September 28, 2004

New insights into Gulf War syndrome


Dallas, TX, Sep. 28 (UPI) -- Dallas researchers have uncovered damage in a specific, primitive part of the nervous systems of veterans suffering from Gulf War syndrome.

The University of Texas team's work, summarized in the October issue of the American Journal of Medicine, found that damage to the parasympathetic nervous system may account for nearly half of the typical symptoms, including gallbladder disease, unrefreshing sleep, depression, joint pain, chronic diarrhea and sexual dysfunction, that afflict those with Gulf War syndrome.

"The high rate of gallbladder disease in these men, reported in a previous study, is particularly disturbing because typically women over 40 get this. It's singularly rare in young men," said Dr. Robert Haley, lead author of the study.

The parasympathetic system regulates primitive, automatic bodily functions such as digestion and sleep, while the sympathetic nervous system controls the "fight or flight" instinct.

The research was supported by the U.S. Army Medical Research and Materiel Command, the U.S. Public Health Service and the Perot Foundation.

September 27, 2004

Former soldiers slow to report

by Tom Squitieri
USA TODAY September 27, 2004

WASHINGTON — Fewer than two-thirds of the former soldiers being reactivated for duty in Iraq and elsewhere have reported on time, prompting the Army to threaten some with punishment for desertion.

The former soldiers, part of what is known as the Individual Ready Reserve (IRR), are being recalled to fill shortages in skills needed for the conflicts in Iraq and Afghanistan.

Of the 1,662 ready reservists ordered to report to Fort Jackson, S.C., by Sept. 22, only 1,038 had done so, the Army said Monday. About 500 of those who failed to report have requested exemptions on health or personal grounds.

"The numbers did not look good," said Lt. Col. Burton Masters, a spokesman for the Army's Human Resources Command. "We are tightening the system, reaching the people and bringing them in."

Masters said most of the requests for exemptions are likely to be denied: "To get an exemption, it has to be a very compelling case, such as a severe medical condition."
The figures are the first on the IRR call-up. They reflect the challenges the Pentagon faces in trying to find enough troops for ongoing operations and show resistance among some servicemembers who returned to civilian life.

The ready reserve is an infrequently used pool of former soldiers who can be called to duty in a national emergency or war. On June 29, the Army announced it would call 5,674 members of its IRR back to active duty this year and next.

Several of those who received recall notices have already been declared AWOL (absent without official leave) and technically are considered deserters. "We are not in a rush to put someone in the AWOL category," Masters said. "We contact them and convince them it is in their best interests to show up. If you are a deserter, it can affect you the rest of your life."

Fourteen people were listed as AWOL last week; six subsequently told the Army they would report. Punishment for being AWOL is up to the unit commander and can include prison time and dishonorable discharge, said Col. Joseph Curtin, an Army spokesman.
With a force that generals say is stretched thin, the Army is considering $1,000-a-month bonuses to ex-soldiers who volunteer to return for overseas duty.

Ready reservists are soldiers who were honorably discharged after finishing their active-duty tours, usually four to six years, but remain part of the IRR for the rest of their original eight-year commitment. The IRR call-up is the first major one in 13 years, since 20,277 troops were ordered back for the Persian Gulf War.

An Uncertain Defense

By W. Wayt Gibbs

How do you test that a human Ebola vaccine works? You don't. The Ebola virus is among the deadliest on earth; in outbreaks last year in the Republic of Congo, 157 of the 178 people infected with it died of hemorrhagic fever. Because it can be exceedingly contagious in aerosol form, the Ebola virus ranks with smallpox and anthrax as one of the most worrisome potential biological weapons. Although there is no effective treatment, recent tests have shown a new vaccine able to prevent infection in monkeys. Clearly, researchers could never intentionally expose human volunteers to the lethal virus. And there are no populations at especially high risk for Ebola, as there are for HIV. So how can doctors determine whether the vaccine works in people?

That question, which applies as well to experimental vaccines for smallpox and anthrax, took on new significance on July 21, when President George W. Bush signed the Project Bioshield Act. The law authorizes the U.S. Department of Homeland Security to spend up to $5.6 billion over 10 years to increase its stockpile of antibioweapons medicines, including drugs that the U.S. Food and Drug Administration has not yet approved as safe and effective.

The secretary of health and human services can now recommend that the president order the distribution of experimental drugs to the armed forces or even to the general populace, should the secretary perceive "a significant potential for a domestic emergency, involving a heightened risk of attack." Although scientific evidence of some kind must suggest that the drugs will do more good than harm, human clinical trials--for decades, the only evidence that has mattered--are no longer strictly required.

The prospect of treating thousands of people with a vaccine or drug only proved to work on animals may seem risky. But the realities of the pharmaceutical market and the lethal character of many bioweapons leave few alternatives. The pharmaceutical industry has already all but abandoned work on vaccines for many of the world's major infectious diseases, such as malaria and tuberculosis, because the people most vulnerable to such illnesses tend to be least able to afford expensive medicines. There is virtually no natural market for vaccines to prevent smallpox (which has been eradicated) or anthrax (which is not contagious) or Ebola (which occurs in vicious but sporadic outbreaks).

So federal agencies are creating a market. "The Project Bioshield law specifies initial stockpiling of Ebola vaccine at about $90 million and a long-term procurement of about $260 million," Vijay B. Samant, president of Vical, observed in an August conference call with investors. Vical is a biotech firm based in San Diego; both it and Crucell, a Dutch company, have won potentially lucrative contracts to manufacture the genetically engineered ingredients in the new vaccine.

"To gain FDA approval, we will have to gather safety data on perhaps 5,000 people," says Gary J. Nabel, director of the Vaccine Research Center at the National Institutes of Health. Nabel's group designed the immunization to have two stages: a DNA primer and a viral booster shot. Both parts contain only minute fragments of Ebola virus, so the vaccine itself could not cause infection. Small human safety trials of just the primer portion, made by Vical, are now under way at the NIH. But recent experiments on macaques have shown that the booster alone led to full immunity against Ebola in less than four weeks. Jaap Goudsmit, chief scientific officer at Crucell, says it remains to be seen how long the protection will last.

That is a question typically answered by a large-scale clinical trial. But a special rule passed in 2002 allows FDA approval even without direct evidence that it works in humans, in cases where subjecting humans to clinical trials would be unethical or infeasible.

A company must first show that the vaccine works in monkeys (or another animal similar to humans). Researchers then have to figure out how the animals' immune systems respond to the optimal dose and find an equivalent dose in humans that generates a similar immune response. Project Bioshield allows the president to waive even that lowered regulation when the nation faces "heightened risk of attack."

It may be years before scientists can determine an optimal human dose for the new Ebola vaccine. That does not mean, however, that it won't soon enter the national stockpile. The Bush administration says that next year it expects to purchase 75 million doses of a new anthrax vaccine that has not yet even completed human safety trials.

Of course, Nabel says, "you can bet there would be follow-up studies if the Ebola vaccine was used in a real outbreak." He acknowledges, however, that "if the vaccine is so good that it aborts infection before the virus induces an immune response, we might not be able to tell who was exposed and who wasn't."

September 26, 2004

Victims of vaccine?

By Elizabeth Leland
Charlotte Observer

Brown had been in the Air Force 14 years and was trained to follow orders. Brown rolled up his sleeve and took the jab. He is now awaiting a heart transplant.
Two days after a military nurse injected Lavester Brown with the anthrax vaccine at Pope Air Force Base near Fayetteville, his heart failed.

Brown was 34, an avid athlete, career military. Doctors had warned him to avoid vaccinations, he said, because of a reaction to a malaria drug in the early ‘90s. But when Brown told superiors, he said, they warned he could be kicked out of the military if he didn’t get vaccinated for anthrax.

Brown was afraid: of the vaccine, of losing his job. He had a wife and four young children to support.

“I kept telling them, `I can’t take the shot.’ ”

The vaccination is mandatory, part of the military’s war on terrorism. Brown had been in the Air Force 14 years and was trained to follow orders. So when a commander, a major, a captain and a first sergeant all ordered him to be vaccinated, Brown, a technical sergeant, rolled up his sleeve and took the jab.

He is now awaiting a heart transplant.

Thousands of soldiers have suffered unexplained illnesses after getting the anthrax vaccine, ranging from muscle aches to death. The federal Food and Drug Administration says the vaccine has no more side effects than other vaccines, but cases like Lavester Brown’s raise troubling questions:

Is the vaccination safe?

Should the military require troops to take it?

There was concern about the anthrax vaccine long before the threat of global terrorism.

In the 1990s, the FDA found problems with quality control procedures at the only U.S. company that makes the vaccine, then owned by the state of Michigan. The FDA warned that if the problems were not corrected, the company could lose its license. The state halted production in 1998 and began renovations, then sold the plant to BioPort.

After terrorists hijacked planes on Sept. 11, 2001, and anthrax-laced letters killed five people and infected at least 13 others, demand for a vaccine erupted. In January 2002, the FDA gave BioPort approval to distribute its vaccine to the military.

The FDA and the Department of Defense and BioPort all say the vaccine is safe. A vocal group of current and former military personnel, doctors and members of Congress claims it is not. Three lawsuits challenging the vaccine are now in federal court.

To the emergency room

Brown knew nothing of the controversy on Friday, Feb. 27, when he got the fourth in a series of six anthrax shots.He rarely got sick, not even a cold. He didn’t drink. He didn’t smoke. He stood 5 feet 11 1/2 inches and weighed 207 pounds, but so much was muscle, he looked lean.

The day after the fourth anthrax shot, Saturday morning, he played basketball at the gym as usual but quickly tired. He went to the emergency room that night, he said, and a military doctor diagnosed a gastrointestinal infection.

By Sunday, he felt as if his body was filling up with fluid. The muscles in his neck throbbed and bulged. He had trouble breathing. Back at the emergency room that night, he said, a doctor again diagnosed gastrointestinal infection.

Something else is happening, Brown remembers saying. I can’t breathe.

He said his wife, Ebony, insisted on X-rays. “When they looked at the X-rays,” Brown recalled, “the doctor got this look on his face. I knew something was terribly wrong.”

Brown said his heart was so enlarged, it had almost stopped pumping. He now takes medication to keep it beating until a transplant becomes available. He has dropped to 151 pounds, and walking only a few feet exhausts him. Friday, he was medically retired from the Air Force.

Before he got sick, Brown sometimes worked two jobs to provide for Ebony and their four children, ages 5 to 12. Now Ebony works and the children help care for him, and that’s been a tough transition.

“I wish we had done our homework before Lavester got in line (for the vaccine),” Ebony said. “We trusted the military.”

Mandatory shots

Until recently, anthrax had been considered primarily a livestock disease. People can be infected in three ways—through skin contact, by eating infected meat or by breathing airborne spores—but it’s rare.

The military became convinced that Iraq had developed biological weapons, including anthrax, and might pack its Scud missiles with the deadly bacteria. Nearly everyone who inhales anthrax dies if not treated.

In 1998, the Defense Department made vaccinations mandatory.

Since then, about 1.2 million military personnel have received the vaccine, six doses over 18 months, followed by yearly boosters. (Several hundred thousand, a Pentagon spokesman said, got the vaccine during the 1991 Persian Gulf War.)

Out of 4.7 million doses given since 1998, the government says it has received 3,817 reports of adverse reactions, from headache, fatigue and fever to cancer, cardiac arrest and autoimmune diseases. The reaction rate, the government says, is about the same as for other adult vaccinations.

Studies have reached conflicting conclusions.

The Pentagon cites a 2002 report by the Institute of Medicine, a private, nonprofit scientific group, that said a better vaccine is needed, but that the current vaccine is “acceptably safe and effective.”

Other studies link the anthrax vaccine to Gulf War illness, a medically unexplained fatigue suffered by veterans of the first Gulf War. One study found more adverse reactions to the anthrax vaccine than to other vaccines, and urged doctors to report all reactions so the scope of the problem could be determined.

Many cases, critics say, still go unreported.

Dead at 29

Christine Nilson, who lives in Wilmington, hadn’t heard about the controversy over the anthrax vaccine until after her husband, Erik, died. Now she’s convinced it killed him.

Erik Nilson flew CH-46 helicopters for the Marine Corps and was vaccinated twice, before two separate six-month deployments to the Mediterranean.

Soon after he came home for the second time, in October 2001, Christine noticed the whites of his eyes had yellowed. Doctors at Walter Reed Army Medical Center in Washington discovered bile duct cancer, a slow-moving, usually fatal cancer that most often attacks people over 60.

Nilson was 29 and had a 2-year-old son, Luke.

He was, Christine said, “a man’s man,” who loved hunting, fishing and the Marines. He had had a rough childhood, she said, and often told her he wanted nothing more than to be a good father.

Six months after the cancer was discovered, Erik Nilson died.

Christine Nilson said no one from the military ever mentioned a possible connection with the anthrax vaccine. The national Vaccine Adverse Events Reporting System has no record of Nilson’s death.

But the more Christine Nilson read, the more she believed there was a connection.

“There is,” she said, “no other explanation for it.”

Rapid-acting diseases

Other service members have died of rapid-acting diseases after getting the vaccine, including Army cook Sandra Larson of Kansas. Four weeks after her sixth anthrax shot, she was diagnosed with aplastic anemia, a rare disorder resulting from failure of bone marrow to produce blood cells.

She died two months later. She was 32.

The package insert on the vaccine, approved by the FDA in 2002, cites her death and the deaths of five other vaccinated military members. But a panel of civilian doctors concluded that none of the deaths was related to the vaccine.

The Pentagon has linked only one death to the vaccine: Rachel Lacy, a 22-year-old Army reservist, who died in April 2003 of a pneumonia-like illness after receiving five vaccines, including anthrax. The Pentagon said the vaccines may have triggered the illness that led to her death, but that “the evidence was not conclusive.”

Critics say the government is stonewalling the way it did with the herbicide Agent Orange in the Vietnam War and with Gulf War illness.

“The first thing they do is fight, deny, obfuscate …,” said Steve Robinson, executive director of the National Gulf War Resource Center, an advocacy group for veterans. “Meanwhile people are getting sick.”

About 10,000 Vietnam veterans receive disability benefits because of exposure to Agent Orange, and tens of thousands of others suffer illnesses. An estimated 100,000 Gulf War veterans suffer a range of symptoms, including memory and thinking problems, fatigue, joint pain, depression, anxiety, insomnia, headaches and rashes.

No proof, no medical help

Robinson said he has spoken with hundreds of veterans who said they had adverse reactions to the anthrax vaccine, but they can’t prove it and are not getting the medical help they need. They complain of chronic fatigue, bone and muscle pain, migraine headaches, short-term memory loss and cognitive impairment.”While anthrax is a threat,” Robinson said, “the American public, much less the military, should not be given an inferior vaccine.”

Meryl Nass, an internist in Bar Harbor, Maine, who has testified before Congress about the vaccine, said she has treated dozens of soldiers and corresponded with thousands more.

“I’ve seen so many people with the exact same thing, the same story,” she said. “They can’t think straight. They have pain in different parts of their bodies … and they’re fatigued.” Usually, she said, they have something else wrong, too: multiple sclerosis or lupus or a sleep disorder.

As a doctor, Nass said, the last few years have been an emotional roller coaster “watching 1 million be vaccinated when I knew at 100,000 what was happening.”

Forced vaccinations

In federal court, two lawsuits are pending against BioPort, a third against the Food and Drug Administration, the Defense Department and the Department of Health and Human Services.

The lawsuits challenge whether the vaccine is safe, effective, even necessary.

On Dec. 22, 2003, U.S. District Judge Emmet Sullivan in Washington, D.C., blocked the Pentagon from forcing soldiers to get vaccinated. He ruled that the FDA had never approved the vaccine for use against inhaled anthrax. The military, he said, could not make troops “serve as guinea pigs for experimental drugs.”

Eight days later, the FDA approved the vaccine against inhaled anthrax.

Although Sullivan called the timing of the order “highly suspicious,” he lifted his injunction.

The military once again ordered vaccination.

Refusal, court-martial

As many as 500 active-duty personnel have been dismissed from the military for refusing vaccination, according to congressional testimony. At least 100 have been court-martialed.Tom Kaufmann, an airman first class at Seymour Johnson Air Force Base in Goldsboro, refused to be vaccinated in December 2002.

He had read about problems at the manufacturing plant, he said, as well as about illnesses among people who got the vaccine.

Kaufmann, now 22, was demoted, then discharged under “conditions other than honorable.”

“My first sergeant repeatedly called me a coward, saying I was afraid of war, afraid of serving my country,” Kaufmann recalled. “I told them that I wanted to deploy. I wasn’t against the war.”

He was, he said, only against the vaccine.

Additional info:

Anthrax comes from the Greek word for “coal” because infected skin forms ugly black lesions. The rod-like bacteria were discovered in the 19th century. Louis Pasteur created the first vaccine in 1881.

Anthrax spores can live in soil for decades. People contract the disease in three ways: through skin contact, eating infected meat or breathing airborne spores.

Most Common Adverse Reactions

erythema, headache, arthralgia, fatigue, fever, peripheral swelling, pruritus, nausea, injection site edema, pain/tenderness and dizziness.

Less Frequent Adverse Reactions

cellulitis, cysts, pemphigus vulgaris, endocarditis, sepsis, angioedema and other hypersensitivity reactions, asthma, aplastic anemia, neutropenia, idiopathic thrombocytopenia purpura, lymphoma, leukemia, collagen vascular disease, systemic lupus erythematosus, multiple sclerosis, polyarteritis nodosa, inflammatory arthritis, transverse myelitis, Guillain-Barré syndrome, immune deficiency, seizure, mental status changes, psychiatric disorders, tremors, cerebrovascular accident (CVA), facial palsy, hearing and visual disorders, aseptic meningitis, encephalitis, myocarditis, cardiomyopathy, atrial fibrillation, syncope, glomerulonephritis, renal failure, spontaneous abortion and liver abscess. Infrequent reports were also received of multisystem disorders defined as chronic symptoms involving at least two of the following three categories: fatigue, mood-cognition, musculoskeletal system.


cardiac arrest (2), myocardial infarction with polyarteritis nodosa (1), aplastic anemia (1), suicide (1) and central nervous system lymphoma (1)

SOURCE: FDA-approved package insert for anthrax vaccine

September 21, 2004

Acambis suffers vaccine letdown

By Rosie Murray-West

Acambis, the company behind the US stockpile of smallpox vaccines, stunned the City yesterday after the American government indicated it would not complete an order for the product.

The shares tumbled 28 to 296p, despite the company also saying that the "clinical hold" placed on trials of the vaccine by the US drug regulator have been removed after a safety review.

Gordon Cameron, Acambis chief executive, said: "I think the bottom line is that the government thinks that, with its old material, it has got enough. Politically they can say they have met their objective."

He said revenue for the year would be reduced from forecasts of £95m-£140m to £85m-£90m.

The Acambis vaccine, which is made in cell cultures, has been added to an old stockpile of smallpox vaccine, which was made by scarifying a calf's stomach. "This would never be allowed today," Mr Cameron said. The company has to prove that its vaccine is as safe and effective as the old one to get it approved by the US government.

The company brought forward its interim results after being told of the decision on the contract late last week. It said revenue had dropped from £82.3m to £51.3m compared with the same six months last year, while pre-tax profit had risen from £20.7m to £26.3m.

The company, which is developing other products but earns most of its profit from smallpox contracts, said revenue is expected to drop to between zero and $20m for 2005.

Mr Cameron said he didn't regret the company's decision to take on the smallpox business, even though revenues have been lumpy.

Acambis is still waiting for a decision on another US government order for 60m doses of a weaker vaccine suitable for vulnerable members of the population. Analysts say that this may be shared between Acambis and Bavarian Nordic, its main smallpox rival. Mr Cameron said that the decision on the earlier contract had no bearing on the weaker vaccine.

He added that other governments are looking at Acambis's vaccine because of fears of biological terrorism and some are waiting for the vaccine to be approved by regulators before they use it.

Now that the drug trials can proceed, he said the company could file for approval in 2005. Some analysts had feared the regulator would make Acambis repeat the trials. Acambis shares, which had dropped more than 10pc in early trading, recovered as analysts digested this news.

September 20, 2004

Integrated BioPharma and United States Navy to Develop Oral Anthrax Vaccine

NuCycle Therapy

HILLSIDE, N.J., Sept. 20 - Integrated BioPharma Inc (Amex: INB - News), announced today that InB:Biotechnologies Inc, a wholly owned biotech subsidiary of INB, has entered into a research and development agreement with the United States Navy to carry out a phase I human clinical trial to test a plant-derived oral anthrax vaccine designed to boost immune responses in vaccinated or primed individuals. The work will be a team effort between Naval Medical Research Center (NMRC), Fraunhofer USA, Inc and NuCycle Therapy Inc.

Integrated BioPharma Chairman and CEO E. Gerald Kay noted that the goal of this project is to create a potent vaccine to protect civilian and military personnel from anthrax, which is often linked to global terrorist activities, as well as to improve procedures for vaccinating large populations. A plant-based oral vaccine could minimize the need for mass injectible immunizations and the risks inherent in that exercise.

Kay said, "This vaccine offers the potential to not only help eliminate the often deadly effects of anthrax, but radically change the way the military and the civilian world vaccinate large groups of people. An oral vaccine can be administered much more quickly and effectively than the traditional methods. We look forward to working very closely with the Navy on this important project."

Dr. William Hartman, Vice President of Fraunhofer USA said, "We are proud to participate on the team that is developing this exciting new vaccination system, and we are very pleased to be part of moving plant-based therapeutic technology toward serving unmet medical needs."

NuCycle will be filing an Investigational New Drug (IND) application with the FDA in preparation for the clinical trial. NuCycle and Fraunhofer will manufacture and formulate the oral vaccine product. The NMRC will furnish the Investigational Research Board Protocol (IRB), recruit volunteers and conduct the study.

September 14, 2004

Study: Terrorism Response Plans May Fail

Finds they don't consider public attitudes, fears
By E.J. Mundell
HealthDay Reporter

TUESDAY, Sept. 14 (HealthDayNews) -- If a smallpox outbreak were to be declared today in the United States, just two in every five Americans would heed official instructions to head to a public vaccination site for immunization against the killer disease, a new study finds.

And in the event of a "dirty bomb" attack, just three-fifths of citizens would stay put in an undamaged building, as current guidelines recommend.

The bottom line, according to experts, is that current local, state and federal government emergency-preparedness responses may be doomed to failure should events like these occur.

"Officials are basing their plans on their assumptions of what the public cares about, and how the public might behave. But what our study shows is that those assumptions -- which are best guesses -- are just not right," said Dr. Roz Lasker, director of the Center for the Advancement of Collaborative Strategies in Health, part of the New York Academy of Medicine.

The Academy released its report, Redefining Readiness: Terrorism Through the Eyes of the Public, at a press conference held in Washington on Tuesday.

The attacks of Sept. 11, 2001, a spate of anthrax-laced letters soon after, and ongoing fears that terrorists might use biological or chemical weapons against an unsuspecting populace have led governments to put together emergency-preparedness plans.

But just how effective would these plans be in real-world situations? To find out, Lasker and her colleagues first conducted in-depth talks with public- and private-sector planners. Then, using a mix of discussion groups and a phone survey of more than 2,500 U.S. adults, they tested out the public's response to current plans aimed at minimizing the threat of two hypothetical terror events: a smallpox outbreak and the detonation of a radioactive dirty bomb.

In the smallpox scenario, current protocol advises citizens to head immediately to a vaccination center for immunization against the highly communicable disease.

"However, we found that twice as many people are seriously worried about the vaccine than are worried about catching smallpox if an outbreak occurred," Lasker said. Two-thirds of those interviewed also said they would simply be afraid of co-mingling with so many strangers for fear of infection.

Overall, three out of five adults surveyed said they might not follow instructions to head to a vaccination site.

Lasker said concerns about the vaccine are "well-founded," since it's estimated that nearly 50 million people are at risk for complications from the vaccine, including people with HIV or eczema, pregnant women, or very young children.

But under the current plan, Lasker said, "individuals would only find out if they had any of those contraindications at the site of vaccination, at which point they might have already been exposed to people with smallpox -- and then they can't get the vaccine."

But there are ways to quell these fears and still make sure the maximum amount of citizens get vaccinated, Lasker said.

"We're calling for strategies that would enable everyone in the country to know their risk status for the vaccine beforehand," she said.

In the case of a dirty bomb attack, government planners again got it wrong when it came to public attitudes toward such an event, Lasker said.

Current guidelines recommend that those in areas threatened by a dirty bomb explosion stay inside an undamaged building.

"But these attacks are most likely to happen during the day, when parents are at work and children are at school," Lasker pointed out. In that type of scenario, two out of every five adults surveyed said they'd be unwilling to stay put if they felt uncertain of the whereabouts and safety of loved ones.

"The trouble is that [under current plans] people don't know that now. And a lot of that is due to the fact that safe-haven plans haven't even been made," Lasker said. "That's important for other situations -- such as happened with the blackouts last summer in New York City and the East Coast."

To help people stay calm and well-informed during such an attack, Lasker advocates setting up and safe havens far in advance and promoting them in public places. Plans like these would also include important contingencies, such as ensuring proper stocks of food and clear communication with other centers.

But how much will all this cost?

"The bottom line is that, with all of the money we're spending now --- the logistics, technology, response teams -- these plans still aren't going to work," Lasker said. "So in a sense, that's money down the drain."

More information

For a look at the full report, go to the New York Academy of Medicine ( ).

September 2, 2004

Iraq troops shunned anthrax jab

The Guardian, UK News
James Meikle

Up to one in three British troops involved in the invasion of Iraq last year refused vaccination against anthrax, a newly retired senior officer of the Royal British Legion said yesterday. Colonel Terry English, the legion's former controller of welfare, revealed the figure when he gave evidence to Lord Lloyd's independent inquiry into veterans' illnesses related to the first Gulf war.

He highlighted what he saw as government failures in the immunisation programme employed before the first Gulf war, and research into the issue.

The cocktail of vaccines, including those against anthrax and plague, administered hurriedly and without adequate keeping of immunisation records, is one of the suggested causes of the high number of veterans reporting sick in the nearly 14 years since the first war.

The MoD's vaccination programme is now clearly voluntary, but it would not comment on the one in three figure for troops who have recently served in Iraq or neighbouring countries, saying that it was an operational matter. If Col English's figure is correct, it would mean that many thousands of the 45,000 troops in Iraq at the height of the 2003 war and the 15,000 that have served there since, refused jabs.