Arguments Against Anthrax

With consideration of the First Responder Anthrax Preparedness Act in the U.S. Senate (S. 1915) following passage in the U.S. House of Representatives (H.R. 1300), as well as House consideration of the PREPARE Act (H.R. 3583), it is important to revisit the concerns of first responders as they relate to the threat of anthrax and anthrax vaccination. The health and safety of America's first responders are the reasons for consideration of these bills, which include language to provide emergency responders access to anthrax vaccine in the Strategic National Stockpile.
OVERALL TAKEAWAY
The best protection for first responders when faced with an intentional or accidental release of anthrax is to be previously vaccinated. Currently, the U.S. Congress
is considering legislation designed to make nearly expiring Strategic National Stockpile anthrax vaccine available to first responders who are at risk for exposure to anthrax during an intentional or accidental release. These Congressional efforts require the support of first responders and the citizens they serve. Please contact your legislators in the U.S. Senate and the U.S. House of Representatives to let them know that you support first responder access to the anthrax vaccine stockpile.
KEY FINDINGS:
1.
The threat of bioterrorism is real. Although the threat of bioterrorism, itself, and the specific use of anthrax cannot be accurately quantified, the threat does exist and includes antibiotic-resistant strains of the organism rendering traditional antibiotic treatment, including all currently stockpiled antibiotics, ineffective.1,2 In this worse-case attack scenario, post-exposure vaccination is likely to fail with infection rapidly progressing to sepsis and death before the vaccine is able to confer immunity to the exposed first responders.3 The best mitigation strategy for the threat to first responders during a bioterrorism-related release of antibiotic-resistant anthrax is a voluntary, pre-exposure immunization program.4 Pre-attack vaccination of any person who self-assesses a high risk of exposure is the best strategy for preparedness to anthrax bioterrorism since the resultant immunity protects against anthrax disease inflicted by both antibiotic-sensitive and antibiotic-resistant
organisms.5
2.
Annually, 1.5 – 2-million vaccine doses of the FDA-licensed anthrax vaccine expire from the Strategic National Stockpile. Every year since 2009, according to the U.S. Government Accountability Office6, an estimated 1.5-2 million vaccine doses of the FDA-licensed anthrax vaccine stored in the Strategic National Stockpile (SNS) go to waste. Some estimates put the waste at 600,000 doses a month. These doses could be offered to Americans at high risk to anthrax bioterrorism, specifically first responders who would routinely respond to “white powder scares”.7 This group includes but is not limited to: police/security officers, fire fighters, paramedics/EMTs, public health officials, public works personnel, utilities employees, HAZMAT, SWAT, and health care professionals who serve as first receivers in emergency rooms. Additionally, based on the deadly two-wave, multi-site attack via the US Postal Service, the vaccine is also appropriate for all Americans from groups victimized by the 2001 anthrax attacks.8 This includes mail/shipping carriers, media personalities, government officials, and their
staff.
3. The anthrax vaccine is safe and effective, and there is very little risk in the pre-event vaccination strategy. Anthrax vaccine adsorbed (AVA) is FDA-licensed as safe and effective.9 To date, over 11.6 million doses of AVA have been administered to more than 2.9 million individuals. The rate of adverse events for this vaccine is similar to rates with other adult vaccines (flu, HAV, Tetanus).10,11 Research shows that out of the 6-million doses administered from 1998 to 2007, there were 79 adverse events per 100,000 doses, or less than 0.1% of all administered doses.12,13
4. First responders are asking for access to the vaccine. Presently, emergency responders (and many civilians) are expressing a wish to receive the vaccine.14 One survey shows 63% of emergency responders want access to the anthrax vaccine. The CDC Advisory Committee on Immunization Practices (ACIP) supports the use of the anthrax vaccine for emergency responders.15 Vaccinating local emergency responders would bring their level of preparedness up to the federal standard of protection enjoyed by the National Guard Weapons of Mass Destruction Civilian Support Teams.16
5. Public support for these Congressional efforts to make stockpiled anthrax vaccine available to first responders is needed. While the pertinent language in these bills (H.R. 1300, H.R. 3583, and S. 1915) is nearly identical in establishing a program that releases anthrax vaccine from the Strategic National Stockpile for first responder protection, public support should be directed, specifically, towards this pertinent language and, in particular, should directly support first responder access to anthrax vaccine that is nearly expiring from the Strategic National Stockpile.