NEW BIOSURVEILLANCE DIVISION WORKING ON BATTLEFIELD BIODEFENSE AND HEALTH SURVEILLANCE

FROM: U.S. DEPARTMENT OF DEFENSE
Global Force's Needs Shape DOD Biosurveillance
By Cheryl Pellerin
American Forces Press Service

WASHINGTON, June 5, 2013 - A new biosurveillance division at the Armed Forces Health Surveillance Center here -- home to a unique serum repository and database for service members and a global network of military laboratories -- is working to fill gaps at the convergence of battlefield biodefense and health surveillance.

Health surveillance involves monitoring human health to identify and prevent infectious and chronic diseases. Biosurveillance, at least for the Defense Department, is the process of gathering, integrating, analyzing and communicating a range of information that relates to health threats for people, animals and plants to help inform decisions and provide for increased global health security.

The Armed Forces Health Surveillance Center vision is to be the central epidemiological resource and global health surveillance proponent for the armed forces. Its mission is to provide timely, relevant and comprehensive health surveillance information to promote, maintain and enhance the health of military and associated populations.

Last year Dr. Rohit Chitale became director of the fledgling Division of Integrated Biosurveillance, which shares a building with the DOD Serum Repository, the world's largest, with more than 55 million serial serum specimens dating back to the mid-1980s.

The specimens are linked to the Defense Medical Surveillance System, a database that can be used to answer questions at the patient level and in the aggregate about the health of the armed forces and beneficiaries.

Also part of AFHSC is the Global Emerging Infections Surveillance and Response System, called GEIS, whose 33 partners include military laboratories, academic institutions and nongovernmental organizations around the world that support service members and population-based surveillance and capacity building in 62 countries.

Leading the new biosurveillance division, Chitale has a doctorate in infectious disease epidemiology from the John Hopkins Bloomberg School of Public Health and a master's of public health in epidemiology from the University of California, Los Angeles.

Before joining AFHSC last year, the 42-year-old scientist was senior analyst in the Global Disease Detection, or GDD, program at the U.S. Centers for Disease Control and Prevention in Atlanta.

Soon after the severe acute respiratory syndrome, or SARS, epidemic in 2002-2003 sickened more than 8,000 people worldwide and killed 774, Congress funded the GDD program at CDC in 2004. The aim was to strengthen the global capacity to detect, identify and contain emerging infectious diseases and international bioterrorism threats.

In 2006, Chitale was one of the first analysts to help establish the GDD Operations Center at CDC. This epidemic intelligence and response operations unit uses many sources of information about disease events, including Internet-based media reports scanned for key words in more than 40 languages.

"What I came to AFHSC to do," he told American Forces Press Service during a recent interview, "was to take the next step."

The new division is part of a multiagency effort to implement the nation's first U.S. National Strategy for Biosurveillance, released in 2012 by the White House to make sure federal agencies can quickly detect and respond to global health and security hazards.

It's also part of a push to increase DOD diagnostics funding through the department's biodefense program, Andrew C. Weber, assistant secretary of defense for nuclear, chemical and biological defense programs, told American Forces Press Service in an interview last year.

Some of the work is done by the Defense Threat Reduction Agency's Joint Science and Technology Office of the Chemical and Biological Defense Program, as well as by the Joint Program Executive Office for Chemical and Biological Defense.

In October 2009, Weber himself ushered the Chemical and Biological Defense Program into the biosurveillance business by signing a memorandum to the military department secretaries announcing that emerging infectious diseases would become part of the chemical and biological defense mission.

Chitale, who says he's spent the past 14 months building his division and learning about the many separate biosurveillance efforts underway across the department and the military services, is looking to better integrate these elements to create a coherent, global picture of biological threats -- and recommendations for action -- specific to the Defense Department.

"We now have a [memorandum of understanding] between Health Affairs, where AFHSC is, and Nuclear, Chemical and Biological Defense Programs," Chitale said.

"Historically," he explained, "NCB's mission is global security -- combating weapons of mass destruction writ large -- and our mission is the medical care and surveillance of the forces and DOD populations. They're different missions, ... [but] recently it has become increasingly clear that they are converging."

The memo, signed last summer, describes how NCB and DOD Health Affairs will collaborate on cooperative activities that contribute to U.S. national security and to global health security.

"NCB and Health Affairs will cooperate on activities that help counter weapons of mass destruction, to include chemical, biological, or radiological events that impact various domains significant to U.S. forces," Chitale said. "In effect, that's the whole spectrum when it comes to health."

His division helped to write a 50-page operational plan in December that lists 61 actions that the two organizations will accomplish together.

"They will be things like facilitating training for more preventive-medicine residents," Chitale said. "We're going to help create and implement better algorithms for syndromic surveillance. We're working to create information management systems so we can all work more smartly -- for example, a system that can bring multiple high-quality information streams into one portal and refresh every 10 minutes, and be shared with trusted partners."

The challenge for DOD is that the biosurveillance mission is complex, he noted. "There are three services that each do what we do here to some extent, but they do it for their own service," he said. "What added value do we have? One thing, at least, is that we can bring it all together to get a complete picture."

Such an augmented system would use information from the DOD agencies, the rest of the U.S. interagency including the CDC, the World Health Organization, the World Organisation for Animal Health, the AFHSC-GEIS network, the Internet-based Program for Monitoring Emerging Diseases, or ProMED, and even more informal sources, such as Twitter.

Ultimately, Chitale said, he envisions being able to do for DOD what he and his CDC colleagues did for global public health, but even more -- collect a broad range of data and information relating to human, animal and plant health, work with partners and analyze it according to DOD needs, and provide guidance, recommendations and reach back support to the department's leadership and DOD customers such as the six geographic combatant commands, and especially their surgeons' offices.

Chitale has initially organized his small division into teams that include alert and response operations, coordination and engagement, and innovation and evaluation.

"We haven't said that we're actually creating an operations center," he said. "But the Alert and Response Operations team, ARO, is a term modeled after WHO's Global Alert and Response Operations [established in 2000], probably the world's first strategic health operations center. Others were since stood up around the world, and under the vision and leadership of Dr. Ray Arthur, we established one at CDC in 2006. In some ways, and based on the needs, I'm trying to model several of our key activities after that."

Already the AFHSC and the new division have relationships broadly across the interagency, including the State Department, the Department of Health and Human Services and the intelligence community, particularly through the Defense Intelligence Agency's National Center for Medical Intelligence in Maryland.

NCMI is an intelligence organization, while AFHSC is a preventive medicine and public health organization. Yet, there is some overlap in methods and certainly in goals. "Importantly," Chitale said, "we are working with NCMI closer than ever before, and are formalizing a MOU with them as well."

Key areas in which AFHSC and the new division can provide value for DOD biosurveillance is in disease detection, preventive medicine guidance and coordination with the interagency, he added. "We're trusted across the DOD and also domestic and international medical and public health communities – a real value add in this new paradigm, this new normal," Chitale said.

"When it comes to something like disease detection," he added, "you need the ability, which we have, to pick up the phone and call someone in Uganda who you trust -- a medical person, U.S. government staff working in the host nation, even someone in the Ministry of Health or WHO staff -- and ask them what's going on. They can talk to their people in the country, and you get high-quality information back within minutes to hours.

"You get real, hard information," he continued, "and those are your boots on the ground -- those are your listening posts across the globe."

BIOSURVEILLANCE

Photo Credit:  U.S. Department Of Homeland Security.

FROM: U.S. DEPARTMENT OF DEFENSEThe DOD And Biosurveillance by jtozer

The Defense Department is working with U.S. cities and countries around the world to enhance capabilities needed to detect and track a range of natural or intentional global disease outbreaks.

Biosurveillance involves using experts and a range of technologies to systematically gather, analyze and interpret data related to disease activity and threats to human and animal health for early warning and detection.

Though the strategy is new, a range of national policy documents has addressed biosurveillance, beginning in 2007 with Homeland Security Presidential Directive 21. The directive defined biosurveillance and discussed the need for a national capability.

In 2009, objectives stated in the National Strategy for Countering Biological Attacks sought to protect against the misuse of the life sciences to support biological weapons proliferation and terrorism. And the National Security Strategy of 2010 noted the ability of emerging infectious diseases to cross borders and threaten national security.

"DOD’s involvement in biosurveillance goes back probably before DOD to the Revolutionary War," Andrew C. Weber, assistant secretary of defense for nuclear, chemical and biological defense programs, told American Forces Press Service.
"We didn’t call it biosurveillance then, but monitoring and understanding infectious disease has always been our priority, because for much of our history, we’ve been a global force," he added.
Today, as part of its effort to prepare for microbial storms unleashed by nature and by adversaries, DOD works internationally and domestically to improve global biosurveillance cooperation, Weber said.

"While we worry a lot about nonstate actors launching a bioterrorist attack," he added, "we also have to worry about rogue states like [North] Korea, Iran and Syria that have biological/chemical weapons programs."

To enhance biodefense capabilities on the Korean peninsula, Weber said DOD and South Korea launched the Able Response exercise in May 2011 and ran it again in May 2012.

"This is a whole-of-government to whole-of-government tabletop exercise focused on a biological incident, not during a conventional war but some type of a covert release, … that could have a major impact on the civilian population … but also on our 28,000 forces deployed on the peninsula," the assistant secretary said.

At the Defense Threat Reduction Agency, Ryan Madden is a science and technology manager in the chemical and biological technologies directorate’s physical science and technology division. Since 2007, DTRA, the Department of Homeland Security and other federal agencies have worked with the cities of Seattle and Denver, and now are working along with the State Department and with Poland on biosurveillance exercises, Madden told American Forces Press Service.

The first exercise, called the Interagency Biological Restoration Demonstration, or IBRD, ran from 2007 to 2010 in Seattle, he said, calling the demonstration "a very unique partnership" between DOD and Homeland Security.

The exercise was prompted by anthrax attacks that killed five people in the United States in 2001, Madden said.

The scenario involved a large biological anthrax release in a large city. The objective, he explained, was to get "from the baseline of more than 10 years for restoration [of the city after the attack] to a manageable number [of months or years for anthrax cleanup] that allows the city to maintain some form of viability."

IBRD was conducted in partnership with the Seattle King County Urban Area Security Initiative, Madden said, "and at the end of the program, we had a number of toolsets for decision support or efficacy."

The IBRD team had done studies on the efficacy of various solutions on bacillus anthracis — the bacterium that causes anthrax — on various surfaces, Madden said. "So there was technical data and decision toolsets that help you use that data to inform sampling approaches or decontamination strategies," he added.

As a result of the exercise, he said, "the [Seattle Urban Area Security Initiative], and their partnership with Joint Base Lewis-McChord as a key military installation there, have a regional consequence management plan that addresses catastrophic biological incidents."

For a large city like Seattle, the community resilience factor — based on how long leases and businesses can stay viable if people can’t get to work — is about six months. "And we’re still not at six months," Madden said.

Last year, Homeland Security took the lead, working with DOD, the Environmental Protection Agency and the Department of Health and Human Services in a follow-on effort in Denver, Madden said, working with the Denver Urban Area Security Initiative.

The Denver recovery and resilience program, which wraps up this year, "expanded on IBRD with anthrax, but added a blister agent and a radiological dispersion device, and it still focuses on physical contamination [and cleanup]," the science and technology manager said.

During the Denver program, Madden added, "we started looking at how this could apply in working with a partner nation."

The international effort began in October as a partnership among DOD, the State Department, Homeland Security and Poland.

"I think [it] ties very closely with both the National Strategy for Countering Biological Threats as well as the National Strategy for Biosurveillance," Madden said, both of which recommend leveraging international collaboration.

Between October 2011 and September 2014, the exercise will use the release of two agents — one contagion and one environmentally persistent biothreat — to develop and demonstrate a capability for resilience in countering a threat that affects U.S. and Polish civilians and military personnel and key infrastructure, Madden said.

"[The international effort] is a capability integration and demonstration program, so we’re looking at technical feasibility and then operational utility," he added. "We’re working so the U.S. European Command, and warfighters are part of it. And later in the program, [we’ll have] field demonstrations and utility assessments."

The first technical demonstration will be held in August 2013, he said, and the second in the early spring of 2014.

The final operational demonstration, involving the 773rd Civil Support Team in Germany, EUCOM assets and Polish officials working together, will be in September 2014, Madden said. In the meantime, he added, "we’re funding Sandia National Laboratory to help with a methodology and a toolset we call Threat Probability to Action. The big gap we’re trying to bridge is between earlier warning and rapid response.

"The quicker you’re warned about something and the quicker you can make decisions about what to do," he said, "all of that has an impact on [saving lives]."