in infectious diseases, including diarrheal disease, malaria vaccine and drug research, viral diseases (specifically, dengue fever and hepatitis), entomology and disease vector research, and retrovirology (including human immunodeficiency virus [HIV] infection/AIDS), existed long before the introduction of the Department of Defense (DoD) Global Emerging Infections Surveillance and Response System (GEIS). In some ways GEIS represents a new departure for AFRIMS, although in other ways GEIS is a natural extension of the field research that has been AFRIMS’s mainstay. For example, the GEIS malaria pillar complements ongoing surveillance for antimalarial drug resistance, whereas surveillance for acute febrile illness is a somewhat new area of involvement.

AFRIMS’s overall strategy integrates GEIS activities into traditional research streams to leverage AFRIMS resources and expertise already in place, to reduce program overhead costs, and to complement the activities of the Thai government. This integration results in more than 80 percent of GEIS funds being allocated to program implementation rather than overhead costs. In addition, this integration complements and reflects the activities of the Thai government.

AFRIMS’s annual budget ranges from $5 million to $7 million and is derived from multiple sources, including the Military Infectious Disease Research Program (MIDRP), HIV prevention and vaccine development programs, the U.S. National Institutes of Health (NIH), various biotechnology and pharmaceutical companies, and the World Health Organization (WHO). GEIS funding for fiscal year 2001, approximately $1,075,000 (GEIS, 2000c), complements these multiple sources of funding. GEIS funding was delayed in the first year of the program, and at the time of the subcommittee’s visit, GEIS was in its first full year of funding and many projects were just getting under way.

A subcommittee of the Institute of Medicine (IOM) Committee to Review the Department of Defense (DoD) Global Emerging Infections Surveillance and Response System visited AFRIMS from October 9 to 13, 2000. The IOM subcommittee consisted of committee members Ruth Berkelman, Donald Burke, and Ronald St. John. A list of the people met and interviewed and the itinerary followed can be found at the end of this chapter.

LABORATORY

AFRIMS has an extensive laboratory facility housed within a 191,000square-foot laboratory building and animal research unit (GEIS, 2000d). AFRIMS is jointly housed with and shares laboratory space with Royal Thai Army facilities. AFRIMS also occupies a large, modern, extremely well equipped veterinary medicine and animal facility that operates primarily at biosafety level 2. In addition, AFRIMS is linked to approxi-



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