An Assessment of the CDC Anthrax Vaccine Safety and Efficacy Research Program

178 Pages·2002·0.68 MB·English

by  Committee to Review the CDC Anthrax Vaccine Safety and Efficacy Research Program

An Assessment of the CDC Anthrax
Vaccine Safety and Efficacy
Research Program
Committee to Review the CDC Anthrax Vaccine Safety
and Efficacy Research Program
Medical Follow-up Agency
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the
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appropriate balance.
Support for this project was provided by the Centers for Disease Control and Prevention, Department of
Health and Human Services (Contract No. 200-2000-00629). The views presented in this report are those
of the Institute of Medicine Committee to Review the CDC Anthrax Vaccine Safety and Efficacy
Research Program and are not necessarily those of the funding agencies.
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COMMITTEE TO REVIEW THE CDC ANTHRAX VACCINE
SAFETY AND EFFICACY RESEARCH PROGRAM
PHILIP S. BRACHMAN (Chair), Professor, Department of International Health, Rollins School of
Public Health, Emory University
ADAORA ALISE ADIMORA, Assistant Professor of Medicine and Clinical Assistant Professor of
Epidemiology, University of North Carolina School of Medicine
SANDRA H. BERRY, Senior Behavioral Scientist and Director, RAND Survey Research Group
*
TRUDY BUSH, Professor and Director of the Graduate Program in the Department of Epidemiology
and Preventive Medicine at the University of Maryland School of Medicine
THEODORE C. EICKHOFF, Professor of Medicine, Division of Infectious Diseases, University of
Colorado Health Sciences Center
PATRICIA FERRIERI, Professor of Laboratory Medicine and Pathology and Pediatrics, University of
Minnesota Medical School, and Director of the Clinical Microbiology Laboratory at Fairview-
University Medical Center
EMIL C. GOTSCHLICH, Vice President for Medical Sciences and R. Gwin Follis-Chevron Professor,
The Rockefeller University
MAURICE HILLEMAN, Director, Merck Institute for Vaccinology
DENNIS L. KASPER, Executive Dean for Academic Programs, William Ellery Channing Professor of
Medicine, and Professor of Microbiology and Molecular Genetics, Harvard Medical School
MICHAEL D. LOCKSHIN, Director, Barbara Volcker Center for Women and Rheumatic Disease, and
Professor of Medicine and Obstetrics-Gynecology, Joan and Sanford I. Weill Medical College of
Cornell University
DAVID MADIGAN, Professor of Statistics, Rutgers University
KATHLEEN M. NEUZIL, Assistant Professor of Medicine, Division of Infectious Diseases, University
of Washington School of Medicine
N. REGINA RABINOVICH, Director, Malaria Vaccine Initiative, Program for Appropriate Technology
in Health (PATH)
BRIAN L. STROM, Professor and Chair, Biostatistics & Epidemiology, University of Pennsylvania
School of Medicine
HUGH H. TILSON, Clinical Professor of Epidemiology and Health Policy and Senior Adviser to the
Dean, University of North Carolina School of Public Health
Staff
LOIS JOELLENBECK, Senior Program Officer (Study Director since January 2002)
LEE ZWANZIGER, Senior Program Officer (Study Director until January 2002)
JANE DURCH, Consultant (January to May 2002), Senior Program Officer (since June 2002)
KAREN KAZMERZAK, Research Associate
PHILLIP BAILEY, Senior Project Assistant
RICHARD MILLER, Director, Medical Follow-up Agency

*
Through March 2001.
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Preface
Anthrax is a deadly disease, and the organism that causes it, Bacillus anthracis, has long been
considered a prime agent for biological warfare and bioterrorism. The United States saw its dangers first
hand in 2001 when letters containing anthrax spores were mailed to media organizations and to two U.S.
senators, resulting in five deaths from inhalational anthrax.
Unlike some biological warfare agents, though, a vaccine is available to prevent anthrax. Anthrax
Vaccine Adsorbed (AVA) was licensed in 1970, and until the 1990s it was used primarily to protect
veterinarians, textile mill workers who processed imported goat hair, and others with a high risk of
occupational exposure to anthrax. Since the Gulf War, however, there has been great concern that U.S.
troops deployed to certain parts of the world faced the threat of exposure to biological weapons. In 1998,
the Department of Defense began a mandatory anthrax vaccination program intended to protect U.S.
forces. Some members of the armed forces have been concerned that the vaccine itself might be
responsible for health problems and that the mandatory vaccination program put them at unnecessary risk.
Facing concerns over both the need to protect military personnel against the threat of biological weapons
and the fears of some about the vaccine, the U.S. Congress directed the Centers for Disease Control and
Prevention (CDC) to develop a research program to study the safety and efficacy of the currently
available anthrax vaccine. In turn, CDC asked the Institute of Medicine to establish a panel of experts to
review the completeness and appropriateness of its research program.
The committee appointed by the Institute of Medicine represented a comprehensive range of
professional competencies to be able to successfully evaluate the full scope of the CDC research
proposals. CDC provided written materials describing its research program. Over the course of several
meetings, the committee also had the opportunity to hear about the evolving research program from CDC
investigators and other participating researchers. The committee also heard from military personnel and
others with concerns about the safety and efficacy of AVA.
The committee’s initial findings and recommendations regarding the CDC research program were
presented in an interim report, issued in July 2001. The present report reflects the final results of the
committee’s detailed deliberations that took into account a final written document describing the entire
research program, which was provided to the committee in late February 2002. The committee strongly
endorsed certain aspects of the CDC research program, made suggestions for changes in some proposals,
and recommended that other planned research activities not be pursued. The committee also found that
the bioterrorist events in the autumn of 2001 raised new questions beyond the scope of the original
congressional charge and has encouraged CDC to incorporate some additional research into its program.
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viii PREFACE
The committee is aware that the currently licensed vaccine, AVA, could be improved upon and
strongly encourages the efforts already under way to develop a new anthrax vaccine. Another Institute of
Medicine committee, the Committee to Assess the Safety and Efficacy of the Anthrax Vaccine, has also
emphasized the need for a more modern anthrax vaccine and recommended in its March 2002 report that
the Department of Defense expedite its work in this area. While reviewing the CDC research program,
our committee was alert to the need to address questions concerning the present anthrax vaccine and to
consider the contribution that CDC’s research might make in support of the evaluation of a newer
vaccine.
The committee would like to thank staff members from the Centers for Disease Control and
Prevention and their collaborators who prepared reports and presentations for the committee and
responded to our questions throughout our deliberations. We especially acknowledge the efforts of Randy
Louchart, R.N., M.P.H., who served graciously as the primary contact for the study, and David Ashford,
D.V.M., M.P.H., D.Sc.; Deborah Gust, Ph.D.; Laurie Kamimoto, M.D.; Jairam Lingappa, M.D., Ph.D.;
Nina Marano, D.V.M., M.P.H.; Stacey Martin, M.Sc.; Michael McNeil, M.D., M.P.H.; Bradley Perkins,
M.D.; Conrad Quinn, Ph.D.; and Benjamin Schwartz, M.D.
In addition, the committee extends its thanks to those who provided personal and written testimony to
the committee regarding concerns about AVA and the military immunization program.
The early work of the committee was also aided by the contributions of committee member Trudy
Bush, Ph.D., M.H.S., of the University of Maryland School of Medicine, who died suddenly in April
2001. Her valuable insights have been missed.
The committee is greatly appreciative of the strong and constant support provided by the study staff
from the Institute of Medicine, who worked diligently over the many months of our deliberations and
report preparation. Without their excellent and unending support we would never have been able to
complete our task. We specifically wish to thank Richard Miller, Lee Zwanziger (study director until
January 2002), Lois Joellenbeck, Karen Kazmerzak, Jane Durch, Phillip Bailey, and Pamela Ramey-
McCray from the staff of the Medical Follow-up Agency. Other members of the Institute of Medicine and
National Academies staff who aided the study include Andrea Cohen, Linda Kilroy, Bronwyn Schrecker,
Jennifer Bitticks, Janice Mehler, Sally Stanfield, and Christine Stencel. Jill Shuman assisted in copy
editing the report.
Philip S. Brachman
Chair
Reviewers
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and
technical expertise, in accordance with procedures approved by the NRC's Report Review Committee.
The purpose of this independent review is to provide candid and critical comments that will assist the
institution in making its published report as sound as possible and to ensure that the report meets
institutional standards for objectivity, evidence, and responsiveness to the study charge. The review
comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We
wish to thank the following individuals for their review of this report:
R. JOHN COLLIER, Harvard Medical School
JAMES W. CURRAN, Rollins School of Public Health, Emory University
BRADLEY N. DOEBBELING, University of Iowa Colleges of Medicine and Public Health
THOMAS R. FLEMING, University of Washington
DOUGLAS T. GOLENBOCK, University of Massachusetts Medical School
MARY GRACE KOVAR, National Opinion Research Center, University of Chicago
MYRON M. LEVINE, School of Medicine, University of Maryland at Baltimore
GEORGES PETER, Brown University School of Medicine
ALEXANDER WALKER, Harvard School of Public Health
Although the reviewers listed above have provided many constructive comments and suggestions,
they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the
report before its release. The review of this report was overseen by Morton Swartz, Massachusetts
General Hospital, and Paul D. Stolley, School of Medicine, University of Maryland at Baltimore.
Appointed by the National Research Council and Institute of Medicine, they were responsible for making
certain that an independent examination of this report was carried out in accordance with institutional
procedures and that all review comments were carefully considered. Responsibility for the final content of
this report rests entirely with the authoring committee and the institution.
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