Since the return of American military personnel deployed to Southwest Asia during Operations Desert Shield and Desert Storm, illnesses have been reported that may relate to service in the Gulf War. A number of veterans and others have expressed concern that the use of vaccines may have contributed to these illnesses. This paper provides information for veterans and other concerned individuals about vaccines, their use by the military, and particularly about issues arising from the administration of biological warfare vaccines in the Gulf War. It includes discussion of several related and contemporary issues, and concludes with some observations that reflect both accomplishments and continuing challenges.  This paper also complements a recent report from the Institute of Medicine that evaluates the published scientific research on the health effects of specific vaccines used during the Gulf War.

Vaccines are commonly used health interventions that broadly benefit populations as well as individuals. Because of its unique and diverse mission, the military employs vaccines as critical countermeasures against infectious diseases and biological warfare agents. Differences in vaccination policies among the military services reflect variations in their respective training cycles, missions, and expected levels of exposure. Military vaccine programs are also constantly being updated to incorporate advances in preventive medicine, as well as in response to changing health threats.

During the Gulf War, anthrax and botulinum toxoid vaccines were used to protect US forces against the threat of Iraq’s biological weapons. Administration of these vaccines during Operations Desert Shield and Desert Storm was characterized by several difficult issues, including obtaining sufficient quantities of the vaccines to protect all forces at risk; prioritizing military units for vaccination because of limited availability of both vaccines; using the investigational botulinum toxoid vaccine; providing servicemembers with information about the vaccines and obtaining their informed consent; employing voluntary and mandatory vaccinations; dealing with operational security considerations; and documenting vaccines in health records.

Military personnel today are increasingly facing routine deployments overseas, exposures to environmentally hazardous battlefields, and risks associated with biological warfare agents. The Gulf War experience has brought to light some shortfalls in vaccine administration and generated improvements in force health protection. Ensuring adequate production sources and maintaining sufficient stockpiles of safe and effective military-unique vaccines—especially vaccines in investigational status—remain daunting challenges, as does the communication of associated health risks to servicemembers. Importantly, progress has been demonstrated in vaccine tracking and documentation for deployments, and robust research on military vaccine development is ongoing. The Department of Defense should continue to build upon lessons learned from the Gulf War to ensure that advances in vaccine development and administration keep pace with changing health threats to military personnel.

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