Naval Medical Research Unit-2 focuses on building capacity among international partners, which has become more important than ever in the aftermath of the COVID-19 pandemic. In support of the Military Health System, their efforts in sharing information and assets have been vital to fight disease and find treatments.

Embedded in the U.S. Embassy in Singapore, “NAMRU-2 is the Navy’s forward research and development unit, primarily focused on infectious disease threats in Southeast Asia and Oceania,” said U.S. Navy Capt. Tammy Services, executive officer of NAMRU-2.

“NAMRU-2’s mission is to monitor and characterize emerging and re-emerging infectious diseases of military and public health importance, and to develop mitigation strategies against these threats in partnership with host nations, international, and local agencies in Southeast Asia,” said U.S. Navy Cmdr. Andrew Letizia, science director of NAMRU-2. “They help to increase readiness and enhance global health security through cooperative engagements, promoting capacity and capability to prevent, detect, and mitigate infectious disease threats.”

NAMRU-2 studies infectious diseases, animal hosts or reservoirs, environmental influences, and vectors of transmission in the Asian and Pacific regions. It is one of several military units in the Armed Forces Health Surveillance Division’s Global Emerging Infections Surveillance partner network, which reaches more than 70 countries worldwide. The international work of GEIS supports force health protection while enhancing global health security through prevention, detection, and response to infectious disease threats.

“Our focus is to fill in gaps of knowledge about those diseases that could pose threats to U.S. and partner nation civilian or military forces in the area,” Servies said.

Currently, NAMRU-2 is focused on collaborations in Southeast Asia and Oceania and studies with military populations across the U.S. Indo-Pacific Command area.

NAMRU-2 Outreach and Engagement in Southeast Asia

NAMRU-2 was established during World War II under the Rockefeller Foundation to study infectious diseases of potential military significance in Asia. The unit works with partner governments and agencies across the Indo-Pacific Command region.

Global health engagement activities build trust, share information, maintain influence, build capacity with partners, and strengthen U.S. national security, according to the Department of Defense.

“While GHE is not the foundational mission of NAMRU-2, by virtue of working with a diverse array of international partners, ranging from ministries of health and defense to university researchers, there is a lot of positive overlap in the structure of our cooperative projects that also meet strategic GHE objectives,” said Servies.

The collaboration benefits both NAMRU-2 and international entities.

“Our partners are experts of diseases in their regions. Their expertise is crucial in knowing where to conduct studies for the greatest impact. Host partner support is essential for any project,” said Letizia. “The benefits of these close, in-country partnerships, include better force health protection recommendations for our own troops and the advancement of science and regional public health in the host nations where we work.”

Interoperability is an added advantage with the work that NAMRU-2 undertakes. “Working side-by-side with our host nation counterparts benefits surveillance and diagnostics in both nations and helps us all learn to work together” said Servies.

An example of this collaboration is a project with a regional World Health Organization designated reference laboratory for dengue virus diagnostics and research. According to the Centers for Disease Control and Prevention, about 4 billion people live in areas with a risk of dengue.

“In a truly collaborative fashion, NAMRU-2 is working with this reference lab and a U.S. university collaborator to characterize the impacts of public health measures on dengue virus genetics by comparing sequences from viruses collected before, during, and following the COVID-19 pandemic,” said U.S. Navy Lt. Cmdr. Nathaniel Christy, microbiologist for NAMRU-2. “The technology that will be used includes a new method to capture any virus, whether known or unknown. Besides the focused scientific goals of the project, a clear benefit will be that the reference laboratory will now be able to detect new, never-seen emerging viruses and report their genetic features in the event of another pandemic.”

NAMRU-2’s work aims to ensure a medically ready force now and in the future.

“All of our medical research projects are focused on improving medical readiness and the operational capabilities of U.S. and partner military forces. NAMRU-2 tries to anticipate what these medical threats might be and help in devising or testing countermeasures to them,” said Christy.

Mitigating the Next Pandemic

A key research component of NAMRU-2 work conducts disease surveillance with host nations in areas where there is a high proximity of animals living alongside humans. “This can be a prime environment for the development of diseases that can cause pandemics, such as influenza and coronaviruses,” said Letizia. “By collaboratively conducting biosurveillance with its regional partners, NAMRU-2 is contributing to a network for sentinel surveillance of diseases that ties into local host-nation laboratory networks. Our work is directly contributing to the worldwide fight to detect and responsibly report new diseases as quickly as possible. We are regularly looking for the next pandemic disease.”

An example of this work is when NAMRU-2 worked with a national center for zoonotic diseases and a school of veterinary medicine in a northern Asian country, a U.S. university, and the U.S. Army Medical Directorate of the Armed Forces Research Institute of Medical Sciences.

“In 2022, we were able to identify the first detection of a bacteria called Bartonella melophagi, which is related to the bacteria that causes cat-scratch disease, and often transmitted by ticks. The bacteria causes disease in humans as well as animals. With this information, local public health officials can inform the populace of this tick-borne threat,” said Letizia. “Military public health officers and medical planners can develop policies that mitigate potential contact between warfighters and the tick vector to decrease the likelihood of infection.”

The international collaboration efforts of NAMRU-2 ultimately aim to enhance the health of warfighters worldwide.

“U.S. national security as well as global health security is enhanced as we work to improve local capabilities in INDOPACOM to prevent, detect, and treat priority disease threats,” said Servies. “If the host nation can decrease the burden of disease in their country and our troops are called in to assist in conflict or during disaster responses, our troops will be healthier which enhances our national security by maintaining a fit and healthy fighting force.”