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Military Medicine: Building on a Tradition of Success in Infectious Diseases

Building on a strong, product-oriented research tradition, the U.S. Military is pursuing a safe and effective HIV vaccine to protect our Armed Forces and reduce the global impact of HIV.

For over a century, the military medical community has solved significant international health problems, particularly in the area of tropical infectious diseases. Cutting edge vaccine development continues today in HIV, malaria, dengue and enteric diseases. The U.S. Military HIV Research Program (MHRP) is dedicated to HIV vaccine development, prevention, disease surveillance and care and treatment for HIV. Headed by the Walter Reed Army Institute of Research (WRAIR), the largest lab within the U.S. Army Medical Research and Materiel Command and the lead agent in DoD infectious disease research, MHRP builds on the established infrastructure and unique capabilities of the U.S. Military. Military Relevance Historically, infectious diseases have had a major impact on U.S. Armed Forces. In fact, more person-days were lost among U.S. Military personnel due to malaria than to bullets during every military campaign fought in malaria-endemic regions during the 20th century. Dengue fever has had a negative impact on military operations dating back as far as World War II, and soldiers have been plagued by diarrheal diseases since before recorded history to modern day. In the 1980s, HIV was identified as an infectious disease threat. Congress initiated MHRP to develop effective preventive measures against HIV in the U.S. and Allied Forces. With 33.2 million infections worldwide, HIV continues to pose a significant and persistent threat in terms of readiness and force protection, and may affect the stability and security of many nation-states. The brisk pace of deployments throughout the world requires WRAIR to develop products and capabilities with an international scope. Through a highly-targeted program, MHRP is able to address military concerns including:

• Developing a globally-effective HIV vaccine • Ensuring accurate HIV testing for the Army • Tracking the HIV epidemic in active-duty forces • Assessing risk of HIV exposure to U.S. and allied forces deployed

U.S. Military sponsored studies have produced:

• Antibiotic cures for typhoid and scrub typhus • New antimalarial drugs • Highly effective vaccines for meningococcal meningitis, encephalitis and adenovirus-caused

respiratory disease

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Military Achievements Infectious Disease and Vaccine Development

By command order, immunized first army against smallpox Developed effective treatment for malaria Discovered New World hookworm Identified mosquito as yellow fever vector Established filterable “virus” as cause of dengue Developed effective typhoid immunization Demonstrated efficacy of tetanus toxoid Differentiated Hepatitis A and B and established gamma globulin treatments Resolved scrub typhus transmission problems and introduced chloraphenicol treatment Isolated vaccine strain for Influenza A virus Unveiled cholera oral rehydration regimen dramatically reducing case mortality Developed attenuated vaccine against Venezuelan Equine Encephalitis Isolated rubella virus used to develop vaccines Developed adenovirus vaccine Developed polysaccharide vaccine against group C meningococci Demonstrated effectiveness of monoclonal antibodies in treatment of wound infections Demonstrated heterosexual contact as major route of HIV transmission Developed rapid diagnostic test for tuberculosis meningitis Demonstrated efficacious Hepatitis A vaccine Conducted first HIV-1 trial with non-B protein Determined entire sequence of the Plasmodium falciparum malaria parasite Began largest Phase III study of HIV vaccine candidate begins in Thailand Performed pivotal research and efficacy testing on leading malaria vaccine candidate Characterized new circulating recombinant forms of HIV in E. Asia Approved Japanese encephalitis vaccine for use in Australia, Europe and the U.S. Participated in the first Phase III trial of a malaria vaccine in Africa, and Tested first HIV vaccine found to be safe and modestly effective in lowering rate of HIV infection in humans Phase III study shows antibiotic cream treats cutaneous leishmaniasis with a high cure rate

1777 The Continental Army is immunized against smallpox per General George Washington’s orders.

World War I (1914-1918) A variety of medical techniques to improve soldiers’ survival rates are developed, including wound treatment, blood transfusions, reconstructive surgery and physical therapy.

Korean War (1950-1953) The Mobile Army Surgical Hospital (MASH) is introduced. Hospital ships equipped with helicopter landing pads are introduced as a method for quick-response medical attention, changing the ships’ roles from medical transports to floating hospitals.

The military medical community has stimulated some of medicine's greatest advances, often during wartime.