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BIOETHICS

Should the New Anthrax Vaccine Be Tested on Children?

SOURCE: AP/Benjamin Sklar A syringe of Anthrax Vaccine. 10 years after an Anthrax attack left 5 dead and 17 sickened, we may be no closer to preventing another similar attack, and the challenges of vaccination may make immunization untenable.

The Department of Health and Human Services National Biodefense Science Board said last Friday that the anthrax vaccine ought to be tested in children. They added, however, that this should only happen if the ethical issues of doing such a trial can be worked out. This is never ever going to happen.

Four factors need to be considered in weighing the real impact of the board’s recommendation: How likely is an attack? How burdensome is the vaccine? If there was an attack, would it make sense to have your kid take an untested vaccine whatever its risks? And would your child even have a chance to get the vaccine if an attack does occur?

American intelligence agencies believe that the possibility of a terrorist group, domestic or foreign, spraying anthrax around a bus, a school, or a train terminal in a town or city is “credible.” But that is as far as they are willing to go.

How worried are you about an anthrax attack on your family? I suspect it is pretty far down on your “things to worry about” list, far behind getting food on the plate, saving for the college fund, and making sure the kids get picked up after sports. Unless the government is willing to scare the living daylights out of parents, few will bring their kids in to act as subjects in what amounts to a safety study.

Even if you are worried, consider this: The current vaccine requires five shots across 18 months. That alone is going to make it somewhere between very unlikely and absolutely hilariously unlikely that any parent or kid is going to make it through a trial. Even if you offered a lot of money to induce parents to bring their sons and daughters down to the test site, it would take a lot of money to make it worth their time to make five separate visits.

The vaccine has problems. It is not safe for pregnant women since it can harm a fetus. The manufacturer has had various run-ins with the FDA about quality control. Still interested in volunteering your child?

Let’s say we don’t test now. We simply wait for the remote possibility that anthrax is used in an attack. Well, at that point, knowing the risk has become real, we would see most parents in affected areas taking the risk of vaccinating their kids even if there were risks.

And the clincher that guarantees this trial will never happen is that even if the vaccine proved safe and effective for kids, could you even get it for them in an attack? As Jonathan Moreno and Tom Daschle recently observed, local health departments have lost 23,000 jobs over the past three years. Among these are the first responders, whom we would all rely on to get us vaccines during a crisis. If many parts of the nation could not get a credible vaccine program going quickly, then what is the point of testing the vaccine now in kids? Shouldn’t that money go to getting kids access to the only vaccine there is if an attack occurs?

The debate about whether to test the anthrax vaccine in kids has drawn a lot of attention. It shouldn’t. The reality is that it is not going to happen.

Arthur Caplan, Ph.D., is the Director of the Center for Bioethics and the Sidney D. Caplan Professor of Bioethics at the University of Pennsylvania.

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