Between World Wars I and II, the research mission of the MDPSS expanded to include the study of typhus and other rickettsial diseases, malaria, combat stress, chemical weapons countermeasures, battle wound treatment, and military dentistry. In 1933, the Army’s research board in Panama conducted the first American studies on the effectiveness of quinacrine, a synthetic quinine compound, as a prophylactic drug against malaria. During World War II, when Germany’s conquest of the Netherlands and Japan’s control of Indonesia cut Allied powers off from 97 percent of the world’s quinine production, quinacrine became the Army’s standard antimalarial agent, and remained so until the 1950s, when it was slowly replaced by chloroquine.

 

A Research Institute

In 1941, with soldiers and Marines once again fighting in the tropics, the MDPSS offered a 30-day Tropical Medicine Course, including both lecture and laboratory elements, to about 30 officers. This course – one of the institute’s longest-running programs – has evolved over the past 70 years, but remains one of WRAIR’s highest-profile products. The institute’s wartime work in tropical medicine – along with several other Army research advances during World War II, including new methods for collecting and shipping blood and refined diagnoses and nomenclature for combat stress-related disorders – helped convince Army leadership to emphasize the school’s research function. In 1947, it was accordingly renamed the Army Medical Department Research and Graduate School.

“By the mid-50s,” said Smith, “most of the education was taking place over in the hospital, with young physicians in residency. And what was left in the buildings that had been the Army Department Medical Research and Graduate School was now a research institute and reference center for non-routine hospital diagnostics, especially for viral and rickettsial diseases.”

In the early 20th century, the model for American medical education had been evolving, with the hospital – in the Army’s case, Walter Reed General Hospital – increasingly at the center of a surgical student’s learning experience. Dale C. Smith, Ph.D., a military medical historian at the Uniformed Services University of the Health Sciences, explained that the separation of medical instruction into the “professional” and “graduate” levels compelled the faculty in Building 40 to focus more on research, especially during World War II. “By the mid-50s,” said Smith, “most of the education was taking place over in the hospital, with young physicians in residency. And what was left in the buildings that had been the Army Department Medical Research and Graduate School was now a research institute and reference center for non-routine hospital diagnostics, especially for viral and rickettsial diseases.” This transformation was formalized in 1954, when the institute, its research work consolidated in Building 40, was renamed the Walter Reed Army Institute of Research.

The Korean War – the first armed conflict of the Cold War – had confronted the institute with several new realizations that led to the rapid development of WRAIR research programs in the 1950s and 1960s: First, soldiers there encountered a new disease called Korean hemorrhagic fever, one of the first known hantavirus diseases. “It was then that we realized,” said Smith, “that we had to do research on diseases all around the world.”

In many cases – especially among those who had been prisoners of war – soldiers in Korea also suffered a variety of psychological traumas. WRAIR responded deftly to these new challenges. While expanding its focus on infectious disease research, both stateside and in the U.S. Army Medical Research Unit-Malaysia, the institute also established a Division of Neuropsychiatry to investigate the Army’s ability to deal with soldiers’ psychological health.

The institute’s singular focus on research freed WRAIR scientists to become more expeditionary. The Armed Forces Research Institute of Medical Sciences (AFRIMS) in Bangkok, Thailand, a joint Thai-American military medical research partnership, was established in 1958 when WRAIR researchers assisted in the response to a cholera outbreak in Southeast Asia. More than a decade later, WRAIR scientists responded to an invitation from the Kenyan government to undertake research into trypanosomiasis, a protozoan parasitic disease afflicting Kenyans in the Lambwe Valley. Both AFRIMS, particularly the U.S. Army Medical Component (USAMC)-AFRIMS to define the American unit, and the U.S. Army Medical Research Unit-Kenya (USAMRU-K) continue to operate today; the USAMC-AFRIMS remains an active and productive joint installation, with programs in enteric diseases, malaria vaccine and drug research, viral diseases, entomology, and HIV/AIDS vaccine studies; while USAMRU-K, the only Department of Defense (DoD) infectious disease research installation in sub-Saharan Africa, investigates a variety of tropical diseases under a cooperative agreement with the Kenya Medical Research Institute.

“The work of WRAIR and the pharmaceutical industry, including the forerunner of Glaxo and Merck, for example,” said Smith, “gave us a host of vaccines against childhood diseases, including measles, mumps, rubella [MMR], chickenpox, [as well as] the adenovirus vaccine, hepatitis A and B [vaccines], the first and current Japanese encephalitis vaccine, and early pneumonia vaccine. As for Hilleman, Merck later hired him away to make all those vaccines available to American kids, and by the 1970s, you had a healthy, vaccinated all-volunteer Army that was simply not going to get sick with these diseases – with the glaring exception of malaria.”

In 1958, WRAIR opened its Department of Biologics Research (later named the Pilot Production Facility) and began manufacturing vaccines and biological products for use in clinical trials that would result in the protection of soldiers against diseases they might encounter in areas of deployment. The next few decades were a remarkably fruitful period for WRAIR vaccinologists, including Maurice Hilleman, who led the institute’s respiratory diseases department and developed or improved more than 25 vaccines in his career – including nine of the 14 now recommended for children.

“The work of WRAIR and the pharmaceutical industry, including the forerunner of Glaxo and Merck, for example,” said Smith, “gave us a host of vaccines against childhood diseases, including measles, mumps, rubella [MMR], chickenpox, [as well as] the adenovirus vaccine, hepatitis A and B [vaccines], the first and current Japanese encephalitis vaccine, and early pneumonia vaccine. As for Hilleman, Merck later hired him away to make all those vaccines available to American kids, and by the 1970s, you had a healthy, vaccinated all-volunteer Army that was simply not going to get sick with these diseases – with the glaring exception of malaria.” Dr. Leonard Binn, who worked with Hilleman and still volunteers at WRAIR today, fondly remembers the tremendous successes of the mid to late 20th century. In 1985, Binn, Dr. Kenneth Eckels, and colleagues tested an effective hepatitis A vaccine formulation, with Col. Bruce Innis and other WRAIR scientists conducting efficacy studies in Thai children in 1991, resulting in the successful 1996 U.S. licensing of the first ever hepatitis A vaccine.