In one way, little has changed for the Walter Reed Army Institute of Research’s (WRAIR’s) work since its original founding – investigate infectious diseases that threaten U.S. warfighters and seek to develop vaccines and treatments against them. But much has evolved in the ever-changing research and mission landscape.
Ongoing advances in technology and genetics, decades of work with partners and collaborators, major field research at four overseas stations, and increasing requirements from the military have led to more advanced science, methods, and techniques. There also are new areas of focus – HIV, the behavioral health of the force, and traumatic brain injury (TBI), among others – but the original goal of WRAIR namesake Maj. Walter Reed to conquer vector-borne infectious disease remains a top priority.
“WRAIR is famous for a one-of-a-kind malaria challenge model, where we take infected mosquitoes and, in a controlled fashion, have them bite volunteer subjects and give them malaria. The volunteers have either received a vaccine or malaria prophylaxis ahead of time, and we then can see what is effective and fully cure those where prevention didn’t work,” WRAIR commander Col. Steven Braverman said.
“Then we have several projects working on a vaccine for the dengue virus, including one covering all four subtypes and some in the process of being tested that work through a different mechanism, but all with the same purpose of preventing all types of dengue. So HIV, malaria, and dengue are our most high-profile disease research areas.”
“We have multiple projects related to the HIV vaccine that are follow-ups to the Thai RV144 trial that was shown to be partly efficacious a few years ago. Some look at what did work, what didn’t, how it worked, and so on.
“Then we have several projects working on a vaccine for the dengue virus, including one covering all four subtypes and some in the process of being tested that work through a different mechanism, but all with the same purpose of preventing all types of dengue. So HIV, malaria, and dengue are our most high-profile disease research areas. Another is trying to identify biomarkers in the bloodstream that are associated with TBI, so we can assist with diagnosis and treatment by identifying something in the blood that shows the injury occurred, how severe it is or if it is getting better.”
With respect to another of the more recent areas of concern, military psychology, some research is under way into developing an education or training program to increase resilience. In work centered at its U.S. Army Medical Research Unit-Europe, WRAIR is also studying soldiers and, in some cases, family members to determine the effects of long-term participation in war, small-unit leadership, effects of sleep and inactivity on performance and well-being, and sleep itself with the Army’s premier sleep lab.
“We have other products that are information and training, so we do research that informs policy or guides military medicine as to whether problems exist and if training can help,” Braverman added. “For example, we research what our soldiers may be enduring in current combat or the growth of antimicrobial resistance in our health care system. We have the capability to evolve as mission requirements evolve. For example, we’re doing research into TBI at a higher priority than it was before the war, especially developing ways to study concussion or mild TBI rather than penetrating models, such as we had in the past.
“The infectious disease side has more to do with prioritization, looking at known pathogens and threats to our soldiers in particular countries. As those change, we can change our priorities. For HIV, the subtypes differ between Africa and Asia and the type Americans generally have, so a vaccine that works for one may not work as well for another. If we have to, we could focus our research on one or another.
“Dengue also has different subtypes in Asia than in the Americas. The type of malaria parasite differs by region and different medications work on different parasites, and infection with those differing parasites causes different symptoms. Some [parasites] also have developed resistance to some of our drugs. There are only a few tools in the malaria prevention and treatment toolbox overall, and if a parasite develops resistance, we could have a real medical problem.”