Anthrax Vaccine - Is South Korea Immune?

Stimson Spotlight

Anthrax Vaccine - Is South Korea Immune?

A recent fake news incident in South Korea highlights two widespread misconceptions about the existing anthrax vaccine and exposes one of the most severe risks posed by North Korea.


By Min Hwang

An ambulance transported Mr. Son Sang-yun to an Emergency Room on Tuesday February 6, marking his eighth day of a hunger strike that demanded the immunization of all South Korean uniformed personnel against anthrax. As the chairman of a news outlet, Mr. Son misreported that the South Korean President purchased five hundred doses of anthrax vaccines to inoculate himself and his immediate bodyguards while leaving the country and the military unprotected. The news erroneously presumed that the vaccines served only preventative purposes and that they were available for mass purchase. The Blue House immediately clarified that it imported the vaccines in response to the accidental shipment of anthrax from the U.S. to South Korea in 2015 and to treat “accidentally” exposed patients. It also added that no one, including the President, was vaccinated. Soon after, the ruling party indicated that the article was fake news and sued Mr. Son for defamation. In response, Mr. Son initiated the strike, kindling a series of national petitions that demanded vaccines for all Koreans.

This incident highlights two widespread misconceptions about the existing anthrax vaccine, namely its purpose and availability. It also illustrates how challenging it is for South Korea to import anthrax vaccines and immunize its citizens on a massive scale. Above all, it exposes one of the most severe risks posed by North Korea.

Unlike other vaccines, the existing anthrax vaccine is neither designed for the public nor for preventative purposes only. The only FDA-approved anthrax vaccine, BioThrax, requires the recipient to inject four booster shots over a period of a year, with the option to receive additional injections every subsequent year if the recipient wishes to extend the protection. Therefore, even the BioThrax’s manufacturer, Emergent BioSolutions, does not recommend immunization for the general population. Not to mention, individual shots are approximately ninety U.S. dollars, so it would cost South Korea nearly twenty-three billion U.S. dollars to inoculate the public for one year. Moreover, BioThrax is approved for post-exposure treatment. In fact, studies have shown that in the event of an anthrax bioterrorist attack over an unvaccinated population, “post-attack vaccination and antibiotic therapy is the most effective and least expensive strategy.” South Korea follows this model. During the 2018 Winter Olympics, for example, South Korea will incorporate 1,000 doses of anthrax vaccines along with antibiotics and spore detectors (Bio Watch) in preparation for bioterrorist attacks.

The second misconception is regarding the vaccine’s availability. Unlike the U.S., which has immunized its soldiers in Korea since 1998, South Korea is not able to purchase BioThrax for its entire military due to a supply shortage. Since the late 1990s, Emergent BioSolutions has exhausted its production capacity to supply the U.S. military and the U.S. Strategic National Stockpile. In 2016, the manufacturer expanded its production capacity to 20-25 million doses per year and started marketing its products internationally while fulfilling its U.S. contract. However, the scale of Emergent BioSolutions’ international sales, which was roughly ten million U.S. dollars in 2016, is far below the amount the Korean military needs to inoculate its 625,000 personnel, who on an average will serve for eighteen months starting this July. Other countries, such as Russia, produce anthrax vaccines as well, but they are infamous for their side effects.

Since 1997, South Korea has focused on producing the vaccines domestically, inoculating the military and stockpiling vaccines for its citizens. However, after twenty-one years, the initiative has not succeeded. In fact, while the Blue House downplayed the recent controversy by reiterating that the vaccines will be finalized in 2019 and that there will be a stock of a million doses by 2020, that promise is likely a stretch. The vaccine still requires two additional clinical trials, and some expect this procedure to take at least a couple more years. Not to mention, this was not the first time that the South Korean government reassured the public with promises. In 2008, for example, the Korea Centers for Disease Control & Prevention said that it would finalize the anthrax vaccine development and begin stockpiling in 2011.

Hence, this incident exposes one of the growing concerns in South Korea regarding its vulnerability to a biological attack by the North. Recent studies suggest that North Korea could now produce military batches of anthrax, weaponize them within ten days, and deliver them through special forces, airplanes, and drones, causing mass casualties with a small amount. Since only 10-15% of patients who inhale anthrax survive, 55% if they are treated “aggressively” for months, only a few pounds of anthrax released in a dense city, such as Seoul, could deliver million lethal doses and incapacitate potentially hundreds of thousands of people. For instance, when Seoul simulated anthrax attacks in 2013 that presumed (just) two attacks in an 8-day interval, causing 2,700 patients and 1,730 casualties, regions in Seoul had to be isolated and decontaminated for six months, resulting in a “severe national disaster.” In the event of a terrorist attack or a war, however, North Korea might deploy hundreds or thousands of biological agents at once, and South Korea will experience an actual national disaster if it is not adequately prepared.

Min Hwang is an intern with the Nuclear Safeguards program at the nonpartisan Stimson Center.