National Academies Press: OpenBook
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×

BATTLING MALARIA

STRENGTHENING THE U.S. MILITARY MALARIA VACCINE PROGRAM

Patricia M. Graves, Myron M. Levine, Editors

Committee on U.S. Military Malaria Vaccine Research: A Program Review

Medical Follow-Up Agency

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×

THE NATIONAL ACADEMIES PRESS,

500 Fifth Street, N.W., Washington, DC 20001

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by Contract No. DAMD 17-99-1-9478 between the National Academy of Sciences and the Department of Defense. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

International Standard Book Number 0-309-10168-9

Additional copies of this report are available from the

National Academies Press,

500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu.

For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.

Copyright 2006 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America.

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×

“Knowing is not enough; we must apply.

Willing is not enough; we must do.”

—Goethe

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×

COMMITTEE ON U.S. MILITARY MALARIA VACCINE RESEARCH: A PROGRAM REVIEW

Myron M. Levine, (Chair) Director,

Center for Vaccine Development at the University of Maryland School of Medicine, Baltimore

Graham V. Brown, James Stewart Professor of Medicine at the University of Melbourne,

Australia

Michael F. Good, Director,

Queensland Institute of Medical Research (QIMR), Brisbane, Australia

David C. Kaslow, Chief Scientific Officer,

Vical Inc., San Diego, California

Margaret A. Liu, Vice-chair,

Transgene, Strasbourg, France, and

Visiting Professor at the Karolinska Institute in Stockholm,

Sweden

Gary J. Nabel, Director,

Vaccine Research Center at the National Institute of Allergy and Infectious Diseases, Bethesda, Maryland

Elizabeth Nardin, Associate Professor,

Division of Molecular Medicine, New York University School of Medicine

N. Regina Rabinovich, Director,

Infectious Diseases Division, Bill & Melinda Gates Foundation Global Health Program, Seattle, Washington

Alan R. Shaw, President and Chief Executive Officer,

VaxInnate, Cranbury, New Jersey

H. Kyle Webster, Distinguished military officer (retired) with 27 years experience primarily at the

Walter Reed Army Institute of Research

Kathryn C. Zoon, Director,

Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland

Staff

Patricia M. Graves, Consulting Scientist and Senior Editor

Frederick (Rick) Erdtmann, Director,

Medical Follow-up Agency

Reine Homawoo, Senior Program Assistant

Pamela Ramey McCray, Administrative Assistant

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×

This page intially left blank

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×

Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:


Walter E. Brandt, The PATH Malaria Vaccine Initiative, Bethesda, Maryland

Carter L. Diggs, Malaria Vaccine Development Program, United States Agency for International Development, Washington, D.C.

Elaine Esber, Merck Vaccine Division, Merck & Co., Inc., Blue Bell, Pennsylvania

Marie-Paul Kieny, Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland

Phil Russell, Professor Emeritus, Johns Hopkins Bloomberg School of Public Health, Plantation, Florida

Jerald C. Sadoff, Aeras Global TB Vaccine Foundation, Bethesda, Maryland

Allan J. Saul, Malaria Vaccine Development Unit, National Institutes of Health, Rockville, Maryland

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by Adel Mahmoud, M.D., Ph.D., president of Merck Vaccines, Merck & Co., Whitehouse Station, New Jersey. Appointed by the National Research Council and Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×

Preface

Malaria, the febrile illness caused by the protozoa Plasmodium falciparum, P. vivax, P. malariae, and P. ovale transmitted via the bites of infected female Anopheles mosquitoes, remains a cardinal endemic public health problem in much of the less developed world. Most fatal cases of malaria are caused by P. falciparum and occur in sub-Saharan Africa. Malaria also constitutes a significant threat for nonimmune travelers from industrialized countries who visit (even for short periods) developing world settings where malaria transmission is ongoing; such travelers include U.S. military personnel. For more than a century malaria has posed a serious threat to U.S. military personnel both in large-scale conflicts involving large numbers of troops deployed in endemic areas for extended periods (e.g., the Vietnam conflict) and in small-scale operations. Indeed, this risk was brought home starkly in 2003 when 80 of 290 members of a Marine expeditionary force deployed to Liberia (28 percent) developed P. falciparum malaria; 40 were so ill that they required evacuation, and several had to be admitted to intensive care. Regrettably, the increasing prevalence of drug-resistant Plasmodium strains makes chemoprophylaxis much less reliable.

Scientific and biotechnological breakthroughs in the 1970s and 1980s generated widespread optimism that malaria vaccines could become a reality in the foreseeable future to provide protection for troops prior to their deployment to high-risk areas. The military has somewhat special needs for a malaria vaccine compared to pediatric populations in endemic areas. Consequently, this has been one instance where the military research establishment has had to achieve a high degree of self-reliance,

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×

while nevertheless coordinating, wherever possible, with global malaria vaccine development efforts.

During the past two decades there have been two highly productive malaria vaccine research programs located within the Walter Reed Army Institute of Research (WRAIR) and the Naval Medical Research Center (NMRC). Whereas there has been considerable collaboration, cooperation, and sharing of resources and reagents by the highly committed and productive staffs of both programs, there has also been a considerable degree of duplication of core facilities, business and regulatory affairs units, and clinical trial processes. There have been divergence of strategies and sometimes direct competition (e.g., by partnering with different vaccine companies to attain access to similar viral vectors). Recognizing the great complexity and expense of the mission to develop a malaria vaccine for the U.S. military in an era of scarce resources, the Department of Defense (DoD) considered it a propitious moment to request the Institute of Medicine (IOM) to convene an expert committee to review all aspects of the DoD malaria vaccine research program. The relocation in 2000 of the WRAIR and NMRC programs to the same building has also provided an opportunity for collaboration and cooperation that did not exist when the programs were physically separate.

Within its overall remit, the committee was asked to identify barriers to achieving success and to make specific recommendations of how to overcome barriers, streamline the program, and improve chances for success. Towards this goal, the IOM convened a committee with experts in malaria biology, industrial and public-sector vaccine development, immunology, basic and clinical vaccinology, regulatory affairs, and knowledge of military preventive medicine, deployments, and procedures. The findings of the committee are summarized in this report. The report also contains a series of specific recommendations, which if followed, the committee believes, will significantly improve the likelihood of successful development and licensure of a first-generation malaria vaccine and will create a knowledge base to allow accelerated development of a subsequent second-generation malaria vaccine. The committee emphasized the need to overhaul the management structure of the DoD malaria vaccine enterprise to utilize existing resources in a more rational manner, and the need for a significant infusion of additional core support to the malaria vaccine development enterprise. If these fundamental changes can be implemented, the committee is optimistic that the mission of developing and licensing a safe and efficacious malaria vaccine for protecting U.S. military personnel can be accomplished.

Myron M. Levine

Chair

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×

Acknowledgments

Despite their considerable knowledge and experience, the members of this Institute of Medicine committee could not have completed their task without the cooperation of the USAMRMC and MIDRP staff, especially Dr. Moshe Shmuklarsky and COL David Vaughn, who responded quickly and helpfully on many occasions to requests for information and clarification. The scientific staffs of WRAIR and NMRC, under the leadership of COL Gray Heppner and CAPT Tom Richie, willingly and comprehensively shared their scientific results and plans openly with the committee during the first meeting and were responsive to later requests for further information or explanation. Thanks are also due to Dr. Filip Dubovsky who provided information on the global malaria vaccine effort. We are especially grateful to Hellen Gelband of the IOM for knowledgeable and constructive input to the report at all stages.

This study was managed, coordinated, and documented by Dr. Rick Erdtmann and myself with assistance from IOM staff members Reine Homawoo and Pamela Ramey-McCray. However, there were many other staff members at the National Academy of Sciences who assisted with this study, especially Bronwyn Schrecker, Clyde Behney, and Susanne Stoiber. Andrea Cohen kept us on track with our budget, Tyjen Tsai helped move the report through the production process, Kristen Gilbertson provided invaluable help with references and formatting the report, and Lois Joellenbeck gave useful advice. The copyeditor, Mark Goodin, did excel-

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×

lent and careful work. We also thank Katie Friedell of the Beckman Center in Irvine, Calfornia, for help with meeting arrangements. We are very grateful to all of these people for their efforts.

Patricia M. Graves, Ph.D.

Consulting Scientist

Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×
   

  

 

 

   

 Scientific Barriers to Malaria Vaccine Development,

 

32

   

 Insufficient Knowledge of Malaria Biology,

 

32

   

 Lack of Understanding of Protective Immunity,

 

32

   

 Inadequate Animal Models,

 

33

   

 Poor Definition of Outcomes,

 

33

   

 The Malaria Vaccine Technology Roadmap,

 

33

   

 Department of Defense Scientific Contributions to the Global Malaria Vaccine Research Effort,

 

35

   

 Status of Current Vaccine Candidates,

 

36

4

 

THE U.S. MILITARY MALARIA VACCINE RESEARCH AND DEVELOPMENT PROGRAM—SCIENTIFIC ASPECTS

 

41

   

 Malaria Threat,

 

41

   

 Department of Defense Mandate for a Malaria Vaccine,

 

42

   

 Malaria Vaccine Requirements,

 

42

   

 Clinical Trials to Test Efficacy of a First-Generation Malaria Vaccine,

 

44

   

 Current and Planned Scientific Program,

 

47

   

 RTS,S,

 

50

   

 Recombinant Proteins,

 

50

   

 Gene-Based Vaccines and Prime-Boost Approaches,

 

51

   

 Antigen Discovery Using Genomics and Proteomics,

 

52

   

 Attenuated Sporozoites,

 

52

   

 Planned Clinical Trials,

 

52

   

 Overall Assessment of Scientific Program,

 

52

5

 

ORGANIZATION AND MANAGEMENT OF THE PROGRAM

 

56

   

 Program Management,

 

56

   

 Project Management Structure,

 

58

   

 IRB Approval Process for Clinical Trials,

 

59

   

 Business and Intellectual Property Issues,

 

59

   

 Communication and Resource Sharing,

 

60

   

 Program Reorganization,

 

61

   

 Previous Reports Addressing DoD Vaccine Development and Acquisition,

 

63

   

 Human Resource Commitments,

 

65

   

 Financial Commitment,

 

67

 

 

REFERENCES

 

71

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×

This page intially left blank

Page xvii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×

Box, Figures, and Tables

BOX

S-1

 

Recommendations,

 

5

FIGURES

3-1

 

The malaria life cycle,

 

22

3-2

 

Current global P. falciparum vaccine development showing the developmental stage reached and the extent of MIDRP Malaria Vaccine Program involvement,

 

37

3-3

 

Results of randomized controlled trials of efficacy of RTS,S vaccine against new malaria infection, clinical malaria, and severe malaria,

 

39

5-1

 

Military infectious diseases research program working relationships,

 

57

5-2

 

Process of USAMRMC approval to conduct human subjects research,

 

60

5-3

 

WRAIR organizational elements involved in the malaria vaccine research and development program and key personnel (expressed in full-time equivalent) dedicated to the malaria vaccine effort,

 

66

5-4

 

NMRC organizational elements involved in the malaria vaccine research and development program and key personnel (expressed in full-time equivalent) dedicated to the malaria vaccine effort,

 

66

5-5

 

MIDRP funding for malaria vaccine research, 1994–2011 (projected),

 

68

Page xviii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×
   

TABLES

2-1

 

Major U.S. Military Actions, Deployments, or Overseas Exercises in Locations with a Malaria Threat,

 

14

2-2

 

Other Limited U.S. Military Actions/Deployments (Actual or Standby) in Locations with a Malaria Threat (1990 Onward),

 

16

2-3

 

Industry Benchmark Cost Estimates for Vaccine Production,

 

19

3-1

 

Malaria Vaccine Needs in Different Groups,

 

25

3-2

 

Top 10 Priority Initiatives for Malaria Vaccine Development According to the Malaria Vaccine Technology Roadmap,

 

34

4-1

 

Important Characteristics of a First-Generation Malaria Vaccine and a Later-Generation Ideal Vaccine,

 

43

4-2

 

Portfolio of Candidate Malaria Vaccines Under Development by the MIDRP Malaria Vaccine Program,

 

48

4-3

 

Current and Pending MIDRP Malaria Vaccine Program Clinical Trials,

 

53

5-1

 

Numbers of FTE Staff in Different Categories in United States and Overseas Labs,

 

67

A-1

 

Phase 1 Trials of Malaria Vaccines That Did Not (or Have Not Yet) Progressed to Phase 2,

 

82

A-2

 

Phase 2 Trials of Malaria Vaccines Using Experimental Challenge of Adult Volunteers from Nonendemic Areas,

 

84

A-3

 

Summarized Results of Randomized Phase 2 Human Malaria Vaccine Trials Using Natural Challenge Conducted to Date (December 2005),

 

87

B-1

 

Current Operational Requirements for a P. falciparum Malaria Vaccine,

 

95

G-1

 

Summary of the Top Report Findings and Recommendations by Deputy Secretary of Defense Focus Areas,

 

109

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×

Abbreviations and Acronyms

AFMIC Armed Forces Medical Intelligence Center

AFRIMS Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

AIBS American Institute of Biological Sciences

AMA apical membrane antigen

AVP acquisition of vaccine production

BMF biological master file

BUMED Bureau of Medicine and Surgery (U.S. Navy)

BWD biological warfare defense

CAPT captain

CDD capability development document

CDMRP congressionally directed medical research program

CG commanding general

CI confidence interval

COL colonel

CRADA cooperative research and development agreement

CSI congressional special interest

CSP circumsporozoite protein

DALY disability adjusted life years

DoD Department of Defense

EPA Environmental Protection Agency

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×

FDA Food and Drug Administration

FTE full-time equivalent

FY fiscal year

GEIS global emerging infections surveillance

GMP good manufacturing practice

GOCO government-owned, contractor-operated

GSK GlaxoSmithKline

HSRRB Human Subjects Research Review Committee

HURC Human Use Research Committee

IAA interagency agreement

ICGEB International Centre for Genetic Engineering and Biotechnology

IND investigational new drug

IRB institutional review board

JTF-MV Joint Task Force—Malaria Vaccine

LSA liver-stage antigen

MAJ major

ME-TRAP multiple epitope—thrombospondin-related adhesion protein

MIDRP Military Infectious Diseases Research Program

MPL monophosphoryl lipid A

MSP merozoite surface protein

MVA modified vaccinia Ankara

MVI Malaria Vaccine Initiative

NAMRU Naval Medical Research Unit

NIAID National Institute of Allergy and Infectious Diseases

NIH National Institutes of Health

NMRC Naval Medical Research Center

ONR Office of Naval Research

ORD operational requirements document

PfEMP P. falciparum erythrocyte membrane protein

POM program objective memorandum

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×

R&D research and development

RAP rhoptry-associated protein

RESA ring-infected erythrocyte surface antigen

SBIR Small Business Innovation Research

SBRI Seattle Biomedical Research Institute

SG surgeon general

SSP sporozoite surface protein

TRAP thrombospondin-related adhesion protein

USAID U.S. Agency for International Development

USAMMDA U.S. Army Medical Materiel Development Activity

USAMRAA U.S. Army Medical Research Acquisition Activity

USAMRIID U.S. Army Medical Research Institute for Infectious Diseases

USAMRMC U.S. Army Medical Research and Materiel Command

WHO World Health Organization

WRAIR Walter Reed Army Institute of Research

Page xxii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×

This page intially left blank

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×
Page R1
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×
Page R2
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×
Page R3
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×
Page R4
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×
Page R5
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×
Page R6
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×
Page R7
Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×
Page R8
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×
Page R9
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×
Page R10
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×
Page R11
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×
Page R12
Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×
Page R13
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×
Page R14
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×
Page R15
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×
Page R16
Page xvii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×
Page R17
Page xviii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×
Page R18
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×
Page R19
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×
Page R20
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×
Page R21
Page xxii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC: The National Academies Press. doi: 10.17226/11656.
×
Page R22
Next: Summary »
Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program Get This Book
×
Buy Paperback | $48.00 Buy Ebook | $38.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

Malaria is an infectious disease common to several parts of the world, including Africa, northern South America, and Asia. During their service in the military, U.S. active members may be sent to any part of the world, including parts of the world where Malaria is an issue. In Liberia in 2003, for example, there was a 28 percent attack rate in Marines who spent a short time ashore, and half of the 80 Marines affected needed to be evacuated to Germany. This was not only costly to the U.S. military but dangerous as well. To fight against this disease, there exists a Malaria Vaccine program in the U.S. military. However, there exists a variety of potential vaccine targets for the most severe and important form of malaria; malaria from the species Plasmodium falciparum. Issues also arise with the fact that there are three possible stages to create vaccines against—preerythrocytic, blood, or transmission.

The Department of Defense (DoD), through the commanding general of the U.S. Army Medical Research and Materiel Command (USAMRMC), requested that the Institute of Medicine (IOM) conduct a programmatic review of the military Plasmodium falciparum malaria vaccine research and development program. There was to be a focus on vaccine against the preerythrocytic and blood stages. The IOM formed a committee of 11 experts with collective expertise in malaria vaccine research, parasite immunology, malarial biology, clinical trials and regulatory affairs, industrial and public-sector vaccine development, biologic products research and development (vaccinology), military research and development programs, tropical medicine, and public health.

The committee focused different tasks including determining whether the DoD malaria vaccine research and development program is scientifically sound and able to achieve the vaccine program objectives within specified timelines, recommending how to overcome significant, identified barriers, and identifying major strategic goals and timelines based on the material received and presentations made by the DoD's program representatives. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program presents the committee's findings, current malaria vaccines, and recommendations for the development of the U.S. Military vaccine research.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!