Military ‘DNA’

This type of research “goes back to our very DNA as an organization,” says Michael, noting that the military has always been a public health organization, and that the search for an HIV vaccine must be understood in the context of modern public health.

“[Military] organizations put themselves in areas of the world that are resource-constrained -- sending citizens there and becoming part of the global community exposed to infectious pathogens outside our normal activities,” Michael explains. “As a consequence of that, controlling infectious diseases is very important for military operations.” The military has had a very long history of success in terms of developing vaccines that not only impact servicemember health, but global health as well, he says.

The U.S. Army was the first to make it clear to the world’s community the importance of looking at patients with ‘pre-AIDS’’ because it had a critical advantage: the ability to perform universal testing. When mandatory testing was conducted, the Army found hundreds of infected service members who had appeared to be quite healthy. “This demonstrated the long incubation period of HIV, which was a very important step,” says Michael.

How significant would a vaccine be for the military? According to the Armed Forces Health Surveillance Centers’ Medical Surveillance Monthly Report (MSMR), from 2008-2009 there have been over 650 new infections in the U.S. military. That number has been “creeping upward,” according to Michael, who says there are currently 1,500 active HIV-infected service members who are being treated in a military health program.

“This means there are 351 newly infected service members per year who can’t deploy and cannot be part of a walking blood pool,” says Michael. In addition, he notes, the military is looking at somewhere between $14,000-$35,000 a year, in 2002 costs, to treat each infected service member. Depending on whether or not they are on anti-retroviral drugs the total cost could be $10 million a year. And, since individuals can now live with HIV for 20 to 30 years, the total lifetime cost (in current dollars) is climbing toward $5 billion to $6 billion, a cost likely to be primarily borne by the VA.

For all those reasons and more --for example, infected service members can transmit the virus to other service members before they are diagnosed and treated -- the development of a vaccine is critical. “Even if you have effective therapies for diseases like malaria they still kill; millions of people are at risk,” says Michael. “At the end of the day we will need a vaccine for HIV.”