BMJ  2004;329:977 (23 October), doi:10.1136/bmj.329.7472.977-a

Letter

Bioterrorism and compulsory vaccination

United States continues vaccinating to keep troops healthy

EDITOR—Jefferson questions military use of anthrax and smallpox vaccines licensed as safe and effective by the US Food and Drug Administration (FDA).¹ The Department of Defense is concerned about the safety of US service members, so we vaccinate them to keep them healthy. Vaccination provides the only round the clock protection against the malicious use of microbes as weapons.

Our vaccination programmes are based on a credible military threat, recognised by multiple government agencies and administrations. Given that a few cubic metres could hide a grievous quantity of anthrax spores or variola virus, the unsuccessful hunt for weapons of mass destruction in Iraq has done little to reassure us. That anthrax and smallpox infections are not circulating naturally is irrelevant when these microbes can be targeted wilfully at our troops. Anthrax spores are all too easy to deliver, as our nation learnt in fall 2001.

The values of anthrax vaccine and smallpox vaccine are established in the medical literature, which is more extensive and more accurate than cited in the editorial. The National Academy of Sciences published a comprehensive review of anthrax vaccine safety and efficacy in March 2002.² The FDA recently affirmed that human and animal evidence show that anthrax vaccine protects regardless of route of exposure.³ The modern military safety surveillance system first identified the rare risk of myopericarditis after smallpox vaccination,⁴ something otherwise unrecognised in America, and then described the extent of recovery from this condition.⁵ The rigorous screening programme adopted in the US civilian and military smallpox vaccination programmes resulted in serious adverse event rates at or below historical expectations.^{w1 w2}

Until improved vaccines are licensed we will not risk our troops' lives against lethal biological weapons. We use today's vaccines to shield our service members so they can succeed in their mission to protect our nation, and return home healthy.

Military Vaccine Agency, 5113 Leesburg Pike, Suite 402, Falls Church, VA 22041 USA john.grabenstein{at}us.army.mil

Washington, DC, USA

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Competing interests: None declared.

Additional references w1 and w2 are on bmj.com

References

1. Jefferson T. Bioterrorism and compulsory vaccination. BMJ 2004;329: 524-5. (4 September.)[Free Full Text]
2. Joellenbeck LM, Zwanziger L, Durch JS, Strom BL, ed. The anthrax vaccine: is it safe? Does it work? Washington, DC: National Academy Press, 2002.
3. Food and Drug Administration. Biological products; Bacterial vaccines and toxoids; implementation of efficacy review. Fed Reg 2004;69 (Jan 5): 255-67; errata 7114-5.
4. Halsell JS, Riddle JR, Atwood JE, Gardner P, Shope R, Poland GA, et al. Myopericarditis following smallpox vaccination among vaccinia-naïve US military personnel. JAMA 2003;289: 3283-9.[Abstract/Free Full Text]
5. Eckart RE, Love SS, Atwood JE, Arness MK, Cassimatis DC, Campbell CL, et al. Incidence and follow-up of inflammatory cardiac complications following smallpox vaccination. J Am Coll Cardiol 2004;44: 201-5.[Abstract/Free Full Text]

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Bioterrorism and compulsory vaccination

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