title: UK armed forces responses to an informed consent policy for anthrax vaccination: a paradoxical effect?
abstract: BACKGROUND
  In recognition of concerns that anthrax vaccination might be a trigger for "Gulf war syndrome", anthrax vaccinations were offered to UK armed forces in the 2003 Iraq conflict using explicit as opposed to implicit consent, as is the policy for all other vaccinations. This paper examines responses of personnel to this policy.
  
  
  METHODS
  Qualitative analysis of free text responses to a question inviting comments on any concerns about the anthrax vaccination, asked in the context of a questionnaire assessing military health amongst 1000 members of the UK armed forces following the invasion of Iraq in 2003.
  
  
  RESULTS
  Two hundred and two (20.2%) respondents made comments reflecting concerns about the vaccine's effectiveness and its safety. These appeared to be magnified by suspicions about the motives behind the informed consent policy for anthrax but not other vaccinations.
  
  
  CONCLUSIONS
  While the informed consent policy for anthrax vaccinations was intended to decrease concern, it may inadvertently have had the opposite effect.
authors.affiliation: King's Centre for Military Health Research, Institute of Psychiatry, Weston Education Centre, Cutcombe Road, London SE5 9RJ, United Kingdom. dominic.murphy@iop.kcl.ac.uk
authors.forename: Dominic
authors.initials: D
authors.lastname: Murphy
authors.forename: Christopher
authors.initials: C
authors.lastname: Dandeker
authors.forename: Oded
authors.initials: O
authors.lastname: Horn
authors.forename: Matthew
authors.initials: M
authors.lastname: Hotopf
authors.forename: Lisa
authors.initials: L
authors.lastname: Hull
authors.forename: Margaret
authors.initials: M
authors.lastname: Jones
authors.forename: Theresa
authors.initials: T
authors.lastname: Marteau
authors.forename: Roberto
authors.initials: R
authors.lastname: Rona
authors.forename: Simon
authors.initials: S
authors.lastname: Wessely
mesh_terms: D022122:Anthrax Vaccines; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007258:Informed Consent; D008297:Male; D008889:Military Personnel; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D006113:United Kingdom; D014611:Vaccination
chemical_list: D022122:Anthrax Vaccines