Anthrax Vaccination and the Deeper Problems of Leadership
 
by Andrew Bacevich
 
  March 10, 2000
 
Andrew J.  Bacevich directs  the  Center  for  International Relations at Boston University. This essay is adapted from a longer article  appearing in the Spring 2000 issue of Orbis,the  quarterly   journal  of  the  Foreign  Policy  Research
Institute.
 
For several years now, the Clinton administration has warned of the  specter of  biological terrorism stalking the United States. As Secretary of Defense William S. Cohen wrote in an op-ed portraying  the horror  that could  ensue:  "Hospitals  would become  warehouses for  the dead  and dying.  A plague more monstrous  than  anything  we  have  experienced  could spread with  all the irrevocability of ink on tissue paper." The question  confronting the  United States, Cohen insists, is not if such an incident will occur, but when.

As a  result of  such fears,  the  administration  has  made biological  defense  a  top  priority.  Testifying  to  that priority, in  December 1997  Secretary Cohen  announced  the mandatory vaccination  against  anthrax  of  more  than  two  million U.S.  military personnel.  But  growing  controversy surrounding that  program is  exposing the  larger flaws  in U.S. preparations for biological war.

OPPOSITION IN THE RANKS
Much to  the chagrin  of top  civilian and military leaders, the vaccination program has prompted vocal opposition -- not  from antiwar  activists or  conspiracy theorists,  but  from  members of  the armed forces. Steadily increasing numbers of service personnel  -- now  totaling more  than 300  --  have refused to  be inoculated.  Some have even left the military to avoid  taking the  shots.   The vaccination policy's most  impassioned  critics  are  pilots,  many  of  them  seasoned officers and  combat veterans.  Hence, they  are not  easily dismissed as  naive,  misinformed,  or  easily  manipulated. These critics  insist that the anthrax vaccine is unsafe and endangers  their   health.  Already  short  of  pilots,  the services can  ill-afford to  lose more.   Yet suspending the vaccinations in  the face  of protests  from the ranks could prove difficult and costly.
 
First, Pentagon  leaders understandably  worry that  such  a retreat may undermine the integrity of the chain of command, setting a  precedent to challenge other onerous or unpopular orders. Second,  Defense   Department  officials  have  made  "force protection" a  high priority,  terminating  the  careers  of officers deemed  insufficiently attentive  to protecting the soldiers under  their command.  Anthrax vaccinations are the  paramount  expression  of  this  priority.    Defending
 the program, Secretary  Cohen has  told his  troops, "I would be derelict in  my duties  sending you out in an environment in which you weren't properly protected."
 
Third,  the   vaccination  program   serves  as  the  public expression  of   the  administration's  overall  bio-defense policy. Abandoning  it would  call the  entire  policy  into question.  Not surprisingly,  therefore, the  Department of Defense has tenaciously  defended   its  anthrax   policy  and   rejects criticism of  the vaccine  as just  wrong.  "It's  safe  and reliable," Pentagon  spokesman Kenneth  Bacon flatly states. The vaccine  is also  essential, Pentagon  officials assert, because at  least ten  nations  possess  or  are  developing biological weapons, and anthrax is "the weapon of choice for  germ warfare."  Senior defense  officials counter reports of debilitating side  effects to  anthrax vaccine  by insisting that adverse  reactions are  occurring at  a lower rate than with mumps  or measles  vaccines. As  if to prove the point, civilian  and   military  leaders   alike,  beginning   with Secretary Cohen  and the  joint chiefs, have rolled up their sleeves and  been vaccinated. But such attempts, rather than quelling  criticism,   have  only   seemed  to  confirm  the suspicion that  the anthrax  vaccination program  is as much about public relations as about military prophylaxis.
 
BROADER CONCERNS
Skeptics of  the program  have raised a plethora of concerns ranging far  beyond  safety.  Those  revelations  suggest  a program plagued  by mismanagement,  reeking of  impropriety, and based  on a  defective strategy.  At this point, even if the Pentagon were to sustain its claims that the vaccine has no malign  effects, more  than sufficient  cause  exists  to indict the administration's biological warfare policy.
 
The  broad   critique  of  the  administration's  biological warfare program consists of four major points.
 
First, the  Defense Department has entrusted the manufacture of anthrax  vaccine to  a single firm.  Serious doubts exist regarding the ability of this firm to produce a vaccine that meets established  standards of  purity and potency. Efforts by the  Defense Department  to ease  those doubts  have been less than  persuasive.   The  company  in  question  is  the BioPort Corporation  of Lansing,  Michigan, a  start-up firm that bought the assets of the previous manufacturer -- which went  out   of  business   after  repeatedly   failing   FDA inspections. Despite  winning the DOD contract to supply the  vaccine    in     late    1998    and    despite    generous  Defense Department subsidies, BioPort -- relying on the same work force  and same  plant management as its predecessor -- has not  yet  achieved  the  FDA  certification  to  produce anthrax vaccine.
Second, government  officials, including  qualified  medical professionals, have  themselves questioned  the efficacy  of the vaccine,  which was developed decades ago not for combat but to  protect tannery  workers at  risk from  handling the hides of  anthrax-infected  animals.  According  to  a  1995 report by  the chief  of the  Bacteriology Division  at U.S. Army
Medical  Research Institute, there exists "insufficient data to demonstrate protection against inhalational disease" -- the  type that soldiers are most likely to encounter. The Pentagon, eager  to allay fears, promised an external review of the  vaccination program  by an  "expert panel."  But the "panel" was  in fact  a single  individual who  was, of  all things, a professor of obstetrics and gynecology. By his own admission, he  had no  expertise in  anthrax and  refused to testify before  a congressional  subcommittee regarding  his evaluation of the program. 
Third, immunizing  U.S. forces  in  the  field  against  one single strain  of anthrax  is woefully inadequate protection against  any   real  biological  threat.  According  to  the administration's own  analysis, toxins  other  than  anthrax pose at  least as  great a  danger --  as does a genetically modified anthrax.  Furthermore, a  biological attack against the  United   States  would  likely  target  civilians,  not soldiers,   and  cities,  not  military  installations.  The implication that  inoculating troops  at Camp  LeJeune  will deter an anthrax-equipped terrorist is absurd. 
Fourth, the  current biological  defense policy  perpetuates the peculiarly  American delusion  that for  every  security problem there exists a technological fix. Erecting a barrier that relies on outdated means and leaves its flanks exposed, the anthrax vaccination policy is a bio-war Maginot Line.
 
A WAY OUT
What is  needed is  an approach  that avoids scare-mongering rhetoric and  focuses the  attention of senior leaders where it belongs  -- on strategy rather than problem-solving. That approach would include several points.
 
First,  policymakers   can  extricate  themselves  from  the present ill-considered policy without having to admit openly its flaws.  BioPort's obvious  failures  provide  sufficient basis to suspend the anthrax vaccination program pending the identification  of   a  reliable  supplier  of  high-quality vaccine -- a process likely to take three years. 

Second, as  an interim  defense against anthrax, the Defense Department should  revert  from  prophylaxis  to  treatment. Administering antibiotics 
and vaccine  to those  exposed to the virus  was, in  fact, how the Pentagon intended to treat soldiers had  U.S. forces  encountered  anthrax  during  the Persian Gulf War.

Third, the president and secretary of defense should restate unambiguously  the   intention  of   the  United  States  to retaliate massively  in response  to any  biological  attack against Americans.  As was  the case with the nuclear threat during the  Cold War,  there is no substitute for a credible promise of swift and potent punishment.
 
Yet all  of that  is, in  a sense,  the easier  part of  the problem. The larger challenge is to restore to U.S. national security  policy  a  sense  of  proportion.  Obsessing  over operational and  tactical details  -- like  anthrax --  as a pretext  for   permitting  leaders   to  dodge   fundamental strategic issues has become unacceptable.  Chief among those issues is  the dominance  of the  international order  by  a highly ideological  nation dedicated  not simply  to its own defense, but to the universal adoption of the values that it espouses.
 
Progress toward  realizing this  vision --  a world  that is peaceful, democratic,  and respectful  of human  rights  and free  enterprise,   with  the  United  States  presiding  as ultimate arbitrator -- has been at best uneven. But with the success  of  this  project  having  become  a  predicate  of national security,  opposition in any form is construed as a "threat." As a result, the nation -- although by any measure at the  height of its power and influence -- is (to judge by administration rhetoric)  beset by  growing danger, not just from terrorists,  but also rogue states, paranoid dictators,and anarchic hackers. 
At the  heart of the problem lies policymakers' certainty as to their  own good  will and  the universality  of  American values. Opposition  to the further spread of American power, ideals, culture,  and  lifestyle  is  --  by  definition  -- perverse or  irrational. This  outlook guarantees  a  never-ending supply of enemies to confront. One need only consider the frequency  with which  the  Clinton  administration  has  found itself obliged to employ U.S. military forces to warn, coerce, punish, and occupy. 
Fixating on  the prospect  of biological  calamity, American leaders avert their eyes from a larger, disconcerting truth: the global  transformation to  which the  United States  has committed itself is not inspiring spontaneous compliance. As a result,  there is  no end  in sight  to the exertions that will be  necessary if  Americans are to realize their vision for the  world.   Are the aspirations implied by that vision feasible? What  will it  cost to  fulfill them? How much are Americans, citizens  as well  as soldiers,  willing to  pay? However  commendable   their  concern  for  protecting  U.S.  forces,  addressing   these  larger  questions  forthrightly describes the  duty  that  American  policymakers  dare  not neglect.