DoD Counters Anthrax Threat

WASHINGTON, December 23, 1998 (GulfLINK) - The Gulf War raised awareness of the catastrophic potential of the proliferation of biological weapons and the need to protect troops in a biological warfare environment. Weaponized toxins and living organisms, experts warn, are capable of devastation equivalent to a nuclear explosion. The threat these weapons pose has changed the rules of warfare. To inform veteran service organizations and military service organizations of the Department of Defense efforts to inoculate troops against the deadly anthrax bacteria, the issue was discussed in detail at a meeting hosted by Bernard Rostker on October 8, 1998.

The anthrax vaccine immunization program has been in effect since December 1997 when Defense Secretary Cohen announced the plan to vaccinate the total force - approximately 2.4 million servicemembers. As of October 8, 1998, nearly 231,000 inoculations have been administered; a total of 91,219 individuals had received at least one dose as part of the time-phased program.

The department views anthrax as a significant battlefield threat for a number of reasons, subject-matter experts explained. More than 10 countries and adversaries around the world are currently developing biological warfare capabilities. When anthrax is weaponized into an aerosol form, the dangerous bacterium can cause 99 percent lethality when inhaled by the unprotected. Initial symptoms include fever, cough, and weakness and can begin as early as 24 hours after inhaling the spores. If untreated with antibiotics during the incubation period, infection progresses to respiratory problems, shock and death.

"If we wanted to create the perfect biological agent it would be anthrax," said Major Guy Strawder, director of the anthrax vaccine immunization program agency, office of the Army surgeon general. "Anthrax is inexpensive and easy to produce and it doesn't require a lot of sophisticated equipment. It can be stored for long periods of time and can survive in the environment for periods as long as 40 years."

"This is a poor man's hydrogen bomb," said Rear Adm. Michael L. Cowan, deputy director for medical readiness, the Joint Staff, emphasizing the seriousness of the global threat.

To counter the threat, DoD is using a vaccine that has a 28-year history of safety and effectiveness and has been fully licensed by the Food and Drug Administration since 1970. The anthrax vaccination protocol consists of a series of six doses over 18 months, with an annual booster. Strawder said that the Department's estimates on effectiveness indicate that 90 percent protection occurs after the second dose of vaccine. With each subsequent dose, the effectiveness moves closer to 99 percent.

The Secretary of Defense approved the anthrax vaccination program contingent upon the successful completion of four conditions, Strawder explained. The first condition called for supplemental testing of the vaccine.

"The Secretary of Defense directed DoD to go back and do testing of all the vaccine in stockpile to ensure it met FDA standards for sterility, potency, purity and general safety," he said.

Strawder acknowledged that the second condition creates a management challenge. Under the guidance of the Joint Chiefs of Staff, Secretary Cohen directed that all services ensure they could track every shot given. This directive is particularly important in checking for adverse reactions, he said. Each service has implemented a tracking system that documents the vaccination and transmits the data to the Defense Enrollment Eligibility Reporting System.

Cohen also required all services develop a communication and implementation plan to make sure that every soldier, sailor, airman and Marine understood the seriousness of the threat and the purpose of the overall program.

Lastly, Cohen directed the selection of a medical expert to review the health aspects of the entire program. Dr. Gerard N. Burrow, special advisor for health affairs for the president of Yale University, completed an independent review of the medical and safety aspects of the vaccination program in February 1998. With this final condition met, the program implementation began.

The vaccine programs' conceptual execution called for a three-phase implementation. However, the department launched an accelerated program on March 10, 1998, to protect individuals deployed to the Gulf region during Operation Desert Thunder.

Phase I officially began August 16, 1998, for forces deployed to, or rotating through, high threat areas in Southwest Asia and Korea. Phase II, starting in late fiscal year 1999 to 2000, includes units deployed in the event of contingency to high threat areas. Phase III will begin in 2003 and includes the remainder of the force.

During the morning session, Cowan and Strawder answered a number of questions about the vaccine's safety. Cowan used the dyptheria, pertusis, tetanus (DPT) immunization as an example of the danger inherent with all vaccines.

"The risk of death from complications after a DPT shot is one in a thousand for a child. However, society accepts that risk since the benefit of DPT is much greater. We carefully measured the risks of anthrax and it is one thousand times safer that DPT," he said.

Cowan emphasized that the anthrax vaccination program was one piece of DoD's important force health protection package that required a "a big cultural change" - moving away from the old paradigm of concentrating on casualty care and management and moving toward standards that also emphasize maintaining a healthy and fit force. This cultural change has to include the commanders who take the responsibility to ensure that record-keeping is maintained, he added.

"They [ commanders ] recognize the threat and that they are an information conduit down to their soldiers," said Strawder, agreeing that commanders must embrace the program.

Another challenge for the DoD is the implemention of the vaccine program for the Reserve Component who are not in close proximity to a military installation where they can receive the inoculation. The Department is responding to this matter with a pilot demonstration program developed to improve access to the vaccine, to implement the vaccine's tracking system nationally and monitor the incidence of adverse reactions for all reserve component soldiers in Florida.

Strawder explained that his office receives several phone calls a day expressing concern about possible adverse reactions. Thus far, reported reactions have been minimal - 10 adverse reactions of 201,059 vaccinations given, which include soreness, redness and swelling. One case of Guillain-Barre Syndrome was reported shortly after a servicemember received the third anthrax inoculation. The individual has completely recovered. Guillain-Barre Syndrome is a rare inflammatory disorder that affects the nervous system and causes paralysis. It is occasionally triggered by unrelated events such as pregnancy, surgery or vaccinations.

The Defense Department is very serious about capturing every adverse reaction reported, he said. Acting on this commitment, the Army has initiated a cohort study at Tripler Army Medical Center in Hawaii to track every vaccination for adverse reactions that were given to 627 medical professionals assigned to the center.

Cowan and Strawder discussed the importance of the program's communication plan in dispelling the misinformation troops encounter - often through the Internet - that creates anxiety and fear over the vaccine's safety.

Each servicemember receives a brochure describing the program, a briefing about the vaccine and an opportunity to ask questions before being vaccinated. When the program was implemented in Korea, brochures were distributed to all servicemembers and their family members, contractors and DoD civilians. Pens and computer mouse pads with inoculation schedules printed on them served as communication tools.

The department reports a refusal rate of .004 percent which decreased with increased education.

"We don't want to lose a refusal," said Cowan, referring to the Department's efforts to ensure that servicemembers don't seek to be discharged because they don't understand or trust the program. Refusal to be vaccinated results in separation from the military. Officials encourage any individual who is reluctant to take the vaccine to discuss those concerns with a medical professional.

More information about the program may be found on the DoD website, DefenseLINK,