FAQs relating to the UK Voluntary Immunisation Programme Against Anthrax
Q. Why have UK Service personnel been offered immunisation against anthrax?
A. The threat from anthrax is real. A number of countries are known to have developed anthrax as a biological weapon. Aware of its potential, terrorist groups could also seek an anthrax capability. Our forces, from the front line to the home bases, could be at risk. Immunisation against anthrax is a safe and effective protective measure.
It takes time to become effective, so it is sensible to offer it to personnel in advance. We have previously offered immunisation against anthrax to personnel deploying on operations to the Gulf and in specialist NBC units. We are now expanding the offer to all UK Service personnel including reserves and essential civilians who could deploy on operations overseas, as a routine immunisation.
Q. Why is UK MOD expanding the programme?
A. Immunisation against anthrax takes six months to become fully effective. This is much longer than the warning we might have of a change in the threat, and longer than the time-scales over which our Forces could be asked to deploy to a high-threat area.
Therefore, it makes sense to offer it to personnel in advance. Previously, we have offered immunisation against anthrax to personnel deploying on operations to the Gulf and to those in specialist NBC units. We have always kept the scope of the programme under review, contingent on new stocks of the vaccine.
Now that new supplies are available, and because we cannot expect to predict exactly where or when a threat might arise, or which units of our Armed Forces might be called upon to respond, we have decided to expand the immunisation programme so that all Service personnel, including reservists and those essential civilians who are likely to deploy on operations overseas, are routinely offered immunisation against anthrax. We plan to expand the programme gradually and over the next few years, starting with those units held at the highest readiness.
Q. Has the threat to the UK from anthrax attack increased?
A. No - we assess that there is no immediate threat to the UK mainland from anthrax used as a biological weapon. The UK MOD continually assesses the threat to our troops on operations, including that from biological warfare.
We have concluded that, while the threat to UK Armed Forces on operations is not immediate, it is one we would be unwise to ignore, and one that could change with little or no notice. The danger therefore remains, and it makes sense to continue to take precautions, like immunisation, to ensure that our personnel have access to the best protection we are able to provide.
Q. Has the expansion of the UK Voluntary Immunisation Programme against anthrax been prompted by the 11 September 2001 attacks or the anthrax letters in the US?
A. No - although these underlined that the threat is real. We have always kept the scope of the programme under review, and now that new stocks are available, we are expanding the programme. This decision has not been prompted by an increase in the threat, or any other factor.
Q. Was the expansion of the programme preparation for action against Iraq?
A. No. We are expanding the programme because new supplies of vaccine have become available, and not for any other reason. The expansion of the programme is not a preparation for any specific deployment, against Iraq or anyone else.
Q. Isn't expanding the programme an over-reaction to the threat? Why take such a drastic step?
A. Expanding our anthrax immunisation programme is not, in fact, a particularly significant step. Immunisation against anthrax is already routine for some veterinarians and some laboratory workers, as they have a slightly higher risk of exposure to anthrax over the course of their working lives, compared to people in other professions.
As anthrax can also be used as a biological weapon, our Service personnel could also face a higher risk of exposure to anthrax during their Service careers. Therefore it is sensible to make immunisation against anthrax routine for Armed Forces personnel. Previously stocks were limited, and MOD had to limit immunisation to those personnel thought to be at the greatest risk, namely those deployed on operations to the Gulf or in specialist NBC units.
Now new, larger supplies are becoming available. This is excellent news, enabling us to expand the programme so that ultimately all Service personnel, including reserves, and those essential civilians likely to deploy on operations overseas, will be routinely immunised against anthrax.
Q. Why immunise personnel routinely - can't you just immunise the units that need it as and when?
A. Like other vaccinations, immunisation against anthrax takes time to become fully effective – around six months. This is much longer than the warning we might have of a change in the threat, and longer than the time-scales over which UK Forces could be asked to deploy to a high threat area.
We cannot expect to predict exactly where or when a threat might arise, or which units of our Armed Forces might be called upon to respond. Therefore, it makes sense to offer it routinely, to all personnel, in advance.
Q. Why immunise the UK Armed Forces, but not the UK public?
A. It is not necessary to immunise the public. UK Service personnel need to be able to respond, potentially at short notice, to a possible anthrax threat in operations world-wide. Therefore, it makes sense for them to be immunised in advance.
Q. When did the UK's anthrax immunisation programme commence, and when will it finish?
A. For personnel deployed to the Gulf and in specialist NBC units, the programme resumed on 21 May 2001. The expansion of the programme to the whole of the UK Armed Forces is proceeding in phases, starting with those units held at the highest readiness. This phased expansion was announced on 13 June 2002 and began shortly afterwards. The programme will continue for as long as we judge that there is a threat to our service personnel from anthrax.
Q. What do you mean by 'essential civilians who are likely to deploy overseas?' When will they be immunised?
A. Essential civilians are those personnel required to remain in theatre alongside our Armed Forces in order to ensure the effectiveness of UK operations. This includes a small number of MOD civil servants with key roles, and some key contractors.
It is important that these essential civilian personnel are provided with an equivalent level of protection as that afforded to our Armed Forces, so they will be included in the programme where appropriate. As the expansion of the programme will begin with those Forces held at the highest readiness, we expect to include essential civilians in the later phases.
Q. Will senior UK MOD personnel, other senior UK Government personnel or their families be immunised?
A. No. Aside from service personnel, immunisation will be offered only to essential civilians who are likely to deploy overseas. These civilians are those non-Armed Forces personnel identified as being likely to deploy to an operational area alongside, and in support of, the Armed Forces.
Q. Are UK personnel forced to accept anthrax immunisation?
A. No. Personnel offered immunisation against anthrax are encouraged to accept it, just as they are encouraged to accept immunisation against naturally occurring diseases such as yellow fever and tetanus.
But all immunisations are voluntary and on the basis of informed consent. Personnel who decline the offer of immunisation are not subject to disciplinary action. Personnel who decline the offer of immunisation would deploy as planned, and any future postings are unaffected.
Q. What happens to someone who refuses anthrax immunisation?
. Nothing - Personnel who decline the offer of immunisation will still be liable for deployment, and any future postings are unaffected.
Q. Why isn’t anthrax immunisation mandatory (as is the case for US personnel)?
A. Long standing medical practice in the UK is to offer immunisations to people on the basis of informed consent. Our policy of giving anthrax immunisation on that basis is consistent with the approach we adopt for all the other immunisations (e.g. yellow fever, tetanus) we offer to personnel.
Q. Why are you only offering immunisation against anthrax?
A. We have decided to make immunisation against anthrax routine, because it takes approximately six months to become fully effective (which is much longer than the warning we might have of a change in the threat, and longer than the time-scales over which our Forces could be asked to deploy to a high-threat area), and because a licensed vaccine is available.
UK forces are afforded a range of capabilities which protect them against, and enable them to respond to, the full spectrum of chemical and biological threats, of which immunisation against anthrax is one component.
Q. What information are personnel given about immunisation?
A. We have put together a package of information concerning anthrax and anthrax immunisation for personnel. Before they decide whether to accept immunisation, all personnel will be briefed by their unit commander supported by medical staff.
They will view an information video and be given a copy of an information leaflet. Special guides have also been produced for commanders and medical staff to help them in the task of briefing personnel and answering any questions that they might have. There is also a helpline.
Q. I am a member of UK Service personnel, a UK Service reservist or a UK MOD civilian who could deploy in support of operations overseas. What do I need to do next?
A. You will be included in the Voluntary Immunisation Programme at an appropriate point as the programme rolls out. This process began on 13 June 2002 and will take a few years to complete, starting with forces at highest readiness.
When their unit is included, military personnel will be called forward to attend their medical centre in order to be offered immunisation. Civilian personnel will be advised on arrangements for receiving immunisation as the programme expands.
Q. Who produces anthrax vaccine?
A. Anthrax vaccine is produced by the Centre for Applied Microbiology & Research (CAMR), a special health authority of the UK Department of Health.
Q. Is it the same vaccine as is given to US troops?
A. No. The UK and US anthrax vaccines work in similar ways, but they are produced and administered differently
Q. What does anthrax immunisation involve?
A. Anthrax immunisation involves a course of four injections given into the muscle of the upper arm, at 0, 3, 6 weeks and then at six months. Thereafter an annual booster maintains immunity.
Q. What protection does immunisation give against anthrax?
A. Independent medical advice confirms that immunisation provides effective protection against anthrax used a biological weapon. The immune response in individuals varies but significant protection against anthrax is normally provided following the third injection (i.e. after six weeks).
Peak protection occurs soon after the fourth dose, six months later. However, no vaccine provides 100% protection which is why we use immunisation in concert with other protective measures against biological weapons.
Q. Is the vaccine effective against inhalational anthrax?
A. Yes - evidence indicates that the vaccine is a highly effective defence against anthrax, including against inhalational anthrax.
Q. What other protective measures are there?
A. The UK's overall defence response to the threat of chemical and biological weapons is based on five elements: Detection and identification. Warning and reporting. Individual and collective protection. Hazard management. Medical countermeasures, including immunisation.
The UK has significant capabilities in each of these categories which protect our troops and enable them to respond effectively to a CBW threat. More details of the UK’s overall approach to chemical and biological defence can be found in the MOD's Public Paper on Chemical & Biological Defence.
Q. What are the side-effects of anthrax immunisation?
A. No serious side-effects have ever been reported. Like all vaccines, anthrax vaccine may cause some minor side effects in some people. These may include a sore arm and, in some cases, a mild fever or general nausea. Any such symptoms generally disappear within a week.
Q. Is anthrax vaccine safe?
A. The safety of our personnel is paramount, which is why we are offering them the additional protection afforded by anthrax immunisation. Independent medical advice has confirmed that anthrax immunisation is safe.
All medicines, including vaccines, have the potential to cause side effects in some people. The UK anthrax vaccine is licensed and has been used for many years and administered to many thousands of people both in the military and civilian occupations such as laboratory workers, veterinary surgeons and abattoir workers. There is no clinical evidence to suggest that any have suffered any long-term ill effects as a result.
Q. Anthrax immunisation was given to many thousands of personnel during the Gulf Conflict. Has anthrax vaccine caused illness amongst Gulf Veterans?
A. Thousands of people, including Service personnel and civilians such as vets and laboratory workers, have been immunised against anthrax over the years. There is no clinical evidence to suggest that any have suffered any long-term ill effects as a result.
Research published in 1999 ["Health of UK servicemen who served in the Persian Gulf War" by Unwin et al, The Lancet, Vol 353, 16 January 1999, pp 169-178] suggested a weak statistical association between anthrax immunisation and the occurrence of some of the ill-health reported by Gulf Veterans, though this was not found to be associated with a decrease in physical functioning.
However, more recent work ["Role of vaccinations as risk factors for ill health in veterans of the Gulf War: cross-sectional study" by Hotopf et al, British Medical Journal, Vol 320, 20 May 2000, pp1363-1367] has failed to confirm such an association.
This research, undertaken by separate groups at Kings College and Manchester University, looked at the possibility of a link between immunisations given during the Gulf conflict and illnesses reported by Gulf Veterans.
To date this study has found no link between ill health and anthrax vaccine, but may have found an effect from multiple vaccinations under some particular circumstances. The study team has carried out a further detailed clinical analysis of a sample of Gulf veterans and controls to see if there is a physical basis for their findings on multiple vaccinations.
This work has not yet been published. MOD is continuing with a major research programme looking at the health impact of multiple vaccinations given to troops during the Gulf conflict. Independent medical advice confirms that immunisation offers safe and effective protection against anthrax used as a biological weapon. The UK Government is committed to addressing the concerns of our Gulf veterans, and seeks to do so openly, sympathetically and seriously. For further information please visit our Gulf Veterans' Illnesses website.
Q. Given the uncertainty over the cause of illnesses amongst Gulf Veterans, why take the risk of using anthrax vaccine?
A. Our primary consideration is the safety of personnel and we believe that it is important that UK personnel have the very best protection available against biological attack.
Anthrax, were it to be used successfully as a biological weapon against unprotected personnel, has the potential to cause large numbers of casualties. Independent medical advice has confirmed that anthrax immunisation is safe and we have therefore decided that personnel should have the opportunity to benefit from the additional protection that immunisation confers.
Q. Some Gulf Veterans groups have advised troops not to take the vaccine as the risks to health are too great. Is this true?
A. This is not the conclusion of the independent, expert scientific and medical advice that informs MOD. Anthrax is a deadly disease that can kill. Anthrax used as a biological weapon represents a real threat to our Armed Forces.
Immunisation offers excellent protection against anthrax. The anthrax vaccine has been used for decades by people in civilian occupations such as veterinarians and laboratory workers, as well as in the Armed Forces. No serious side effects have ever been reported, and independent medical advice confirms that immunisation against anthrax is safe and effective.
Q. Does the UK anthrax vaccine contain squalene?
A. No. Squalene is not added to or used in the production of the UK licensed anthrax vaccine.
Q. Is the vaccine really necessary? Can't anthrax be prevented using broad-spectrum antibiotics?
A. Prevention is better than treatment. Broad-spectrum antibiotics, such as Ciprofloxacin, have a role to play, in combination with the vaccine, in the treatment of unprotected people who have been exposed to anthrax, but are in general only effective if administered before the major symptoms become apparent.
Independent medical advice confirms that immunisation against anthrax offers safe and effective additional protection to personnel in the event that they are exposed to anthrax used as a biological weapon. The alternative would be to place personnel permanently on antibiotics, which is not advised.
