Compulsory vaccination against terrorist attack is unjustified

The compulsory use of vaccines to prevent the effects of a bioterrorist attack seems to be based on an unproved threat, according to an editorial in this week's BMJ.

In 1997 the United States began a compulsory anthrax vaccination programme for military personnel. In 2002, a similar programme also involving civilians, was started against smallpox. Yet these programmes rely on old vaccines for which relatively few data exist, writes Tom Jefferson.

For instance, no large scale trial of the US anthrax vaccine (AVA) has ever been conducted, and trials of the current smallpox vaccine have recently been halted because of safety concerns. Despite this, the website of the United States anthrax vaccine immunisation programme claims proved protection against inhalation anthrax, says the author. Newer vaccines are currently being developed but are a long way from field testing.

"Although field trials are expensive and complex, investment in evaluation and in better and safer vaccines surely must be a requisite to have credible compulsory immunisation programmes involving huge numbers of adults of reproductive age," adds the author. "Until such time, the choice of whether to be vaccinated or not should be left to the individual."