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It's been a decade since a series of anthrax attacks on some people in the United States. Since then, the government has stockpiled an arsenal of anthrax vaccines which have been tested on adults, mostly soldiers who were at risk for bioterrorism attacks. However, a 2011 game called Dark Zephyr posed a question to policymakers: if a major American city like San Francisco was under attack by anthrax, doctors would not know what dosage was appropriate for children. Should they vaccinate them anyway, or should they test the vaccine on children now in order to find a safe dosage?

The President's Bioethics Commission has finally issued its answer to the question. According to the Los Angeles Times, the answer is a shaky thumbs' up. The commission says that children may be tested for the vaccine, but only after more testing in animals and in adults.

Afterwards, if the vaccine poses minimal risk equivalent to, say, visiting the doctor's office for a check-up, the vaccine can be tested on children as long as they progressively test children lower in age. That means that, if the vaccine is found to be all right in 18-year-olds, the youngest adults, the vaccine can then be tested on 16- and 17-year-olds. In extraordinary cases, a trial can be developed that allows for a minor increase over minimal risk, like a fever after receiving a shot. The youngest age for testing is not clear, but the immune systems of children are different than that of adults, just as a baby's immune system is different than that of a five-year-old, Reuters reports.

The 2011 exercise found that 8 million people in a large city like San Francisco could be affected by such a threat. A quarter of those people could be children. In such an attack, antibiotics would be a key part of the response. However, proponents of the vaccine say that the vaccine would add increased protection, since much of the danger from anthrax lies in spores that can remain dormant for months after infection.

For children, the bar for testing remains high. In a pre-attack trial, children would not stand to directly benefit from testing. They can also not legally assent to testing. The commission recommended the development of a framework for such testing, which would be able to be used for countermeasures against other biological, chemical, nuclear or radiological attacks.

A 2005 law would prevent children from seeking legal damages if they were harmed from such an experiment. The commission strongly recommends that the law would be reversed or modified to allow damages for children harmed from such an experiment.