1. During the Autumn of 1990, UK forces deployed to the
Arabian Gulf as part of a multi-national force in response to
Saddam Hussein's invasion of Kuwait. They faced a nation
assessed to have extensive biological and chemical(1) warfare
capabilities. Iraq was assessed to have stockpiled - and
possibly weaponised - anthrax and botulinum toxin (BTx).
Intelligence subsequently acquired during the military build-up
suggested additionally a risk of the use of plague. Exposure
to anthrax or plague leads to the early onset of respiratory
disease, is debilitating and often fatal. Exposure to BTx
leads to rapid collapse and death unless effective treatment is
provided quickly.
2. In response to these possible threats, the Ministry of
Defence placed a precautionary order for anthrax vaccine in
August 1990. Anthrax vaccine was licensed in the UK and
produced by the Public Health Laboratory Service (PHLS) at the
Centre for Applied Microbiology and Research (CAMR).
Ideally, 4 vaccinations were required to provide maximum
protection: an initial dose followed by doses at 3, 7 and 32
weeks. The degree of protection would increase after each
dose, but research suggested that effectiveness would be
enhanced if anthrax vaccine was given together with an adjuvant such as pertussis (whooping cough) vaccine. It was recognised
that in the immediate environment of a BW attack, where a large
number of anthrax spores would probably have been ingested,
100% protection could not be guaranteed. But it was assessed
that vaccination coupled with post-attack treatment with
antibiotics should significantly reduce mortality.
3. A vaccine was known against BTx, but advice from potential
suppliers in the US indicated that it would take many months to
acquire and 4 doses (at 0, 2, 12 and 36 weeks) to confer
immunity. An alternative was to acquire antitoxin serum
fractionated from the plasma of either humans or goats who had
previously been vaccinated against BTx, for use as a post-
attack treatment. Production of human and animal serum against
BTx was authorised in October 1990.
4. Biological Antibiotic Treatment Sets (BATS) for post-
attack use (following exposure to anthrax or plague) were also
issued to the Gulf. Medical units in theatre also held large
additional stocks of antibiotics.
5. The Ministry of Defence authorised anthrax vaccination to
commence in theatre from 2 January 1991. All vaccines were to
be offered on the basis of voluntary informed consent. This
meant that the name and nature of the vaccine, the reason why
it was being given, and any possible side-effects, should be
described before inoculation. Personnel were free to refuse
inoculation if they wished, but the possible consequences of
doing--so (the infection with and possible death from a serious
disease) were to be made clear. As for other inoculations
given to military personnel on a voluntary basis, it was not
necessary for personnel to sign a consent form.
6. The pertussis vaccine used in the Gulf was purchased from
France. Although this product was produced and licensed in the
UK, production capacity was insufficient to meet the
requirement for the Gulf without disrupting the Department of
Health child immunisation programme. The imported vaccine was
tested and released by the National Institute of Biological
Standards and Control (NIBSC).
7. There was a difference of assessment between the US and the
UK concerning plague. The US decided not to vaccinate against
it. (It is likely that some US personnel deployed to the Gulf
had previously been vaccinated against plague as part of
routine vaccinations and were, therefore, already immune.) But
based-on UK intelligence assessment, a vaccination programme
against plague was initiated for British troops. The first
dose was to be administered together with,or shortly after,
the second anthrax and pertussis doses, to take advantage of
the pertussis adjuvant effect.
8. Records suggest that there was a significantly lower take-
up in theatre of the plague vaccination programme and the
second pertussis adjuvant. Following administration of the
first anthrax and pertussis inoculations, a significant number
of personnel had developed short-term side-effects.
Recollections of those in theatre at the time suggest that the
take-up rate of plague vaccine in units belonging to 7 Brigade
was low, whereas in units belonging to 4 Brigade it was higher.
These differences reflected variations in local medical advice
and operational considerations. The latter were important
since while troops were deploying forward it would have had a
detrimental effect on operational capability if a significant
number had been allowed to become temporarily unwell. (It was
considered likely by local medical staff that the plague ,
vaccine would have caused unwelcome side-effects for up to 48
hours.)
9. On 28 February 1991 hostilities in the Gulf were
suspended. The third anthrax and second plague inoculations
were not administered to the vast majority of personnel.
10. Because of weaknesses in the system of medical record-
keeping during the Gulf War it is now difficult or in some
instances impossible to determine which personnel received
which vaccinations. The Ministry is considering ways of
improving the system of medical record-keeping in any future
conflict.
11. Stocks of BTx antitoxin serum (both human and goat) were
sent to the Gulf. Although neither form of the serum had a
Medicines Act product licence, the NIBSC approved its use as a
post-attack treatment on a named patient basis. This meant
that, should it be used, records would have to be kept of the
names of personnel to whom it was administered. As no BW
agents were released during the Gulf conflict, the serum was
never used.
12. Since the Gulf conflict, UNSCOM have attempted to uncover
the extent of Iraq's BW programme up until July 1991. By Iraq's
own admission, large amounts of anthrax and BTx had been
weaponised by the time of the Gulf conflict. Although Iraq
continues to deny the existence of plague in its BW inventory,
UNSCOM do not believe that Iraq has yet fully disclosed the
extent of its programme.
13. During the conflict, the Government took all available
steps to offer protection to its personnel. In doing so it
drew on the best professional advice. The Government's
motivation was to maintain our operational capability to
confront the aggression of Saddam Hussein while, as far as
possible, reducing the risks to our own personnel. Although,
as events turned out, BW weapons were not used in the conflict,
no responsible Government could have ignored the clear assessed
risk of such use.
(1) The threat from chemical weapons was addressed by the use of Nerve
Agent Pre-treatment Sets (NAPS) which were issued to personnel in the Gulf.
These have been described elsewhere and are not addressed further in this
memorandum.
There are some obvious errors in this memorandum and misleading facts, I will try to address them here along with descriptions of the diseases and threats. As far as I can I will offer links to text that backup the arguments I am presenting here.
1. Anthrax, the the disease and the vaccine, details of both can be found by following these links.
2. Plague, information regarding both the disease and vaccine can be found by following this link, pay particular attention to the manufacturers recommendations for administration because we will return to this.
3. So now we come to the role of pertussis as an adjuvant for anthrax and, as it seems from above, plague as well. We have read from the above " but research suggested that effectiveness would be ", I offer this link to a short passage regarding the use of pertussis in this role. You will see that the article was published in August '91 a full 7 months after this combination was administered, TWICE! Would it be unreasonable to suggest that this cocktail was experimental?
4. Voluntary informed consent is the subject here. Well as we have just established that pertussis/anthrax was somewhat experimental, does that mean that informed consent was required here, read the words and make up your own mind !
5. So, there was a difference of opinion and the US decided not to vaccinate with plague, well you had better read this extract from GulfLINK, (see table 1.) so did the US use plague, I think yes. Both the DoD and the US vets confirm this.
6. The anthrax, pertussis and plague should be administered as closely as possible to each other, doesn't the MoD read the manufacturers instructions for use "Plague Vaccine should not be given on the same occasion as typhoid or cholera vaccines". There is additional comment made about this by the manufacturer (see letter of 16 May '94):
"Anthrax pertussis (whooping cough) and Yersinia pestis (plague) are all bacterial vaccines, each of which cause similar side effects and if given together, can cause additive reactions. If given together, one should expect a high rate of systemic reactions, such as malaise, muscle soreness, headache and possible fever. Giving the vaccines in different arms or muscles may be helpful in minimizing local reactions at the injection site, but the systemic reactions will likely be the same. It is a medical decision as to whether the expected higher rate of reactions are acceptable to achieve earlier vaccination protection than could be gained by staggering the vaccinations further apart."
7. Finally we address the question of "named patient basis". This should have been used in 2 of the situations: 1. Plague vaccine, licensed in the US and Canada, but not the UK, see what the manufacturer (see letter of 11 Aug '94 para 4) has to say about this. 2. NAPS, these were unlicensed for the manner in which they were used at the time of administration, so doesnt named patient basis come into play here as well.
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