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Defense Department should avoid a rush to vaccinate

Defense Department should avoid a rush to vaccinate
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Four hundred infectious disease experts have urged the FDA to make safety and efficacy data for any coronavirus vaccine public before engaging in distribution. They emphasize that public trust will be crucial to the acceptance of a vaccine, especially amid a crisis in which communication from the highest reaches of government has been less than clear and consistent. 

This cautious approach should include the Department of Defense. Allocation schemes typically include the military as a designated class that should be among the first to receive a vaccine. Unlike other groups, military personnel have no choice about declining a vaccination if their commanders determine that it is needed to maintain force readiness. There is certainly a good argument for the earliest reasonable mass inoculation in the military. The spectacle of death and illness on the USS Theodore Roosevelt, disruptions in training, and the lengthened tours of duty for units worldwide to avoid spreading the virus have made this clear.  

Commanders are acutely aware of the dangers of infection in the congregate settings typical of military units. In World War I, tens of thousands of sailors and soldiers brought the so-called Spanish flu to Europe from crowded camps and vessels, many dying en route. Infectious disease sickened hundreds of thousands in the Pacific Theater during World War II.

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Too often, illness and disease have taken more soldiers off the battlefield than battle wounds. Preventive medicine has been a core competence of military medicine. It would be understandable if the military leadership chose to act quickly to mitigate the harmful impact of this pandemic on their forces. Military leaders are taught to factor taking calculated risks in their planning, but a considerable measure of prudence is called for.

Previous experience with vaccination orders for products that have not been fully validated has weakened confidence and created morale problems among military personnel. In a politically charged atmosphere, the men and women who wear the uniform should not suspect that they are being used as "guinea pigs" for an unproven vaccine. They volunteered to put their lives in harm's way as it is. During the first Gulf War, many thousands of soldiers and marines were inoculated with an anthrax vaccine that had not been approved for inhaled anthrax, out of concern about suspected Iraqi biological weapons. In the mid-1990s, many veterans complained of symptoms brought under the heading of Gulf War Illness. This controversy continued through the early 2000s.  

Whether medical complaints about the anthrax vaccination program are warranted or not, men and women in uniform and their families are exquisitely sensitive to suspicions of exploitation. Unlike civilians, soldiers have limited options to exercise discretion about their health. They have good reason to wonder about the efficacy and possible adverse effects of an untested vaccine. The military faces a dilemma of protecting the force against illness and disease that can compromise readiness or possibly exposing its men and women to long-term problems by rushing to vaccinate. 

The pandemic presents unique considerations and challenges to military planning and readiness. All nations and groups that threaten American security areas vulnerable to the coronavirus and illness as the U.S. The infection defies national boundaries and barriers. The pandemic's trajectory is uncertain and how it will degrade the readiness of all military forces, not just Americans. Much confidence, if not exactly a "magic bullet," has been cast on a vaccine to contain it over the coming months.

The specter of tens of thousands more deaths frightens everyone. The best protection for America and national security is preventing the spread of the virus and limiting the number of new cases across the globe. The pandemic is not like the influenza epidemic during World War I (or any other major conflict), so there no need to rush to action. A solid course of action relies on hard-nosed analysis and deliberation. It will be tragic if early experience and harm from a coronavirus vaccine across the military backfire resulted in exacerbating vaccine resistance in the country more generally.  

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The Russian government's "Sputnik V" vaccine, approved without releasing data on its safety and effectiveness after trials too brief to be reliable, was tested on some soldiers who are said to have volunteered. The Chinese government has also approved a vaccine for military use without a complete course of testing. These are not precedents the U.S. military should follow.

We urge the Secretary of Defense to make it clear that, like in the civilian population, there will be no rush to vaccinate the nation's forces before the safety and efficacy of any vaccine have been fully and transparently evaluated.  

Stephen N. Xenakis, a psychiatrist and retired Army Brigadier General serves on the executive boards of The Center for Ethics & the Rule of Law at the University of Pennsylvania and is an Adjunct Professor at the Uniformed Services University of Health Sciences. Follow him on Twitter: @SteveXen

Jonathan D. Moreno teaches medical ethics and health policy at the University of Pennsylvania. His most recent book is, "Everybody Wants to Go to Heaven, but Nobody Wants to Die: Bioethics and the Transformation of Health Care in America." Follow him on Twitter: @pennprof