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Guinea Pig Soldiers?
Prompted by worries that Iraq and other rogue nations have and might use biological weapons, the Department of Defense has been vaccinating all active and reserve soldiers against anthrax. The program began in 1998, and has so far inoculated 400,000 out of 2.4 million military personnel. A few hundred soldiers have refused the six-injection regimen, saying it hasn't been proven either safe or effective and that they are unlikely to fight against the few nations that have such bio-warfare capabilities.
Of those already vaccinated, almost 500 have reported reactions to it. In response, the military has court-martialed soldiers who refuse the vaccination, and there are reports that some National Guard pilots are choosing to resign rather than accept the vaccine.
Last week a Congressional panel recommended that the inoculation program be stopped until tests show the safety and efficacy of the vaccine. The Pentagon has responded that it plans to continue the military-wide program.
How well-proven must a preventive measure be before it is used by the military, especially when there is no other treatment? How far can the military go in forcing soldiers to receive medical treatments in the name of military readiness? And how different are the rights of soldiers from the rights of other American citizens?
Experimental agent or safe vaccine?
The House panel concluded that there isn't enough evidence that the vaccine is either safe or that it really offers protection from anthrax attacks.
Usually, a vaccine isn't allowed to be used by the general public until the FDA has ruled that there is evidence that it is both safe and that it works. Such evidence usually comes from using the vaccine on people who are likely to be exposed to the disease in question. In the case of anthrax the intial tests and only real experience with exposed individuals come from its use on farmers and veternarians who are in close contact with cattle -- which are the reservoir of the form of the disease that infects humans.
But that doesn't mean that the vaccine would work against anthrax used as a weapon. With little data about its effectiveness, but no other available protection for our soldiers, should the vaccine be used without more testing?
Military readiness or a massive clinical trial?
When American soldiers may be in harm's way, how are we to weigh the trade-off between using an imperfect treatment and no protection at all?
Making decisions means something different in the military, and soldiers don't get to exercise choice in many aspects of their lives. Part of serving in the military is to accept the risks of training and service, whether it be plane crashes, combat hazards, or the side effects of vaccines. And part of improving military readiness comes from the results of large-scale efforts -- such as military-wide training or vaccination programs.
At the same time, data from large military health efforts can be used much like that from clinical trials -- they both have many subjects, are controlled environments, and have good access to subjects for ongoing follow-up. And military programs offer one additional feature: military personnel generally can't opt out of participation.
Different rights for soldiers?
Soldiers have different rights and obligations than civilians. Soldiers must follow the rules dictated by their branch of the service, and in return the military is obligated to assure that the troops are ready to serve. The Pentagon must make sure soldiers are well-trained, well-equipped, and well-protected against threats.
Second-guessing by soldiers about what counts as readiness would lead to dire consequences. Even so, the military must first satisfy those for whom it has the greatest responsibility -- its soldiers -- or the threat from inside will be greater than that posed by our enemies.
"Ethics Matters" Archive
where you'll find other columns from Jeffrey Kahn
on a wide range of bioethics topics.
Despite criticism, Pentagon won't suspend anthrax vaccinations
Anthrax- General Information
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