U.S. and Israeli Collaboration at 20th Shoresh Meeting Promotes Advancement of CBRN Medical Countermeasure Development

By Christina CIAKDecember 8, 2022

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Chemical, Biological, Radiological, and Nuclear (CBRN) agents do not observe international treaties or geographical boundaries. Military service members, regardless of nationality, may find themselves facing these serious threats on the battlefield. For both the United States and Israel, advancing military medical capabilities to protect and treat the warfighter, including those that combat against CBRN threats, is a top priority.

To that end, this past September, representatives from the U.S. Defense Department (DoD) participated in the 20th biennial Shoresh Military Medicine Conference in Rockville, Maryland. Shoresh, co-hosted by the Israeli Defense Force (IDF) and the U.S. Army Medical Research and Development Command (USAMRDC), is a collaborative gathering of DoD and IDF medical personnel that covers medical, chemical, biological defense, and military medicine topics. “You all save lives,” said Dr. Brian Lein, the Defense Health Agency’s assistant director for healthcare administration. “The things we talked about four or six years ago are now saving American and Israeli lives, based on innovation first developed here.”

More than 50 U.S. and DoD organizations attended. Participants included nurses, doctors, medics, research physiologists, psychologists, trauma specialists, and hospital managers, as well as scientific and acquisition professionals from the Joint Program Executive Office for Chemical, Biological, Radiological and Nuclear Defense’s (JPEO-CBRND) Joint Project Manager for Chemical, Biological, Radiological, and Nuclear Medical (JPM CBRN Medical). While the conference covered medical topics beyond the CBRN battlespace, JPM CBRN Medical experts specifically discussed current and future CBRN medical countermeasure (MCM) initiatives with their U.S. colleagues, Israeli Ministry of Defense, Israel Institute for Biological Research (IIBR), and IDF counterparts, in order to identify programs where collaboration would provide the greatest benefit to both U.S. and Israeli forces.

“We are honored to continue our over 40 years of collaborating with the Israeli Ministry of Defense on medical countermeasures against chemical and biological defense threats,” said COL Matthew G. Clark, Joint Project Manager for the JPM CBRN Medical. “We spearhead advanced development for the Joint Forces and our partners, and the collaboration with the IDF gives us the opportunity to demonstrate our capabilities and programs, as well as learn about potential partnerships with mutual benefit for warfighters.”

For subject matter experts representing the JPM CBRN Medical, the focus for this year’s Shoresh conference was two-fold. LTC Amanda Love and her team showcased two newer programs in the JPM CBRN Medical’s portfolio, where collaboration with both traditional and non-traditional DoD performers, to include international external partners, is key. Both the Rapid Acquisition and Investigation of Drugs for Repurposing (RAIDR) and Vaccine Acceleration by Modular Progression (VAMP) programs were introduced to an audience constantly striving for streamlined ways to provide medical solutions to troops on the frontlines.

RAIDR and VAMP enable a quicker way to deliver these MCM solutions. RAIDR leverages the proven safety profile of U.S. Food and Drug Administration (FDA)-approved (or late-stage) therapeutics that were developed for a certain indication, and repurposes them to be used against other threats, bridging the gap until a targeted MCM is developed. The VAMP program utilizes a flexible contracting strategy to develop multiple platform technologies and alternate delivery mechanisms to deliver new and enhanced capabilities to the warfighter.

In addition, the JPM CBRN Medical’s chemical defense team, led by LTC Owen Roberts II, shared best practices and lessons learned associated with developing nerve agent MCMs, particularly those delivered via autoinjectors. The FDA requires emergency-use autoinjectors to have high device system reliability; many design teams struggle to achieve this level of reliability on-time and on-budget. A shared concern between the U.S. and Israeli participants was how to ensure confidence of medicines delivered by autoinjectors outside of controlled conditions.

The JPM CBRN Medical’s chemical defense team also shared success stories in regard to advancing solutions to counter nerve agent threats, including the recent FDA approval of the midazolam autoinjector in August 2022, completion of a clinical trial for the nerve agent adjunct scopolamine, and efforts to deliver a sustained release formulation of pyridostigmine bromide to ease dosing requirements. There was mutual interest in determining if reciprocity between U.S. and Israeli regulatory bodies could be pursued. In addition, the team absorbed information from colleagues presenting combined injury models for assessing decontamination procedures, traumatic brain injury after nerve agent exposure, and trauma after radiation exposure.

After four days of dynamic presentations and discussion, the conference attendees returned to their respective countries to continue their important, and often difficult, work. However, it is clear that the connections made at Shoresh will pay dividends for years to come. It was reiterated throughout the conference that both countries cannot rely on yesterday’s medical solutions, as future conflict will be different and require prolonged field care. The way forward to meet future challenges is through cooperative research and development resulting in tangible endpoints. Ultimately, the opportunity to collaborate with like-minded military and civilian professionals is essential to deliver effective MCM products faster, and at a lower cost, in order to enhance the protection and readiness of U.S. and Israeli forces – a win-win for both countries.