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Before the twentieth century gave armies antibiotics, the leading killer of American soldiers in wartime was neither enemy fire nor shrapnel. Two-thirds of the roughly 620,000 deaths in the U.S. Civil War came from diseases like typhoid and dysentery. Spread through contaminated water and crowded camps, they were eventually controlled through inoculation and field sanitation rather than the antibiotics that would not arrive until the following generation. Later in World War I, American forces lost more men to disease than to combat: 63,000 to 51,000.
By 1940, military medicine had largely closed that gap. Vaccines, sterile surgical technique, sulfa drugs, and organized battlefield triage meant that a soldier who could reach a surgeon had a fighting chance. But medicine could still not solve the issue of soldiers bleeding to death. A man with a survivable wound could still die in minutes, and uncontrolled hemorrhage has long been the leading cause of preventable death in combat. No army had a way to keep blood ready where the wounded fell.
Whole blood breaks down within weeks even under refrigeration, so it could not be stockpiled ahead of a campaign. Refrigerated railcars existed by 1940, and they could carry blood from a city to a railhead, but they did nothing for more difficult legs of the journey (e.g., from railhead to port, across an ocean, or to an aid station under fire) where there was no refrigeration at all. And whole blood had to be matched to each casualty’s blood type at the bedside, which few could do reliably in the field. Before the war, a battlefield transfusion usually meant a live donor lying beside the wounded man, giving blood directly. Across a war on three continents, that was no way to save men whose wounds were otherwise survivable.
An organizational breakthrough came from an American surgeon completing his doctoral research at Columbia University’s Presbyterian Hospital. Dr. Charles Drew was working on the most fundamental problem in transfusion medicine — blood preservation. While he was not the first to work on plasma preservation, he was the first to solve the problem at scale. The blood banking system that grew out of this work would help sustain the forces that won the war and then permanently integrate into American civilian life.
Eighty years later, militaries are confronting a modern version of this “blood problem.” A war in the Pacific would stretch supply lines across thousands of miles of ocean, and the fighting in Ukraine has already shown what happens when an enemy can hit rear areas and evacuation routes. The wounded can no longer count on a fast ride to a hospital. The answer, like the prior effort of WWII, is to push a blood product forward and keep it usable once it arrives.
Drew’s doctoral thesis, completed in 1940 and titled “Banked Blood: A Study on Blood Preservation,” synthesized what the field had learned about storing blood. The obstacle was that red blood cells in whole blood break down quickly, and blood types are determined by those cells. Plasma, the liquid component of blood stripped of its cells, became a solution to these problems. (Plasma carries no blood type, which means it can be administered to any patient regardless of type.) Because plasma could be separated from whole blood, lyophilized (freeze-dried), reconstituted with sterile water when needed, and shipped without refrigeration, it was shelf-stable for far longer than whole blood, which keeps for a few weeks.
None of this was Drew’s discovery alone. The science of drying plasma had been worked out by others. At the University of Pennsylvania in the early 1930s, the bacteriologist Stuart Mudd and the engineer Earl Flosdorf developed lyophilization, the freeze-drying method that lets plasma be reduced to a powder and brought back with water. Max Strumia and John Reichel built equipment to do it at scale. At Harvard, Edwin Cohn developed the cold-ethanol process that split plasma into albumin and other usable fractions, and John Elliott designed the vacuum bottle that the Red Cross would collect blood in. By the time the war reached America, the Army and Navy already had a dried-plasma standard and a manufacturer, Sharp & Dohme, gearing up to produce it.
In the summer of 1940, Drew was recruited to run Blood for Britain, an emergency effort to collect plasma in New York and ship it to Britain, which was experiencing nightly bombing. The program was in trouble when he took it over. Nine hospitals were collecting blood their own way, without a shared method for drawing, processing, or checking it, and too much of the plasma reached Britain contaminated and useless. Drew replaced the improvisation with a single system. He centralized the process, required sterile technique and bacterial testing on every batch, standardized the bottles and the labeling, and controlled handling and temperature from the donor’s arm to the dock. The contamination problem receded, and over five months, the program drew on roughly 15,000 donors and shipped more than 5,500 vials of plasma. Nothing like it had ever existed because transfusion had always been a bedside matter, one donor and one patient in the same room. Drew was the first to run it as a standardized supply that could be produced in bulk and shipped across an ocean. This process was why he is remembered as the “father of the blood bank” instead of just another researcher who worked on plasma.
As American entry into the war became inevitable, the U.S. government asked the National Research Council and the American Red Cross to build a national blood program. Drew became the assistant director of a pilot program to mass-produce dried plasma in New York, which became the model for the first American Red Cross Blood Bank. In February 1941, the Red Cross Blood Bank launched 35 collection centers across the United States, charged with maintaining blood reserves for the Army and Navy. Drew also introduced the “bloodmobile”, refrigerated trucks that could travel to donors rather than waiting for them to come to fixed centers. That system Drew designed became the operational spine of the American military blood supply for the rest of the war. It standardized collection protocols, scaled up plasma processing and preservation, put collection on wheels, tested every batch before shipment, and built a coordination layer that reached thousands of civilian donors.
By 1944, American forces had a blood supply that moved with the front. Of the wounded who reached a field hospital alive, the share who died there fell to about 4.5 in 100 in World War II, down sharply from 8 in 100 in World War I, and it would fall again to 2.6 in 100 in Korea. The Army’s historians tied that improvement directly to prompt resuscitation, where blood and plasma did much of the work.
Plasma restores lost volume and helps blood clot, but it carries no red cells and no oxygen, which the most severely bleeding men need to survive. By late in the war, the Army had accepted that plasma alone was not enough and stood up a second pipeline to fly refrigerated whole blood forward to the theaters. While Drew’s system did not make whole blood obsolete, it critically kept men alive long enough for whole blood to eventually reach them.
But the man who solved the blood supply problem was, under the Red Cross’s own policy, ineligible to donate to it. In 1941, the Red Cross announced it would segregate blood donations by race. Drew, who was black, condemned the segregation of the supply as scientifically baseless. He left the Red Cross in 1941: Accounts differ on why and on how much protest was involved, with his widow saying he simply missed teaching and surgery, and some historians casting the departure more dramatically. The Red Cross stopped segregating blood by race around 1950, though the practice lingered elsewhere for two more decades.
After 1945, the military blood banking remained: military blood programs carried into Korea and Vietnam, and forward transfusion expanded again in Iraq and Afghanistan, where blood loss was the leading cause of preventable death in combat. The collection protocols and distribution infrastructure Drew designed later became the foundation of the American civilian hospital blood supply system that operates today. The American Red Cross, which supplies roughly 40 percent of the nation’s blood, remains in charge of the program he built. Every surgery performed in an American hospital that requires a transfusion is downstream of this wartime invention.
This is a familiar pattern in American military innovation. A war creates a shortage, the shortage forces someone to rebuild how a thing is made or moved, and the fix outlives the war. Penicillin production and radar first began as wartime necessities and stayed on as civilian infrastructure.
Planning for a potential conflict in the Pacific means reckoning with distances that cannot be easily covered by ambulances or medevacs and are easily contestable. That prospect has revived the forward blood problem Drew’s generation thought it had put to rest.
Freeze-dried plasma is emerging as a current answer. French-manufactured freeze-dried plasma has been fielded under U.S. investigational and emergency authorizations since roughly 2010, first with special operations medics. The Defense Health Agency began to push in 2026 to field it across the Joint Force to conventional units. It is a shelf-stable plasma product built for “far-forward environments,” positioned explicitly against the “challenges of time and distance found in places like the Indo-Pacific and Arctic.”
The Russo-Ukrainian War teaches us a similar lesson. Russian strikes on hospitals and evacuation routes have pushed Ukrainian units to move blood and resuscitation far forward, because a wounded soldier can no longer count on a helicopter to a rear hospital. Drones and air defenses have made medevac flights too dangerous to rely on across much of the front, and ground evacuation is regularly attacked. Ukrainian medics now carry whole blood to the point of injury and transfuse there, the reverse of the evacuate-first approach of the last two decades.
American planners preparing for large-scale combat are reaching the same conclusion that the evacuate-then-treat system built over two decades of the Global War on Terror will not hold against an enemy who can strike the rear. While freeze-dried plasma and forward whole blood have narrowed the gap, keeping blood moving to the wounded across a contested ocean theater is still unsolved, the same problem Drew’s generation faced in 1940. Ukraine has surfaced a second medical regression alongside the blood problem with the widespread return of wound infections resistant to standard antibiotics. The medical advances of the antibiotic era cannot be taken for granted under the conditions of prolonged high-intensity conflict.
Arguments about military technology tend to fixate on the sharp end: novel weapons. Those definitely matter, but whether they are even employed in a real war depends on the dull machinery behind them: the supply lines that move fuel, parts, and blood to where they are needed. Drew and his blood bank built one of those critical systems that is still keeping people alive today.
Naveen Krishnan is a Belfer Young Leaders fellow at the Belfer Center for Science and International Affairs at Harvard, where he researches artificial intelligence and U.S. national security policy. He is an intelligence officer in the U.S. Navy Reserve, a polyglot, and former Liu Xiaobo fellow to the Congressional Commission on China.
He studied neuroscience at Vanderbilt University before working in BCG’s life sciences practice. His views are his own and do not represent those of the U.S. Navy or Harvard.
Image: Signal Corps Archive via Wikimedia Commons.
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