Rise of the Bugs, and DoD the Biosurveillance Enterprise

Swine flu strain virus particles: Colorized transmission electron micrograph of negatively stained SW31 (swine strain) flu virus particles. National Institute of Allergy and Infectious Disease photo

Swine flu strain virus particles: Colorized transmission electron micrograph of negatively stained SW31 (swine strain) flu virus particles. National Institute of Allergy and Infectious Disease photo

By Cheryl Pellerin
DoD News, Defense Media Activity

It was always true that an infectious disease epidemic at the community-state level or pandemic at the continent-world level could affect nearly anyone at any time.

But pandemic opportunities increased radically in 1909 with the establishment in Germany of the first airline. Now commercial passenger airlines and for the military services the C-17 Globemaster are the international vector, or carrier, of choice for infectious diseases.

Watching for emerging infectious diseases and outbreaks around the world is called biosurveillance, and the Defense Department runs one of the planet’s most active biosurveillance programs, with good reason — in 2015 more than 150,000 troops were stationed in foreign countries and more than 1.3 million troops were active worldwide, according to the Defense Manpower Data Center.

To help protect them, since 1946 DoD has had a medical post in Egypt called the Navy Medical Research Unit, or NAMRU-3, in Cairo, to provide military health services, build partner diagnostic and reporting capabilities and carry out biosurveillance activities.

NAMRU-3 and other military posts in Kenya, Peru, Bangkok and elsewhere worked for years with military patients and country and international partners like the World Health Organization.

In 1997 the outposts became part of the DoD Global Emerging Infections Surveillance and Response System, or GEIS, when a presidential directive expanded the role of most federal agencies in improving domestic and international infectious disease surveillance, prevention and response.

Today GEIS, part of the Defense Health Agency’s Armed Forces Health Surveillance Branch, provides direction, funding and oversight to a military health and biosurveillance network of more than 70 partners based all over the world.

That DoD network and others in the department contributed to the overall effort before and after June 2009, when WHO and the U.S. Centers for Disease Control and Prevention declared that a global pandemic of H1N1 swine flu was underway.

In April 2009, two months before the WHO-CDC declaration, an intelligence assessment by the National Center for Medical Intelligence at Fort Detrick in Maryland, predicted the pandemic potential of H1N1.

Around the same time, the work of Navy Cmdr. Patrick Blair, respiratory diseases research department head at the Naval Health Research Center in San Diego, California, was contributing to the early recognition of and response to the 2009-2010 pandemic.

In October 2009, then-assistant secretary of defense for nuclear, chemical and biological defense programs signed a memo to military department secretaries making emerging infectious diseases part of the chem-bio — “bugs and gas” to those in the business — defense mission.

The White House issued the first U.S. National Strategy for Biosurveillance in 2012, introducing it in a letter that said the United States “must be prepared for the full range of threats, including a terrorist attack involving a biological agent [and] the spread of infectious diseases.”

Two years later, in 2014, the West African Ebola pandemic began killing the 11,300 people who died from the disease.

Before it was over, Ebola virus disease had pushed a couple of West African health care systems to the brink of collapse, infected people in nine other countries, and gave governments everywhere a new appreciation for the utility of biosurveillance.

Africa had no effective early warning systems for the Ebola virus although government officials in Guinea announced the outbreak fairly early in the process and notified WHO in March 2014.

But the defense medical countermeasures effort, through scientists at the U.S. Army Medical Research Institute of Infectious Diseases, or USAMRIID, had years earlier begun to develop vaccines and diagnostics for different strains of Ebola virus and Marburg virus diseases in case an adversary attempted to weaponize them and use them against U.S. troops.

It was scientists at USAMRIID, the Defense Threat Reduction Agency, or DTRA, the U.S. Army Edgewood Chemical Biological Center and others in the defense enterprise who made it possible to create the early diagnostics and vaccine candidates against Ebola.

In September 2014, U.S. Army Africa leadership and the first troops arrived in Liberia to begin helping contain the historic outbreak, later building an outpost for coordinating the Ebola response and infrastructure for treating the growing number of patients.

U.S. Army Africa supported the lead U.S. Agency for International Development, and all worked with West African governments and health officials and many U.S. defense and federal partners — soldiers, sailors, airmen and Marines, scientists from USAMRIID and DTRA, and so many other DoD and interagency contributors.

Even with the department’s long involvement in biosurveillance, no one in DoD or the White House thinks disease detection is early enough or outbreak response is fast enough, and everyone is still working hard to improve it.

In the next couple of blog posts we’ll take a look at technologies and systems being developed by DoD and its partners to more quickly detect and effectively monitor and even predict the emergence of infectious diseases around the world.

(Follow Cheryl Pellerin on Twitter @PellerinDoDNews)