How to Test the Anthrax Vaccine in Children


Later this week, a Federal advisory committee, the Health and Human Service Department’s National Biodefense Science Board will recommend whether and how the anthrax vaccine should be tested in children. Why is the board, all MDs and PhDs, being consulted now?

  1. Because the safe and effective vaccine that is used by the military has never been tested in children.  If there were releases of anthrax, children would need protection. Quarantine or isolation might not keep them away from sources of the disease.  Parents would be in the awful position of having a vaccine for themselves and nothing for their children.
  2. Because the board has been told by the intelligence agencies that the threat of anthrax releases in the United States is “credible,” even if not quantifiable.

The board will be making public health judgments about the risks of testing the vaccine in children.  But the intelligence agencies alone will assess how likely it is that anthrax will be released in the United States.  Even if the CIA or Defense Intelligence Agency provided classified information to the board’s public health participants so they could understand what is new since the anthrax scare ten years ago, the latter will not be able to share that information with the public.

A vaccine trial to establish safety in young children whose immature immune system might respond differently than adults’, would involve relatively few subjects, but their parents would have to “volunteer” them.  On what basis would parents make that decision?  Can they balance the risks and consequences of anthrax release against the risks and consequences of possible reactions to the vaccine for their children?

How can they assess the risk of releases? Parents offered a slot in the anthrax vaccine trial for their children would have to rely on the same experts who believed there were biological weapon stockpiles in Iraq. In the run-up to the invasion of Iraq, our government intelligence agencies invented a biological weapons threat, imagining Iraqi stockpiles of smallpox virus and anthrax spores; stockpiles that were never found.

Trust dissipated.  And when the government launched a public health program to give smallpox vaccine to first responders and military personnel, most of them rejected it. The program floundered.

Civilian public health experts will be little help to parents.  They are appropriately wary of saying “Trust me,” particularly when it is unlikely that the intelligence agencies will share their information that support the claim that the threat is “credible.” Surely they will not allowed to relay classified information to the public.

Can we get beyond our distrust of the intelligence community and meet the needs of public health professionals to explain their decisions to the public?  Possibly not, but there may be a way around the problem, a way to find the right group of “volunteer” children.

You want to find the right children to receive experimental injections of the anthrax vaccine? How about the children of people who have the national security clearance required for the government to share with them all the evidence that adds up to a “credible threat?” With that information in hand, these parents would be able to make the choice-an informed decision for their children-that the rest of the public surely cannot.


Dr. Robbins, a Professor of Public Health at Tufts University School of Medicine, is a former director of the US National Vaccine Program.