Current status of immunization against anthrax: old vaccines may be here to stay for a while

Anthrax vaccination has become a 'hot' topic. On the one hand, fears that I raq holds secret caches of anthrax-based weaponry, that other countries may be developing or may have developed similar devices, or that hard-line gro ups may make their own anthrax-based devices for bioterrorist attacks have focused official attention on the need for means of protection, principally , though, for the military. On the other hand, the unsolved issues of the G ulf War illnesses have left elements of doubt in the minds of some as to th e possible role of anthrax (among other) vaccines in this syndrome, and hav e drawn attention to the shortage of pre-clinical, clinical, pharmacologica l and safety data on the existing UK and US anthrax vaccines. In the middle are those hotly debating the US and Canadian policies of mandatory anthrax immunization for military personnel or, in the case of the UK policy of vo luntary immunization, simply voting with their feet. Compounding matters ha ve been the publicized failures of the US vaccine production facility and t he less publicized UK problems of supply. Meanwhile, those in genuine at-ri sk occupations are left unsure whether, if they can get the vaccine at all, they really want it. Despite two decades of elegant science aimed at formu lating alternative vaccines to overcome all the problems of efficacy, safet y and supply, such an alternative is at least five years away, and the curr ent status is that we must live with the old vaccines or not vaccinate. Cur r Opin Infect Dis 13:113-120. (C) 2000 Lippincott Williams & Wilkins.