Tuesday, October 25, 2011

Testing Anthrax vaccines in children?!

I came across this piece in the Washington Post today:

Possible study of anthrax vaccine’s effectiveness in children stirs debate

Apparently, a "key working group of federal advisers" endorsed testing in September, to see whether the anthrax vaccine would safely protect healthy children against a bioterrorism attack.

What bioterrorism attack? The possibility of the use of anthrax by (foreign) terrorists was one of the fears addressed post 9/11. However, the only documented use of anthrax in the United States with the intention to harm in the past 10 years happened a week after the 9/11 attacks, when "letters containing anthrax spores arrived at several media offices and two Senate offices, killing five people and sickening 17 others. The FBI eventually concluded that the letters were mailed by Bruce Ivins, a disgruntled scientist at Fort Detrick in Maryland who committed suicide in 2008, although some experts question the FBI’s findings."

As a consequence of the anthrax bioterrorism fears, 2.6 million US military personnel were vaccinated with the anthrax vaccine, and the federal government has spent $1.1 billion to stockpile the vaccine to protect Americans in the event of an attack. This is in addition to treatment option by antibiotics.

The Washington Post reports:

Unlike with measles, mumps and other diseases, the chance that children will be exposed to anthrax is theoretical, making the risk-benefit calculus of testing a vaccine on them much more questionable.

“It’s hard to believe that it’s something that makes a great deal of sense,” said Joel Frader, a pediatrician and bioethicist at Northwestern University’s Feinberg School of Medicine. “It would be difficult to justify testing it on kids simply on the hypothetical possibility that there might be an attack.”

In addition to these ethical considerations, I have several other concerns, this paper sums one up well:

In response to the attacks on Sept 11, 2001 (9/11), and the related security concerns, the USA and its coalition partners began a war in Afghanistan and subsequently invaded Iraq. The wars caused many deaths of non-combatant civilians, further damaged the health-supporting infrastructure and the environment (already adversely affected by previous wars), forced many people to migrate, led to violations of human rights, and diverted resources away from important health needs. After 9/11 and the anthrax outbreak shortly afterwards, the USA and other countries have improved emergency preparedness and response capabilities, but these actions have often diverted attention and resources from more urgent health issues. The documentation and dissemination of information about the adverse health effects of these wars and about the diversion of resources could help to mitigate these consequences and prevent their recurrence.

Given the publicly available data, there is only a "theoretical" anthrax threat to US children. The current disease burden for them, for all we know, is zero. Anthrax vaccine trials and/or general vaccination programmes for children would be a very hard sell to the general public and would significantly support anti-vaccine sentiments. Ultimately, it would detract funds from essential health care research and provision in areas of actual need (i.e. where a measurable disease risk and burden exists), and it may erode vaccination compliance for the essential childhood vaccinations (measles, anyone? Pertussis?).


  1. I can see the argument here with regards to diverting limited resources for what appears to be a hypothetical threat and it's valid. However, I believe we take it for granted that these threats will remain hypothetical, particularly when the consequences are probably too overwhelming to ponder and there are more immediate problems for us to deal with.

    On the flip side, anthrax has already been weaponised and who-knows-what else. So is it in our best interests to keep our fingers crossed that emergency vaccination of children will be safe or to test this prior to the need and develop a better vaccine in the interim?

  2. given the problematic history of this vaccine (in terms of demonstrated and alleged side effects) and the theoretical risk, there is really no justification to test this vaccine on children. I am with you regarding the preparedness, and there were children exposed in 2001, but I am totally uncomfortable with the recommendation to test this vaccine on children now and I am not sure in which situation it would be used...

  3. WOW...I just read this on Fox News and this stirs up so many of my emotions, I'm not quite sure where to begin.

    "Testing" for this vax, imo, is scientifically unethical and I would not allow my lo to become a guinea pig.

    God forbid if any of us EVER have to make such a *real* decision.

  4. AoA's dark lord of vaccination, Dr. Offit, is against the study:

    "I don't see how you can ethically do a study on a child where there is no chance the child benefits from that study," says Paul Offit, an infectious disease specialist at the Children's Hospital of Philadelphia in Pennsylvania, who often speaks out in favor of childhood vaccination. Offit attended one of the meetings of the working group and spoke out against a study. "I didn't prevail," he says.

  5. Whoa, that's saying something. So much for Dr. Offit being a pharma shill.

  6. The vaccine has been used in adults, especially those headed overseas in war zones. I agree that it's not worth the risk for something that is currently theoretical, but anthrax is the kind of thing that can go from theoretical to real overnight. Literally. I worry about something happening and a flood of parents begging for an anthrax vaccine that has never been tested in children because the threat was "theoretical." This is a head-scratcher, for sure.

  7. There are plenty of pharma shills who disagree with some vaccines.

  8. it is called "evidence based" decisions. If there is a real need for the vaccine and the vaccine has been shown to be safe and effective, anyone with two brain cells to rub together will be for it.