Medical Engagement: A Strategic Enabler

RADM Mike Mittelman, SHCE, USNUSPACOM J07

Command Surgeon16 March 2011

Outline

• Partners• Levels of Capability• Commander’s Focus Areas• The Strategy• PI/EID Programs• Pacific Partnership• Pacific Angel• Challenges and Opportunities• Questions

Partners

• Components: Army (USARPAC), Navy (PACFLT), Air Force (PACAF/13th AF), Marines (MARFORPAC) and Special Operations Command (SOCPAC)

• Other Governmental agencies such as Defense Threat Reduction Agency (DTRA), Center for Disease Control (CDC), USAID, Armed Forces Research Institute of Medical Sciences (AFRIMS), Defense Institute for Medical Operations (DIMO), Global Emerging Infections Surveillance (GEIS) and others

• Non-governmental organizations such as Family Health International, Red Cross and The Hope Foundation

Levels of Capability

Internal

Regional

Expeditionary

Commander’s Focus Areas

• Strengthen and advance alliances and partnerships

• Mature the U.S.-China military-to-military relationship

• Develop the U.S.-India strategic partnership

• Remain prepared to respond to Korean peninsula contingency

• Counter transnational threats

Overarching Strategy

Promote regional stability and

security

Build trust &

sustain partnerships

Build capacity&

capabilityBuild resiliency

Promote coalition and joint medical

interoperability and

capabilities

Develop military public health

capacities&

capabilities

Improved health

surveillance

Increased transparency

Must be coordinated

& focused

effort

MEDICAL OFTEN

TRANSCENDSPOLITICS

Specifically

• Increase military to military medical engagements with China

• Increase regional military partnership events with India

• Increase demonstration of interoperability with Allies and Partners during exercises

• Increase military health engagement events in or with specified Nations to counter transnational threats

• Establish a working group to develop Strategic and Operational Measures of Effectiveness (MOEs)

Emerging Infectious Disease/Pandemics

Emerging Disease Surveillance/Mitigation Overview

Mil-MilElectronic Surveillance

Systemfor the Early Notification of

Community-based Epidemics (ESSENCE)

Civilian World Health Organization

(WHO)

PACOM Surgeon’s Office Force Health Protection

monitoring

Mil-Mil/Mil-CivInfectious Disease capacity building

engagements

APAN

The All Partners Access Network fosters information exchange and collaboration between the United States Department of Defense (DOD) and any external country, organization, agency or individual that does not have ready access to traditional DOD systems and networks.

Pandemic Influenza

BILAT PI workshop and SMEE - 2008

MUTILAT PI workshop and SMEE - 2009

PI TTX- 2010

Surveillance and Response - 2011

PI FTX- 2012?

Challenges and Opportunities

• Synchronization and coordination– Between ourselves– With the Interagency– With host nation– Amongst multitude of other players (NGO’s, WHO, etc.)

• Transparency• Documentation and application of best practice• Measures of effectiveness vs. measures of performance• Capacity and capability building vs. direct health care provision

– Long term vs. short term– Nation enhancing vs photo opportunity

• Managing expectations– Internally and externally

Conclusion

• Health Engagement can be a potent strategic enabler in any AOR

• Success facilitates:– Local, regional and global responses to most

contingencies– Increased trust and cooperation– Increased responsiveness of local governments– Increased mil-mil interoperability within the AOR– Quick identification/isolation of emerging diseases

• Strategic Health Engagement directly supports the U.S. National Security Strategy by promoting peace and stability in the Asia-Pacific region

Questions

BACK-UP SLIDES

Surfaces that are Most Likely to be Sources of Contamination

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• Influenza virus can be spread when a person touches something that is contaminated with the virus and then touches his or her eyes, nose, or mouth (fomites).

• Frequent hand washing reduces chance of getting contamination from these common surfaces.

Overarching Strategy

• Promote partner nation and regional stability and security– Build trust and sustain partnerships– Health can go where others cannot

• Build capacity and capability• Build resiliency throughout the AOR• Promote coalition and joint medical interoperability and capabilities

through exercises and subject matter expert exchanges. • Development of military public health capacities to collaborate with

host nations in planning for and containing infectious disease threats.

– Improved health surveillance– Increase transparency between nations – eliminate “Viral

Sovereignty”• Must be a focused effort – not spread thinly around AOR

Influenza A Virus

Hemagglutinin (H)

• 16 (3) Forms

• Attachment/Penetration

Neuraminidase (N)

• 9 (2) Forms

• Viral release

RNA (genetic material)

• 8 strands

• Gene sequences

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Diagnosis of Human H1N1 Infections

• Identification of the H1N1 influenza virus is by laboratory testing (PCR).

• No rapid test yet.

• The influenza A/B rapid tests are unreliable for H1N1.

• During current pandemic, meeting clinical case definition is sufficient for diagnosis.

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Medicines to Treat H1N1

• US CDC recommends the use of two antiviral drugs, oseltamivir (Tamiflu®) and zanamivir (Relenza®) for the treatment and/or prevention of infection with these swine.

• If you get sick, antiviral drugs can make your illness milder and may prevent serious flu complications.

• For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of onset of symptoms).

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Herd Immunity

• 90% rule for vaccinations and herd immunity…