The American Public Health
Association
(Extracted from policies adopted at the Annual Conference, 1999)
9930: Anthrax Immunization
The American Public Health Association,
Recognizing that personnel of the armed forces of the United States
are required to accept standard medical treatment;
1 and
Noting that efficacy of the currently available vaccine against
anthrax remains controversial;
2 and
Recognizing that prior to the Gulf War, 20,000 inoculations had
been routinely administered to persons who were at high risk,
including veterinarians and workers in industries handling wool
and hides without any reports of adverse reactions; and
Noting that due to poor record-keeping during the Gulf War no
data is available relating adverse events; and
Noting that the current vaccine was licensed by the Food and Drug
Administration (FDA) in 1970, two years before efficacy data were
required for licensing, and that the Deputy Director for Science
and Public Health of the Centers for Disease Control and Prevention
(CDC) stated on December 14, 1998 that: "Although the current
anthrax vaccine has been shown to be effective in preventing the
cutaneous form of anthrax, CDC is neither aware of definitive
data that demonstrates the vaccine's ability to protect against
the inhalation form of this disease in humans, nor are we aware
of any data relative to the efficacy of this vaccine in humans
exposed to genetically altered Bacillus anthracis strains";
3 and
Noting that a number of US troops have refused immunization with
this vaccine because of concern about the efficacy and unsubstantiated
concern about the safety of the vaccine, resulting in reduction
in their rank and pay, dismissal with other-than-honorable discharges
and, in some cases, threats of court martial;
4 and
Noting that the Ministry of Defense of the United Kingdom has
made anthrax immunization voluntary rather than mandatory and
that 73 percent of the British troops to whom it was offered refused
it;
5 and
Recognizing that new types of anthrax immunization are in the
process of development;
6 and
Concerned that mandatory immunization with a vaccine of unproved
efficacy when an improved vaccine may soon be available, is contrary
to public health principles and may adversely affect the acceptance
of voluntary or mandatory immunization programs in which there
is good evidence of vaccine efficacy and safety;
7 therefore
1. Urges the US Department of Defense to delay any further immunization
against anthrax using the current vaccine or at least to make
immunization voluntary; and
2. Urges that a commission of military and non-military public
health experts be formed to review the evidence for effectiveness
and safety of the current vaccine and the time at which an improved
vaccine may be available, and to make recommendations about the
continuation of the current immunization program.
References
1. Annas G. Changing the consent rules for Desert Storm. N
Engl J Med. 1992;326: 770.
2. Nass M. Anthrax vaccine. Infectious Disease Clinics of North
America. 1999;13: 187-208.
3. Letter from Claire Broome, Deputy Director for Science and
Public Health, Centers for Disease Control and Prevention, December
14, 1998.
4. Anthrax vaccine is refused. Washington Post. April 9, 1998,
p. A5.
5. Gilligan A. British troops mutiny over Gulf anthrax jab. Sunday
Telegraph. June 7, 1998.
6. Barnard JP, Friedlander AM. Vaccination against anthrax with
attentuated recombinant strains of Bacillus anthracis that produce
protective antigen. Infect Immun. 1999;67:562-567. Singh Y, Ivins
BE, Leppla SH. Study of immunization against anthrax with the
purified recombinant protective antigen of Bacillus anthracis.
Infect Immun. 1998;66:3447-3449. Stepanov AV, et al. Development
of novel vaccines against anthrax in man. J Biotechnol. 1996;44:155-160.
7. Sidel VW, Nass K, Ensign T. The Anthrax Dilemma. Medicine and
Global Survival. 1998;5:97-104.
Contents
Official Documents
Congressional Testimony
Position Papers
Troop Experiences
News Articles
Government Contact Information
Opinion
Informative WWW Sites
Benefit versus Risk
Last revised: March 2000