The following are some general observations on vaccine use during the Gulf War deployment. They are intended primarily for veterans who continue to have concerns about the way in which the vaccine programs were planned and implemented. They include areas of success and areas of continuing challenge in the ongoing effort to provide safe and effective vaccines for the protection of military personnel. These observations have been forwarded to the Lessons Learned Implementation Directorate of the Office of the Special Assistant for coordination with applicable offices within the military departments to help ensure that identified issues are appropriately addressed.
The decisions to select and use specific vaccines for the Gulf War deployment were based on accurate assessments of the infectious diseases and biological warfare agents that servicemembers were likely to encounter. The low number of reported casualties from infectious diseases is due in part to the vaccines given to servicemembers before and during the deployment.
Shortages of the biological warfare vaccines and delays in implementing this program meant that substantial numbers of servicemembers either did not receive the protection affordable by these vaccines, or received fewer than the desirable number of doses to gain the maximum benefit from these vaccines.
Information available to servicemembers about vaccinations, especially the biological warfare and investigational vaccines, was inconsistent. Operational security required for the biological warfare vaccines, the necessary prioritization of vaccine recipients, confusion about whether the vaccines were mandatory or voluntary, and the uncertain guidance as to how and where vaccinations would be recorded, all likely contributed to the concern among servicemembers about taking these vaccines. Military personnel at all levels need to appreciate the health risks inherent in military operations, including the relative risks of infectious diseases and biological warfare agents on the one hand, and of the vaccines available as countermeasures on the other.
Inadequate medical record keeping, especially for the biological warfare vaccines, has made it difficult to know which vaccines were given to individual servicemembers, and has complicated research on possible connections between vaccines and the persistent and unexplained illnesses in some Gulf War veterans. Newer and largely electronic vaccine record keeping systems now in place for at least some vaccines will also need to capture immunizations given during the accelerated tempo of a major deployment.
For some vaccines of special use to the military, production during the Gulf War was insufficient to meet the needs of the forces. It will still be necessary to find ways to regularly supply vaccines in amounts sufficient for routine use and to increase production at times of major deployments.
Research by the military has played a substantial role in vaccine development and testing, including some vaccines used during the Gulf War. As vaccines are potentially the easiest and best countermeasures, the military should continue its active research program to improve existing vaccines and to develop new vaccines for the infectious diseases and biological warfare agents servicemembers may encounter in future deployments.
Difficult issues remain concerning the demonstration of effectiveness of vaccines that cannot be adequately tested in humans. Similarly, there is a need for better resolution of problems that accompany the use of investigational vaccines during deployments, especially the needs for adequate record keeping and informed consent, which are difficult to achieve under these conditions. The Department of Defense and the Food and Drug Administration should continue to work toward resolution of these issues.
This information topic remains open. Should additional information become available, it will be incorporated. If you have records, photographs, recollections, or find errors in the details reported, please call 1-800-497-6261.
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