Performing the Duties of the Assistant Secretary of Defense for Health AffairsJuly 25, 2017

Global Health EngagementU.S. Department of Defense

Dr. David Smith

Defense HIV-AIDS Prevention Program

Building Coalition & Partner Military

Medical Interoperability

Building PartnerMil Med Capacity

Operational/Contingency Plans

International Military Education & Training

Theater SecurityCooperation

Subject Matter Expert Exchanges

Biosurveillance

Global Health Security Agenda

Humanitarian andCivic Assistance

Medical Support to Stability Ops

Humanitarian Assistance (HA)

Disaster Relief (DR)

Cooperative Biological Engagement Program

Ebola Response

Civ-Mil EmergencyPlanning

Disaster Preparedness

Program

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Cooperative Threat Reduction

DoD GHE Defined

• GHEactivitiesestablish,reconstitute,maintain,orimprovecapabilities ofPartnerNation’smilitaryorcivilianhealthsector,and/orthoseofDoD

• Interactions between DoD and Partner Nation’s armed forces and/or civilian authorities• Coordinated with other USG departments and agencies

• Build trust and confidence, share information, coordinate mutual activities, maintain influence, and achieve interoperability

• Support national security policy and military strategy

DoDGlobalHealthEngagement(GHE)

History of DoD and Global Health

DoD has been involved in global health issues for over a century• Traditionally viewed global health engagement through the lens of force health

protection

• Established first overseas medical research laboratories after WWII

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Evolution of DoD Global Health Engagement

• Over time, DoD has recognized that global health and global security are linked

• Events like infectious disease crises and natural disasters have caused severe disruption and instability across the globe– HIV– SARS– MERS-CoV– Ebola– Zika

• Not in our interest to allow that instability to grow, especially when we have capability to mitigate.

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U.S.ArmyengineersassisttheLiberianmilitaryintheconstruction ofanEbolatreatmentunitduring the2014West

AfricanEbolaepidemic.

AedesAegyptimosquito,primaryvectoroftheZikaVirus

Supporting the 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.” 5

How does Global Health Engagement contribute to DoD objectives?

A powerful national security instrument that directly supports force health protection and security cooperation across the range of military

operations around the world, enhancing

REGIONAL STABILITYGHE contributes to social well-being, rule of law, governance,

economics, and security

COOPERATIONGHE enhances collaboration

with foreign ministries and civil structures

PARTNER CAPABILITIESGHE improves interoperability

and increases self-reliance

READINESSGHE provides unique and effective training opportunities for DoD health personnel, and improves ability of PNs to contribute to Globally Integrated Health Service Support

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Building military medical capabilities means:

• Partner Nations can respond rapidly to disasters and outbreaks

• Partner Nations maintain mission-capable status for peacekeeping missions, and to partner in the fight against threat groups

• U.S. troop operational readiness enhanced 7

U.S.ArmySpc.ChrisSpringercontributes tothedevelopmentofaZikavaccinecandidate atthe

WalterReedArmyInstituteofResearch.

DoD’s RoleinGlobalHealth

Militaryexercisesprovideopportunities topracticeinteroperability in disastermedicine procedures.

Key outcomes: • Operational readiness• Enhanced military medical capabilities• Security Cooperation• Stability and security

Focus Areas:• Force Health Protection• Building Partner Capacity• Humanitarian Assistance and Disaster Response• Nuclear, Chemical, and Biological Defense

Global Health Security Agenda

Aworldsafeandsecure fromglobalhealththreatsposedbyinfectiousdiseases,whethernaturallyoccurring,deliberateor

accidental

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Overview of DoD’s Role in the GHSA

• In the U.S., DoD is in a supportive role to other elements of US Government

• DoD supports the GHSA through existing missions and activities such as force health protection, threat reduction, cooperative health security engagements and biodefense

• DoD has a long history of global health security activities that are resourced and conducted to meet national security objectives which also provide benefit toward the achievement of GHSA targets

• The GHSA aligns with national strategic guidance and offers DoD and other militaries a framework within which to engage and better coordinate with interagency (other ministries) and international partners

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Global Health Security Agenda Action Packages

• PREVENT Avoidable Epidemics– Prevent 1: Antimicrobial Resistance – Prevent 2: Zoonotic Disease– Prevent 3: Biosafety and Biosecurity – Prevent 4: Immunization

• DETECT Threats Early– Detect 1: National Laboratory System– Detect 2/3: Real-time Biosurveillance– Detect 4: Reporting– Detect 5: Workforce Development

• RESPOND Rapidly and Effectively

– Respond 1: Emergency Operations Centers – Respond 2: Linking Public Health with Law Enforcement & Multi-sectoral

Response– Respond 3: Medical Countermeasures and Personnel Deployment

DoD Programs that Benefit GHSA

• Armed Forces Health Surveillance Branch/Global Emerging Infections Surveillance and Response System (GEIS)

• Overseas Medical Research Laboratories

• DoD Cooperative Threat Reduction (CTR)/Cooperative Biological Engagement Program (CBEP)

• Defense Health Program Research, Development, Test and Evaluation (DHP RDT&E)

• Chemical and Biological Defense Program (CBDP)

• Combatant Commands

GHSAPhaseIICambodiaDemocraticRepublic ofCongoGeorgiaGhanaHaitiJordanKazakhstan

LaosMalaysiaMozambiquePeruRwandaThailandUkraineCARICOM*

GHSAPhaseIBangladeshBurkinaFasoCameroonCoted’IvoireGuineaEthiopiaIndiaIndonesiaKenya

LiberiaMaliPakistanSenegalSierraLeoneTanzaniaUgandaVietnam

U.S. Support to GHSA Countries

*CaribbeanCommunity(CARICOM) isanorganizationof15Caribbeannationsanddependencies.GHSPhaseIIwillhavearegionalfocus.

DoD’s Role in Broader Global Health Efforts

Examples:

• PEPFAR– Defense HIV/AIDS Prevention

Program (DHAPP)

• President’s Malaria Initiative– Defense Malaria Assistance

Program (DMAP)

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Summary

v GHE represents a diverse set of DoD activities that collectively establish, reconstitute, maintain, or improve the capabilities or capacities of a partner nation’s military or civilian health sector, and/or those of DoD.

v DoD GHE activities are key contributors to U.S. national security, directly supporting Force Health Protection and Security Cooperation across the range of military operations.

v GHE efforts enhance readiness by providing unique and effective training opportunities for DoD health personnel and improving interoperability with our partner nations. Building PN capabilities to address health issues within their borders and regions reduces health threats to our Joint Force, our PNs, and our homeland.

v GHE activities support geographic Combatant Command Theater Campaign Plans as they help to obtain access and influence, strengthen alliances, and foster health security. 14