Vaccines are one of the principal countermeasures the Department of Defense (DoD) uses against infectious diseases and other biological hazards, so military personnel routinely receive many immunizations. These immunizations help protect servicemembers from the infectious diseases they may encounter in ordinary times between deployments, as well as the infectious diseases and biological warfare agents they may encounter during deployments. Differences in vaccination policies and practices among the military services are based upon their different training cycles, different missions, and different levels of exposure to biological threats.[2] Because of the missions they are prepared to undertake, military personnel are more broadly immunized than civilians against a variety of infectious diseases and biological warfare agents.[3]

Vaccine policy for the US Armed Forces is based on the recommendations of both military and civilian medical experts. For vaccines of special importance to the military, two organizations play central roles. The Armed Forces Epidemiological Board is composed of civilian experts in the fields of public health, preventive medicine, and environmental health, and advises the DoD on various disease prevention issues, particularly in the area of vaccines and immunization policy.[4] The Armed Forces Medical Intelligence Center, an activity of the Defense Intelligence Agency, provides the DoD with medical intelligence, including information on worldwide infectious disease and environmental health risks.[5]

For vaccines not unique to the military, the Centers for Disease Control and Prevention (CDC), an agency of the Department of Health and Human Services whose activities include vaccine, infectious disease, and travelers' health programs, provides much of the necessary information.[6] The CDC’s Advisory Committee on Immunization Practices provides guidance and recommendations on general immunization issues and the use of specific vaccines.[7] These organizations also consider the reports of worldwide disease surveillance, regulatory documents, and travel-related health reports published by the World Health Organization.[8]

Military immunization policies, procedures, and responsibilities during the Gulf War were contained in DoD and joint service publications. DoD Instruction 6205.2 provides broad policy guidance regarding military immunizations. Among the directive's key points are that DoD is to follow the recommendations of the US Public Health Service, as developed by the CDC’s Advisory Committee on Immunization Practices and published in CDC's Morbidity and Mortality Weekly Report. The directive also points out that military immunization procedures are to be developed in consultation with the Armed Forces Epidemiological Board and the Armed Forces Medical Intelligence Center. Particular emphasis is to be given to conditions that affect operational readiness, pose a risk in the community or occupational environment, or are unique to a particular geographic or cultural setting. DoD organizations are also directed to comply with communicable disease and adverse reaction reporting requirements established by civilian (e.g., public health) authorities.[9]

The 1988 joint regulation on immunizations implemented the DoD instruction and applied during the Gulf War to active and reserve components of the Army, Navy, Air Force, Marine Corps, and Coast Guard. It incorporated more detailed guidance for the military medical services regarding their respective immunization programs. This guidance indicated that all immunizing agents for use by the Armed Forces were to meet the minimum requirements of the Department of Health and Human Services, as well as standards acceptable to the Food and Drug Administration; that medical personnel were to keep current on the Advisory Committee on Immunization Practices recommendations for immunizing agents and requirements for international travel; and that adverse reactions to immunizing agents were to be appropriately recorded and reported. (See also Adverse Reactions to Vaccines, section V.) It also allowed for commanders of unified commands to establish specific immunization requirements for deploying personnel based on special threat assessments.[10]

The current version of this joint publication includes updated recommendations by the US Public Health Service, expanded guidance on reporting adverse events, and specific guidance on immunizations for biological warfare defense.[11] This 1995 publication is now undergoing review and revision.[12]

The DoD published a new directive in 1993 outlining the policies, responsibilities, and procedures for the development, acquisition, and stockpiling of biological defense vaccines. Broadly stated, it is DoD policy that military personnel should be immunized against validated biological warfare threat agents, for which suitable vaccines are available, in sufficient time to develop immunity before deployment to high-threat areas.[13]

Because of the military's unique mission, the DoD requires several vaccines (e.g., anthrax, plague, and certain adenovirus vaccines) that have limited or no commercial market. Consequently, it has been difficult for the DoD to maintain a reliable manufacturing base to supply these vaccines. Procurement of vaccines against Iraq's biological warfare threat was a challenging problem during the Gulf War, and recent experiences with DoD's anthrax vaccination program demonstrate that optimal solutions have yet to be found.[14]

Vaccines are an integral part of DoD's new strategy of force health protection, which was developed in part from lessons learned from the Gulf War.[15] Force health protection uses preventive health techniques and emerging technologies in environmental surveillance and combat medicine to protect servicemembers before, during, and after deployment. It is designed to improve individual health, proactively address medical threats, and provide care for any illness or injury that does occur.[16] Vaccines can help ensure that military forces are healthy and fit to fight, as well as prevent casualties from biological warfare and endemic diseases.[17]

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