Anthrax Vaccinations for Soldiers are Not Mandatory Elsewhere, and Few International Soldiers Choose Vaccination (Editorial)
Anthrax vaccinations for soldiers are not mandatory elsewhere, and few international soldiers choose vaccination
Meryl Nass, MD
In 1998, when mandatory vaccinations began in the United States, Canada and the United Kingdome also began vaccinations. Canada’s vaccinations were mandatory—but not for long (see below). It had always been policy in the UK to give voluntary vaccinations to soldiers, and anthrax vaccine was no exception.
United Kingdom British authorities have claimed that 50% of troops accepted the vaccine voluntarily. [1] However, the only two published studies, both conducted by military researchers, to look at vaccine acceptance in the UK military indicated that fewer than 50% accepted the vaccine. In the first paper,[2] 129 soldiers working in a military field hospital were offered vaccine; 76% (98 soldiers) accepted and began the series. Initially 63% had adverse reactions, and the authors noted, “forty-five percent of these caused incapacity.” Approximately 22% of reactors had arm pain that prevented lifting or driving for 48 hours. Twenty-one percent of reactions were designated severe. Only 21% of the soldiers offered vaccinations completed the four dose series. The authors concluded, “Although the old vaccine is considered safe, the number of adverse reactions and incapacity reported by a military medical unit was unexpected.”
The second paper looked at vaccine acceptance and adverse reactions in personnel at five Royal Air Force bases.[3] According to the study, “Those completing the [vaccine] course as a percentage of those starting it varied from 22% at base 2 to 3.7% at base 4.” Yet the authors reported that only 11% of vaccinees had side effects, which were mild. Neither set of authors analyzed the drop-off in vaccine uptake, but it seems obvious that the vast majority of soldiers either had adverse reactions or saw others with severe enough reactions that they chose to stop the vaccinations before they were considered ‘fully vaccinated.’
In 2004, The Parliamentary Under-Secretary of State, Ministry of Defence (Lord Bach), acknowledged to a question in Parliament: “No studies of the efficacy of United Kingdom anthrax vaccine against inhalation anthrax have been undertaken in humans.” [4]
The same is true for the US vaccine; therefore, no one knows how effective either will be in the event of an attack.
British sailors were said to have thrown anthrax vaccine overboard from military vessels leaving for the Gulf in 2003. Nearly 500 vials of vaccine were found washed up on shore.[5]
Canada
In Canada in 1998, one brave airman, Michael Kipling, who felt he had been made ill by the vaccine when he received it during the Gulf War, refused the mandatory vaccination. Kipling’s refusal garnered national publicity, and the military subjected him to court martial. Canada seems to have a fairer system of military justice than the US. Kipling had extensive pre-trial proceedings in 2000, overseen by Canada’s highest military judge, Guy Brais. At the conclusion of these proceedings, Judge Brais found that Kipling could not be compelled to accept a dangerous vaccine: “It was sufficient and the court is satisfied on the balance of probabilities that the defense has successfully demonstrated that the anthrax vaccine contained in lot 020 was unsafe and hazardous and could be responsible for the important symptoms reported by so many persons who received that vaccine.
In those circumstances, the court concludes that the accused's right to life, liberty and security of the person in section 7 of the Charter of Rights and Freedoms were infringed. And as the court stated earlier, the government, through its Department of National Defense and the Canadian Forces, could never be justified to impose inoculation of soldiers with an unsafe and dangerous vaccine as a limit of their rights under section 7.”[6]
Since 2000, there have been no mandatory anthrax vaccinations in Canada. Given the ruling above, it is unlikely they will ever return. Since the Afghanistan war began in 2002, Canadian troops have not even been offered voluntary anthrax vaccinations. [7]
One Canadian military study of medical charts of vaccinated and unvaccinated soldiers concluded that vaccinated soldiers had fewer medical problems recorded by military medical facilities than unvaccinated soldiers.[8] Of 571 vaccine recipients’ charts selected for review, 165 charts could not be obtained, including 27 charts “required for current treatment.” Although the “study suggests that anthrax vaccination did not cause adverse health effects in Canadian Forces members up to 8 months after deployment,” because service members under active medical treatment were dropped from the study, its validity is questionable. Furthermore, a GAO study done for Congress of US aircrew found that 60% who became ill following anthrax vaccinations chose to seek treatment outside military medical facilities, to assure the privacy of their medical concerns and maintain their ability to continue flying.[9]
Australia
Australian troops have also been given voluntary vaccinations. However, troops felt they had been misled by their leaders regarding vaccinations on several occasions. First, information on severe reactions seen in earlier troops who received vaccine was withheld from troops receiving vaccine later.[10] [11] Second, troops were sent by ship toward the Gulf in 2003, but only when they were far from home were they told they would be receiving anthrax vaccinations. Although the vaccine was ‘voluntary’ they were told they would not be deployable if they refused, they would have to be flown home, and a refusal would have adverse effects on their future military careers.[12] This also led to much adverse publicity in Australia.[13]
The Australian Medical Association had concerns about the vaccine as well: “The Australian Medical Association has called upon the military to prove the vaccination is safe. ‘If they have that data, the medical profession in Australia would very much like to see it,’ the Association' s president Kerryn Phelps told Australian Broadcasting Corporation radio.” [14]
France
France never vaccinated Gulf War soldiers for anthrax, nor has it been used in France since the first Gulf War. France has a much smaller percentage of chronic illness in its Gulf War veterans than any of the countries mentioned above, which did vaccinate some of their troops. [15]
World Health Organization
According to the WHO: “There is a vaccine against anthrax, but it is not approved for widespread use because it has never been comprehensively tested in human trials. The vaccine is sometimes given to people who are likely to be exposed to anthrax through their occupation, for example, tannery workers, or to military personnel. It is not widely available, nor is its use for mass immunization recommended.” [16]
[1] http://news.bbc.co.uk/1/hi/uk_politics/2749735.stm
[2] Hayes SC and World MJ. Adverse reactions to anthrax immunisation in a military field hospital. J Royal Army Med Corps. 2000 Oct;146(3): 191-5.
[3] Enstone JE, Wale MCJ, Nguyen-Van-Tam JS et al. Adverse medical events in British service personnel following anthrax vaccination. Vaccine 2003; 21:1348-54.
[4] http://www.publications.parliament.uk/pa/ld200304/ldhansrd/vo040106/text/40106w02.htm
[5] http://observer.guardian.co.uk/uk_news/story/0,6903,1376906,00.html
[6] http://www.mvrd.org/AVN/sonnie/law/canadatranscript.htm#judge
[7] http://www.cbc.ca/cp/health/070305/x030519A.html
[8] Hunter D, Zoutman D, Whitehead J et al. Health Effects of Anthrax Vaccination in Canadian Forces. Military Med 2004; 169: 833-8.
[9] http://www.gao.gov/cgi-bin/getrpt?GAO-01-92T
www.gao.gov/cgi-bin/getrpt?GAO-02-445
[10] http://www.usatoday.com/news/world/2004-02-21-australia-anthrax_x.htm
[11] http://www.abc.net.au/lateline/stories/s783068.htm
[12] http://www.abc.net.au/news/newsitems/200408/s1175466.htm
[13] Ackermann D, Chapman S, Leask J. Media coverage of anthrax vaccination refusal by Australian Defence Force personnel. Vaccine. 2004 Dec 2; 23(3):411-7.“BACKGROUND: During February 2003 a number of Australian sailors were returned home from their deployment to the Persian Gulf after refusing anthrax vaccination. This paper examines the media coverage of this episode as a case study in how controversies about vaccine safety escalate. METHODS: Frame analysis of articles from major Australian newspapers (n=83) and transcripts of radio and television news and current affairs programs (n=22) to identify the main supportive and oppositional themes used in reportage and media debate. FINDINGS: Initially, the major news frames were supportive of the vaccine refusing soldiers, and conveyed a sense of distrust of the government's actions. These initial themes were rapidly re-framed and new dominant discourses appeared. First, sailors went from brave whistleblowers to being portrayed as deserters and cowards. Second, proponents shifted from their portrayal as faceless regulators to personal risk takers embodied in a well-respected Major General having the vaccine. Third, the voluntary nature of the vaccine was emphasized, thus dousing the flames of implied coercion. CONCLUSION: Marked shifts in the representation of vaccine opponents and proponents possibly contributed to the rapid diminishment of media interest in the story.” Entire article can be found at: http://tobacco.health.usyd.edu.au/site/supersite/contact/pdfs/anthrax.pdf
[14] http://news.bbc.co.uk/1/hi/world/asia-pacific/2760253.stm
[15] http://www.gao.gov/cgi-bin/getrpt?GAO-02-359T
[16] http://www.who.int/csr/disease/Anthrax/anthraxfaq/en/
Meryl Nass, MD
Mount Desert Island Hospital
Bar Harbor, Maine 04609
207-288-5081 ext. 220
Meryl Nass, MD
In 1998, when mandatory vaccinations began in the United States, Canada and the United Kingdome also began vaccinations. Canada’s vaccinations were mandatory—but not for long (see below). It had always been policy in the UK to give voluntary vaccinations to soldiers, and anthrax vaccine was no exception.
United Kingdom British authorities have claimed that 50% of troops accepted the vaccine voluntarily. [1] However, the only two published studies, both conducted by military researchers, to look at vaccine acceptance in the UK military indicated that fewer than 50% accepted the vaccine. In the first paper,[2] 129 soldiers working in a military field hospital were offered vaccine; 76% (98 soldiers) accepted and began the series. Initially 63% had adverse reactions, and the authors noted, “forty-five percent of these caused incapacity.” Approximately 22% of reactors had arm pain that prevented lifting or driving for 48 hours. Twenty-one percent of reactions were designated severe. Only 21% of the soldiers offered vaccinations completed the four dose series. The authors concluded, “Although the old vaccine is considered safe, the number of adverse reactions and incapacity reported by a military medical unit was unexpected.”
The second paper looked at vaccine acceptance and adverse reactions in personnel at five Royal Air Force bases.[3] According to the study, “Those completing the [vaccine] course as a percentage of those starting it varied from 22% at base 2 to 3.7% at base 4.” Yet the authors reported that only 11% of vaccinees had side effects, which were mild. Neither set of authors analyzed the drop-off in vaccine uptake, but it seems obvious that the vast majority of soldiers either had adverse reactions or saw others with severe enough reactions that they chose to stop the vaccinations before they were considered ‘fully vaccinated.’
In 2004, The Parliamentary Under-Secretary of State, Ministry of Defence (Lord Bach), acknowledged to a question in Parliament: “No studies of the efficacy of United Kingdom anthrax vaccine against inhalation anthrax have been undertaken in humans.” [4]
The same is true for the US vaccine; therefore, no one knows how effective either will be in the event of an attack.
British sailors were said to have thrown anthrax vaccine overboard from military vessels leaving for the Gulf in 2003. Nearly 500 vials of vaccine were found washed up on shore.[5]
Canada
In Canada in 1998, one brave airman, Michael Kipling, who felt he had been made ill by the vaccine when he received it during the Gulf War, refused the mandatory vaccination. Kipling’s refusal garnered national publicity, and the military subjected him to court martial. Canada seems to have a fairer system of military justice than the US. Kipling had extensive pre-trial proceedings in 2000, overseen by Canada’s highest military judge, Guy Brais. At the conclusion of these proceedings, Judge Brais found that Kipling could not be compelled to accept a dangerous vaccine: “It was sufficient and the court is satisfied on the balance of probabilities that the defense has successfully demonstrated that the anthrax vaccine contained in lot 020 was unsafe and hazardous and could be responsible for the important symptoms reported by so many persons who received that vaccine.
In those circumstances, the court concludes that the accused's right to life, liberty and security of the person in section 7 of the Charter of Rights and Freedoms were infringed. And as the court stated earlier, the government, through its Department of National Defense and the Canadian Forces, could never be justified to impose inoculation of soldiers with an unsafe and dangerous vaccine as a limit of their rights under section 7.”[6]
Since 2000, there have been no mandatory anthrax vaccinations in Canada. Given the ruling above, it is unlikely they will ever return. Since the Afghanistan war began in 2002, Canadian troops have not even been offered voluntary anthrax vaccinations. [7]
One Canadian military study of medical charts of vaccinated and unvaccinated soldiers concluded that vaccinated soldiers had fewer medical problems recorded by military medical facilities than unvaccinated soldiers.[8] Of 571 vaccine recipients’ charts selected for review, 165 charts could not be obtained, including 27 charts “required for current treatment.” Although the “study suggests that anthrax vaccination did not cause adverse health effects in Canadian Forces members up to 8 months after deployment,” because service members under active medical treatment were dropped from the study, its validity is questionable. Furthermore, a GAO study done for Congress of US aircrew found that 60% who became ill following anthrax vaccinations chose to seek treatment outside military medical facilities, to assure the privacy of their medical concerns and maintain their ability to continue flying.[9]
Australia
Australian troops have also been given voluntary vaccinations. However, troops felt they had been misled by their leaders regarding vaccinations on several occasions. First, information on severe reactions seen in earlier troops who received vaccine was withheld from troops receiving vaccine later.[10] [11] Second, troops were sent by ship toward the Gulf in 2003, but only when they were far from home were they told they would be receiving anthrax vaccinations. Although the vaccine was ‘voluntary’ they were told they would not be deployable if they refused, they would have to be flown home, and a refusal would have adverse effects on their future military careers.[12] This also led to much adverse publicity in Australia.[13]
The Australian Medical Association had concerns about the vaccine as well: “The Australian Medical Association has called upon the military to prove the vaccination is safe. ‘If they have that data, the medical profession in Australia would very much like to see it,’ the Association' s president Kerryn Phelps told Australian Broadcasting Corporation radio.” [14]
France
France never vaccinated Gulf War soldiers for anthrax, nor has it been used in France since the first Gulf War. France has a much smaller percentage of chronic illness in its Gulf War veterans than any of the countries mentioned above, which did vaccinate some of their troops. [15]
World Health Organization
According to the WHO: “There is a vaccine against anthrax, but it is not approved for widespread use because it has never been comprehensively tested in human trials. The vaccine is sometimes given to people who are likely to be exposed to anthrax through their occupation, for example, tannery workers, or to military personnel. It is not widely available, nor is its use for mass immunization recommended.” [16]
[1] http://news.bbc.co.uk/1/hi/uk_politics/2749735.stm
[2] Hayes SC and World MJ. Adverse reactions to anthrax immunisation in a military field hospital. J Royal Army Med Corps. 2000 Oct;146(3): 191-5.
[3] Enstone JE, Wale MCJ, Nguyen-Van-Tam JS et al. Adverse medical events in British service personnel following anthrax vaccination. Vaccine 2003; 21:1348-54.
[4] http://www.publications.parliament.uk/pa/ld200304/ldhansrd/vo040106/text/40106w02.htm
[5] http://observer.guardian.co.uk/uk_news/story/0,6903,1376906,00.html
[6] http://www.mvrd.org/AVN/sonnie/law/canadatranscript.htm#judge
[7] http://www.cbc.ca/cp/health/070305/x030519A.html
[8] Hunter D, Zoutman D, Whitehead J et al. Health Effects of Anthrax Vaccination in Canadian Forces. Military Med 2004; 169: 833-8.
[9] http://www.gao.gov/cgi-bin/getrpt?GAO-01-92T
www.gao.gov/cgi-bin/getrpt?GAO-02-445
[10] http://www.usatoday.com/news/world/2004-02-21-australia-anthrax_x.htm
[11] http://www.abc.net.au/lateline/stories/s783068.htm
[12] http://www.abc.net.au/news/newsitems/200408/s1175466.htm
[13] Ackermann D, Chapman S, Leask J. Media coverage of anthrax vaccination refusal by Australian Defence Force personnel. Vaccine. 2004 Dec 2; 23(3):411-7.“BACKGROUND: During February 2003 a number of Australian sailors were returned home from their deployment to the Persian Gulf after refusing anthrax vaccination. This paper examines the media coverage of this episode as a case study in how controversies about vaccine safety escalate. METHODS: Frame analysis of articles from major Australian newspapers (n=83) and transcripts of radio and television news and current affairs programs (n=22) to identify the main supportive and oppositional themes used in reportage and media debate. FINDINGS: Initially, the major news frames were supportive of the vaccine refusing soldiers, and conveyed a sense of distrust of the government's actions. These initial themes were rapidly re-framed and new dominant discourses appeared. First, sailors went from brave whistleblowers to being portrayed as deserters and cowards. Second, proponents shifted from their portrayal as faceless regulators to personal risk takers embodied in a well-respected Major General having the vaccine. Third, the voluntary nature of the vaccine was emphasized, thus dousing the flames of implied coercion. CONCLUSION: Marked shifts in the representation of vaccine opponents and proponents possibly contributed to the rapid diminishment of media interest in the story.” Entire article can be found at: http://tobacco.health.usyd.edu.au/site/supersite/contact/pdfs/anthrax.pdf
[14] http://news.bbc.co.uk/1/hi/world/asia-pacific/2760253.stm
[15] http://www.gao.gov/cgi-bin/getrpt?GAO-02-359T
[16] http://www.who.int/csr/disease/Anthrax/anthraxfaq/en/
Meryl Nass, MD
Mount Desert Island Hospital
Bar Harbor, Maine 04609
207-288-5081 ext. 220
