Col (Ret) Zygmunt F. Dembek reviews Covid-19 vaccination hesitancy and progress in the US military.

In Risk: A User’s Guide by Stanley McChrystal, the retired US Army general outlines the global failures in combating Covid-19 and apportions considerable blame on US government officials. “We always knew another virus was going to come and threaten a pandemic. We not only knew it was inevitable, but we know how to deal with a threat like that through public health. And we blew it; we absolutely have flubbed the response”.

There has been no lack of criticism regarding the response to the Covid-19 pandemic. A significantly part of “flubbing” the Covid-19 response has been Covid-19 vaccine hesitancy. This has become a global issue.

Of note is that this had also been a significant problem in the military services, where required immunisations have long been a fact of life. Over the past 80 years, it has become common practice for newly entering military recruits to receive various regular vaccinations.

Today, at least eight different vaccinations are required upon service entry, not counting the Covid-19 jabs. Can Covid-19 vaccine hesitancy in the military be overcome?

Cases in the military
As of writing (early November 2021) there had been about 46 million Covid-19 cases and 745,000 deaths in the US and over 9 million Covid-19 cases and 141,000 deaths in the UK. Globally, there have been over 246 million cases and 5 million deaths attributed to Covid-19.

There have also been over 250,000 Covid-19 cases in the US military, with 73 Covid-19 deaths. The small number of deaths among these cases as compared to the civilian population is largely due to the youth and overall state of health among the military population.

But this does not guarantee that this population is either immune from Covid-19 nor is unable to further spread the illness. Additionally, there have been over 39,000 cases among military dependents, with an associated 30 deaths. These numbers present overwhelming evidence for vaccination requirements among the military population.

Ship outbreak
A wake-up call for the US military in terms of potential for Covid-19 spread within its populations was the massive outbreak that occurred on board the aircraft carrier USS Theodore Roosevelt in March 2020.

A recent RAND study of this outbreak found that the Navy had dealt poorly with escalating Covid-19 cases aboard this ship and conflicting information also hampered the needed response.

The Navy’s chain of command was as bewildered as was the ship’s Captain in responding appropriately to the ongoing epidemic aboard the ship. Altogether 238 crew members contracted Covid-19, and two died. Consequently, the ship’s Captain was relieved of command.

This outbreak served as the figurative ‘shot across the bow’ as to how Covid-19 could affect the Navy and greater military populations. It also forced military and health authorities to become aware that they needed to respond rapidly to Covid-19 outbreaks and to proactively promote effective vaccination among the total military population.

Exposure magnifiers
Social behaviours can be adjusted somewhat to ameliorate exposures via these real-world potential COVID ‘exposure magnifiers’ due to close living and working conditions. Certainly after two years of the Covid-19 pandemic, we are all familiar with the non-pharmaceutical interventions (NPIs) of social distancing, cohorting and proper mask wear. However, many of these measures are just not as practical in military life as they are in the civilian sphere (where they are also by no means universally followed either at the start of the pandemic or during the subsequent waves).

Military close quarters where Covid-19 can quickly spread include aboard Navy ships and submarines, and also in military barracks and basic military training facilities. These military missions must continue, regardless of the current status of global Covid-19 pandemic spread. Which is why having the military force fully vaccinated is so important.

Vaccine hesitancy
Hopefully the numbers of Covid-19 cases and deaths previously described should be enough to convince most folks to receive a successful and approved vaccine. Covid-19 vaccine hesitancy in the military has been a serious problem. But as the Covid-19 pandemic has progressed, and some have demonstrated reluctance to become fully vaccinated, military leadership has stepped up to enforce vaccination requirements.

The Pfizer-BioNTech Covid-19 became fully approved by the US Food and Drug Administration (FDA) on 23 August 2021. As a result, vaccine hesitancy for most military members to receive their Covid-19 vaccine has diminished.

Vaccination deadlines
To motivate US military personnel to become vaccinated against Covid-19, deadlines for complying with full vaccination status were put in place by the various US armed services.

All active-duty components, Air Force, Space Force, Navy and Marine Reserve and Guard components and all Department of Defense (DoD) civilians were required to be fully vaccinated by year’s end of 2021. The Army Reserve and National Guard now have until 30 June 2022 to become fully vaccinated.

As of November 2021, according to the US DOD, about 97% of the US military had received at least one vaccine dose. This included 99% of the Navy, 97% of the Air Force, 93% of Marines, and over 90% of the Army. About 65% of all US military have been fully vaccinated.

I think the Secretary of Defense, Lloyd Austin, has been very clear with the leaders of the military departments that he wants them to execute the mandate with a sense of compassion and understanding.”

While this guidance may provide ‘wiggle room’ for some servicemembers to delay their required Covid-19 vaccination, it’s a safe bet that most military personnel will comply with their required jabs due to deployment requirements for full Covid-19 vaccination.

No vaccine, no entry
Additionally, military facilities are now requiring proof of vaccination or a recent negative Covid-19 test result for certain visitor categories to enter these facilities. New Force Health Protection Guidance directives issued on 1 November 2021 established a ‘no-entry-unless-vaccinated-or-tested’ policy, which applies to all official visitors, including contractors.

These rules excludes military families and their dependents and DoD personnel, most of whom are already vaccinated or are in the process of being vaccinated for Covid-19.

Per this guidance, as has been the case for all previous US government guidance, a person is considered fully vaccinated two weeks post-vaccination for the second dose of a two-dose Covid vaccine (Pfizer or Moderna), or two weeks after a single dose of the one-dose Covid vaccine (Johnson & Johnson).

Those vaccinated with other unlicensed or non-approved Covid-19 vaccines are not considered fully vaccinated under these guidelines.

The Covid-19 pandemic has forced the military to adapt to a 24/7 awareness of biological threats. Unlike much of civilian workforce employment, most military personnel cannot work remotely. Similar to healthcare personnel, most all military jobs require hands-on work and work practice.

Jobs that include logistics, personnel and equipment movement, required military training, and movement of aircraft and ships at sea, are all hands-on tasks. This is not likely to change anytime soon. After two years of combating the Covid-19 pandemic, the US military is determined to continue its missions and to apply the many lessons learned to help prepare for the next pandemic.

 Col (Ret) Zygmunt F. Dembek is an epidemiologist and biochemist. He has written extensively on biodefence and has conducted pandemic preparedness exercises worldwide.

21st Theater Sustainment Command provides Covid-19 vaccinations to Afghan evacuees in Kaiserslautern, Germany. More than 2,400 Afghan evacuees received the vaccine. 
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