Emerging and Re-emerging Infectious Diseases 

Challenges and Opportunities for Militaries

LTC (Dr) Vernon LeeMBBS, PhD, FAMS, MPH,MBA

Singapore Armed Forces Biodefence Centre

Health security risks • Public health emergencies– Infectious disease outbreaks• MERS-CoV, Ebola, avian and pandemic influenza

– Contaminated food or water– Environmental and technological hazards• Chemicals, radionuclear incidents

– Natural or man-made humanitarian disasters• Earthquakes, tsumanis, floods• Deliberate use of biological agents

The Global Challenge• Impact on populations– Direct health effects– Social and economic effects– Impact to military training and operations

• End to such risks not foreseeable• Public health preparedness & responses better

than before– But remains inadequate

"The world is ill-prepared to respond to a severe influenza pandemic or to any similarly global, sustained and threatening public-health emergency."

Report of the Review Committee on the Functioning of the International Health Regulations (2005) in relation to Pandemic (H1N1) 2009

Stark Assessment

Strengthening Country Capacity• International Health Regulations (IHR), 2005– Strengthen national capacity for surveillance and

control– Prevention, alert and response to international

public health emergencies– Global partnership and international collaboration– Rights, obligations, procedures, and progress

monitoring

Principal ConsiderationsPrincipal Considerations• Comprehensive risk management

approach• All-hazard• Multisectoral• Multidisciplinary• Community resilience• Sustainable development• Ethical

Principal ConsiderationsPrincipal Considerations• Comprehensive risk management

approach• All-hazard• Multisectoral• Multidisciplinary• Community resilience• Sustainable development• Ethical

Risk management

• Risk management

– Systematic analysis and management of health risks, through a combination of hazard and vulnerability reduction to prevent and mitigate risks; preparedness; response; and recovery measures

Risk Management• Risk assessment: identification and analysis of risks for planning

and action

• Prevention: measures to avoid or reduce risks by reducing hazards and vulnerabilities

• Preparedness: capacities in place to anticipate, respond and recover from potential threats

• Response: measures taken in anticipation of or during an emergency to minimize the impact

– Mitigation: measures to reduce impact, and address related vulnerable conditions and their underlying causes

• Recovery: measures which support restoration, and improvement, of situation

All-hazards approach

• What it IS– Builds capabilities that can be flexibly used to deal

with a range of emergencies• E.g. Command and coordination structures,

communications networks, logistics system

– If it is good for all-hazards, it is good for any specific hazard

• What it is NOT– One size fits all• Specific hazards• Local context

All Hazards

Individual Hazards

Individual HazardsIndividual

Hazards

Individual Hazards

Engaging all sectors Engaging all sectors

"Beyond implementation of core public health capacities called for in the IHR, global preparedness can be advanced through research, reliance on a multisectoral approach, strengthened health-care delivery systems, economic development in low and middle-income countries and improved health status."

Report of the Review Committee on the Functioning of the International Health Regulations (2005) in relation to Pandemic (H1N1) 2009

What can militaries do?

• Work with – International organizations (UN, WHO)– Other government agencies (MOH, disaster

management agency)– NGOs– Other relevant sectors

• Provide surge capacity and expertise

Ho et al, MMJ 2014

Challenges

1. Ease of disease transmission– Close communal living and training, operational environment and stressors, and

field hygiene

2. Transmission between military and community– Outbreaks in military linked to increased disease incidence in local population.

• Hepatitis A outbreak from 1976 to 1977 in U.S. (Benenson et al. Am J Epidemiol 1980)• Human Adenovirus type 14 in Texas and Oregon in 2007 (CDC 2007)• Enteroviral conjunctivitis outbreaks in Singapore in 2005 (Ong et al. Southeast Asian J Trop Med

Public Health 2008)• Mumps in Luxembourg in 2008 (Mossong et al. Euro Surveill 2009)

3. Infection during deployments– Field and rural deployments– Water/food hygiene– Absence/interruption of vector control programmes– Challenges in vaccinations, prophylaxis and personal hygiene measures

Challenges

4. Increasing deployment of military forces– Provide health services for civilians in remote areas– Reporting surveillance data to local health authorities– Contribute to national surveillance– Ensuring force protection

5. Novel infectious agents– Challenges in early detection and prevention strategies– Overseas importation

6. Biological warfare and bioterrorism– Development of detection and diagnostic facilities

Opportunities

1. Surveillance programs – International surveillance programs– Component of population-wide protection measures

2. Public health interventions– Contact precautions– Food and water hygiene– Health education– Prevention and containment of infection

3. Vaccination– Militaries led in use of many vaccines – Vaccination programs often more comprehensive than civilian

populations

Opportunities

4. Chemoprophylaxis and treatment– Novel drug developments and usage

5. Co-operation between militaries and Non-military organisations– International networks allow pooling resources, providing greater

equity– International military aid in disaster relief operations

6. Enhancing lab diagnostic capabilities– Strengthen national capabilities in detecting of novel infectious agents – Militaries require rapid diagnosis of common diseases especially

during field deployments– Enhancing laboratory capacity in field and austere conditions

SAF ApproachCAPABILITY DESCRIPTION

Early Warning Surveillance programs

Protection Medical, Physical, Public Health Protection

Diagnosis Decisive Identification, Rapid Screening

Containment Breaking the Chain of Transmission

Recovery Resuming Operations, Medical Treatment and Decontamination

Thank You