The U.S. military’s contributions to global health and the HIV response might not be well publicized, but advocates tried to change that Friday by hosting a Capitol Hill briefing touting the accomplishments of the Walter Reed Army Institute of Research (WRAIR) Military HIV Research Program (MHRP) – a $175 million program supported by the Department of Defense and other entities that is vulnerable to cuts in the fiscal year 2012 funding battle currently taking place on the Hill.
The relatively small program’s “claim to fame” is its instrumental role in the development of a globally effective HIV-1 vaccine. In 2009 the MHRP-sponsored clinical trial RV-144 demonstrated that an HIV vaccine is possible reducing the rate of HIV infection of those in the trial by about 31 percent. This fall they identified two important molecular clues from the trial – antibodies whose presence either increases or decreases the risk in HIV infection.
“These represent a crucial step forward in the quest for an HIV vaccine,” said Chris Collins, vice president and director of public policy at the Foundation for AIDS Research (amfAR). The Center for Global Health Policy joined amfAR and AVAC to host Friday’s briefing, which included a panel discussion with several former and current MHRP officials.
“This is an example of where a small investment has a huge, huge impact,” Collins said.
Col. Nelson Michael, head of the MHRP, said there are several follow-up studies to RV-144 that are in progress. Since the early effect of the vaccine (12 months after inoculation) showed a nearly 60 percent protective benefit, clearly the immune responses waned by the end of the trial period, Michael said. They are currently investigating whether adding a “boost” at the end of the 12-month period would extend and increase the immune response among men who have sex with men in Thailand and high-risk heterosexual men and women in sub-Saharan Africa.
Outside of the research headquarters in Rockville, MD, the MHRP has research stations in Kenya, Nigeria, Uganda, Tanzania, Thailand and Mozambique. The U.S. military researchers at these centers have contributed to the development of eight U.S. licensed vaccines, Michael said. The U.S. Congress mandated the formation of MHRP in 1986 to protect military personnel and serve the global community. Tasked with tracking the HIV epidemic in active duty forces and assessing the risk of HIV exposure to U.S. and allied forces deployed overseas, the MHRP conducts targeted HIV surveillance and oversees all HIV testing for the military. Since 2004, the MHRP has been supporting the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program, complementing its vaccine and clinical research portfolio by serving as a major provider of HIV prevention, care and treatment in the communities where its facilities are nested.
“Currently more than 100,000 Africans are receiving [antiretroviral] therapy as a consequence of MHRP,” Michael said, adding that approximately a quarter of Tanzanian citizens receiving care through PEPFAR are receiving it through MHRP.
The program’s relatively small budget is made up of a $28 million investment from the Department of Defense budget, and $147 million in other funding, the bulk of which is from PEPFAR and additional vaccine research resources from the National Institute of Allergies and Infectious Diseases (NIAID) the at the National Institutes of Health.
“They train people, they leave instrumentation and they leave capacity behind. They understand the importance of research and the importance of community taken together,” said Dr. Debbie Birx of the U.S. Centers for Disease Control and Prevention (CDC). She listed some of the other myriad accomplishments of the program: their innovative and “incredibly cost-effective” field operations; the early observations from MHRP research that showed HIV prevalence was so much higher among women in sub-Saharan Africa, especially in the 25-29 age group; and their trial early on that demonstrated the efficacy of voluntary medical male circumcision in HIV prevention that brought attention to the intervention that is more than 60 percent effective in protecting men from HIV during vaginal sex. Many of the gains made in taking the PEPFAR program to scale are thanks to programs such as MHRP, she said. Last year, 34 million people were tested for HIV through PEPFAR, Birx said, 9 million of them were pregnant women.
“These are teams that build capacity in country… [It’s] a program to be applauded both for the unique place they play within HIV research but also for the unique part they play within PEPFAR,” Birx said.
“It is hard to imagine a federally funded program that does so much with so little,” said Christine Lubinski, head of the Center for Global Health Policy and vice president of Global Health at the Infectious Diseases Society of America, visited the MHRP research site in Kericho, Kenya with Congressional staff members in August, to show them examples of tax payer dollars at work combating HIV in Africa. “This program saves lives today through its role in PEPFAR and is working to save the lives of millions more in the years ahead through its vaccine research. And it builds extraordinary good will. We talked to many people in Kericho receiving care through the MHRP Center. They all told us that Walter Reed had saved their lives.”
“For us, the importance of continuing this program is how intricately research is tied to the prevention, care and treatment work,” said Dr. Fred Sawe of the WRAIR, who works with the PEPFAR program in Kenya. “Without it, the rest will not work as well. We will risk losing the gains that we have made on all other fronts.”