The cases, corresponding with a massive Defense Department effort to vaccinate U.S. forces against anthrax and smallpox before and after the invasion of Iraq, included muscle and joint weakness and pain, chronic fatigue, intense migraines, cognitive problems, and severe diseases such as multiple sclerosis. Some of these have ended military careers.
More common and less serious side effects from the vaccines are said to include temporary headaches, fatigue, fever, nausea and dizziness.
In light of the large number people who received the vaccines, the number of serious cases treated by the Vaccine Health Care Centers, a network of four clinics at domestic U.S. military bases, is rare. Overall, the military says more than 1.3 million military and civilian personnel have received the anthrax vaccine, called Anthrax Vaccine Adsorbed, since 1998, when it resumed the vaccinations after a hiatus over quality control problems. The military has also vaccinated hundreds of thousands of personnel, many who also received the anthrax treatment, for smallpox beginning in December 2002.
The Defense Department, on a Web site that provides information on the vaccine, maintains the anthrax vaccinations are "as safe as other vaccines" and necessary.
None of the personnel treated in fiscal 2004 "has suffered loss of life, limb or eyesight," according to a statement from Walter Reed Army Medical Center, which houses the main Vaccine Healthcare Center in Washington.
Nevertheless, some cases have been quite severe, such as that of retired Air Force Reserve Lt. Col. Michael Gylock, who within nine days after receiving anthrax and smallpox vaccinations in March 2003 started showing symptoms and was eventually diagnosed with multiple sclerosis and some vision loss.
"I've been retired because of it. I'm not fit for military duty," he said. Gylock and other cases were referred to Global Security Newswire by an advocate of soldiers who believe they were harmed by the vaccine.
Questions have surfaced in recent years about the safety of the anthrax vaccine, and when massive numbers of personnel are vaccinated, even a small percentage of rare disorders can add up.
Walter Reed said that about 600 anthrax vaccine recipients in fiscal 2003 and 600 in fiscal 2004 received in-depth assessment or treatment by the centers' staff. In addition, officials have said the Vaccine Healthcare Centers during the two years conducted more than 250,000 telephone, e-mail or face-to-face communications with personnel or physicians to discuss reactions, however minor or major, or to provide guidance on how to avoid or treat complications.
Sufficient funding for the four Vaccine Healthcare Centers, created by Congress in 2001 is in question this year. The centers were not included last year in the Pentagon's fiscal 2005 budget and did not receive a specific congressional appropriation. A nonbinding resolution passed by the Senate urging full funding was stripped from a supplemental appropriations bill this week by leaders from both houses.
Meanwhile, the Pentagon, citing a determination that there is potential for a heightened risk of an anthrax threat to U.S. forces, announced Tuesday it would resume providing mass anthrax vaccinations to service members mainly in South Korea and across the Middle East and South Asia.
"Without the centers [there are] over 1,000 military personnel who would not have gotten the care they deserve, the best possible care we can provide," Senator Joseph Biden (D-Del.), who had proposed specific funding for the centers, said in a Senate floor speech last month.
"If the department believes it is an emergency to resume that vaccine, how can we consider preserving the Vaccine Health Care Centers any less?" he said.
While the data on Vaccine Healthcare Center treatments give some indication of the numbers and types of rare illnesses that may result from anthrax or smallpox vaccinations, there is no definitive data on how many and which illnesses were caused by the military inoculations.
One reason is that the numbers of cases treated by the centers, and otherwise identified through its Vaccine Adverse Event Reporting System, do not necessarily account for all serious illnesses caused by a vaccine because military reporting on side effects is passive. In other words, the onus is on the soldiers to seek help from the centers and many are said to be unaware the clinics exist, are unwilling to inform superiors they may have a career-jeopardizing disorder, or have had trouble convincing authorities of the illness.
As little is understood about how vaccines cause serious illness, some doctors have appeared reluctant to conclude a vaccination may have caused a specific illness, experts have said.
"Because serious problems are rare, it is difficult for the average base physician to develop the expertise needed to provide the best treatment," Biden said in his speech.
In addition, as multiple military vaccines are often given around the same time, researchers have difficulty determining which one might have been the cause of a particular illness, experts have said.
Furthermore, just because a person had experienced adverse events after those vaccinations, does not necessarily mean the events were caused by the vaccinations, Walter Reed said in a statement.
"Cause-and-effect evaluations require consideration of at least six factors; timing is only one of those factors. Cause-and-effect evaluations are often difficult in individual cases," it said.
Air National Guard Technical Sgt. Rick Brown's case is illustrative of the challenge to understanding causality. A Philadelphia firefighter and formerly an avid bodybuilder and hockey player, Brown said that soon after receiving anthrax and smallpox vaccinations in March 2003 he experienced intense pain in muscles and joints and decreased mobility.
"My first indication was a mass on the side of my neck that was about the size of a grape and immediately my body started feeling really bad. I had open mucus membranes throughout my body, oozing out of my ears, my nose, my penis, my mouth," he said.
Brown said he was eventually diagnosed with degenerative arthritis, including joint and muscle aches, and may have had a heart attack. He was also twice ruled unfit for military work after 19 years of service.
"For a while, my muscles turned to jelly, my joints were just all screwed up," he said.
Brown said he learned of the Vaccine Healthcare Centers from an Internet search. Military physicians were initially unwilling to send him to a center and unwilling to consider that the anthrax vaccination might be causing his illnesses, he said.
"They said, 'We want to send you to a clinical psychiatrist. We want to heavily medicate you,'" he said.
In a case review delivered to Brown, the Vaccine Healthcare Center at Walter Reed said it had identified possible side effects from the anthrax vaccine. It noted, though, causality between the vaccination and such chronic illness has not been proven. The center and another organization are preparing to study that question.
"At the present time, it is impossible to prove or disprove a causal link between the vaccine and chronic problems but efforts are under way … to collect information regarding these problems and continue to define the range of the problem," the center said generically in its review of Brown's case.
Brown, who served for a year in Afghanistan until November 2002, "loves the military" and wishes he could resume service, said he might be forced out before he is eligible for retirement, which is in about six months. "Let's put this stuff on the shelf, because a lot of people are getting sick," he said.
Gylock said an informal Air Force medical board had recommended discharging him without benefits because the illness was not caused by military action. An appeal to a formal board reversed the decision. That board cited a Vaccine Healthcare Center conclusion that his symptoms may have been caused by the anthrax vaccine, he said.
The center, also said, though there is a medical community controversy over whether vaccines can cause multiple sclerosis and that, that "causality cannot be established."
The Vaccine Healthcare Center's "review of my records was probably the most beneficial thing that happened to me," he said.