Experts attending the 2015 Military Health System Research Symposium in Fort Lauderdale, Florida, Aug. 17-20, united to discuss the battle against the invisible enemy -- infectious diseases.
Historically, infectious diseases are responsible for more U.S. casualties than enemy fire. The reason is that military service members often deploy to areas endemic with infectious diseases transmitted by mosquitoes or from person to person such as malaria, dengue, and infectious diarrhea. Thousands of U.S. Service Members recently deployed to West Africa to support the largest Ebola virus disease outbreak in history.
"Clearly, we have to be able to push our folks forward anywhere, anytime and anyplace that the nation needs them to move," said Dr. David Smith, Deputy Assistant Secretary of Defense for Health Readiness Programs. "So, we have to be able to protect them. First we have to be aware of what the various threats and infectious disease hazards are and then, hopefully, [we have to] be able to prevent [infectious diseases] in their deployment."
In a roundtable discussion focusing on infectious disease research, Smith joined Col. Stephen Thomas, Deputy Commander of the Walter Reed Army Institute of Research and Infectious Diseases and Consultant to the U.S. Army Surgeon General; Randal Schoepp, Ph.D., Chief of the Applied Diagnostics Department at the U.S. Army Medical Research Institute of Infectious Diseases; Dr. David Tribble, science director of the Infectious Disease Clinical Research Program at the Uniformed Services University of the Health Sciences; Capt. Tim Burgess, MD, Infectious Diseases Service Chief at the Walter Reed National Military Medical Center; and Cmdr. Ramiro Gutierrez, MD, deputy director of the Infectious Diseases Directorate at the Naval Medical Research Center.
Thomas, who also led the USAMRMC's Ebola Response Management Team during Operation United
Assistance, explained that the recent Ebola relief effort served as a good example of the value of military infectious disease research.
"The missions we are asked to undertake are very diverse. At times, we are asked to go places that are developing nations or that don't have a public health infrastructure…or places where there have been war or other causes of turmoil," said Thomas. "In those places, public health infrastructure breaks down, immunizations programs go away, and that is certainly the opportunity that these infectious disease threats need to rear their heads again."
Thomas explained how the Ebola mission was not just about Ebola but also about protecting troops from many other infectious diseases within West Africa, which was only possible because of the long-term investment the Department of Defense has made in force health protection and readiness.
"When you go into a place like West Africa that has an Ebola outbreak, where there are thousands and thousands of [Ebola] infections…that is actually not your primary infectious diseases concern -- its malaria or infectious diarrhea or other infectious pathogens that exist there."
While the research the military focuses on is relevant to the warfighter, many of the efforts also have applications for public health.
"It gives me a lot of personal satisfaction to know that whatever…contribution that I do helps protect a service member now and in the future, and protect the mission," said Gutierrez. "Many of these diseases also cause an incredible burden to these populations in these developing countries. I mean children and others die of diarrhea and malaria every day."
Schoepp, who has personally deployed to Africa several times, added that even before the Ebola virus outbreak, DOD researchers understood that force readiness and public health depend on disease surveillance, as well as the development of diagnostics, vaccines, and therapeutics. Schoepp explained that the USAMRIID had been working on a collaborative project in West Africa since 2006 where he and several others helped set up an Ebola virus testing laboratory in Liberia and trained local personnel to run diagnostic tests on suspected Ebola hemorrhagic fever clinical samples.
"The major lesson learned from the Ebola mission was the all of DOD's preparatory work turned out to be a saving moment for the entire outbreak," said Schoepp.
The work paid off. USAMRIID research led to the only laboratory test, or assay, currently authorized to diagnose Ebola in U.S. citizens. The assay, which detects the Zaire strain of Ebola virus in patient samples, is called the Ebola Zaire Real-Time PCR Assay Test Kit. It was developed, manufactured and tested with help from the U.S. Army Medical Materiel Development Activity. While the test has not been approved by the U.S. Food and Drug Administration, the FDA has authorized its use under an Emergency Use Authorization granted in August 2014. The EUA provides a legal basis for the use of unapproved medical products, including diagnostics, in a declared emergency when there are no alternatives. The test is available at authorized DOD laboratories in the U.S. and overseas, as well as select CDC Laboratory Response Network state public health labs throughout the country for testing U.S citizens.
"We had been working on pre-Emergency Use Authorization packages that we could pre-position with the FDA 10 years ago and that allowed us to have the first EUA for diagnostics for Ebola during the outbreak," explained Schoepp.
Schoepp emphasized that the military has to have its own infectious disease research program because they often focus on the enemies others do not -- the orphan diseases. Orphan diseases are not necessarily rare diseases; they just are not endemic in the developed countries, such as the U.S. Therefore, the pharmaceutical industry provides little financial incentive for the private sector to make and market new medications to treat or prevent these diseases.
Experts, however, warned that the Ebola outbreak included an important lesson learned in that way of thinking.
"If the Ebola outbreak -- that is still ongoing -- taught us anything, it is the ease at which threats that we wouldn't think could make it to our shores can very easily be exportable," said Thomas.
Tribble added that the key to preparedness both domestic and abroad lay with collaborations between the public and private sector.
"I think [we must continue to] find ways to integrate between R&D and the clinical sides, integrate and use military health system data on a large scale, as well as [achieve] seamless continuity between to DOD and the Veterans Affairs," said Tribble.
Thomas said, "The priority for me is not necessarily a list of threats, per se, but of ensuring that we have our senior leadership's support and that we have the resources required to maintain capabilities, both in terms of infrastructure and subject matter expertise."
Echoing the need for a continued and sustained DOD investment in infectious disease research and development, Smith added, "When you see what is happening around the world, I don't see any time in the near future when we will be letting our guard down."
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