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Advances in Global Health Engagement
Dr. David Smith
Deputy Assistant Secretary of Defense (Health Affairs)
Health Readiness Policy and Oversight
December 3, 2015
DoD Global Health Engagement
DoD Global Health Engagement comprises health and
medical related actions and programs undertaken by the
DoD to improve foreign armed forces’ or foreign civilian
authorities’ health system capacity; and to promote and
strengthen their human and/or animal health systems in
support of national security objectives.
-Global Health Working Group, January 2014
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Why is DoD involved in
Global Health Engagement?
A powerful national security instrument that supports
USG efforts around the world
Through:
STABILITY
GHE contributes to social wellbeing, rule of law, governance,
economics, and security
COOPERATION
GHE enhances collaboration
with foreign ministries and civil
structures
CAPACITY
GHE is leveraged to develop
partner capabilities to increase
self-reliance
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2015 National Security Strategy
• We will advance the security
of the United States, its
citizens, and U.S. allies and
partners by:
– Developing a global capacity to
prevent, detect, and rapidly respond to
biological threats like Ebola through
the Global Health Security Agenda.
– Leading efforts to reduce extreme
poverty, food insecurity, and
preventable deaths with initiatives
such as Feed the Future and the
President’s Emergency Plan for AIDS
Relief.”
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Disclosures
Presenter has no interest to disclose.
PESG and AMSUS staff have no interest to disclose.
This continuing education activity is managed and
accredited by Professional Education Services Group
in cooperation with AMSUS. PESG, AMSUS, and all
accrediting organization do not support or endorse
any product or service mentioned in this activity.
Learning Objectives
At the conclusion of this activity, the participant
will be able to:
1.
2.
3.
Contextualization of DoD role in global health engagement efforts
Insight into the new DoD policies being developed on global health
engagement, and how they will effect the future of DoD involvement
in those engagements
Greater perspective on the intricacies of coordinating U.S.
government global health engagement efforts, and the collaborative
work being done to bridge gaps
2015 National Security Strategy (Cont)
•
“We will advance an international
order that promotes peace, security,
and opportunity through stronger
cooperation to meet global
challenges by…
– Strengthening and growing our global
alliances and partnerships, forging
diverse coalitions, and leading at the
United Nations and other multilateral
organizations.
– Rebalancing to Asia and the Pacific
through increased diplomacy, stronger
alliances and partnerships, expanded
trade and investment, and a diverse
security posture.
– Building upon the success of the U.S.Africa Leaders’ Summit by investing in
Africa’s economic, agricultural, health,
governance, and security capacity.
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History of DoD and Global Health
DoD has actually been involved in global health
issues for over a century
• Traditionally viewed global health engagement
through the lens of force health protection
• MAJ Walter Reed pioneered research into
diseases like yellow fever
• Theorized and proved transmission by
mosquito
• Established first overseas medical research
and surveillance laboratories after WWII
Major Walter Reed, M.D., U.S. Army
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Evolution of DoD Global Health Engagement
•
•
•
Over time, DoD has recognized that global health and global security are
inextricably linked
In the last decade, events like infectious disease crises (HIV, SARS, Ebola,
MERS) and natural disasters have caused severe disruption and instability
across the globe
Not in our interest to allow that instability to grow, especially when we have
capability to mitigate.
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Evolution of DoD Global Health Engagement
•
Partnership building is a
significant priority for DoD in
its GHE efforts
•
Healthy, capable partners are
one of the most effective ways
to mitigate health security
threats
•
Security threats from health
catastrophes are real; and the
spillover effects from
breakdowns in health systems
can be harder to contain than
armed conflicts themselves.
U.S. Army engineers assist the Liberian military in
the construction of an Ebola treatment unit
during the 2014 West African Ebola epidemic.
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DoD Global Health Functions
Force Health Protection
Medical Research
& Development
Public Health
LEGEND
SMEEs ---- Subject Matter
Expert Exchanges
GHSA ----- Global Health
Security Agenda
DHAPP --- Defense HIV-AIDS
Prevention Program
CBEP ------ Cooperative Biological
Engagement Program
DPP ------- Disaster Preparedness
Program
IMET ----- International Military
Education & Training
Preventive
Medicine
Building Partner
Civ Med Capacity
Theater Security
Cooperation
Operational/
Contingency Plans
Building Partner
Capacity/
Interoperability
Building Coalition &
Partner Military
Medical Interoperability
Humanitarian
and
Civic Assistance
DHAPP
Medical Support to
Stability Ops
Building Partner
Mil Med Capacity
Biosurveillance
Civ-Mil
Emergency
Planning
Ebola Response
Humanitarian
Assistance (HA)
Humanitarian
Assistance &
Disaster Response
GHSA
DPP
IMET
Disaster Relief (DR)
SMEEs
CBEP
Cooperative Threat Reduction
Research & Development on
Select Agents: Detection,
Countermeasures, Vaccines
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DoD Global Health Engagement
Around the World (2014)
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Importance of International Collaboration
“Infectious disease does not
respect international borders
or government bureaucracies.
Identifying and cultivating
areas where our cooperation
can be strengthened is
something that all of us should
be focused on.”
- ASD(HA) Dr. Jonathan Woodson,
Asia Pacific Military Health Exchange
2015
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Military-to-Military Health Engagement
Senior leader engagements between USPACOM and the
Peoples Liberation Army/Navy have opened up new opportunities for collaboration with
China
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Interoperability Health Engagement
Bi-lateral and multi-lateral military exercises provide opportunities to
practice and test interoperability in battlefield and disaster medicine
processes and procedures
USNS Comfort anchors off Haiti for Continuing Promise 2015,
during which its personnel conducted medical training exercises
and exchanges with partner nations in Latin America.
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Humanitarian Assistance & Disaster Relief
Nepalese service members offload supplies from a U.S. Marine Corps MV-22
Osprey in the aftermath of the 2015 Nepal earthquake
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Pacific Partnership 2015
Partner
Nations:
Host
Nations:
•
4-month Deployment
•
US lead multinational command-and
control structure including a deputy
mission commander from the Australian
Defense Force and a mission chief of staff
from the New Zealand Defense Force
•
•
First visit by a U.S. Navy vessel to Fiji in 9
years.
Visit to Vietnam was in conjunction with
the 20th anniversary of the normalization
of diplomatic relations between the United
States and Vietnam
• First PP mission to use a joint high speed
vessel (JHSV)
To date, PP missions have provided:
• Medical care to 270,000 patients
• Veterinary care to 38,000 animals
• 180 engineering projects to Host Nations
“Pacific Partnership strengthens
relationships that are critical to deter
conflict while increasing regional
stability and security - the crux of the
U.S. strategic “rebalance” to the IndoAsia-Pacific.”
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Continuing Promise 2015
Host
Nations:
• 6-month Deployment
CP’15 anticipated:
• Joint training mission, with units from Army, Navy,
Air Force, and Marines participating
• Medical/dental care to 133,00 patients ashore
• Mission: to remain Forward, Engaged and Ready
in support of US Naval Forces SOUTHCOM/US
Fourth Fleet; Commander, US SOUTHCOM; US
national objectives; and US Global Maritime
Strategy
• Delivered deliberate, sustainable and transparent
method to enhance host nation capabilities
• Includes uniformed and civilian health providers
(NGOs)
• 1000 surgeries aboard USNS Comfort
• 800 subject matter expert exchanges
“Continuing Promise 2015 will enable us to
strengthen ties in support of our enduring
partnerships with the people of Central America,
South America and the Caribbean – a partnership
that will enhance our shared values, interests and
commitment to unity, security and stability
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within the region.”
Value of Global Partnership
In A More Connected World
• Our research / Your research
demands greater publicprivate, and national/
international partnerships
– Strengthens medical
research
– Strengthens long-term
partnerships
– Strengthens national
security
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Global Health Engagement
Whole of Government Approach
3D (Diplomacy, Development, and Defense)
Global Health Group
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Global Health Security Agenda
A world safe and secure from global health threats posed by
infectious diseases, whether naturally occurring, deliberate or
accidental
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A Role for Military Medicine in GHSA
 Biological threats, both natural and intentional, jeopardize our national security, mission assurance,
and force health
 DoD has a long-time focus on bio threats, even prior to the GHS Agenda
 Increased understanding and awareness improves force health protection for force
 Activities within force health protection, countering weapons of mass destruction, threat
reduction, building partner capacity, and supporting Science & Technology programs
complement GHS Agenda objectives
 Prevention, detection and response require holistic solutions through strengthened relationships with
health services, other government and industry partners, and academia
 Cooperation is a force multiplier; cross-cutting collaboration is required at the national as well as
the international level
 The GHS Agenda offers DoD and other militaries a framework within which to engage and better
coordinate with interagency (other ministries) and international partners
 MULTI-SECTORAL: IN US, DOD is in SUPPORTIVE ROLE with other elements of our
government
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Defense Programs in Support of GHSA
 DoD Cooperative Threat Reduction (CTR)/Cooperative Biological Engagement Program (CBEP)
 Enhance partners’ biosafety and biosecurity systems to consolidate and secure collections of
pathogens and diseases of security concern to prevent the diversion or accidental release of
such pathogens
 Enhance partners’ capability to survey, detect, diagnose, and report outbreaks of pathogens of
security concern in accordance with international reporting requirements
 In FY2014, DoD CBEP leveraged collaboration with the Centers for Disease Control and
Prevention in ten countries to enable more efficient threat reduction efforts
 Armed Forces Health Surveillance Center/Global Emerging Infections Surveillance and Response
System Division (GEIS)
 Conducts public health research and surveillance for force health protection
 Supports timely, effective, agile response to outbreaks and emerging threats
 Develops, disseminates and coordinates new surveillance capabilities in the DoD overseas
laboratories
 Facilitates interagency, intergovernmental and NGO collaborations
 Facilitating the “multi-sectoral” aspect of the GHSA; bring MoDs to the table
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DoD HIV-AIDS Prevention Program (DHAPP)
• HIV prevention and education program
involved in over 80 countries
• Why is the DoD concerned about HIV?
– We send our service members into environments
where HIV is a major risk
– But foreign strains of the virus are not an area of
focus for National Institutes of Health (NIH)
– DoD is thus a natural actor to tackle the issue in a
global context
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Infectious Disease Vaccine Research
US Military HIV Research Program led
first HIV vaccine to show efficacy
–
RV144 was international collaboration involving NIH, Thai
government, and private industry
–
16,000 Thai volunteers
–
Showed a preventive vaccine IS possible
Advancing three Ebola vaccine candidates
–
MHRP sites in Africa leveraged for Ebola vaccine research
–
Conducted first Ebola vaccine study in Africa
–
Ongoing trials in Uganda and Nigeria
–
US trial of VSV-EBOV candidate at Walter Reed Army Institute
of Research (WRAIR)
Key capabilities for responding to the next infectious diseases crisis
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Artemisinin-resistant malaria
• We have seen a 50% decline in malaria prevalence in
Africa—amazing global health success story
• Artemisinin-resistant malaria, however, remains
major concern in Mekong Delta/Southeast Asia
• DoD is already working closely to coordinate malaria
control efforts with President’s Malaria Initiative
(PMI), Global Fund for Tuberculosis, Aids, & Malaria
(GFTAM), and the Bill and Melinda Gates Foundation
• But If ARM were to expand to vulnerable regions like
Africa, could undo decades of progress in malaria
control
• DoD needs analogue to DHAPP to combat spread of
ARM—partner with foreign militaries to create an
environment for effective surveillance, prevention,
and treatment of disease
• Just as HIV threatened global stability and we needed
DHAPP, malaria represents a similar threat
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Combatting Antibiotic Resistance
• Whole of Government / Whole of Nation Responsibilities
(Government and Private Sector engagement)
• White House – led conference
• Federal Leadership -- HHS / Agriculture / DoD
• Presidential Action Plan
• DoD Role – Antimicrobial Stewardship
• Multi-drug Resistant Organism Repository and Surveillance Network
(MRSN)
• Bioinformatics pipeline – 25 genomes per week
• Medical research and development in infectious disease
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Protection Against Infections Disease Threats
Global Infectious Disease Forecasting
Major interagency initiative from White House Office
of Science & Technology Policy (OSTP)
•
Improved forecasting is a national security
imperative…highlighted by West African Ebola outbreak
•
The Armed Forces Health Surveillance Center (AFHSC)
leads public health / infectious disease surveillance efforts
for DoD, and is positioned to support the OSTP effort.
•
Research and development funding may be needed to
augment the AFHSC effort to apply transformative
forecasting approaches to real-world crises of DoD and
national security relevance.
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Protection Against Infections Disease Threats
Global Infectious Disease Forecasting
• Infectious disease forecasting must:
– Incorporate the traditional components of
traditional forecasting models
– Along with the more challenging elements of
anticipating human behavior on a global scale
• across multiple cultures
• and types of government
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DoD Global Health Engagement Council
(MORE TO COME)
• Update with relevant info in late fall
• Add GHE consortium as details jell
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USUHS
Center for Global Health Engagement
• Developing center of gravity for GHE-related
work
• Fill out details post-establishment
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The Future of GHE
• Health engagement is going to be the
major pillar supporting the DoD’s vision
and effort to partner around the world.
• Doing this right better supports the US
Government, DoD, and our partner
nations in developing capability and
capacity.
• This not only makes our partners more
secure, but it makes the world more
secure.
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