On 6 February 2000, 60 Minutes aired an interview of an active duty Air Force major who had refused to receive the vaccine for anthrax. Viewers learned that he faced the potential of a court-martial for refusing to obey orders. The major's refusal is just one aspect of a complex controversy surrounding the Department of Defense's Anthrax Vaccination Immunization Program. Adding to the confusion are a myriad of press releases, communications and opinions from concerned individuals on the internet, Congressional testimony, issues raised by those in the Reserve Components regarding any potential effects on their civilian careers, and numerous internet web sites both supporting and opposing vaccination. Needless to say the anthrax vaccine debate is extremely complex. It is possible, however, to categorize the issues and concerns with the Anthrax Vaccine Immunization Program as either clinically related or administrative policy related, then address the two categories separately. An important aspect of the clinically related issues is to determine if the anthrax vaccine, Anthrax Vaccine, Adsorbed (AVA), is safe and provides effective protection against the effects of exposure to anthrax spores. What is needed is a clinical assessment based on data in the published, peer-reviewed medical literature and medical textbooks. In addition, it is necessary to assess if credible alternatives to vaccination using Anthrax Vaccine, Adsorbed exist. If medical personnel determine the vaccine is clinically safe and effective, as documented in the medical literature, then administrative policy-makers may determine if the vaccine should be administered to Department of Defense personnel. The decision to vaccinate Defense Department personnel is a policy decision made by those in the legal chain of command and is based on intelligence estimates and relative risk assessments related to the potential use of anthrax spores in a biological weapon. Clinicians and Service medical corps officers do not set policy. Nor do they have the authority to order vaccination of all personnel. The intent of this book is to provide military commanders and supervisors with pertinent clinical facts and information about anthrax and Anthrax Vaccine, Adsorbed in a single source document, written in lay terms, to serve as a working reference for use to educate those within their chain of command. Due to time and space limitations, this paper is not intended to be an exhaustive review. Reviews and discussions of the evidence related to the risk of the use of anthrax as a biological weapon and the policy decision to vaccinate Defense Department personnel are beyond the scope of this book, which focuses instead on clinical issues related to the vaccine. The book will present a brief review of anthrax, including a description of the causative organism and how it causes disease in humans, along with a review of the history of the vaccine and its manufacturer. Next, the work will provide an overview of the medical literature to address safety, efficacy, side effects, and complications from vaccination, followed by the major points of controversy found in the media, on information world-wide-web sites, and in Congressional testimony. Then, the work will attempt to bring the controversy into perspective, examining several of the arguments of those opposed to vaccination against anthrax, followed by presenting some conclusions and recommendations. The research methods employed for this book include a review of the peer-reviewed medical literature, medical textbooks, press releases, and internet world-wide-web sites presenting information and opinions both for and against vaccination.