MIDRP Focuses on Mitigating Disease Impacts in Large-Scale Combat Operations

Story by Paul Lagasse

Medical Research and Development Command

FORT DETRICK, Md. – Prolonged care, degraded MEDEVAC capability and overstretched lines of communication during large-scale combat operations could increase the prevalence of disease-related injury and death among Warfighters, risks that the U.S. Army Medical Research and Development Command’s Military Infectious Diseases Research Program is working hard to mitigate.

In his presentation on disease and non-battle injury threats to the Joint Force during LSCO at the second annual Army Medical Center of Excellence Medical Warfighting Forum, held Sept. 4-6 at Joint Base San Antonio-Lackland Air Force Base, Texas, MIDRP Director Col. Christian Hofer explained that infectious disease has been the single largest cause of hospitalization of U.S. Warfighters in theater conflicts, representing an average of nearly 60% of casualties in Korea, Vietnam, the Persian Gulf and Operations Iraqi Freedom and Enduring Freedom. Nearly two-thirds of Ukrainian casualties in the current conflict with Russia are the result of disease.

“MIDRP’s role is to develop solutions to prevent, diagnose and treat infectious disease and wound infection threats across all roles of care,” says Hofer, who manages the infectious disease science and technology portfolio. “We measure our success by being able to maintain combat power, keeping the Warfighters in competition or getting them back as quickly as possible if they do fall out due to disease.”

MIDRP’s efforts are focused on increasing patient survivability in a prolonged care environment and reducing the logistical burden to the Military Health System, which will result in faster patient recovery, fewer lost duty days, reduced health care and training expenses and lower mortality rates.

To counter the significant threat to operational effectiveness posed by infectious diseases such as mpox and dengue fever, the national military strategy emphasizes a multi-pronged approach that includes surveillance, prevention, diagnosis and treatment. MIDRP supports this approach by investing in biomedical innovation aimed at maintaining the health of the Joint Force both globally and in key regions. It accomplishes this by partnering with other DOD laboratories, federal agencies and private partners to conduct research and development of medical products that address Army and Joint Force requirements.

“The DOD invests in infectious diseases because we have a very specific military use case,” says Hofer. “We may be going after specific solutions that pharmaceutical companies and academia would not necessarily go after because those solutions don’t meet a market demand.”

For example, Hofer says, the DOD might decide to invest in the development of a medicine that is highly effective but that only provides protection for a short time, which makes it less attractive for commercial drug developers to invest in.

“Even though infectious disease of all types is really a global concern, the military may have very specific needs because of the way we employ medical countermeasure solutions,” says Hofer. “We work with pharmaceutical manufacturers and academia to buy down their risk, and in exchange we get strong partners who help us get the products we need onto the shelves and to the Service Members who need them.”

Every three years, MIDRP sponsors an Infectious Disease Threat Prioritization Panel to develop a prioritized list of infectious disease agents based on the risk they pose to the Joint Force. Participants in the TPP include representatives from the combatant commands, the Joint Staff Surgeon’s Office, experts in disease surveillance and pest management, and medical product manufacturers. The panel members review infectious diseases identified by the National Center for Medical Intelligence and submitted by each of the combatant commands and vote on a prioritized list of pathogens that are categorized as either high, moderate or low risk. The Defense Health Agency Military Infectious Disease Portfolio uses this list as one of several tools to determine the investment strategy for S&T development as laid out in its Strategic Research Plan for Military Infectious Diseases.

Hofer explained that it’s important to revisit the prioritization list regularly because infectious disease threats change over time as a result of changes to ecological conditions, operational areas and countermeasure availability and effectiveness.

“We’re constantly revisiting what we’re focusing on, but we have to also be cautious in how quickly we try to pivot to the next threat because it may go away on its own,” notes Hofer.

The pivot to LSCO has brought a renewed focus on the prevention, prediction and treatment of combat wound infections, including multi-drug resistant infections, across the continuum of care. In addition to focusing on protecting wounds from infection through the use of foams, hydrogels and matrices impregnated with antibiotics, MIDRP researchers are also looking at developing a range of non-antibiotic treatments, improved wound irrigation techniques and improved protection against hospital-acquired infections. MIDRP is also actively collaborating with MRDC’s Combat Casualty Care Research Program to develop clinical studies to assess the effectiveness of antibiotics currently used in the field.

“We’re trying to get after solutions that are targeted not only to the threats we’re facing today, but also to the next unknown threat,” says Hofer “We want to make sure that we are utilizing technology not only to develop the next best mousetrap, but to shake up the world and address the problems we’ll be facing tomorrow.”