These advances laid the groundwork for the complex network of military infectious disease research and development that exists today – a program of global reach that increasingly involves joint planning, coordination, and execution. The agencies and laboratories within this program are focused on infectious disease as an obstacle to military missions, but for reasons both strategic and humanitarian, are engaged in a growing number of international partnerships. The Cooperative Biological Engagement Program (CBEP), for example, conducted by the Defense Threat Reduction Agency (DTRA, the Department of Defense [DOD] agency devoted to countering weapons of mass destruction), is designed to prevent the proliferation of biological agents, in part by strengthening the detection, diagnostic, and reporting systems of partner nations.

At the time of the West African Ebola outbreak, U.S. military researchers had an established presence on the African continent, many of them attached to the infectious disease directorates of the Walter Reed Army Institute of Research (WRAIR) and the Naval Medical Research Center (NMRC) in Silver Spring, Maryland. Naval Medical Research Unit Number 3 (NMRU-3) had been monitoring infectious diseases in western Africa since 1946. Army researchers, most of them associated with WRAIR’s HIV research program, were working in Kenya, Uganda, Mozambique, and Tanzania; the first Ebola vaccine trial ever conducted in Africa was conducted by WRAIR’s HIV group in 2008 and 2009.

Building on vaccine research and development that began in 2010, the group also worked to identify the most promising candidates for vaccine research – one of which, the vaccine now known as VSV-EBOV, has proven to be the most promising candidate yet.

When Guinea’s Ministry of Health reported an outbreak of Ebola hemorrhagic fever in the region – 86 suspected cases, 59 of which proved fatal by March 24, 2014 – members of the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID, the Army’s main institution for research into countermeasures against biological warfare) had been supporting diagnostic capabilities at the Kenema Government Hospital in Sierra Leone, developing diagnostic procedures to detect Lassa virus, another causative agent of viral hemorrhagic fever. Because USAMRIID personnel had developed Ebola diagnostics after the 1995 Ebola outbreak in Kikwit, Zaire (now the Democratic Republic of the Congo), they were able to provide updated assays and diagnostics. These tests and the necessary equipment were delivered to medical personnel in afflicted countries through CBEP and the Critical Reagents Program, an initiative administered by DOD’s Medical Countermeasure Systems. A research team from the Navy’s Biological Defense Research Directorate (BDRD) began producing diagnostic assays – more than 100,000 total, by October 2014 – for use in Sierra Leone and Liberia. These tests, which definitively confirmed or ruled out the presence of Ebola virus, proved invaluable in focusing the efforts of health care workers and preventing further transmissions of the virus.

 

Operation United Assistance

The Ebola virus, transmitted through direct contact with infected blood or body fluids, causes severe hemorrhagic fever, and is considered a Risk Group 4 Pathogen by the World Health Organization. At the time of this writing, there is no proven treatment for Ebola virus disease, nor a field-ready vaccine, and its extreme fatality rate – as high as 70 percent in some areas; even among those who found their way to hospitals, more than half died – was the root cause of the panic that proliferated among West African countries in the summer of 2014.

Obama’s plan for West Africa included a detachment of 3,000 military personnel whose work would be coordinated by a DOD Ebola Working Group, established within the Office of the Assistant Secretary of Defense for Special Operations/Low-Intensity Conflict (SO/LIC). The JFC in Monrovia, eventually led by Maj. Gen. Gary Volesky, commander of the Army’s 101st Airborne Division, was set up to execute a mission that included command and control; engineering support (including the construction of a 25-bed hospital in Monrovia for international aid workers and 12 Ebola treatment units); medical support, focused on protecting the health of international responders (U.S. military medical personnel did not provide direct patient care); and sustainment of the expeditionary infrastructure.

At the same time, military infectious disease experts began to focus efforts on the Ebola virus itself.

USAMRIID experts began tracking the genome of the virus, to ensure diagnostics, experimental therapeutics, and vaccines would continue to target the right organism. According to Col. Neal Woollen, USAMRIID’s director of biosecurity, mobile teams of USAMRIID experts also spent 1,800 man-hours providing pre-deployment training to 4,000 personnel in the use of personal protective equipment (PPE) – clothing, masks, and other equipment designed to protect wearers from infection. In October, when the first case of Ebola virus disease was reported in the United States, USAMRIID experts provided similar training to the 30-member rapid-response team, composed of volunteers from the Army, Navy, and Air Force, formed by the Pentagon to support civilian health care workers.

The DOD’s Joint Program Executive Office for Chemical and Biological Defense (JPEO-CBD), normally tasked with developing diagnostics, drugs, and vaccines to protect U.S. military forces from chemical and biological agents, stepped up its existing programs in the development of Ebola treatments and vaccines. As Col. Russell Coleman, program manager for Medical Countermeasure Systems, explained, his group worked with commercial partners in the development and testing of therapeutic drugs specifically targeting the West African strain of Ebola. Building on vaccine research and development that began in 2010, the group also worked to identify the most promising candidates for vaccine research – one of which, the vaccine now known as VSV-EBOV, has proven to be the most promising candidate yet.