Practicalities of warfare required service personnel to be vaccinated against anthrax

Editor—Ness et al suggest that service personnel in the Gulf should be randomised to receive either active anthrax vaccination or placebo, but they fail to appreciate the issues behind the decision to give the vaccine.¹ The independent Advisory Group on Medical Countermeasures assessed that there was a real risk that, if a conflict occurred in the Gulf, service personnel could be exposed to anthrax aerosol used as a biological warfare agent. Infection by the aerosol route is associated with over 95% mortality.² The anthrax vaccination programme provides protection for the individual as well as collective protection of the personnel of active service units. It is equivalent to the other methods of personal protection that enable the collective and efficient operation of a military unit. To suggest that this should be randomised is equivalent to a randomised distribution of blank and live ammunition.

Anthrax vaccine has been used widely for many years to protect civilians at risk from occupational exposure to anthrax and is regarded as safe. The 55 000 doses given to date have not been associated with any important adverse events; only minor discomfort at the injection site has occurred. This vaccine on its own is considered highly unlikely to have had any role in Gulf war illnesses. We welcome the involvement of epidemiologists, such as Ness et al, in helping to resolve the issue of Gulf war illness, but this must recognise the need to reconcile scientific rigour with the practicalities of warfare.