Recommendation 5.7: A workforce plan must be developed and implemented by the JTF-MV. This plan should include training and budgeting for the next generation of scientists in the military program, ways to improve recruitment and retention of civilians and foreign nationals, and succession planning to ensure availability of required staff in 5–10 years time. The DoD should respond to the lack of sufficient depth of human resources to carry through current objectives with increased resources to carry out the workforce plan.

Recommendation 5.8: Sufficient funding should be made available to support the infrastructure to produce pilot-lot formulations of MIDRP malaria vaccine candidates in-house at the pilot production plant at Forest Glen (an invaluable part of the MIDRP Malaria Vaccine Program). Although pilot lots of all candidate vaccines cannot be made at Forest Glen, the ability to prepare certain candidates removes a major obstacle that would otherwise impede the program.

Recommendation 5.9: A formal economic analysis would be helpful in order to clarify current costs of malaria (both P. falciparum and P. vivax) prevention, treatment, and case management. This economic analysis would reveal the direct (monetary) and indirect (lost work time) costs that would be averted by both a first-generation vaccine (to be used in conjunction with chemoprophylaxis) and a second-generation vaccine (to replace chemoprophylaxis).

Recommendation 5.10: Given that malaria remains a major problem for U.S. military personnel deployed to endemic areas and this threat is not diminishing in importance with time, the MIDRP program to develop a malaria vaccine compatible with the needs for protecting U.S. military personnel should be fully supported. To increase the likelihood of achieving the current goals for a first-generation vaccine and to test the limited number of vaccine candidates described above will almost certainly require a several-fold increase in the current malaria vaccine development budget by 2010, with continuation at that level to at least 2015.