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 February 6, marking his eighth day of a hunger strike that demanded the immunization of all South Korean uniformed personnel against anthrax. As a Chairman of a news outlet, Mr. Son had previously reported 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 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, panicking the public and kindling a series of national petitions that demanded vaccines for all Koreans. The public demanded justifications for the lack of anthrax immunization among Korean citizens.

This incident generated numerous petitions due to the two widespread misconceptions about the existing anthrax vaccine, namely its purpose and availability. Nevertheless, it highlighted South Korea’s vulnerability to biological warfare and exposed one of the most severe risks posed by North Korea’s Weapons of Mass Destruction.

The first misconception is regarding the vaccine’s purpose. Unlike other vaccines, the existing anthrax vaccine is neither designed to vaccinate population with low risk of infection nor limited to pre-exposure applications. 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 civilians with low risk of infection. Not to mention, it could cost billions of dollars every year to immunize the entire population. BioThrax is also approved for post-exposure therapy in conjunction with other antibiotics. 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 incorporated 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 was not able to vaccinate its military in the 90s because the U.S. “declined to provide vaccines” because of its stockpile insufficiency and lack of precedence for overseas sales. Other countries, such as Russia, produce anthrax vaccines as well, but they are infamous for their side effects. South Korea has, thus, focused on producing the vaccines domestically since 1997. In 2016, the vaccine manufacturer Emergent BioSolutions has expanded its production capacity to 20-25 million doses per year and started marketing its products internationally while fulfilling its U.S. contract. However, rather than importing the vaccines for its military, South Korea has continued to maintain its initiative in the name of self-sufficiency.

South Korea’s commitment to produce the vaccines domestically, inoculate the military and stockpile vaccines for its citizens, however, has yet to succeed after twenty-one years. 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.