Demand Growing for Anthrax Vaccine (washingtonpost.com)

[Guest guest]

By Rick Weiss

Washington Post Staff Writer

Saturday, September 29, 2001; Page A16

The nation's only vaccine approved against anthrax has never been a

best-seller. The only civilians who ever needed it were ranchers, hide handlers,

veterinarians and the few scientists who worked with the deadly soil bacterium.

Sept. 11 changed all that. Doctors' offices and travel clinics around the

country have been swamped with requests for the vaccine amid concern that the

tragedies in New York and Washington might foreshadow a bioterrorist attack.

More than 1,000 people in the past two weeks have tried to get shots directly

from the vaccine's maker, BioPort of Lansing, Mich. Callers there are being

shunted to a recorded message that reflects what doctors everywhere are saying:

" All the stockpile that currently exists is owned by the Department of

Defense. At this time there is no opportunity for any commercial sales. "

That reality has infuriated some. " After all, we are all now soldiers in

the war trenches of our offices, hospitals and backyards, " said Gray, an

Atlanta area health care worker. He noted that Iraq, the Soviet Union and

perhaps other nations have made weapons loaded with the deadly spores.

Yet BioPort's vaccine was until two weeks ago perhaps the most shunned and

controversial shot ever produced. For years it has been at the center of a

political, medical and legal struggle, with more than 400 members of the

military opting to quit or be court-martialed rather than roll up their sleeves.

Indeed, the history of the vaccine suggests that the nation faces some

difficult decisions as it tries to prepare for what is widely believed to be the

No. 1 biowarfare threat today.

The Food and Drug Administration has repeatedly cited BioPort for

violations at its manufacturing plant, including contamination problems and

suspicious changes made to quality assurance records. So severe have those

problems been that the agency has blocked the release of all batches for several

years, contributing to a severe shortage that was causing problems for the

military long before the public wanted a share of the doses.

BioPort may eventually overcome its manufacturing problems – the company

says it will apply for FDA licensure of an upgraded plant in mid-October. But

questions remain as to whether the FDA itself is in violation of the law by

allowing the military to use the vaccine against inhaled anthrax when the shot's

usefulness has been proven only for a different version of the disease.

In May, two Air Force officers filed a federal class action suit,

contending that the vaccine should be classified as " investigational " for

inhaled anthrax and should be offered only to volunteers who sign

informed-consent documents clearly stating they are subjects in an experiment.

Pentagon leaders also are apparently engaged in a heated battle among

themselves over the vaccine. Undersecretaries of Defense Pete Aldridge and

Chu, who were reviewing the anthrax vaccine situation for Defense Secretary

H. Rumsfeld, sent a memo to Rumsfeld on Aug. 10 saying they would make

their final recommendations about BioPort by Sept. 1.

Language in the memo supports long-standing rumors that they may recommend

canceling the contract with BioPort and developing a new facility for the

military's vaccine needs.

Their final Sept. 1 recommendation has not been made public. But on Aug.

30 Gen. Henry H. Shelton, chairman of the Joint Chiefs of Staff, sent his own

preemptory memo to Rumsfeld.

That memo, which was obtained by The Washington Post, urges Rumsfeld to

keep the BioPort vaccine " as the centerpiece of our defense " against anthrax.

Sources inside and outside the military, speaking on the condition of anonymity,

said the memo appears to be an effort to derail the undersecretaries' review.

They say it reflects the joint chiefs' position that the vaccine will give them

political, if not medical, cover if U.S. troops are attacked with anthrax.

One of BioPort's four board members is former Joint Chiefs of Staff member

Adm. J. Crowe Jr.

Inhaled anthrax is fatal in 80 percent of unvaccinated people. Antibiotics

for the disease, such as ciprofloxacin (brand name Cipro), which have been

selling in record quantities in the past two weeks, are largely useless by the

time symptoms arise.

The vaccine was approved in 1970, based on a study that showed it

protected against " cutaneous " anthrax, a form of the disease that occurs when

spores infect the skin. The vaccine was never tested against inhaled anthrax in

people (and could not be today for ethical reasons). Nonetheless, about half a

million members of the military were ordered to take the shots to protect

against inhaled anthrax during the Gulf War.

In 1996, BioPort applied to the FDA for a change in the vaccine's approval

to deem it officially protective against inhaled anthrax. That application is

still pending, but in 1997 the military embarked on a massive program to

vaccinate all 2.4 million active and reserve military personnel.

Those plans have shrunk over the years, largely as a result of dwindling

supplies caused by BioPort's ongoing failure to pass FDA requirements. About

520,000 members of the service have been inoculated to date.

Critics of the vaccine say no one should be forced to get the shot

because, in their view, its safety and efficacy against inhalation anthrax are

still in question. The U.S. General Accounting Office has agreed – among other

problems, it concluded, the current vaccine does not have the same chemical

formulation as that approved in 1970. A scathing report by the House Government

Reform Committee also agreed.

The FDA has been highly critical of BioPort's performance, telling

Congress on numerous occasions that the agency continues to find " significant

deviations " from its standards. The most recent inspection records available,

obtained by The Post through the Freedom of Information Act, contain 17 pages of

violations from October 2000, including sterility failures, mysteriously

post-dated quality control forms and the use of improper calculations that

effectively made abnormal test results appear to be normal.

Nonetheless, the FDA and the federal Centers for Disease Control and

Prevention have repeatedly asserted that they believe the vaccine being

circulated to the military is safe, and that it is not illegal to prescribe it

for inhalation anthrax. Side effects appear to be no more frequent than for

other vaccines, BioPort and the Defense Department have said.

It remains to be seen whether the military will use the heightened threat

of terrorism to justify a new push for mass vaccination of troops.

Alternatively, soldiers could be given the choice of opting out of what they see

as an unfair experiment, or the president could invoke a 1998 law that allows

him to compel soldiers to submit to experimental shots.

Neither of those options is politically attractive, observers said. And

given the current climate of fear, it may be that – in a twist no one had

predicted – the real challenge will be making enough of the vaccine to satisfy

public demand.

© 2001 The Washington Post Company