By Douglas J. Gillert American Forces Press Service ALBUQUERQUE, N.M. -- Mandatory anthrax vaccinations are just the beginning of medical countermeasures DoD has planned to protect deployed service members, a senior health official said here Nov. 2. "The anthrax vaccination is the first in a long series of force protection measures to come," Mary Gerwin, deputy assistant secretary of defense for health affairs, told TRICARE communications, customer service and education representatives attending a conference. While she didn't elaborate on future measures, the Pentagon sponsors a number of research projects, including one looking at smallpox as a potential threat to troop health. Noting that at least 10 nations currently have the ability to use anthrax as a weapon, Gerwin said, "The anthrax threat is real. A high priority of the department is to make sure we have effective countermeasures in place." Gerwin rejected concerns of some that the shots are unsafe. "We have a safe and effective vaccine that we have administered to more than one million," she said. "The adverse reaction rate is lower than for common childhood vaccinations." Defense Secretary William S. Cohen announced the total force vaccination plans in December 1997. Vaccinations were accelerated in March 1998 for troops assigned or deploying to Southwest Asia and, subsequently, to Korea. After a three-year study, Cohen concluded that the vaccination is the safest way to protect highly mobile U.S. military forces against a potential threat that is 99 percent lethal to unprotected individuals. The immunization program consists of a series of six inoculations per service member over an 18-month period, followed by an annual booster. Although protection levels increase as shots in the series are given, the entire six-shot series is required for full protection, as determined by the FDA. The cost to immunize an estimated 2.4 million military people is approximately $130 million. "A small number are refusing to take the shots, largely because of misinformation on the Internet," Gerwin said. Most of the resistance to the shots has come from Guard and Reserve members, although some active duty members also have resisted Cohen's order. Service members who refuse the shots first go through education and counseling to ensure they know all the facts and are making an informed decision. If they still refuse, the commander can then impose nonjudicial punishment, separation from the service or court-martial. Responding to concerns of some service members and their families, the Army's Anthrax Vaccine Immunization Program office established a committee to look closer at the vaccine. The office comes under the Army surgeon general, executive agent for the DoD anthrax immunization program. The group will define research needs and set up studies to answer questions raised about the vaccine. More information about the DoD anthrax immunization program is available on the Internet at www.anthrax.osd.mil/.