Perspectives on the Department of Defense Global Emerging Infections: Surveillance and Response System, A Program Review

215 Pages·2001·1.16 MB·English

by  Institute of Medicine, Committee to Review the Department of Defense Global Emerging Infections Surveillance and Response System, Medical Follow-Up Agency

Perspectives on the
Department of Defense
Global Emerging Infections
Surveillance and Response System
A Program Review
Philip S. Brachman, Heather C. O’Maonaigh, and Richard N. Miller, Editors
Committee to Review the Department of Defense Global Emerging Infections
Surveillance and Response System
Medical Follow-Up Agency
INSTITUTE OF MEDICINE
NATIONAL ACADEMY PRESS
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Support for this project was provided by Contract No. DAM17-00-P-0412. The views
presented in this report are those of the Institute of Medicine Committee to Review the
Department of Defense Global Emerging Infections Surveillance Response System and are
not necessarily those of the funding agencies.
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COMMITTEE TO REVIEW THE DEPARTMENT OF DEFENSE
GLOBAL EMERGING INFECTIONS SURVEILLANCE AND
RESPONSE SYSTEM
PHILIP S. BRACHMAN (Chair), Professor, Department of International
Health, Rollins School of Public Health, Emory University, Atlanta,
Georgia
RUTH L. BERKELMAN, Professor, Department of Epidemiology,
Rollins School of Public Health, Emory University, Atlanta, Georgia
DONALD S. BURKE, Professor, Department of International Health
and Director of the Center for Immunization Research, Johns
Hopkins School of Public Health, Baltimore, Maryland
KATHLEEN F. GENSHEIMER, State Epidemiologist, Bureau of Health,
Maine Department of Human Services, Augusta, Maine
C. JAMES HOSPEDALES, Director, Caribbean Epidemiology Center,
Pan American Health Organization, World Health Organization,
Port of Spain, Trinidad, West Indies
ANN MARIE KIMBALL, Professor, Health Services and Epidemiology,
Adjunct in Medicine, University of Washington, Seattle,
Washington
GUÉNAËL R. RODIER, Director, Department of Communicable
Disease Surveillance and Response, World Health Organization,
Geneva, Switzerland
RONALD K. ST. JOHN, Executive Director, Center for Emergency
Preparedness and Response, Health Canada, Ottawa, Ontario,
Canada
Project Staff
RICHARD N. MILLER, Study Director
HEATHER C. O’MAONAIGH, Program Officer
PAMELA RAMEY-McCRAY, Administrative Assistant
ANDREA COHEN, Financial Associate
v
Preface
The U.S. Department of Defense (DoD) has historically defined its
interest in infectious diseases almost exclusively in terms of “battle-
stopper” illnesses—those resulting in acute effects that can directly affect
military operations. Although this approach remains central to the U.S.
military’s infectious disease doctrine, development of the DoD Global
Emerging Infections Surveillance and Response System (GEIS) is part of
an important transition in the way that the threat of infectious diseases—
and, more specifically, the threat of emerging infectious diseases—is per-
ceived and addressed by the U.S. military.
Emerging infectious disease surveillance is sustained globally through
a network of activities maintained through the collective efforts of numer-
ous governmental and nongovernmental agencies. It is through the con-
tributions of many partners that surveillance for emerging infectious
diseases is possible. The DoD possesses valuable resources that can be
brought to bear in this effort. It maintains an extensive, diverse array of
laboratory facilities, both within the United States and overseas. These
DoD laboratories can perform routine diagnostic testing, but they also
possess rare, sometimes unique, diagnostic capabilities. DoD overseas
laboratories are located throughout the world in areas where the potential
for the emergence of infectious diseases is high. Often, laboratories oper-
ate in regions where alternative laboratory resources are sparse or nonex-
istent (e.g., sub-Saharan Africa). No other organization or government in
the world maintains such extensive or capable laboratory facilities and
staffing internationally. DoD laboratory facilities represent medical re-
vii
viii PREFACE
search, public health, and diplomatic resources that serve U.S. military,
U.S. civilian, and global interests alike.
For more than a decade, formal DoD participation in emerging infec-
tious disease surveillance has been encouraged by many in the U.S. public
health community and within the DoD. In 1996, Presidential Decision
Directive NSTC-7 (NSTC is the National Science and Technology Council
of the Executive Office of the President) transformed these recommenda-
tions into a mandate. Thereafter, the National Intelligence Council de-
clared emerging infectious diseases to be a threat to the national security
of the United States, underscoring the importance of DoD participation in
disease surveillance efforts. This role is not an altogether new one, as the
DoD has been conducting various infectious disease surveillance projects
(e.g., for influenza) for many years. Accommodation of its expanded role
has led the DoD to implement GEIS. The committee recognizes this effort
as a responsive and effective step toward addressing the problem of
emerging infectious diseases.
We would like to thank the staff of the DoD laboratories, both domes-
tic and overseas, and the staff of the GEIS Central Hub for the time and
effort that they have invested in sharing with us information about the
GEIS operations that they support. This review effort was very much a
collegial one, and the report benefited from the openness of all those who
provided us with documentation, presentations, and conversations. This
study was also enriched by the insights that GEIS collaborators and asso-
ciates provided regarding their views of GEIS from the outside looking in.
Lists of the laboratory staff and GEIS collaborators and associates who
shared their time with the committee can be found at the ends of Chapters
2 through 7 of this report. Any omissions are strictly the result of over-
sight.
The support provided by Institute of Medicine staff was instrumental
in keeping this study moving apace. We extend our thanks to Richard
Miller, Heather O’Maonaigh, and Pamela Ramey-McCray of the Institute
of Medicine’s Medical Follow-Up Agency and to National Academies
Travel staff, particularly Ann-Marie Walko, for their assistance. This study
also benefited from the attention of Andrea Cohen, financial associate;
Michael Hayes, consulting editor; and Linda Kilroy, contracting officer.
Medical Follow-Up Agency staff members Phillip Bailey, Salem Fisseha,
Lois Joellenbeck, and Karen Kazmerzak also helped along the way.
In addition, we are grateful to GEIS Central Hub staff members, par-
ticularly Joel Gaydos, Steve Gubenia, Patrick Kelley, Jennifer Rubenstein,
and James Writer for their tireless assistance in preparing and compiling
background documents and for helping to plan and negotiate the logistics
of site visits. Likewise, we offer special thanks to Roxana Lescano, Lucy
Rubio, and Trueman Sharp, Naval Medical Research Center Detachment,
PREFACE ix
Peru; Andrew Corwin and John Sisson, Naval Medical Research Unit 2,
Indonesia; Gaye Ruble, Armed Forces Research Institute of Medical Sci-
ences, Thailand; Cole Church, Naval Medical Research Unit 3, Egypt;
Ronald Rosenberg, U.S. Army Medical Research Unit, Kenya; and Leslie
Henry, Naval Health Research Center, San Diego, for their help in putting
site visits together.
This report is a testament to the hard work, patience, and resolve of
many. We extend to all involved our appreciation and gratitude.
Philip S. Brachman (Committee Chair)
Ruth L. Berkelman
Donald S. Burke
Kathleen F. Gensheimer
C. James Hospedales
Ann Marie Kimball
Guénaël R. Rodier
Ronald K. St. John