety. In addition, questions concerning its safety have been raised, based on reports that associate the anthrax vaccine with high frequencies of adverse reactions and chronic illnesses. The chronic signs and symptoms associated with anthrax vaccination are similar to those found in Gulf War Illness patients, suggesting that at least some of the chronic illnesses suffered by veterans of the 1991 Gulf War may have been caused by vaccines. Commercial vaccines are often contaminated with microorganisms, such as Mycoplasma species, and this type of microbe has been found in the blood of a sizable subset of Gulf War Illness patients along with antibodies against an unapproved vaccine adjuvant. With concerns about safety and efficacy of the military’s vaccines, the strategy of using multiple vaccines to protect against biological warfare agents must be re-evaluated in the context of integrated warfare and the potential simultaneous exposure of forces to chemical, biological and radiological agents along with conventional warfare environmental (smoke, chemicals, etc.) exposures. Introduction—Anthrax Biological Warfare To counter an increasing threat that anthrax spores could be used as a biological warfare (BW) agent all U.S. Armed Forces personnel, including reserve and National Guard members, were ordered to receive anthrax vaccine. This decision has resulted in disciplinary hearings among U.S. Armed Forces personnel who have refused, based on safety considerations, the anthrax vaccine.1 Although rarely found in North America, Bacillus anthracis is a relatively common spore-forming, infectious soil bacterium in some areas of the world, and exposure to a lethal dose can cause death within one week of exposure. 2,3 Spore-forming bacteria like Bacillus anthracis fulfill the most important criteria for a BW agent—their spores are highly infectious, very pathogenic and stable in the air and environment for effective dissemination and infection by inhalation. Spores are relatively inactive metabolically and are much more resistant to sunlight, heat, dryness and chemicals than the replicating microorganism and are thus more effective as BW agents. 4 Bacillus anthracis is one of dozens of lethal and incapacitating (causing nonlethal sicknesses) agents that have been produced for BW, 2 and it is one of the few BW agents for which a vaccine exists that is capable of preventing some (but not all) lethal infections.3,4 Although weaponized (with enhanced survival and pathogenicity over naturally occurring strains) bacterial, viral, fungal and toxin BW agents have been produced by several countries,2 Bacillus anthracis is considered one of the greatest threats because of the ease of its production, storage and dissemination as airborne spores.2,4