The facilities of Bioport, the sole manufacturer of the anthrax vaccine, are under the watchful eyes of armed guards these days, as the company finds itself under new scrutiny.
With investigators warning that more anthrax attacks are a near certainty, questions about the vaccine have been pushed to the front and center: Who should get it? Is it safe? Is there enough?
The vaccine's availability remains uncertain, both in terms of safety and supply. Used only in the military and for people who work in labs and with animals, the vaccine has not been approved for civilian use.
For years the FDA has had problems with Bioport's manufacturing processes. Stocks of quarantined vaccine remain unused because of safety concerns. But Bioport, which recently renovated and upgraded its plant, believes its product is finally in compliance.
"This is one of the most scrutinized vaccines in history, and it's been looked at every which way. This product is safe," says Dr. Tom Waytes, vice president of medical affairs at Bioport.
Overall, studies show the vaccine is effective, especially in combination with antibiotics. One of its drawbacks is that it requires six shots over 18 months. That's why a second-generation vaccine is in development that would only require two or three doses, a much easier way to vaccinate on a wide scale. Some believe that wide-scale vaccination will be necessary soon.
In the wake of the anthrax attacks on American postal workers, even Surgeon General David Satcher has suggested that it might be time to put the vaccine in the anthrax arsenal.
"Certainly, we would consider using the vaccine wherever there are high-risk workers, and certainly the more we learn about postal workers, [the more] we have to consider that," says Dr. Satcher.
Other public health experts, however, believe rolling out an anthrax vaccine for public use would be a hasty mistake.
"It's good to be prepared, but we certainly do not have a vaccine that I think...is safe and effective enough to warrant being used in a widespread way," says Dr. Linda Rosenstock, dean of the UCLA School of Public Health.
In the meantime, the FDA is taking another hard look at the Bioport vaccine, under the pressure to weigh risk versus need at a time when America is under attack.
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