Astmh.org

American Society for Tropical Medicine and Hygiene
Tropical Disease and Military Preparedness
2008 Issue Brief

The American Society of Tropical Medicine and Hygiene (ASTMH) – the nation’s
leading professional organization for tropical medicine – represents 3,300 researchers
and clinicians engaged in the battle against infectious and tropical disease in the United
States and internationally. ASTMH promotes world health through research and
education to prevent and control tropical diseases.
As part of our efforts, we advocate implementation and funding of federal programs
that address the prevention and control infectious diseases that are leading causes of
death and disability in the developing world, and which pose threat to U.S. citizens.
Priority diseases include malaria, Dengue fever, Ebola, cholera, and tuberculosis.
For the 2nd Session of the 110th Congress (2008), our public policy efforts are focused
principally on issues related to malaria control. ASTMH supports and encourages
Congress and the Administration to expand funding for – and commitments to –
domestic, military, and international malaria control initiatives.

Tropical Disease Control and Prevention:
A Key Component to Military Preparedness
Servicemen and women deployed from the U.S. military are among a number of healthy adults traveling each year to malarial regions on behalf of the U.S. government. For this reason, the U.S. military has long taken a primary role in the development of anti-malarial drugs, and many of the most effective and widely used anti-malarials were developed by U.S. military researchers. Drugs that have saved countless lives throughout the world were originally developed by the U.S. military to protect troops serving in tropical regions during WWII, the Vietnam War, and the Korean War. Fortunately, in recent years the broader international community has stepped up its efforts to reduce the impact of malaria in the developing world, particularly by reducing childhood malaria mortality, and the U.S. military is playing an important role in this broad partnership. The U.S. military also makes significant contributions to the global effort to develop a malaria vaccine. Unfortunately, military malaria researchers are working practically alone in the area most directly related to U.S. national security: drugs designed to protect or treat healthy adults with no developed resistance to malaria who travel to regions endemic to the disease. These drugs benefit everyone living or traveling in the tropics, but are particularly essential to the U.S. for the protection of forces from disease during deployment. American Society for Tropical Medicine and Hygiene
Tropical Disease and Military Preparedness
2008 Issue Brief

Drugs are losing their effectiveness, and our ability to deploy to tropical regions is at
risk.
Unfortunately, the prophylaxis and treatments currently given to U.S. servicemen and
women are losing their effectiveness. During World War II, the Korean War, and
Vietnam, the quinine-based anti-malaria drug chloroquine was the chemoprophylaxis
and therapy of choice for the U.S. military. Over time, however, the malaria parasite
developed widespread resistance against choloroquine, making the drug less effective
at protecting deployed troops from malaria. Fortunately, military researchers at the
Walter Reed Army Institute of Research (WRAIR) performed the scientific
breakthroughs that led to the development of mefloquine, which quickly replaced
chloroquine as the military’s front-line drug against malaria.
Unfortunately, the malaria parasite has consistently demonstrated a frustrating ability
to become quickly resistant to new drugs, and the latest generation of medicines is no
exception. Malaria parasites in Southeast Asia have already developed significant
resistance to mefloquine, and resistant strains of the parasite have been identified in
West Africa and South America. Indeed, the most deadly variant of malaria –
Plasmodium falciparum – is believed by the World Health Organization to have become
resistant to “nearly all antimalarials in current use.” This resistance is not yet universal
among the global Plasmodium falciparum population, with parasites in a given
geographic area having developed resistance to some drugs and not others. But the
sheer speed with which the parasite has developed resistance to mefloquine – a drug
developed in the 1970s – reminds us that military malaria researchers cannot afford to
rest on their laurels. Developing new anti-malarials as quickly as the parasite becomes
resistant to existing drugs is an extraordinary challenge, and one that requires
significant resources.
Our inability to protect forces is not hypothetical: overseas operations are already
being impacted.
“Malaria has affected almost all military deployments since the
American Civil War and remains a severe and ongoing threat.”
From Battling Malaria: Strengthening the
U.S. Military Malaria Vaccine Program
Institute of Medicine Report, 2006

As the Institute of Medicine (IOM) cites in its 2006 report, current malaria prevention
strategies are inadequate. A 2007 study by Army researchers found that during the
period from 2000 to 2006, at least 423 U.S. service members contracted malaria while
American Society for Tropical Medicine and Hygiene
Tropical Disease and Military Preparedness
2008 Issue Brief

deployed overseas, with the vast majority of these cases the result of deployments to
South Korea (where malaria has recently remerged along the demilitarized zone with
North Korea), Afghanistan and, to a lesser extent, Iraq. Notably, none of these countries
is thought of by experts as especially dangerous in terms of malaria. This differs from
the countries of Sub-Saharan Africa and Southeast Asia where malaria is much more
prevalent, deadlier (because of the strains of the parasite that thrive there), and where
U.S. troops are at greater risk.
The consequence that inadequate prevention of malaria can have on a U.S. military
deployment was highlighted a few years ago during a peacekeeping operation in
Liberia in 2003. Of 157 Marines who spent at least one night ashore during this
operation, 80 contracted malaria and one-half of those troops had to be evacuated by air
to Germany, where many required intensive care.
In reviewing this matter, Department of Defense (DoD) investigations identified the
predominant cause as being a failure of soldiers to comply with actually taking the
prescribed regimen of drugs to prevent malaria. The problem was compounded by
wide-spread drug resistance in the predominant malaria parasite; such that there are
few effective drugs and several of these have appreciable troublesome side-effects.
Whenever troops are deployed in areas where drug resistance is of growing concern,
even full compliance with current drug protocols may not provide full protection
against malaria. In the Liberia case, the fact that compliance posed a challenge even
among individuals who had access to the best-available medications serves as further
evidence of the need to press on in the quest to develop a preventive measure for which
compliance is not an issue: a vaccine against malaria.
Despite this, the Department of Defense appears to be planning cuts to malaria
research programs

To ensure that as many American soldiers as possible are protected from tropical and
other diseases, Congress provides funding each year to support DoD programs focused
on the development of vaccines and drugs for priority infectious disease. To that end,
the Walter Reed Army Institute of Research and Naval Medical Research Center –
which are co-located in the Inouye Building in Silver Spring, Maryland – coordinate one
of the world’s premier tropical disease research programs. These entities contributed to
the development of the gold standard for experimental malaria immunization of
humans, and the most advanced and successful vaccine and drugs current being
deployed around the world.
American Society for Tropical Medicine and Hygiene
Tropical Disease and Military Preparedness
2008 Issue Brief
The need to develop new and improved malaria prophylaxis and treatment for U.S. service members is not yet a crisis, but it would quickly become one if the U.S. were to become involved in a large deployment to a country or region where malaria is endemic, especially sub-Saharan Africa. Fortunately, a relatively tiny amount of increased support for this program would restore the levels of research and development investment required to produce the drugs that will safeguard U.S. troops from malaria. In terms of the overall DoD budget, malaria research program’s funding is small – approximately $27.8 million in FY 2006 – but very important. Cutting funding for this program would deal a major blow to the military’s work to reduce the impact of malaria on soldiers and civilians alike, thereby undercutting both the safety of troops deployed to tropical climates, and the health of civilians in those regions. FY 2009 DoD Appropriations
ASTMH maintains that the battle against malaria requires funding for a comprehensive
approach to disease control including public health infrastructure improvements,
mosquito abatement initiatives, and increased availability of existing anti-malarial
drugs. In addition, research must continue in order to develop new anti-malarial drugs
and better diagnostics, and to identify an effective malaria vaccine. Much of this
important research currently is underway at the DoD. Additional funds and a greater
commitment from the federal government are necessary to make progress in malaria
prevention, treatment, and control.
In FY 2006, the DoD spent only $27.8 million annually for malaria vaccine research, this
despite the fact that malaria historically has been a leading cause of troop impairment
and continues to be a leading cause of death worldwide. A more substantial investment
will help to protect American soldiers and potentially save the lives of millions of
individuals around the world.
ASTMH calls upon Congress and the Administration to dedicate $30 million in the
FY 2009 Defense appropriations and authorization measures to support efforts to
develop a vaccine against malaria and for development of new anti-malarial drugs.
Further, ASTMH urges Congress and the Department of the Defense to ensure that
the next five year budget cycle (FY2010-FY2015) sustains investment in DoD malaria
research programs by providing additional funds over the next five years resulting in
$76.6 million in funding by FY2015.

Source: http://www.astmh.org/Content/NavigationMenu/Advocacy/2008_ASTMH__MilitaryPreparedness_FY_2009_Issue_Brief.pdf