The field of public health endeavors to prevent disease and ensure the best possible health of populations, from small communities to the entire world. In many ways, militaries around the globe face the same public health threats as civil society. So, it is fitting that the lexicon of public health and the military is strikingly similar, with terms like “war” and “fight” reflecting the often acute struggle between life and death on the battlefield or in the hospital. We as a society must face transnational challenges such as pandemics with a solidarity of purpose that includes transparent contributions from all components.
Military collaboration in global public health security
Because of the need to protect the health of their personnel, military public health officials have made numerous contributions to the medical field over the centuries. Many will recall the ground-breaking work of Sir Ronald Ross, a British officer in the Indian Medical Service who first described the relationship of Anopheles mosquitoes and transmission of malaria to humans. More recent contributions include the development of the Hepatitis A and Japanese Encephalitis vaccines as well as the first demonstration of partial protection from an HIV vaccine (Rerks-Ngarm, 2009). The recurring theme is that of “dual benefit”, because while these advances were important for protecting military health or furthering a mission, they had equal if not greater impact on the lives of millions of civilians as well.
In times past and today, timely detection of new diseases and epidemics is important to the military for protection of their troops, and this is also one of the key requirements of global public health security. Timely detection requires adequate infectious disease surveillance, ability and will to report to global public health authorities, and a meaningful mechanism for providing response to control an outbreak. Additionally, the military and other populations dispatched around the world have a special responsibility to prevent the spread of contagious diseases through their travels. This stems from the recognition that in the past, militaries have inadvertently spread infectious diseases, including during the 1918-19 influenza pandemic and more recently in Haiti (Johns, 2005 and Enserink, 2011).
Because of this reality and recognized responsibility, militaries continue to make significant contributions to global infectious disease surveillance efforts, often in direct support of the International Health Regulations (IHR). The US Department of Defense (DoD) created the Global Emerging Infections Surveillance and Response System (GEIS) in 1997. Through this program, the US DoD created a global network based on regional surveillance efforts utilizing several DoD overseas medical research laboratories that had been working with host countries for decades on infectious diseases of common interest. These laboratories work side by side with host country scientists and have been responsible for many scientific discoveries concerning emerging and tropical infectious diseases, including several strain contributions to Northern and Southern hemisphere influenza vaccines (including the seed strain for the 2009 influenza A/H1N1 virus) (Russell, 2011).
Other efforts within the US DoD contribute to a holistic approach to global public health security. The DoD has significant efforts in the reduction of threats due to existing high risk biological agents, in HIV prevention, treatment and vaccine development, and in development of diagnostics and vaccines for vector-borne infections and diarrheal disease. Several of the overseas laboratories serve as WHO reference or collaborating centers, and assist developing countries with consultation on biosafety, occupational health, human subject protection training/Institutional Review Board training, electronic disease surveillance efforts, and outbreak response when requested. The DoD is also better prepared than most to respond to natural disasters and has provided substantial aid following the 2004 tsunami, in Pakistan following recent floods, and in Haiti following the 2010 earthquake. Finally, the DoD invests in building partner nation public health capacity through extensive training, exercises with host country militaries, and providing laboratory renovations in partner countries in developing settings (Russell, 2011).
The future – the power of transparency
Sometimes, military contributions to public health are discounted due to concern about intention. For global public health to fully capitalize on military investments in public health security, several steps must occur to mark a clear way forward. Trust is at the heart of success. Trust requires transparency. Everyone is a stakeholder for improved global public health security, but different priority sets for different stakeholders is a reality, and current barriers to trust must be addressed.
At the developing country level, many have expressed that compliance with the International Health Regulations may not be their highest priority, and could result in serious economic ramifications. Additionally, sharing information and samples from disease surveillance activities has not resulted in equitable benefits for their countries. This concept of viral sovereignty has created major challenges to trust and transparency, and thus global disease surveillance and global public health security. There has recently been diplomatic progress with a resolution from the May 2011 World Health Assembly (WHA 60.28) creating a Pandemic Influenza Preparedness framework for influenza virus sharing, benefits sharing, and standard material transfer agreements (Sixtieth World Health Assembly, 2011). These issues are not insignificant, and concerted efforts in this regard must continue.
Equity of response is another facet of trust building. Whether in the development of collaborations throughout the world, or in response to natural or man-made emergencies, efforts must be made to provide equitable resources, treatments, and information sharing to not only our own uniformed members, but all associated local populations. A two-way street of information sharing is required. Without these open lines of communication, transparency will not exist, trust will not be built, and objectives not met.
Militaries from around the world should continue to monitor for influenza and emerging disease outbreaks among their vulnerable and dispersed populations, and cooperate with each other through formal and informal networks. In addition, since militaries would potentially play an important role in any serious pandemic, it is imperative that militaries plan and exercise with their civilian counterparts in the Ministry of Health to optimize response and ultimately ensure public health security.
In times of increasing global complexity and fiscal constraints, all components of society engaged in public health, including the military, should work together to secure global public health through transparent actions.
The opinions stated in this paper are those of the authors and do not represent the official position of the U.S. DoD. The author would like to thank the entire GEIS network for its tireless efforts in support of global public health security.
|Author :||DL Blazes
Commander, Medical Corps, US Navy
Chief, Division of GEIS Operations
Armed Forces Health Surveillance Center
Rerks-Ngarm S, Pitisuttithum P, Nitayaphan S, Kaewkungwal J et al. Vaccination with ALVAC and AIDSVAX to prevent HIV-1 infection in Thailand. N Engl J Med. 2009 Dec 3;361(23):2209-20.
Johns MJ, Blazes DL, Fernandez J, Russell KL, Chen DW, Loftis R. The US Military and the International Health Regulations (2005): Perceptions, Pitfalls and Progress toward Implementation. Bulletin of the World Health Organization 2011;89:234-235. doi: 10.2471/BLT.10.082321.
Enserink M. Haiti’s cholera outbreak. Cholera linked to U.N. forces, but questions remain. Science. 2011 May 13;332(6031):776-7.
Russell KL, Rubenstein J, Burke RL, Vest KG, et al. The Global Emerging Infection Surveillance and Response System (GEIS), a U.S. government tool for improved global biosurveillance: a review of 2009. BMC Public Health 2011, 11(Suppl 2):S2 (4 March 2011).
Sixtieth World Health Assembly (Resolution WHA 60.28), May 2011 (Accessed 02 August 2011).