Why military vaccinations are important for force protection

History is full of incidents that have altered the course of battle and wars that have hinged upon the administration of medical vaccines to the troops involved. Let me portray several incidents that fall into this realm.

In the Peloponnesian War in 430 B.C., there is historical suggestion that an overwhelming smallpox infection sufficiently reduced the fighting force of the Athenians, so that the Spartans were able to overcome Athenian defenses, resulting in the downfall of Athens.

In A.D. 1346, at the City of Kaffa on the Black Sea, the Tartars catapulted dead bodies of its own plague victims over the walls of the city, which had been under siege. This quickly spread plague throughout the city. The Black Death (plague), which swept through Europe from 1347-1351 and killed more than 25 million (one-third of the population of Europe at that time), was thought to have originated with this event at Kaffa.

During the French and Indian War in 1767, Sir Jeffrey Amherst of the British Army ordered a devious plan to defeat Ft. Carillon, which was later named Ft. Ticonderoga. He gave the Indian tribes in the region a "gift" of blankets as a show of friendship. However, the blankets were infected with the smallpox scabs of victims who had previously used the blankets. When the Indians accepted the gifts and brought them back to their villages, they were infected with smallpox, which proceeded to kill almost 80 percent of the tribal members.

In 1776, the Continental Army was engaged in the Battle of Quebec. About 5,500 out of 10,000 American troops, including their commander MG John Thomas, came down with smallpox and died as a result of the disease. The Americans lost this battle and subsequently retreated from Canada. After this extreme lesson on the devastating effect of disease on a fighting force, General Washington in 1777 required all members of the Continental Army to be vaccinated against smallpox, despite a known adverse event incidence of a loss of between 1-2 percent of those variolated (the process of taking material from the scabs or pox pustules and using it to scratch into the skin of a non-infected person to produce a mild form of the disease, thereby reducing the mortality rate of 30 percent down to 1-2 percent and providing lifelong protection against smallpox). The Continental Army never had a problem with smallpox after that. Many American citizens also allowed themselves to be variolated against smallpox because of the devas tating effect it was having on the populace.

In 1899 during the Boer War, the British developed the typhoid vaccine. As history has shown, people are usually opposed to vaccines, and the opposition to the typhoid vaccine grew among the British Army troops. Opposition personnel even boarded transport ships in Southampton Harbor and threw the typhoid vaccine into the water. As a result, the British Army made the typhoid vaccine optional and only 14,000 soldiers volunteered to take it. During the Boer War itself, 58,000 British troops contracted typhoid fever and 9,000 needlessly died from the disease. Among those vaccinated, only 2 percent became infected, and they survived. The overall result, however, was that the British lost the Boer War. But a lesson had been learned; in 1914 during World War 1,97 percent of the British troops opted to take the typhoid vaccine.

During World War II, about 99 percent of the American military was vaccinated with smallpox vaccine and there were no cases of smallpox reported among the U.S. forces. Interestingly, there were no reports of any major side effects from the vaccine either and no reports of any deaths among those taking the vaccine. Vaccination against tetanus during World War II led to the fact that only 12 cases of tetanus occurred among American troops, compared with numerous deaths from tetanus among the German Wehrmacht.

Vaccines in general have been around for thousands of years. Around B.C. 1000, the people in India first practiced variolation inoculation. This practice spread to Tibet and eventually made its way to China by monks at a Buddhist monastery in Sichuan province around A.D. 1000. During the 1600s, this process was widely practiced by physicians of the Ottoman Empire.

In 1717, Lady Mary Montagu of London, who had survived smallpox two years earlier, accompanied her husband to Constantinople where he was appointed as the British ambassador. It was there that she learned of the variolation process and insisted that her son be vaccinated against the dreaded smallpox. On return to London in 1721, she persuaded the Prince of Wales to allow a public variolation experiment against smallpox, which was successful. By the 1740s, variolation was popular in England.

In England in 1796, Edward Jenner discovered that a virus similar to another virus could be used to protect people against the deadly smallpox. In 1806, President Thomas Jefferson wrote a letter to Jenner and said: "It is owing to your discovery that in the future peoples of the world will learn about this disgusting smallpox disease only from ancient traditions."

In 1880, William Greenfleld in England and then in 1881 Louis Pasteur in Paris discovered a vaccine against the bacteria anthrax. So the road to preventing infectious diseases was heing paved with scientific discovery about the mechanism of disease production and the ways to short-circuit their destructive ways. In spite of these advances, smallpox continued to spread rapidly throughout the world up through the 20th century and resulted in almost 500 million deaths in the 20th century alone. As late as 1966, there were 2 million deaths from smallpox in that year alone. Not until the Global Eradication Program, sponsored by the World Health Organization, was fully put into effect was smallpox successfully eradicated in 1980 as a naturally occurring disease and smallpox vaccinations stopped being necessary worldwide.

The United States has had an active defensive biological weapons program that dates back to 1969 when President Nixon declared that the United States would not develop any offensive biological weapons but would concentrate only on developing defensive measures against biological agents. It has become part of the overall U.S. military strategy to protect our military forces against all naturally occurring infectious diseases, as well as those potential diseases that could be inflicted on a battlefield by the use of biological weapons agents. As a result, U.S. forces receive vaccination protection against yellow fever, typhoid, hepatitis A and B, as well as others necessary, depending on the particular theater to which troops are sent. Because of the known threat of biological weapons from adversaries such as Iraq, and based upon knowledge of prior Soviet bioweapons programs, the decision was made to vaccinate U.S. troops against anthrax and, more recently, smallpox.

Vaccines that protect against numerous other agents are currently undergoing research protocols. Among those are research on vaccines for botulinum, Q-fever, plague, tularemia, and hemorrhagic fever viruses such as Ebola, Marburg and Rift Valley Fever. New vaccines for anthrax and smallpox are also being developed.

Although there are and always have been groups of citizens throughout history who have opposed vaccines and their use, it is estimated that of the four major contributions of medicine to the longevity of people (proper hygiene, clean water, antibiotics and vaccines), vaccines are credited with saving more lives than the others except for the advent of clean water. It is and has been Department of Defense policy to use only FDA-licensed and approved vaccines for its troops. Starting back in 1997, there was considerable controversy relating to the use of the anthrax vaccine. It will be comforting to all that a thorough review of the anthrax program was carried out by the American National Academy of Sciences' Institute of Medicine (JOM). In its report, published in March 2002, IOM stated that the DoD anthrax vaccine immunization program was a safe and effective program to prevent anthrax of all types. Therefore, the U.S. military continues to follow a long tradition of using vaccines to protect its members and save lives so that it will be able to fulfill its missions. The current military smallpox vaccination program is being coordinated with the CDC and uses only FDA-licensed vaccines to protect DoD forces. DoD provides numerous other mechanisms to protect its troops, including protective clothing and breathing apparatus and the use of appropriate antibiotics, but the only around-the-clock continual protection against biological agents is vaccinations.

So, as you see, diseases and vaccines have had a profound impact on the outcomes of warfare throughout history. We are fortunate to live in a time when we can rely on our medical resources to help prevent diseases, and we are also fortunate to live in a country that provides this protection for its people.

REFERENCES

(1.) J.B. Tucker, Scourge. New York, NY: Grove Press, 2001.

(2.) D.A. Henderson, T.V. Inglesby, J.G. Bartlett, et al., "Smallpox as a biological weapon: medical and public health management," JAMA 1999,281:2127-2137.

(3.) D.A. Henderson, I. Arlta, E. Shafa, World Health Organization paper on smallpox eradication. 1972, SE/72.5.

(4.) D.R. Franz, P.B. Jahrling, A.M. Friedlander, et al., "Clinical recognition and management of patients exposed to biological warfare agents, " JAMa 1997, 278:399-411.

(5.) K. Alibek, Biohazard. New York, NY: Random House, Inc., 1999.

(6.) Institute of Medicine Report, "The Anthrax Vaccine." Washington, D.C.: National Academy Press, 2002.

(7.) Biological Warfare Timeline, www.worldhistory.com.

(8.) J.A. Davis, B.R. Schneider, The Gathering Biological Warfare Storm. Maxwell AFB, Ala.: USAF Counterproliferation Center, Air University, 2002.

(9.) www.anthrax.mil and www.smallpox.army.mil.

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