Usawc strategy research project the case for "forced" health protection

CONCLUSIONS

Various intelligence and threat assessments have led certain combatant commanders, then the Joint Chiefs, and ultimately the civilian leadership of DoD to the conclusion that a number of the United States’ adversaries and non-state terrorist groups have both the capability and will to use anthrax against United States forces. Advised by medical and scientific experts that an FDA-licensed vaccine had been successfully used for decades in the United States, these leaders rightly concluded that it would be irresponsible to send service members into harms way and potential exposure to anthrax without preventive vaccination.

Making vaccination mandatory generated concern, anxiety, and fear among some service members and energized Congress to question publicly the safety of the vaccine and credibility of the threat. Every “refusal” instantly became a media event. Internet sites, such as “AnthraxNo@one-list.com,” further fueled rumors and, in some cases, misinformation about the vaccine’s safety record and BioPort’s struggle to achieve FDA approval. Initially, every service member who suffered from some ailment who previously had begun the anthrax vaccination series was encouraged by AVIP opponents to believe that the vaccine was the source of the problem. Although adverse events from the anthrax vaccine compared very favorably with a host of other vaccines, such as the influenza vaccine, the naysayers tended to “demonize” the anthrax vaccine as the root of all problems even though ailments suffered by those vaccinated remained virtually the same as those in the unvaccinated population.¹⁰⁹

As the number of service members vaccinated increased without any disproportional increase in adverse events, AVIP opponents seized upon a legal device to end mandatory vaccination. The lawsuits maintained that the vaccine had never been licensed and approved for use to protect against exposure to anthrax spores through the lungs, the very threat DoD sought to counter with the AVIP. As asserted by opponents of AVIP, the vaccine was being used off-label thereby making it an investigational new drug requiring informed consent.

Allowing individual service members to chose to be vaccinated and protected or not is incompatible with how the Nation’s military fights and wins on the battlefield. The United States military fights as part of team with each individual dependent on the other team member. No commander can be expected to prosecute the war with the uncertainly that the unvaccinated part of the force would become combat casualties in the event of an anthrax bioweapon attack. Those sick and diseased persons would not only put their fellow service members at risk, but also the mission itself. A force health protection program in the face of a real threat simply cannot be left to the discretion of individual service members without jeopardizing strategic objectives.

In hindsight, DoD was unprepared for the magnitude of opposition against the AVIP and the manner in which the issue became politicized. Although AVIP and the Services did a tremendous job producing educational materials to address the myths and misinformation about the vaccine, much of what was done was reactive and not proactive. DoD was also naïve or, at least, overly optimistic regarding the time and effort it would take for BioPort to be approved by the FDA to begin manufacturing new lots of vaccine necessary to execute the program as envisioned. Because there was only one source for AVA in the United States, BioPort, became the albatross that hung heavily around the AVIP’s neck for years. DoD also underestimated at best or failed to appreciate at worst how the legacy of government actions from generations past—Gulf War Syndrome, Agent Orange, Atomic Veterans, etc.—would inhibit the level of trust that must exist between leaders and the led.

Notwithstanding the foregoing, the bottom line for the AVIP is that until a “better” vaccine is developed, the current FDA-approved vaccine is the best defense and protection that exists today for service members facing the deadly threat of anthrax bioweapons.

RECOMMENDATIONS

In light of the production unpredictability issues that surfaced with having a single commercial source for AVA, DoD must aggressively pursue a government-owned contractor- operated (GOCO) vaccine manufacturing facility that meets FDA approval to ensure the availability of future vaccines that may not have mass market commercial appeal. In conjunction with pursuing a GOCO, DoD must continue to fund the research and development of a “better” anthrax vaccine and other vaccines based on future biowarfare threats.

Last, DoD must come to grips with the legacy of the past and seek to rebuild trust in government with affected veterans and, in turn, today’s Soldiers, Sailors, Airmen, Marines, and Coast Guardsmen. Open and honest dialogue, acknowledgment of responsibility where appropriate, and compensation must underpin this effort. Continued education of the force and Congress on the nature of the threat and strong leadership will set the foundation for future force health protection initiatives.

WORD COUNT=5990

ENDNOTES
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