A Review of the History, Current Use, and Future of Insecticide Treated Uniforms Among Militaries in the Indo-Pacific

The Indo-Pacific Command (INDOPACOM) encompasses a large area with many endemic vector-borne diseases that are a persistent threat to military personnel. During previous wars, casualty rates from vector-borne diseases have often surpassed combat casualties. One of the most effective countermeasures developed to reduce the risk of vector-borne diseases has been the use of insecticide treated uniforms. This review explores the history, current practices, and future innovations required for using treated uniforms in this region. Uniform treatments began during World War II when the United States and its Allies developed and deployed insecticides such as dimethyl phthalate, dibutyl phthalate, benzyl benzoate, and later M-1960. These chemicals were widely used during World War II and the Korean and Vietnam Wars to prevent vector-borne diseases. A breakthrough came with the introduction of permethrin in the 1980's. This chemical replaced the earlier generation of insecticides and was rapidly adopted by many militaries because of its residual efficacy, low toxicity, and broad-spectrum protection. Currently, Australia, New Zealand, Singapore, and the United States military personnel rely on permethrin to treat their uniforms. Other militaries also treat their uniforms with permethrin in limited or trial capacities. However, there are challenges involved with current practices that include insecticide resistance, variable fabric compatibility, declining availability of insecticide products, and logistical constraints. Looking ahead, emerging technologies such as etofenprox-based treatments, bite-proof textiles, and graphene-embedded fabrics offer promising alternatives to permethrin. Additionally, advancements in field-based residue detection and extended-wear treatments may enhance durability and compliance. As militaries in the Indo-Pacific confront evolving vector-borne disease threats and operate in diverse environments, modernizing uniform-based vector protection remains a critical operational and force health protection priority.