Walter Reed And Military Medicine's Long War Against Malaria The Walter Reed Army Medical Center is famous for treating both presidents and soldiers. But the institution is also a longtime leader in the fight to develop vaccines, including one against malaria — something many thought wasn't possible. That vaccine is currently in a large-scale human trial in Africa.

Military Medicine's Long War Against Malaria

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From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.


And I'm Melissa Block.


BLOCK: This past Saturday, the flags were lowered in front of Walter Reed Army Medical Center after the last patients were transferred out. This week, we're talking about the closing of the iconic Army hospital here in Washington, where presidents and war-wounded troops have received care for more than a century.

SIEGEL: Today, we look at one legacy of Walter Reed that most people don't know about. It's one of the world's premier research centers for infectious diseases, and that research continues even as the medical center is closing.

BLOCK: One major focus is on malaria. The disease kills nearly 800,000 people each year, mostly children in sub-Saharan Africa. It's also a big problem for soldiers deployed to many parts of the world. NPR's Richard Knox takes us inside the malaria labs at the Walter Reed Army Institute for Research.

CHRISTIAN OCKENHOUSE: So it's one, two, three, four...

RICHARD KNOX: We're in a high-security lab of the Walter Reed Institute outside Washington, D.C. Colonel Christian Ockenhouse is showing off the military's huge colony of mosquitoes. They transmit malaria to people.

OCKENHOUSE: We're going through a number of doors for security purposes, so we don't allow mosquitoes to escape.

KNOX: Mosquitoes have been important at Walter Reed from the beginning or, really, before the beginning. Long before the medical center opened, Major Walter Reed showed in 1900 that mosquitoes transmit yellow fever. Controlling mosquitoes conquered yellow fever. That was not only a boon for American soldiers. It enabled workmen to complete the Panama Canal.

OCKENHOUSE: You're going to hear, as we go through this door, a large whoosh sound.


KNOX: If there are any renegade mosquitoes flying around in here, they won't get through that curtain of air.

OCKENHOUSE: OK, now we're in the main body of the insectary...

KNOX: The insectary is basically an insect factory. It produces millions of mosquitoes each year, like these.


KNOX: Major Jittawadee Murphy is an insect specialist. She shows me a bucket full of hundreds of freshly hatched mosquitoes.

JITTAWADEE MURPHY: All right, so see this one here? That's a female. That's a male.

KNOX: Only the females bite. So Murphy shows me how she separates the girls from the boys for her research.

MURPHY: See, the males are briefly - the males are always skinnier. The males are - the females are stockier. And look at the antennae. The males have feathery antennae. But the females have no feather.

KNOX: You're right.

MURPHY: A little bit of feather, but - and if you look closer, look at the mouth part.


MURPHY: Look at the female's mouth. It's sticking out like a needle. It's called proboscis. That stab through your skin, into your blood.

KNOX: I think I can see it as long as they hold still. So that is a female.

MURPHY: Yes. And this is what?

KNOX: Oh, that looks like a male.


KNOX: But Major Murphy doesn't have to separate the mosquitoes one by one. Females are attracted to heat, so she simply places the bucket next to a hot plate.

MURPHY: And that side of bucket is hot now. So all the gals, all the female mosquitoes go and sit on that side of the bucket.

KNOX: Where Murphy can suck them up with a straw.


KNOX: Army scientists then infect these female bugs with Plasmodium falciparum, the deadliest kind of malaria. Colonel Ockenhouse says it's an exacting and gory process.

OCKENHOUSE: Now we're going to go into the area where we're going to feed the mosquitoes on cultured blood.

KNOX: It has to be human blood. It's served up on trays kept at body temperature.

OCKENHOUSE: This is how the mosquitoes become infected with the malaria parasite. And you could see the mosquitoes just having a great time.

KNOX: Malaria has always been a problem for soldiers. Roman legions had to contend with it, so did George Washington's troops. Civil War battles were won and lost because of it. And it was a huge problem in the South Pacific during World War II. Dale Smith, a military medical historian, recalls General Douglas MacArthur complaining to the Army's chief malaria expert.

DALE SMITH: General MacArthur argued that: Doctor, it's going to be a very long war if for every division I have facing the enemy, I have one sick in hospital and another recovering from this dreadful disease.

KNOX: Smith says the military counted more than a half-million cases of malaria during the war.

SMITH: Malaria is a troop waster.

KNOX: The Japanese controlled the world's supply of quinine, the standard anti-malarial drug of the day. So the Americans muddled through with a drug called Atabrine, but it wasn't a great drug. It famously turned soldiers' skin and eyes yellow, and it had other side effects. So Walter Reed scientists launched a successful effort to find new malaria drugs. It was the biggest campaign ever to find new drugs. Then the war ended.

ALAN MAGILL: By early 1946, the entire anti-malarial drug development program was discontinued.

KNOX: That's Dr. Alan Magill, a retired Army colonel and malaria expert.

MAGILL: People went home. They went back to their jobs. And like someone turned a light switch, that program ended.

KNOX: Malaria was a bit of a problem in Korea. But it came roaring back as a major military headache in the Vietnam era.


UNIDENTIFIED MAN: Three months ago, the 1st Air Cavalry Division shipped out from Charleston, South Carolina. They were destined for the high country of central Vietnam. Last week, some of them came home. Their lives were the price of victory in the Battle of Ia Drang Valley.

KNOX: The Battle of Ia Drang Valley in 1965 was the first big clash between the U.S. and North Vietnamese. For both sides, malaria was almost as big an adversary as the enemy soldiers. By then, Army medics had a drug called chloroquine. That was introduced in 1947. But Magill says by the mid-'60s, malaria parasites in Southeast Asia had grown resistant to the drug.

MAGILL: We literally introduced a half a million Americans into Vietnam facing chloroquine-resistant falciparum malaria. And, of course, all we had was chloroquine.

KNOX: Walter Reed scientists came to the rescue. Another crash campaign produced a whole slew of new anti-malaria drugs, something drug companies weren't eager to do. And that's no less important today, because the malaria parasite has developed resistance against every new drug scientists have thrown at it. And now, malaria's developing resistance to the current last bastion against the parasite, a class of drugs called artemisinins that come from a Chinese herb. Alan Magill says that's alarming.

MAGILL: If we were to lose that class of drugs, we don't have an obvious candidate for a backup.

KNOX: And that's increased the urgency to develop the ultimate weapon against malaria: an effective vaccine. Many said it would never be possible. But back in the 1980s, Walter Reed researchers produced the first glimmer that a vaccine against malaria could work. That launched several decades of dogged research that continues today with the help of volunteers who are willing to risk getting malaria to test each new experimental vaccine. Army Specialist Navdeep Saini is one of those guinea pigs.

NAVDEEP SAINI: I'm originally from India. Northern India, it's called Punjab. And I traveled a lot around the world. I have seen a lot of people suffering, having this malaria. And I have seen a lot of kids dying from this disease. So that was a big motivator to participate, help science and help those people back home.

KNOX: Once again, the research has paid off. A vaccine that came out of Walter Reed is now in the final stages of a human trial involving 16,000 children throughout sub-Saharan Africa. It's the first malaria vaccine ever to reach this advanced stage. So far, it's looking good. It may be 40 to 50 percent effective in preventing malaria, and that's good enough to save millions of lives. Richard Knox, NPR News.

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