Prof. Garth L. Nicolson
(email: gnicimm@ix.netcom.com )
Chief Scientific Officer and Professor
The Institute for Molecular Medicine
15162 Triton Lane
Huntington Beach, Ca 92649
The Deputy Secretary of the Department of Defense, John Hamre, and the Surgeon
General of the Army, LtGeneral Ronald Blank, have strongly supported the U.S. vaccine
strategy for Biological Weapons (BW) defense, such as against weapons-grade anthrax (Bacillus
anthracis), a commonly used spore-forming bacteria that causes death within 1-6 days
of lethal exposure. Although this is probably the most commonly manufactured and used BW
weapon, it is only one of over a dozen BW agents that have been produced in large
quantities suitable for deployment and tactical use in recent years. It is also one of the
few BW agents where commonly used commercial vaccines actually exist that are capable of
preventing most (but not all) lethal infections. Unfortunately, there are a number of
considerations that must be taken into account before such vaccines should be considered
extremely effective against the types of BW weapons likely to be encountered in future
conflicts.
1. The vaccine against Bacillus anthracis to be administered by the U.S. Armed
Forces to over one million men and woman is claimed to be highly effective as an anti-BW
strategy. I have not been able to find any published scientific evidence for this claim
(effectiveness against weapons-grade anthrax strains of Bacillus anthracis modified
to be more pathogenic and evasive than the usual strains found in the environment). The
published data do not include an examination of the effectiveness of various vaccines
against infections via inhalation of aerosolized anthrax spores, nor do they include data
for highly pathogenic strains of anthrax that are likely ones to be encountered in an
actual BW attack.
2. In general, the medical and scientific reports on the effectiveness of vaccines against
Bacillus anthracis are limited to examination of the protection of animals against
injected sublethal or lethal doses of the microorganism. In a real BW attack, many times
the lethal (human) dose could be encountered in an aerosolized BW and chemical mixture
that is designed to inhibit and overwhelm the body's defensive abilities. "Russian
Doll Cocktails" containing microorganisms plus macrophage and other inhibitors are
likely to be used in BW attacks to impede the immune system's ability to contain the
infection by blocking pulmonary macrophages. The pulmonary macrophage is the first level
of defense against inhaled foreign microorganisms. In addition to destroying many of the
inhaled microorganisms or preventing their entry into the body, macrophages help mobilize
another arm of the immune system that contains the "memory T cells" (a type of
immune "helper" cell preprogrammed by prior immunizations that tell other immune
cells to attack the infection directly or produce antibodies against the infectious agent)
that are essential in immune responses of the types that vaccines are designed to
stimulate.
3. What assurances do we have that future vaccines will be free of bacterial contamination
that could cause disease? Obviously, the purity and safety of vaccines depend on their
abilities to remain free of contamination by the same or other microorganisms. When I
dared to present this as a possibility to a group of Defense Department physicians and
scientists, I was roundly attacked. Vaccine preparation methods are considered adequate to
prevent this as a possibility, but unless each "batch" or lot of vaccine is
routinely tested for possible contamination, including animal testing, this remains a
possibility that must be carefully examined, not uncritically dismissed as a remote
hypothetical possibility.
4. BW use on the battlefield of the future will likely involve MULTIPLE agents, not just
one or even a few. Countries like Iraq operate under "Soviet War Doctrine," a
battle strategy that stresses combinations of conventional and unconventional weapons.
This means that combinations of multiple BW, CW (Chemical Warfare) or even NW (Nuclear
Warfare) agents may be used together to confuse the diagnosis and treatment of casualties.
The rationale is to overwhelm a medical corps ability to effectively manage large numbers
of casualties with unknown or incomplete diagnoses. Iraqi Field Manuals found during the
Gulf War described this strategy in detail. Unfortunately, the vaccines against other
likely BW agents are even less proven and more problematic than the anthrax vaccine. I
know of no scientific information on the effects of and prevention of disease due to
combinations of different BW agents.
5. The vaccine against Bacillus anthracis to be administered to the U.S. Armed
Forces is considered safe. As evidence for this, the Dept of Defense has stated that there
have been few adverse reactions to the vaccine to be used. If our most recent conflict,
the Persian Gulf War, is any example of our ability to monitor adverse reactions, the
provisions for recording and monitoring of adverse reactions to vaccines were extremely
poor. I have personally interviewed veterans (and I have also interviewed several nurses
involved in the vaccinations) who described classical vaccine reactions in the Gulf,
possibly due to the injection of multiple vaccines all at once or within a short period of
time. The multiple use of vaccines administered at the same time could have resulted in
immune suppression in many solders. This, in turn, could have inadvertently increased the
chance of opportunistic infections taking hold that under ordinary circumstances might
have been preventable.
6. Our strategy of defense against BW agents is prior immunization using multiple
vaccines. Unfortunately, this can only be successful if the exact BW agents likely to be
encountered are known in great detail and for some time in advance of exposure. For
example, most effective commercial vaccines against Bacillus anthracis require a
rather lengthy immunization protocol, administering multiple vaccine and booster doses
over a period of a year or more. If multiple vaccines are to be administered, then they
would have to be administered at different times to prevent immune suppression. Obviously,
this strategy requires advance knowledge of the threat and careful long term preparation
against the threat. Any new threat that arises will require some time to prepare for,
possibly years.
7. What information exists that supports the rationale that multiple immunizations will
protect against a BW attack using multiple BW agents? I know of no published scientific
information that tests the hypothesis that vaccines can protect against simultaneous
exposure to multiple aerosolized agents. In addition, I know of no evidence that there is
a vaccine that protects against all strains of a single agent. Recently in the press
reports it appears that the Russians have developed Bacillus anthracis strains for
which they claim protective vaccines do not exist. Irrespective of the accuracy of such
reports, what is the evidence that our "multivalent" Bacillus anthracis
vaccine will protect against all known anthrax strains?
8. Are there other strategies besides the vaccine approach to BW defense? During the Gulf
War the French forces elected not to use vaccines as a primary defense against Iraqi BW
and not to use anti-nerve agents as a defense against Iraqi CW. Instead, they used
prophylactic antibiotics to counter Iraqi BW, and they depended on protective suits to
counter Iraqi CW. Interestingly, the French Armed Forces were the ONLY nation in the
Coalition Forces that did not report any cases of Gulf War Illness, nor were there any
illnesses reported in the immediate families of French Gulf War veterans. In contrast, in
U.S. forces there are now well over 100,000 veterans with Gulf War Illnesses, and
according to U.S. Senate report, in many cases these illnesses have spread to immediate
family members.
9. Are there ways to counter prophylactic antibiotic use for BW defense? Yes, BW agents
can be modified or "constructed" that have integrated into their genetics
antibiotic-resistance genes. Just like the "engineering" of more lethal BW
agents to circumvent known vaccines, such microorganisms can be "engineered" to
resist specific antibiotics. Oddly enough, certain U.S. units were issued antibiotics like
ciproflaxin and doxycycline just before the ground offensive in the Gulf War. These
antibiotics would be expected to be effective in preventing infections of at least two of
the agents identified in veterans with Gulf War Illness (Mycoplasma fermentans and
Brucella spp.). Examination of the numbers, deployments and types of casualties and
their diagnoses in the units administered antibiotics before and during the Gulf War could
tell us if the French approach to BW defense was more or less effective than our approach
of administering multiple vaccines to prevent BW casualties.
Although our Armed Forces must be mission oriented for their success in any future
conflict, we owe it to the men and women who serve to be just as forceful, thoughtful and
careful about their protection when we place them in harms way.