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U.S. Army Provides No Funds for Vaccine Care Centers

By David Ruppe
Global Security Newswire

WASHINGTON — The U.S. Army has not budgeted any money in fiscal 2005 for a widely praised chain of centers for treating soldiers with serious complications from military-administered vaccines, even as the network expands this year.

Exactly why is not clear. The Army offered no direct explanation, instead it forwarded requests for information to the spokesman for the Vaccine Healthcare Centers (VHC) Network. Army Col. Renata Engler, who runs the network, cited Army budget constraints and the process of Army budgeting.

Critics of the Defense Department’s vaccine policies have questioned whether there is a strong commitment in the Army and the Bush administration to the network, which by the nature of its work generates evidence of illnesses potentially caused by already-controversial vaccines (see GSN, Feb. 20).

By cutting the funding, “the administration is sending the wrong message to the brave men and women who risk their lives to serve our country by telling them their health is not a priority. In my view it is of the highest priority and I will work to ensure that the program is fully funded,” said Senator Jeff Bingaman (D-N.M.) in a statement last week.

Bingaman plans to introduce an amendment to the fiscal 2005 defense authorization bill, which is on the Senate floor this week, to authorize $10 million for the centers, and “such sums as would be necessary for each fiscal year thereafter.”

Significant Work

Congress in 2000 directed the creation of the network, which now operates four sites to monitor and treat severe reactions to vaccines given by the military.

Since the headquarters center opened in 2001 at Walter Reed Army Medical Center in Washington, the network has evaluated more than 1,000 patients — military personnel, contractors and civilians — and counseled far more personnel — 139,000 in fiscal 2003 alone — by telephone and e-mail, according to Engler.

In addition, the centers’ activities have included: monitoring and researching possible negative effects of vaccines, developing and distributing standards for improving vaccination safety, and providing training, education and guidance about vaccinations to military health care providers.

Senior defense health officials publicly praised them this year.

“Our Vaccine Healthcare Centers Network is a network of specialty clinics to provide the best possible care in rare situations where serious adverse events follow vaccination,” William Winkenwerder, assistant secretary of defense for health affairs, said in March 30 congressional testimony.

In February, Army Surgeon General Lt. Gen. James Peake issued a memorandum repeatedly urging clinicians to utilize the network’s resources, while also noting the much-publicized death of a soldier last year shortly after receiving five vaccinations (see GSN, Nov. 19).

While already in operation, the other three centers, at the Naval Medical Center in Portsmouth, Va., Womack Army Medical Center at Ft. Bragg, N.C., and the Wilford Hall Medical Center in San Antonio, Texas, were expected to have for ribbon cuttings this year.

Funding for the network, though, did not appear in the Army’s fiscal 2005 budget request. Engler said she would need a minimum $5.7 million to keep the centers going “with no frills” through the fiscal year.

“But as of fiscal year 2005, we’re an unfunded requirement. As of 1 October, our budget is zero,” she said.

Suggestions have been made to close down some of the four centers, each of which has 12 clinical staff members, but the centers are overwhelmed, Engler said.

In addition to treatment, each is “trying to do all of this massive response [remote consultation] work,” she said.

A total of nine centers based at major vaccination centers worldwide were originally envisioned, she said, but added, “We’re really in tight budget times.”

Insufficient Prioritization Alleged

Critics of the military’s vaccine program suspect an effort to silence the centers.

The Bush administration has “clearly decided that the way to reduce any reporting of anthrax vaccine adverse reactions — and the cost of paying for them — is to eliminate the only clinic in the United States doing valid reporting of the illnesses that result from the vaccine,” retired U.S. Air Force pilot and Gulf War veteran Lt. Col. John Richardson wrote in an e-mail.

The Pentagon has been under pressure to stop requiring anthrax vaccinations. Four service members and two civilians are anonymously suing the Defense Department and the Food and Drug Administration over the inoculation’s safety, arguing that military personnel should be allowed to refuse the vaccine (see GSN, Jan. 8).

Senator Bingaman this year asked Defense Secretary Donald Rumsfeld to reconsider the policy in light of “the potential for serious health consequences for our troops” and an apparent absence of Iraqi biological warfare capabilities. No change has been made.

The network lately has been researching several cases of blistering skin rashes and oral ulcers, identified as the rare disease “pemphigus vulgarus,” occurring after anthrax vaccinations. It also is aiding investigations of at least 71 cases of myopericarditis occurring following smallpox vaccinations (see GSN, May 13).

Congress created the network following revelations in the late 1990s that the anthrax vaccine was causing a significant number of serious illnesses among military personnel, said Meryl Nass, another prominent military vaccine critic and physician who regularly treats soldiers with suspected vaccination complications.

“Congress pointed out that people, who were becoming ill following vaccinations, needed to be treated appropriately within the military, not just discharged because of their medical disability,” she said.

By doing so, the centers inevitably expose vaccine hazards officials may not want to see publicized, she asserted.

To some vaccination proponents, the centers are basically “an invitation to leak,” she said.

A History of Uncertainty

Engler, who is seeking to put network funding into the Army’s next long-term budget plan, the Program Objective Memorandum (POM), offered a different explanation for the network’s uncertainty: a general funding shortage.

“We’ve briefed over the last few months numerous venues, and everyone says you’re doing a good job, we need you. … People continue to apologize to us and say we know you’re a good thing, we just don’t know how to pay for you,” she said.

Engler said it is not uncommon for new programs not included in the Army’s Project Objective Memorandum to have to compete with other programs for resources.

Since the network’s conception, long-term funding has never been certain. The program in its first year was funded by the Centers for Disease Control and Prevention. In fiscal 2002 and 2003, Congress appropriated money for it directly. During this fiscal year, the Army’s North Atlantic Regional Medical Command is sharing funds.

The fact that the Army did not include the program in its previous long-term budget plan [which is the fiscal 2004-2009 POM] could indicate just how much or little it values the network, said defense spending expert Steve Kosiak, budget director of the Center for Strategic and Budgetary Assessments.

“To say it’s not in the POM, is to say it’s not enough of a priority for you,” he said.

Changing a Way of Thinking

Engler said the centers occupy a middle ground between opposition to certain vaccinations and mandatory vaccinations without exceptions. She said she supports the mass vaccinations against anthrax and smallpox, but along with rigorous screening for potential risk factors that could forecast serious reactions and warrant exemptions.

She said the centers’ work represents a new approach to understanding the potential consequences of vaccinations that requires a change of thinking in the military and civilian medical communities.

Traditionally, the military as well the civilian Centers for Disease Control and Prevention focused on epidemiological analysis, she said, by examining large numbers of vaccinations for problems among a significant number of people.

“The problem is that rare adverse events are not as amenable to the epidemiological approach,” she said.

Engler’s centers, and the comparable Clinical Immunization Safety Assessment centers at the CDC, offer a clinical, micro-level approach to vaccine safety questions by treating and researching potentially rare but serious reactions.

The medical community needs to come to the view that vaccines are prescription drugs and need to be treated as such, she said. That is, that vaccines pose uncommon though potentially serious complications that often can be avoided by screening patients with potential risk factors, but those factors should not be considered a reason to stop mass vaccinations.

Her centers aim to spread that message to military patients and health care providers who, like their civilian counterparts, may have given little attention to the uncommon side effects of vaccinations.

“I get [medical] folks who say, ‘What’s the problem? You know. I stuck my arm out and I’m just fine. It’s just a shot,’” she said.

“We want to bring the standards of how prescription drugs are handled to the world of vaccines and it’s a learning curve. There are no bad guys. We’re teaching people to look at things differently,” she said.