Active-duty medical researchers are essential to maintaining U.S. naval superiority. As long as outbreaks and chemical, biological, radiological, and nuclear incidents remain threats, the Department of the Navy (DoN) should retain medical research capabilities within the active-duty population.
Some might ask why medical researchers are needed in the military health system when relying on nonuniformed researchers could lower costs and improve efficiency. However, these purported advantages of outsourcing are tempting but ill-advised. The COVID-19 pandemic demonstrated the military’s unique needs and the role only active-duty researchers can play in addressing them.
Population specific
One difficulty with using non-active-duty organizations such as contractors or academia to execute research is ensuring their findings are generalizable to the active-duty force—including similar demographics and risk factors—and therefore appropriate for informing military health-protection strategies.
Even early in the pandemic, the variable effect of age on the transmission and control of COVID-19 was apparent.1 DoN could not rely on information obtained from cohorts primarily composed of older Americans with comorbidities to inform policies for its young and mainly healthy population.
In addition, civilian settings in which young, healthy adults share living and work spaces, such as schools and sports teams, could temporarily close or pause operations to mitigate the spread of infection. The military could not. Recruiting, training, and operations necessary for national security had to continue. When schools closed in the spring of 2020, the naval services could not rely on the civilian sector to research the transmission, epidemiology, and immunology of COVID-19 among young adults and apply those lessons to the military setting. Outside organizations could not initiate a study with enough statistical power and similar demographic profile to meaningfully represent active-duty service members.
Instead, DoN needed to develop its own cohort to understand how a novel virus is transmitted within a military environment.2 Its subsequent research helped inform not only military health but also civilian public health practices concerning shared living situations, especially for young adults.3 Because closing locations where people gather is likely to be a common strategy to prevent the spread of future infectious diseases, especially respiratory threats, the department needs to remain prepared to stand up its own military-specific research when required.
Operationally focused
Active-duty researchers have a mission-first mindset, free from other potential conflicting motivators such as future grants or funding. They understand the challenges inherent in conducting research in a military setting, including minimizing interference with operational tempo and sympathizing with participants’ concerns. They have shared experiences—such as initial military training and working in the same locations—and similar stressors as potential study participants and the base officials responsible for setting public health policy. These commonalities foster trust.
Active-duty military medical researchers also are able to develop military-relevant protocols quickly when time is of the essence: navigating the regulatory process, obtaining approvals from various commands, designing studies to answer relevant questions, and ensuring data are reviewed by public health officers and line leaders. During the COVID-19 pandemic, for example, the DoN active-duty research component helped protect the force by conducting key research, such as examining reinfection and helping to describe a correlate of protection.4
Navy and Marine Corps scientists and support staff are trained to perform field research, which often includes working in austere environments. This requires different skills from those taught in school and practiced in the civilian sector. Only through training, practice, and execution can a researcher become adept at skills essential for successful field research, including participant recruitment and enrollment; sample acquisition, accessioning, processing, freezing, and shipping; and quality control and assessment in suboptimal conditions.
Active-duty medical researchers are experts in technical improvisation. When needed material is not present, they find acceptable solutions that meet mission requirements and scientific integrity and validity. In addition, each receives training in leadership, teamwork, and Navy core values that is key to successful field operations.
Complementing these officers is a cadre of active-duty enlisted research personnel experienced in operational improvisation. With a broad set of skills including phlebotomy, laboratory safety and techniques, sample processing, cataloging, and acquisition, enlisted personnel are the backbone of medical research studies. An established chain of command and standard operating procedures allow them to establish operations and designate tasks quickly.
Logistically ready
Military researchers use a network of facilities around the world to support what is perhaps the greatest obstacle to field research: logistics. This is the process of procuring matériel, getting it where it needs to be, properly storing it, and ensuring it is operational when and where it is deployed. Simply put, logistics can spell the difference between success and failure in medical research operations.
The COVID-19 pandemic exposed the flaws in current systems, including near-universal shortages of viral transport mediums, personal protective equipment, and nasopharyngeal swabs.5 However, the Department of Defense (DoD) was able to use its diverse supply chains and network of manufacturers to obtain needed materials to support clinical care and research. DoD is one of a handful of organizations with the means, technical experience, and training to move large amounts of equipment almost anywhere in the world to support a mission. Enlisted medical researchers use their knowledge of logistics and DoD supply chains to deliver materials where needed, even during shortages such as those caused by the pandemic.
Few academic or contract organizations have access to an appropriate cohort or the logistic capability, training, organizational structure, and worldwide deployable staff to conduct a research study during an outbreak or pandemic. The Department of the Navy needs to maintain its research officers and enlisted personnel and sustain their skills in the operational environment to meet ongoing and future research requirements and capabilities. Like organic medical care teams, uniformed medical researchers are critical enablers to the Navy and Marine Corps warfighting mission. To outsource the expertise they bring to the fight is to create unacceptable risk to the force and to the mission itself.
1. Nicholas G. Davies et al., “Age-dependent Effects in the Transmission and Control of COVID-19 Epidemics,” Nature Medicine 26 (August 2020).
2. Andrew G. Letizia et al., “SARS-CoV-2 Transmission among Marine Recruits during Quarantine,” The New England Journal of Medicine 383, no. 25 (December 2020).
3. Nelson L. Michael, “SARS-CoV-2 in the U.S. Military—Lessons for Civil Society,” editorial, The New England Journal of Medicine 383, no. 25 (December 2020).
4. Andrew G. Letizia et al., “SARS-CoV-2 Seropositivity and Subsequent Infection Risk in Healthy Young Adults: A Prospective Cohort Study,” The Lancet Respiratory Medicine 9, no. 7 (July 2021).
5. Megan L. Ranney, Valerie Griffeth, and Ashish K. Jha, “Critical Supply Shortages—The Need for Ventilators and Personal Protective Equipment during the COVID-19 Pandemic,” The New England Journal of Medicine 382, no. 18 (April 2020).
