More than halfway through what he hoped would be a long career in the military, an Arizona Air National Guard member we'll call Joe is struggling to decide whether to take a mandatory shot he believes could endanger his health.
The Pentagon says Joe and the other 2.4 million members of the active and reserve military in the United States must be vaccinated to protect them from a biological attack involving anthrax, a lethal bacterial weapon. But Joe is torn between his duty to his country -- including a promise to obey orders -- and his concern for his health and the financial stability of his family.
He is worried. So worried that he doesn't want his name used or anything revealed that could identify him. He has seen what happens in the military when you question authority. He says people have gotten in trouble for merely suggesting that the issue be looked into further.
Joe, a member of the 161st Refueling Wing of the Guard installation near Phoenix Sky Harbor International Airport, first heard about the anthrax vaccine a year ago. He sat through a meeting about it that left him wondering.
"They said it was safe and approved by the FDA. But there were a lot of questions they couldn't answer," he says.
Joe, who's in his 30s, and his wife did their own research. They learned some unsettling things: that many across the country claim the shots have been making them sick, that some -- even experts -- are questioning the safety and effectiveness of the vaccines and that anyone who refuses to take them are being punished.
Joe says about 40 members of his Guard unit -- including a couple of his friends -- quit rather than begin the series of shots. And he expects more to follow when the vaccines are doled out to everyone. Others who were deployed to Kosovo or the Middle East already began the series of shots, he says, and many are suffering ill effects.
"They are just being knocked on their butts. And these are tough guys," he says.
Among the symptoms his friends suffer from are debilitating fatigue and insomnia. One complains of an itchy, crawly feeling on his head.
Joe and his wife can't say for sure the shots have caused their friends' problems. But they are not convinced it is safe. They don't believe it will have any effect on inhaled anthrax -- the most likely form of contamination. And they fear it could affect their plans to start a family.
The Department of Defense, on its official anthrax program Web site (www.anthrax.osd.mil/), includes reassurances that the vaccine won't harm any baby conceived while the father is taking the shots. But Joe and his wife -- who accuses the government of using its military as guinea pigs -- aren't so easily swayed.
Joe and others hope that the program may be delayed long enough that their service will be over, or canceled before they actually have to roll up their sleeves. But if Joe has to quit or be kicked out, he would lose his benefits and a substantial retirement. And he would have to hit the streets to try to find a new job. Without a college degree, he's not sure where he would go.
The anthrax program was first announced in December 1997 by U.S. Secretary of Defense William Cohen. Originally budgeted as a $130 million, six-year program, the cost has increased by $24 million, and there may be at least a year delay because of problems with the only anthrax vaccine manufacturing plant in the United States.
Pentagon officials and their medical experts insist the shots are safe, effective and necessary to protect the U.S. military from the threat of an international or domestic anthrax attack. Originally a disease associated with certain livestock, new forms of anthrax have been developed for use in biological warfare. And experts say even one deep breath of airborne anthrax could be enough to kill a person.
The vaccine, a series of six shots over an 18-month period plus annual boosters, has been given to more than 400,000 troops so far in the first phase of the program, military officials say. According to the program's three-phase schedule, those who are deploying to risky areas like the Middle East and Korea will be the first to get the shots, those who would back up those troops would be the second and the remainder of the military would follow.
In the Phoenix area, the Air National Guard -- which is often sent to risky zones -- would need to have larger percentages of its members inoculated than troops at Luke Air Force Base, which is primarily a training installation.
Defense Department authorities are standing firm behind not only the need for the vaccinations, but the safety of the program. They point out that many top officials -- including Defense Secretary Cohen and the chairman of the Joint Chiefs of Staff -- have completed the vaccine series with no ill effects. And their Web site includes reports from many who say they have received the shots with no reaction.
Dr. Sue Bailey, assistant secretary of defense for health affairs, summed up the Pentagon's views during a briefing on the program in December: "The vaccine is safe and very effective. The vaccine has very few side effects, and they are mild and they are temporary."
Officials say the vaccine, approved by the Federal Drug Administration in 1970, has been successfully given to people who come into contact with livestock that could carry the disease, the government says. And although production of the vaccine has been temporarily halted because of problems with a new BioPort Corporation manufacturing plant in Lansing, Michigan, defense officials say they have millions of doses stockpiled and are continuing to inoculate those in the first phase of the program.
Opponents of the program point out numerous causes for concern. They're particularly suspicious in light of the multitude of similar medical complaints from military personnel in the Gulf War.
They say the anthrax vaccine that was approved 30 years ago by the FDA is being given to troops now. But, they say, the studies to determine the safety of the vaccine were actually done on a different vaccine. They raise serious questions about the purity and consistency of the doses being administered. They say while the government touts studies showing the vaccine effective in protecting laboratory animals against an anthrax contact, those same studies show the vaccine may not work against inhaled anthrax -- the most likely form of biological warfare -- and numerous other strains of the disease.
And some -- including the Government Accounting Office -- are warning that there are no long-term studies regarding the safety of the vaccine.
Troubles with the BioPort Corporation's production plant are further alarming those opposed to the anthrax vaccination program. The company, which is headed by Admiral William Crowe, former chairman of the Joint Chiefs of Staff, bought the facility from the state of Michigan. But because of quality-control problems, the plant had to be razed and a new one built. In December, the FDA announced that the new plant failed safety inspections.
Although the government claims there have been only six cases of reactions to the shot serious enough to require hospitalization, statements before congressional subcommittees -- as well as an abundance of testimonials on the Internet -- suggest a much higher incidence of adverse reactions.
Meryl Nass, a Maine doctor who is an expert on anthrax and biological weapons, says she believes as many as 10 percent of those receiving the vaccine could be getting ill. With more than 400,000 members of the national military forces already getting shots -- including nearly 6,000 from Arizona's military installations -- that would mean more than 40,000 adverse reactions.
At the Arizona Air National Guard, 15 people have begun the series of shots, including the base commander, according to Captain Eileen Bienz, a Guard spokeswoman. She says a plan to inoculate the rest of the nearly 900 guardsmen has been put on hold because of problems getting the vaccine and because of concerns raised by personnel.
At Luke Air Force Base, public affairs spokesperson Mary Jo May says 840 people are receiving the series of shots. None has refused and none has experienced "reportable" adverse reactions, she says.
In Tucson, according to the Air Force Surgeon General's Office, more than 1,300 active duty troops at Davis-Monthan Air Force Base are being immunized. The Army says more than 1,100 have received the shots at Fort Huachuca and 60 reservists throughout the state have also begun the regimen.
The government says it has records of about 200 people across the country refusing to take the shots -- none in Arizona.
But people in the military as well as others who are following the issue say that hundreds more are getting out of the service to avoid the program. And interviews with people familiar with the programs at Arizona's military installations say dozens have resigned -- or plan to -- rather than submit to the series of shots.
Dr. Jane Orient, a Tucson internist who heads a national organization called Doctors for Disaster Preparedness, says she worries about the loss of large numbers of pilots and other seasoned members of the military. At a time when the Pentagon admits its military population is declining and recruitment is difficult, she and others say the mandatory anthrax program is hurting already depleted forces.
"It's a national security issue," she says.
Schuyler McCorkle is not the type of guy who is leery of shots. In fact, the opposite is true. As a commercial airline pilot and an officer in the Arizona Air National Guard, he made sure he always got all his immunizations and even annual flu shots. He felt he needed that to protect himself against strange diseases, biological warfare attacks, as well as common illnesses he might encounter while overseas or while breathing recirculated air in the cockpit of a plane.
And so when the 20-year Guard veteran was asked about a year ago to help implement the anthrax inoculation program for about 900 members of the 161st Refueling Wing at Phoenix Sky Harbor Airport, he didn't question the wisdom of the decision. A firm believer that the military should be protected against the deadly anthrax virus, he set about scheduling the shots, a complicated task given the fact that the program calls for a carefully timed regimen.
But when some members of his unit came to him with questions about the safety and effectiveness of the shots, McCorkle took a closer look at the program. And he didn't like what he saw.
"I started researching it and looked at all the testimony that was put before Congress, and a large portion of it was expert testimony. The military and the DOD [Department of Defense] tend to put their spin on it, saying, 'Oh, [these claims of adverse reactions] -- it's hysteria.'
"But I'm wondering why these experts would be testifying before Congress unless there was a problem. People who previously had been very healthy now aren't," he says.
McCorkle, 42, says his concern over the vaccine was a key factor in his decision to retire from his full-time job with the Guard in June. While many of those who had to deploy to high risk areas abroad had already begun the series of shots, the unit-wide inoculation was scheduled to begin in October. (It has since been delayed.) McCorkle would have had to decide whether to start the shots or face punishment and possible loss of benefits. And any adverse reaction, even something as minor as a sore arm, could have affected his career as a commercial airline pilot.
Across the country, active and reserve military pilots are concerned about the possible impact of the anthrax vaccine on their lucrative commercial careers. Many of them are choosing to abandon their military careers rather than jeopardize their ability to fly.
McCorkle says a job as an airline pilot can mean millions of dollars in salary. And he estimates that about half of the Guard pilots he knows are either also employed as commercial pilots or trying to get a job with an airline.
McCorkle, married and the father of two in a single-income Phoenix household, says he considered the risk of losing his military salary because of illness or disciplinary action when deciding on the anthrax shots. But he also weighed the effect on his airline salary and benefits.
"I said, 'Is the Guard or military going to cover us for lost earnings and pension?' The answer is no. The best we'd get is a cup of coffee at the VA hospital," he says.
Air Force Master Sergeant Robert Ramirez, 42, is in constant pain.
His hips, legs, back and joints ache so much that he can't perform the simplest movements without suffering.
"If I move my arm, my elbow hurts. If I move my hand, my wrist hurts. If I get up, my knees hurt. If I walk, my ankles hurt," he says.
He can't bend over. He can't get on his knees to pray. He can't play with his youngest, 8-year-old son.
Every six weeks, he says, a large blood blister shows up on his skin. The last one, his sixth, was so big it had to be cut open by a doctor; it drained for three days.
Ramirez thinks his ailments were caused by the anthrax shots he received. But he doesn't know for sure, and doctors he has seen have little if any experience with anthrax cases.
A 17-year veteran of the service, he is still at work at Davis-Monthan Air Force Base in Tucson, trying to last another two years or so until he can retire. Meanwhile, Ramirez is writing to congressmen, asking them to take a hard look at the anthrax vaccine program.
Ramirez says he knew little about it when he was told he had to begin the shot series. Stationed at a South Korean air base and recovering from hernia surgery, he remembers seeing an Air Force news channel video depicting military authorities getting the vaccine. He says the troops there weren't told much else about the shots.
In a letter to U.S. Senator John McCain and U.S. Representative Jim Kolbe of Tucson, Ramirez described trying to find out whether he should be taking the shot while he was still recovering from the surgery.
"I asked the surgeon that had done the operation if this would be a problem, and he basically said that he didn't know anything about the vaccine, but since it was mandatory, that I better take the vaccine."
He received his first inoculation in October 1998 and the second two weeks later. It was after that dose, Ramirez says, that he began experiencing severe pain in his hip. His doctor said it was likely caused by some sort of nerve problem related to his surgery. Ramirez says the doctor treated him with steroid injections.
Later, Ramirez learned that the vaccine carries a warning that it should not be given to anyone on steroids. But overseas, his steroid therapy continued. And he got his third anthrax injection.
The pain worsened in his hips and traveled down his knees. He says he was told then that he likely had an arthritic hip and would need hip replacement surgery. Before the surgery, Ramirez says, he was in top physical condition, usually running five or six miles a day plus putting in two to three hours working out at the gym.
Ramirez requested a transfer to Davis-Monthan Air Force Base in Tucson, where he has lived with his wife and three children since March. He has been given a medical waiver, postponing the resumption of the shot series. And he has been sent to a variety of specialists, both on and off base, to determine what is wrong with him. Valley fever, arthritis and other ailments have been ruled out, he says. But a rheumatologist has determined that he has some sort of degenerative disease and that it is now in his spine.
In another letter mailed recently to more members of Congress, he asked for their advice on whether he should resume the shots once his medical waiver ends:
"Should I risk more medical problems and stay in until I retire or do I speak up and risk all the years of dedicated service and say no? Please help me with this."
Dr. Meryl Nass, the internist and anthrax expert from Maine, says that in 1998, when the vaccination program began, she wasn't sure whether people should submit to the series of vaccinations.
"But now I tell them you are really playing Russian roulette with your health," she says. "You have to be aware of it because there is a very good chance you're going to develop things like sleep disturbances, neurological problems, muscle joint aches and headaches, significant memory loss, seizures or spacing out where you wake up 50 miles away from where you're supposed to be."
Nass, who has testified twice before Congress on anthrax, says when she first heard the Department of Defense was considering ordering mandatory vaccinations, she thought it was a bad idea. Her chief argument then was simply that the plan wouldn't work. Vaccinating everyone against one particular strain of anthrax, or one particular biological weapon, for that matter, would only protect them against that one thing. The enemy forces could then merely develop a new strain of the disease or another type of biological weapon, she reasoned, making the whole effort moot.
Her opinions, which were published in a U.S. infectious-disease publication and later cited in a British medical journal, apparently didn't have much influence. She continued to oppose the idea, but "I did not anticipate that it would make people sick," she says.
But within months after the first shots were given in early 1998, Nass started getting calls. People reported a host of problems that began after they took the vaccine. Nass says she talked to more than 1,000 people and now believes that the vaccine is indeed making people sick. She has set up a Web site (www.anthraxvaccine.org) with her conclusions.
Her research has shown that the vaccine can cause chronic symptoms that often worsen after the fourth shot is administered. Initially, she says, many experience abdominal cramping, diarrhea, fever, chills and a headache. Later symptoms can include chronic fatigue, dizziness, joint and muscle pain, headaches, memory loss, sleep disorders, chest pains and recurring rashes.
According to a list of actual cases presented during a congressional hearing, some of these symptoms can be disabling. One specialist reported vertigo so severe she couldn't walk, a major suffered crippling joint pain, a flight engineer had numerous seizures.
Many of these symptoms could have other causes, so the government and many doctors are reluctant to link them directly to the vaccine, Nass and others say. Also, congressional testimony shows, many troops are afraid to report their symptoms, fearing they will lose job opportunities or be forced to take a medical retirement with a fraction of their pay and benefits.
And according to Nass and others, the Vaccine Adverse Event Reporting System, used by the Defense Department to monitor bad reactions, doesn't accurately reflect the numbers of problems caused by the vaccines. Reporting is voluntary, so not all adverse reactions are reported. Many doctors or medical workers are unwilling to say a symptom has been caused by a shot.
And many of the chronic reactions that are being reported fail to meet the criteria for serious reactions -- more than 24 hours off work or hospitalization. (Even Robert Ramirez, the suffering Tucson airman who did file a report, says his case won't show up in those serious categories. "I come to work every day. When my [medical] appointments come up, I go to them. And what would they hospitalize me for?")
The federal numbers that are being reported are posted on the Internet and updated regularly. The most recent chart showed that of 620 reports filed, there were 70 cases in which the shot "certainly or probably" caused a recipient to stay off work for more than 24 hours and only six cases in which the vaccine resulted in hospitalization. And all of those six cases, according to the report, involved allergic, inflammation reactions at the injection site.
Defense officials say these are not alarming results. They say all vaccines can have side effects. But they say the anthrax serum only rarely causes serious problems.
Mild local reactions, which include redness and warmth at the shot site, affect about 30 percent of those vaccinated, the government says. Moderate local reactions, more serious redness and itching, can affect 1 percent to 5 percent of people getting the shots. And larger local reactions, like a swollen arm, occur in about 1 percent of the cases.
Systemic reactions, including things like fatigue, joint and muscle pain and flulike symptoms, can occur in up to 35 percent of the cases. The military says serious reactions requiring hospitalization can occur once in every 50,000 doses and severe allergic reactions might occur once in every 100,000 doses.
Jane Orient, the Tucson physician, disagrees with the government's contention that the vaccine is safe and necessary.
"We may be endangering our troops by giving it," she says.
Her organization, Doctors for Disaster Preparedness, represents about 1,500 doctors across the country who are interested in protecting the American public from domestic emergencies, including biological attacks. In a statement to a congressional subcommittee, the group questioned the wisdom and safety of the program and suggested efforts be made toward better protection measures. In a telephone interview, Orient says such methods would include better detection and warning systems and further research into antibiotics to immediately treat anthrax exposure and decontaminant foam. Orient says the program should be stopped while questions are addressed, or made voluntary.
Meryl Nass suggests the government also work on developing anthrax antidotes as well as better arms control. She also suggests the program be halted.
Two bills in Congress propose both those things. A House bill sponsored by U.S. Representative Walter Jones (R-N.C.) would make the program voluntary until the FDA approves a new vaccine or a new, reduced course of inoculation. Another sponsored by U.S. Representative Benjamin Gilman (R-N.Y.) would suspend the vaccinations until the National Institutes of Health can study the issue.
No members of the Arizona Congressional delegation are signed on as co-sponsors to either bill.
Representatives of most members of Arizona's Congressional delegation could not be reached for comment about either the vaccination program or the proposed House resolutions. A spokesperson for Republican Senator Jon Kyl says he supports the program. Representative Ed Pastor, the only Democrat in Congress from Arizona, hasn't taken a stand on the issue, according to his spokesperson.
Senator John McCain -- who often cites his military background in his presidential campaign -- did not return phone calls seeking comment on the anthrax issue.
Opponents of the program -- including some military personnel, many concerned mothers and relatives who have found each other on the Internet (www.dallasnw.quik.com/cyberella/index.htm) -- are trying to drum up support for legislation that stops the program. They don't believe the general public is really aware of the vaccination plans. They wonder why it hasn't come up in the presidential race, noting that the "don't ask, don't tell" policy regarding gays in the military has received much more press, yet affects only a small percentage of those in the service.
Schuyler McCorkle, the retired Phoenix major, says he is free to talk about the controversy now only because he is a private citizen. "My concern is I have a lot of friends down there [at the Arizona Air National Guard]. And I want to be able to live long and be able to go out and play golf with some of those guys in our 60s and 70s. I don't want them dropping dead because they took a bad vaccine."
He was one of 2,500 people who signed a petition sent to President Bill Clinton supporting the House bills that would suspend the program. Mark Zaid, the Washington, D.C., attorney who has represented servicemen disciplined for refusing the vaccine, organized that petition drive. He says he's received no response from the White House.
Major Sonnie Bates is speaking up, too. And his stellar career in the Air Force is in ruins because of it.
The highest-ranking officer in the Air Force to face a court-martial and up to five years imprisonment for refusing to take the shots, Bates says life as he knew it is over.
"My career is over," he says in an interview. "The decision I had to make was do I want my health or do I want my career?"
A pilot with more than 13 years of service, Bates says what he saw at Dover Air Force Base in Delaware when he arrived there in August convinced him he would be jeopardizing his health -- and hurting his family -- if he agreed to start the series of inoculations.
"In all my life, I have never seen sickness of this magnitude, especially in a group of people that should be physically fit for battle," Bates testified during a congressional hearing in October.
Bates, 35, says he wanted to be a pilot since he was 4 years old. And he served his country without question until he was transferred to Dover. In fact, before going to Delaware, Bates asked to start the series of shots at his former base. But he was told to wait until he got to his new base.
There, he found 12 people in his squadron alone with unusual or disabling illnesses that began after they took the vaccine. Many of the problems involved crippling joint and bone pain, autoimmune system disorders and memory problems.
Bates learned that more than 60 reserve pilots had quit rather than take the series of shots and that dozens had reported adverse reactions to the Department of Defense. Before Bates arrived, an alarmed base commander temporarily halted the shot program, but he was removed and replaced with a pro-anthrax commander, according to news reports and interviews with a Dover reservist.
Bates was grounded in December after he refused to begin the shots. He asked to resign but was turned down. He was then offered an Article 15, a kind of military plea bargain in which he admits his error, gives up his right to trial and is punished. He says he considered agreeing to this, but was told he would still be ordered to start the vaccinations.
Bates says he could not in good conscience obey what he considers to be an unlawful order -- particularly in peacetime. If it were wartime, he says, he would probably take the shot. Then a disabling or fatal reaction could be considered a casualty of war.
Bates' wife doesn't work. And the youngest of their three children is autistic. Bates says he wants to stay healthy to be able to help care for his son in later years. But Bates also suspects that the autism may have been triggered by a series of inoculations the boy received as an infant.
Bates says he expects to be railroaded through a court-martial, convicted by higher-ranking officers and dishonorably discharged.
Bates may be the highest-ranking military man to face a court-martial for refusing to take the shots, but he is not the first. That widely publicized case involved Airman 1st Class Jeffrey Bettendorf, an Arizonan who faced a court-martial for refusing the shots at Travis Air Force Base in California. Early last year, he aborted the proceeding by agreeing to an "other than honorable" discharge.
Many others have received other forms of discipline for refusing the shots. While no exact tally is available, a review of news articles about publicized cases shows punishment can range from court-martials and dishonorable discharges to reduction in rank and pay to confinement.
Bettendorf, who says he had a "spotless" record before refusing the shots, was at first demoted a grade, given 45 days extra duty and reprimanded. When he again said he wouldn't take the shot, he faced the court-martial.
A Texas airman entered into an agreement that allowed him to serve 21 days in confinement, be docked $500 in pay and receive a nonpunitive discharge. A Marine in San Diego was court-martialed for disobeying an order, reduced in rank, forced to give-up two-thirds of his pay, sentenced to 30 days confinement and given a bad-conduct discharge. An Alaskan airman with only months to go in her stint in the Air Force was demoted to the lowest possible rank when she refused the shots.
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Others get into trouble for merely questioning the safety of the program. At the Marine Air Corps Station in Yuma, some who expressed reservations about taking the shot were called on the carpet and pressured into taking the vaccine. Those who refused were sent to the brig, according to one person familiar with the situation who was fearful of being identified.
Captain Winston Jimenez, public affairs officer at the Yuma installation, contradicts this, however, saying that out of approximately 2,500 troops that have begun the shots there, none has refused and none has been disciplined. This is because of "a tremendous job of informing [and] educating," he says.
When and if Sonnie Bates is given a less-than-honorable discharge, it will cost him not only his job and salary, but all of his benefits, including medical and retirement. And such a black mark would effectively erase his years of federal service were he to apply for a job at another federal agency, such as the Federal Aviation Administration, he says.
"It's just going to be an absolute hit for our family," Bates says. "But I think we'll be the better for it. I tell my kids happiness is not tied to financial means. You have to fight for what you think is right."