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SUBJECT : BACKGROUND PAPER ON PROPOSED ANTHRAX VACCINATION/ANTIBIOTICS DESCRIPTION: THIS PAPER RECOMMENDS HOW TO PROVIDE ANTHRAX IMMUNIZATIONS AND ANTIBIOTICS TO CENTAF PERSONNEL AS PART OF AN INTEGRATED BIOLOGICAL WARFARE DEFENSE PLAN. BACKGROUND PAPER PROPOSED ANTHRAX VACCINATION/ANTIBIOTICS PLAN SUBJECT Purpose of this paper is to recommend how to provide anthrax immunizations and antibiotics to CENTAF personnel as part of an integrated biological warfare (BOO) defense plan. The final determination of priorities and implementation methods is a CINCCENT prerogative. DISCUSSION A timely decision to vaccinate and establish vaccination priorities is critical to provide protection by mid-Jan 91. The UK is implementing its own BW protection plan and has informally offered its excess vaccine to the US. The persistency and wide area coverage possible with anthrax make it the most significant threat to CENTAF forces. Iraq's likely delivery means for anthrax are spray tanks, bombs, SRBM, And Iraqi agents. A preemptive Iraqi BW attack is improbable. Anthrax use on the tactical battlefield is also unlikely because of its delayed effects-and possible impact on Iraqi troops. Due to its intelli- gence limitations, Iraq would probably employ anthrax against large, fixed targets. Because effects usually do not show for 1 - 6 days, anthrax is most militarily useful against rear area targets supporting combat operations. The best protection against BW is a combination of vaccina- tion prior to exposure and use of antibiotics before onset of symptoms. The preferred post-exposure treatment for those not vaccinated is, in order of priority: 1-antibiotics plus vaccina- tion; 2-antibiotics alone; 3-vaccination alone. Other facets of the BW defense plan include: enhanced detection, warning and reporting; effective use of protective masks; and, heightened CENTAF awareness. The Army is leading the effort to field early warning and point detectors to fill current void. The CENTCOM/CENTAF warning and reporting system is in place. [(b)(1)sec 3.4(b)(5)]
[(b)(l) sec 3.4 (b)(5)] Primary employment difficulty: only seven samplers and-200 ID kits will-be available by mid-Jan. Currently fielded protective masks provide adequate protec- tion if properly fitted. Host country collective protection filter systems are thought to provide adequate protection. Some commercially available industrial or disposable masks can filter out BW particles and could be made available to the civilian populace. Emphasis on local orientation/training programs removes much of the uncertainty and apprehension about the possibility of BW attacks and the efficacy of US protective measures. RECOMMENDATIONS Initiation of vaccination program should be immediate to achieve effectiveness by mid-Jan 91. The US should pursue the UK offer to share excess vaccine. Priority for immunization should be based on protecting - personnel in the AOR by 31 Jan 91 at operating locations thought to be primary targets, as well as aircrew members at other loca- tions with missions likely to penetrate Iraqi airspace. Priority One - must be immunized ASAP (30,800 personnel -- initial estimate of 15,000 didn't take into account additional deployment and relocation of existing assets within AOR). Area A: All CENTAF personnel in Riyadh area -- Riyadh AB, King Khalid Int'l, and A1 Kharj (19,000 personnel). This area includes: CENTAF staff; only TACC, all AWACS, ABCCC, and RC-135s in AOR; plus some F-15C/Es, F- 16s and tankers. Area B: All CENTAF personnel in Dammam area -- Dhah- ran, King Fahd Int'l, Shaikh Isa, and Doha (11,000 personnel). This area includes: all A-l0s, AC/HC/MC-130s, F-4Gs, Volant Solo, and RF-4Cs in AOR; plus some F-15Cs and F-16s. All other aircrew members flying missions fragged to penetrate Iraqi airspace -- B-52s, EF-llls, F-16s, F-15C/Es, F-lllFs and F-117s (800 personnel). Recovery of aircraft which may have flown through BW contamination presents a minimal hazard to base personnel, if units adhere to necessary precautionary measures -- protective masks, segregation and decontamination of aircraft, and antibiotics.
Priority Two - should be immunized as soon as additional vaccine becomes available. Includes all other CENTAF personnel in-the AOR-(28,500 personnel). When possible, immunize personnel prior to deployment. Transportation of vaccines to AOR should receive highest priority via military aircraft in a split shipment with accompa- nying Army couriers ensuring custody and proper handling. APOD should be Riyadh or Dhahran because intratheater airlift is readily available and a majority of priority personnel are at or near those locations. Similar handling priorities and measures should apply. -- (U) Total shipment (includes vaccine, syringes, etc., for 134K personnel) weighs 7800 lbs and takes up 840 cubic feet, comprising seven 463L pallets Administration of initial dose of vaccine in AOR should be done within 24-48 hours by local US medical personnel, based on info package accompanying or preceding vaccine shipment. A1- though DNIF is not required, consideration should be given to staggering vaccination of aircrew members over 48 hours to allow 12-24 hours DNIF as safety measure. From decision to vaccinate, best case gets vaccine to each base in 3 days, completes first dose vaccination in 5 days, completes second dose in 19 days, and provides full vaccine protection in 33 days. Priority for antibiotics issue should be the same as the immunization priority, and should begin ASAP. Once sufficient stocks are available in the AOR, time to issue to all CENTAF forces will be minimal. Personnel should begin taking antibiot- ics ASAP after confirmed exposure but before onset of symptoms. Earlier administration is at the commanders's discretion. Public affairs and educational programs need to focus on the purpose of vaccination/antibiotics programs and how they fit into total BW defense program. Disclosure of BW defense program is necessary to minimize misinformation and develop maximum confidence in this effort. CONCLUSION This paper recommends priorities and methods for administra- tion of anthrax vaccine and antibiotics based on the inputs of an Air Staff working group composed of XO, SG, IN, LE and DP repre- sentatives. It provides an Air Staff position for further JCS discussion/decisions.
PAGE 4 - SEE IMAGE FILE FOR CHART SUBJECT: TIME AND TEMPERATURE NECESSARY TO DESTROY 200,000 SPORES
PAGE 5 - SEE IMAGE FILE FOR CHART SUBJECT: POLICIES AND PROCEDURES FOR HANDLING CASUALTIES IN WARTIME AND OTHER CONTINGENCIES
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