120 years of advances for military and public health
A boy in India is immunized against Japanese encephalitis. Photo courtesy of PATH/Julie Jacobson
Meanwhile, the military’s neuropsychiatric casualty terminology continued to evolve. What had been known, at least in part, as “nostalgia” during the Civil War; “shell shock” in World War I, and “combat exhaustion” in World War II was known by the mid-1970s as post-traumatic stress disorder, or PTSD. WRAIR and its associates at USAMRU-E continued to work on ways to maximize post-traumatic growth through coping skills and unit cohesion as troops undertook their most significant post-Vietnam deployments: to Saudi Arabia, Kuwait, and Iraq to fight the Persian Gulf War of 1990-1991. The abrupt, dramatic, and relatively bloodless end to the Cold War resulted in a massive demobilization of resources that completely reoriented the missions of the DoD. The Base Realignment and Closure (BRAC) process launched in 1988 relocated several WRAIR research programs and resulted in the reorganization of the USAMRDC into the USAMRMC. By the mid-1990s, the command had shed about a third of its research programs. BRAC, including the “Medical BRAC” of 2005, realigned and focused the work of WRAIR – but it remains the oldest, largest, and most diverse research program in the command, and the largest military medical laboratory in DoD.
A WRAIR for the 21st Century In 2001, WRAIR left its 60-year-old home in Building 40 and moved to newly built quarters on the Forest Glen Annex of the Walter Reed Army Medical Center near Silver Spring, Md. The
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new building, named in honor of the late Sen. Daniel K. Inouye, is co-located with the Naval Medical Research Center. As transformative as BRAC was for the Army’s military medical research, nothing would refocus the work of WRAIR as powerfully as the Global War on Terrorism that began on Sept. 11, 2001. America’s longest war has been, in the words of Smith, “a funny kind of war. There are no front lines – to a worse degree than Vietnam, where troops defined post-traumatic stress. We’ve had no choice but to recognize PTSD as a significant problem, now that we have an all-volunteer force who are worried about their careers, and we’re worried about their ability to continue working. We’re beginning to spend some real time and energy on these problems of traumatic stress and what we now call mild traumatic brain injury.” The influences of the wars in Iraq and Afghanistan are evident in WRAIR’s current organizational structure: Its work is now focused in two new research centers: the Center for Infectious Disease Research (CIDR), which continues to pursue the prevention, diagnosis, care, and treatment of a variety of endemic diseases; and the Center for Military Psychiatry and Neuroscience (CMPN), whose research emphases are post-traumatic stress, sleep management/resilience, and brain injury and neuroprotection. WRAIR researchers have followed the precedent set by its Vietnam teams, who collocated researchers in the field with warfighters; the institute’s Mental Health Advisory Teams (MHATs) have been instrumental in expanding troops’ access to mental health care and, ultimately, improving outcomes for returning veterans – who have been the first American warfighters to endure multiple yearlong deployments, over a conflict that has lasted more than a decade. “It’s the first time in our history we’ve dealt with this,” said Smith. “It’s really the first time anybody has dealt with it ... it’s a readiness problem, and WRAIR has been tasked to do something about it in the same way they were told to do something about malaria, which was reducing the readiness of the force in Vietnam. The purpose of the Army is to fight – so in Vietnam, WRAIR worked and built new drugs to keep people healthy while they were in a malaria zone. Now, we’ll build something to keep them resilient enough to fight through the kinds of stressors associated with these multiple deployments.” It’s gratifying when a WRAIR breakthrough proves valuable to the larger world: The vaccines developed or improved by its researchers have likely saved thousands, perhaps millions, of lives, and the solutions being developed today for warfighters – protecting them from disease; helping them become more resilient in the face of unprecedented service-related stress; and keeping them alert and ready to fight – will surely bring lifesaving or life-enhancing discoveries to a multitude of civilians. But the Army Medical School was established 120 years ago to serve the Army, and its descendant, WRAIR, shares that purpose, a fact that ensures it will continue to evolve as America’s national security concerns change – as they always have, and always will. “The people of WRAIR, civilians and military,” said Smith, “are not like university scientists, allowed to work on whatever they want to this week; they do what they are funded to do. WRAIR’s history has been made by those research commanders, staff officers to the surgeon general, working with ‘Big Army’ and DoD to shape what’s doable – and what ought to be done – with the medical research funding available, to make the Army as healthy as we can.”
A BRIEF HISTORY