In addition to Thailand, AFRIMS maintains permanent facilities in the Philippines and Nepal, in major metropolitan areas across the region and two permanent field sites in Cambodia, located outside metro areas and run by locals, often without 24/7 power.

“We are also actively engaged with military, government, or university partners in Mongolia and Vietnam, beginning some dialogue with China and, through the Thais to meet with military and civilian officials from Myanmar [Burma],” he added. “Infectious diseases are a major destabilizing issue with many nations. If you back up 50 years, all of the early research done for diseases in Thailand has led to improved public health here so we have expanded to [neighboring nations] where there are still endemic diseases of interest.

“Our primary mission is the development of infectious disease diagnostics, drugs, and vaccines for the military as well as the civilian populations. The first thing we generally do is surveillance, to find out where the diseases are and their prevalence. Based on that, we develop further research studies leading eventually to clinical trials. The U.S. Army contributed significantly to the development of all of the currently U.S. FDA-approved malaria drugs and much of that work happened at AFRIMS.”

AFRIMS conducts its research on top infectious disease priorities through seven science departments:

1. Enteric Disease – primarily studies the infectious causes of diarrhea. They partner with many host nation institutions and U.S. agencies such as NIH to conduct preclinical and clinical assessments of vaccine candidates and to understand the epidemiology of diarrheal diseases in the region.
2. Immunology and Medicine – is primarily engaged in the development of drugs and vaccines targeting malaria. With major field sites in Cambodia, they are partnering with the Royal Cambodian Armed Forces and the Cambodian National Malaria Control Program to monitor the emergence of malaria drug resistance and to assess malaria elimination strategies in rural Cambodia.
3. Virology –  studies flaviviruses such as dengue and respiratory pathogens such as influenza. Currently, this department is conducting Phase III clinical trials of a dengue vaccine in Thailand and the Philippines.
4. Retrovirology – is focused on developing an HIV vaccine. This department conducted the 16,000 subject Phase III vaccine study called RV144, which was the world’s first HIV vaccine to demonstrate efficacy. This study changed the entire field of HIV prevention. Currently they work with many collaborators to understand the immunology of protection and to develop the second-generation vaccine with higher levels of efficacy.
5. Entomology – is a support department that manages DoD’s largest insectary, breeding mosquito vectors for use in vector biology research and animal and human challenge models. They also collaborate with the Department of Agriculture on pesticide effectiveness and safety, vector surveillance, and dispersing equipment.
6. Veterinary Medicine – is another support department that maintains an AAALAC-accredited non-human primate research facility that is used to explore the pathophysiology of diseases and conduct pre-clinical animal studies of products.
7. Epidemiology and Disease Surveillance – is primarily responsible for coordinating infectious disease surveillance activities across 8 different countries in the region funded by DoD-GEIS. Led by a veterinary microbiologist, they also support zoonotic disease field research.

All AFRIMS projects are collaborations with militaries, universities, private institutions, governments, etc., which became more difficult due to travel restrictions under recent budget restrictions.

“That has been frustrating. Building relationships in Asia is extremely important, but slow developing. And if I’m engaging a collaboration running on generator power a few hours a day and can’t actually travel to meet with them personally, it can make things difficult,” he explained.

U.S. Army Medical Research Unit-Kenya

USAMRU-K is composed of 11 U.S. military officers, four locally engaged staff, and approximately 550 locally contracted personnel. In 1969, WRAIR was invited by the government of Kenya to perform research on trypanosomiasis in western Kenya. The success of this effort led to a cooperative agreement between USAMRU-K and the Kenya Medical Research Institute (KEMRI) in 1979 to conduct militarily and public health relevant infectious disease research and surveillance. KEMRI is the principal human medical research component of the Kenya government. The expanded mission includes developing and testing improved products for predicting, detecting, treating, and preventing infectious disease threats to deployed U.S. military personnel and the people of Kenya. USAMRU-K also provides HIV prevention, care, and treatment to Kenyan civilians and military through the PEPFAR program. Some other specific areas of USAMRU-K’s research and surveillance activities are: drugs and vaccines for malaria and other tropical diseases; drugs and vaccines for HIV; DoD-GEIS; medical entomology and vector biology; military-to-military medical engagement with the Kenya Ministry of Defense; Malaria Drug Resistance Laboratory; and Malaria Diagnostics Center.