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Interview With Col. Steve E. Braverman, M.D., Commander, Walter Reed Army Institute of Research

On June 25, 2013, Col. Steven E. Braverman assumed command of the Walter Reed Army Institute of Research (WRAIR). With degrees from the University of Virginia, the National Defense University, and Vanderbilt University, Col. Braverman began his medical career at Fort Gordon, Ga., in 1987, moving a year later to the Walter Reed Army Medical Center in Washington, D.C., where he eventually became chief of the Physical Medicine and Rehabilitation (PM&R) Service and director of the PM&R Residency Training Program. In 2000, he became the deputy commander for clinical services at Moncrief Army Community Hospital, Fort Jackson, S.C., followed by an assignment as command surgeon for the National Defense University. After attending the National War College for a year, he commanded the Fort Knox, Ky., U.S. Army Medical Department Activity and Ireland Army Community Hospital from 2005 to 2007.

From 2007 to 2009, Col. Braverman served as chief of the Clinical Services Division at the U.S. Army Medical Command, deputy director of Health Policy and Services at the Office of the Surgeon General, and chief consultant to the Army Surgeon General. He deployed to Iraq, from October 2008 to April 2009, as the Multi-National Corps-Iraq Deputy Surgeon for Clinical Operations. After his deployment, from 2009 to 2011, he commanded the Carl R. Darnall Army Medical Center, Fort Hood, Texas. Before taking over leadership of WRAIR, Col. Braverman served as the Medical Corps deputy chief and Corps Specific Branch Proponent Officer.

Col. Braverman has been awarded the Legion of Merit, Defense Meritorious Service Medal, Meritorious Service Medal, Army Commendation Medal, Army Achievement Medal, and Iraq Campaign Medal. He has received the “A” designator award for professional expertise, the Order of Military Medical Merit, and the General Claire L. Chennault Award for teaching excellence.

 I think there are a few things that really distinguish WRAIR. One is its long history. When you have an institution – not just an institute – it earns a reputation over time. And we have a worldwide reputation as an organization that is providing both basic science and clinical research, and translating the research into biomedical products – equipment, or medications, or vaccines – valuable not only to the military but also to global health.

Craig Collins: Over the past 120 years, the Army’s Medical Research and Materiel Command has been reorganized and reshuffled multiple times, with laboratories and offices being terminated, recombined, or reshuffled. WRAIR has not merely survived these changes – it’s thrived. It’s as important now as ever. Why has it had such staying power?

Col. Steven E. Braverman: I think there are a few things that really distinguish WRAIR. One is its long history. When you have an institution – not just an institute – it earns a reputation over time. And we have a worldwide reputation as an organization that is providing both basic science and clinical research, and translating the research into biomedical products – equipment, or medications, or vaccines – valuable not only to the military but also to global health.

And, in fact, several of our OCONUS labs, the labs outside the continental United States, have close ties with academic institutions, and in some cases commercial enterprises, and that has made a difference in building capacity and capability in countries on every continent except Antarctica. The agreements under which we conduct research in those labs require that the work benefits the participating populations – so when we do research in our primary labs in Kenya and Thailand, or in Tanzania, or Uganda, or Nepal, or any of our other various clinical sites, their people benefit from that work.

U.S. Military HIV Research Program

The U.S. Military HIV Research Program works closely with the Armed Forces Research Institute of Medical Sciences in Bangkok, Thailand. U.S. Army photo

In those countries, we’re known as the Walter Reed Program [for malaria work] or [as the Walter Reed] Project [for HIV work], named for Maj. Reed, who established the mosquito as the yellow fever carrier and laid the groundwork for the yellow fever vaccination.

 

But since Reed’s discovery, the institute has added a few layers to that capacity – to translate research into products with the potential to save lives.

One of the things that really stood out was that some of the improvements in the development of treatments or vaccines – including developments that happened outside of WRAIR, or in partnership with federal interagency organizations, commercial or private-sector partners – happened because of the clinical trials networks that we established through WRAIR and our labs in Kenya and Thailand to test these products, some of which were developed at WRAIR, but most of which were developed in collaboration with other organizations.

Right, and this really hit home for me when we held ceremonies to observe World AIDS Day. We had a couple of speakers here, one of whom was Dr. Edmund Tramont, who was more or less the founder of WRAIR’s effort in the Military HIV Research Program. Another was Dr. Mary Marovich, who now heads the vaccine research program at the National Institute of Allergy and Infectious Diseases. Both of them were former WRAIR senior scientists here. One of the things that really stood out was that some of the improvements in the development of treatments or vaccines – including developments that happened outside of WRAIR, or in partnership with federal interagency organizations, commercial or private-sector partners – happened because of the clinical trials networks that we established through WRAIR and our labs in Kenya and Thailand to test these products, some of which were developed at WRAIR, but most of which were developed in collaboration with other organizations.

In some ways, our nation’s ability to participate in this research is reliant on the infrastructure we’ve set up through the military, to do the research necessary to protect our soldiers. That infrastructure has attracted funding from the President’s Emergency Plan for AIDS Relief, or PEPFAR. We receive support from the Gates Foundation to support research not only with HIV, but also with malaria and dengue fever, which are diseases of great concern to the military because soldiers go into endemic areas in the Pacific region. Our ability to provide the network to do the clinical trials helps us to partner with these other organizations to make a bigger impact than we could if we were trying to do it alone.

Richard G. Lugar Center for Public Health Research

The Richard G. Lugar Center for Public Health Research is a state-of-the-art medical research facility constructed by the U.S. Department of Defense, Defense Threat Reduction Agency, as part of its collaboration with the Georgian Ministry of Defense. The U.S. Army Medical Research and Material Command is establishing a U.S. Army Medical Research Unit as a tenant organization in the Lugar Center at the request of the Georgian government in order to collaborate on public health research. U.S. Army photo by Lt. Col. Jamie Blow

Malaria is a perfect example, actually, of how we’re necessary to this capability, providing both clinical products, such as medications or vaccines, and well as preventive products, such as pesticides, repellents, or netting – or anything else that will keep mosquitoes away from you. We’ve developed products in each of those categories.

Another thing that’s unique to us is our malaria challenge model. We’ve developed a population of mosquitoes that we can infect with the malaria parasite, and then we have people who volunteer to come in and stick their arm over a box to be bitten by five infected mosquitoes. We watch and see what happens – they may have received an experimental treatment or vaccine before becoming infected – to determine whether we might have prevented an infection. We may not have developed all the medications or vaccines being tested, but we developed the model that facilitates the ability to do some of that in-lab testing before it goes to larger clinical trials.

It was through one of our challenge-model trials, incidentally, that we discovered that some people have a genetic mutation that reduces the effectiveness of an important class of malaria medications, because their livers don’t metabolize it as expected. Before, that had been a big unknown – did the medication not work because the malaria parasite developed resistance to the medication, or because the medication didn’t work on the same old parasite?

It was through one of our challenge-model trials, incidentally, that we discovered that some people have a genetic mutation that reduces the effectiveness of an important class of malaria medications, because their livers don’t metabolize it as expected. Before, that had been a big unknown – did the medication not work because the malaria parasite developed resistance to the medication, or because the medication didn’t work on the same old parasite? Our continued ability to test and do the bench research proved it was a genetic mutation that caused the medication not to be broken down into a metabolite that kills the malaria parasite.

The next step for those researchers will be to identify ways to make the metabolite, instead of relying on the parent medication. Is there a way for a different body organ to break down the medication into the metabolite, or are there other medicines, in a whole different chemical class, that could work by bypassing the liver? These are questions generated as a direct result of working with our challenge model.

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Craig Collins is a veteran freelance writer and a regular Faircount Media Group contributor who...