Three specimens of Borrelia burgdorferi, the bacteria that causes Lyme Disease. Photo credit CDC.
Military Lyme Disease Cases Can’t Wait for New Vaccine
Following another summer of rising Lyme Disease cases across the United States, clinical trials are underway for a new Pfizer and Valneva vaccine expected for release in 2026. Given how debilitating the disease can be, this is good news for both American citizens and military service members, who may face disproportionate rates of infection compared to the general population. Unfortunately, structural problems stemming from lack of health education, insufficient diagnosis and treatment, and data collection and reporting concerns prevent the threat from Lyme being well-addressed in the U.S. Armed Forces.
Lyme Disease is the most common vector-borne illness in the United States. If treated quickly with oral antibiotics, symptoms include fever, headache, and fatigue lasting two to four weeks. If left untreated, however, the infection can spread to the joints, heart, and nervous system, causing arthritis, Lyme carditis, asceptic meningitis, and neuropathy. While the LYMErix vaccine was FDA-approved in 1998 and was proven to be 75% effective in preventing the disease, it was taken off the market in 2002 due to insufficient demand from vaccine hesitancy and complaints it worsened Lyme symptoms. Since then, no Lyme Disease vaccine has been available for humans. Incidents of Lyme Disease in the US, meanwhile, have almost doubled since 1991, partially driven by climate change, which has increased the range over which ticks can spread.
While annual statistics on Lyme diagnoses of service members and veterans have been unpublished since 2015, the spread of the disease has reached epidemic levels—and military installations are particularly at risk. The majority of US bases are found in states that are responsible for 99% of reported Lyme Disease cases, and the Army program responsible for tracking tick bites receives 2500-3000 voluntary ticks sent in each year. Given that not all soldiers who are bitten send a tick in to be tested and that there is no reason to assume there is a lower rate of exposure for the other branches of the military, this suggests a very high rate of tick exposure across the services. This fact, along with the fact that military training drills and exercises often take place in environments where ticks thrive, make treating Lyme Disease a national security imperative.
Military members unfortunately face difficulty in getting diagnosed in time to avoid severe disability and life-long problems. Lyme Disease is difficult to diagnose for a variety of reasons. The early symptoms are found in many other conditions and may not show up until months after the initial bite. Other problems arise from the myths many doctors hold about the disease, particularly that it is easy to diagnose, easy to treat, or not that severe. All of this leads to service members with Lyme struggling to receive a diagnosis. Col. Malachowski, the first woman to fly with the Thunderbirds, was rated 100% unfit for duty after 21 years of service due to years of misdiagnosis. Not only is there loss of expertise that the United States needs when a service member is forced to retire from Lyme, but there is also a huge economic cost both in money invested in training and payments for disability. The problem is not a small one: a 2021 study of vector-borne Reportable Medical Events (RME) from 2016-2020 showed Lyme Disease to be the disease with the most cases, comprising 43% of reports.
The DOD does give some, but not enough, attention to Lyme Disease. From 2020 onwards, it has been appropriated $7 million for use in the Tick-Borne Disease Research Program. Yet it does not use all of it: between two categories in 2020, $2.7 million was awarded, though this rose to $6.188 million in 2022. Policy implementation also faces problems. Military uniforms are treated in permethrin, which can keep ticks away, but many in the service are unaware those uniforms require eventual retreatment. Additionally, while DOD’s Global Emerging Infection Surveillance Program recommends preventative measures, military medical training does not reinforce these measures.
While the discussion of biothreats has seen more attention in the light of Covid-19, Lyme is proof that it is not only new diseases which need attention. The news of the Lyme vaccine is welcome, but with it already delayed by over a year, continuing to wait is not enough. While vaccination is easier and less expensive than addressing the root causes of misdiagnosis and insufficient research funding, the threat that Lyme Disease poses to the military and security of the country requires immediate action. Disbanding myths held about Lyme Disease, educating military doctors and service members, and maintaining a publicly available record of diagnoses and treatments may resolve many of the unexplained illnesses and symptoms that cause service members to be discharged and separated, saving lives in the process.
