You may have seen this Hollywood movie before. There’s a new disease outbreak that confounds the local doctors in a foreign land called Ceswela. They discover that Ceswelian virus is contagious and soon enough, the disease spreads to other countries as air flights from the affected region transport infected carriers across the globe. The Centers for Disease Control and Prevention warn that the increase in cases is worrying and they are ready to call it a global pandemic outbreak. The virus mutates to an airborne strain and soon the numbers of infected grow to the hundreds, with some deaths occurring among those with weak immune systems. Fearing that the Ceswelian authorities cannot handle the outbreak, the US president orders military forces to deploy in a humanitarian-assistance role to support their efforts. “Our troops can make the difference to secure our health interests,” she states in a nationally televised speech. “They have the resources and the experience to complete this mission.”

The movie plot advances predictably, with Army soldiers in protective masks who are either forcibly evacuating civilians or quarantining towns where the outbreak is spreading, as Air Force planes load up incendiary munitions to drop on the towns and burn out the disease.

How realistic is such a silver-screen depiction of a military-led response to a medical crisis? Retired Adm. James Stavridis argued recently that the US military ought to play a lead role in global responses to pandemic outbreaks. He asserts that the Department of Defense has trained its forces to operate in a world of bioweapons, that it has the necessary medical countermeasures, and it can provide logistics to move personnel and materiel rapidly around the globe. While there’s no question that the US military can provide vital assistance during a global disease outbreak, the real question is, should it?

There’s a reflexive assumption by many policymakers and senior officials that our military forces are able to take on any threat in any location in the world. Given its significant resources and wide-ranging authorities, the US military can support a wide range of humanitarian-assistance and disaster-relief contingencies through the flow of food and water, medical operations, search and rescue efforts, and construction work. When the US military supported the response to the Ebola virus epidemic in West Africa in 2014, the Department of Defense spent more than $400 million to build treatment units, train and equip African medical teams, and research a vaccine.

There’s no question that this was good work, but it’s often forgotten (at least within DoD) that there were other government agencies involved. The military was not the lead for US government activities for Ebola response between 2014 and 2019. The US Agency for International Development (USAID) had the lead along with the Department for Health and Human Services (HHS), which was working both the domestic and international response. The National Institute of Allergy and Infectious Diseases had the lead to develop a vaccine, and although DoD allocated tens of millions of dollars to vaccine research, it was the Public Health Agency of Canada that researched and Merck who developed the vaccine that would eventually receive FDA authorization for use.

We Need Better Policy

How the US government approaches its “Global Health Security Agenda” is too broad a topic for casual discussion. However, it is relevant to note some of the major points of the US military’s general policy approach to responding to biological threats. Military medicine became formalized during the Civil War, where nearly two-thirds of the deaths were the result of natural disease. Preventive medicine became a necessary component to commanders who needed to maintain a capable military force that was unhampered by communicable diseases. The rise of biological-warfare technologies during the two world wars expanded the responsibilities of military medical organizations to anticipating disease outbreaks from deliberate releases of biological organisms. Fort Detrick, Maryland became the center for DoD research and development of medical diagnostics and countermeasures to protect US forces.

Things changed in the twenty-first century after the ”Amerithrax” incidents in 2001. The release of weaponized anthrax into the American public sector brought a recognition that US biosecurity policy was immature and not sufficiently coordinated across the government. These incidents led to the development of Homeland Security Presidential Directive-10, “Biodefense for the 21st Century,” in 2005. This directive called for a cooperative effort between HHS, DoD, and the new Department of Homeland Security. Notably, DoD was tasked to support, not lead, to the other agencies. This initiated a public dialogue (that continues today) as to how the US government addresses biological threats.

DoD leadership was seeking a new concept for biological-warfare defense at this same time, citing the concern that the military’s general concept for chemical-biological-radiological-nuclear (CBRN) defense did not provide adequate means for the unique challenges posed by a natural or intentional release of a biological disease. And sure, they had a point. US military forces had significant biological-defense shortfalls during the Persian Gulf War, many of which remained unaddressed up to the 2003 Iraq invasion. On the other hand, the proposed solution—something DoD calls a “Chairman’s Instruction,” which was titled “Joint Strategy for Biological Warfare Defense” and released in May 2006—didn’t really change how the military would practice biodefense.

Since 2006, one of US Northern Command’s key responsibilities has been to  develop measures in response to pandemic influenza outbreaks. To be clear, the command’s primary responsibility was to support the armed services’ efforts to keep their people healthy and to minimize the impact on military operations. Providing military assistance to civil authorities continues as a vital mission, as it does with all requests for disaster response, but the DoD health system’s primary mandate is to take care of its own first. Also, there are many health concerns under the category of “disease and nonbattle injuries” other than “pandemic disease outbreak.”

DoD does have a significant investment in “force health protection” and I do not want to underemphasize the importance of its role in keeping military forces medically ready and protected from all potential health effects, wherever they might be deployed. The Defense Health Agency is a huge organization with billions of dollars spent every year to anticipate health hazards and treat servicemembers. The DoD medical community is very tightly connected with its civilian counterparts, as one might expect, especially in the area of global biosurveillance. Perhaps surprising to some, the term “biosurveillance” is not limited to watching for disease outbreaks, as one might be led to believe by this DHS definition. Rather it involves the broad effort to “identify and understand potential human, animal, or plant health impacts resulting from [CBRN] and environmental incidents, as well as influenza and other public health trends.” That covers a lot of territory and doesn’t suggest a priority of effort.

In 2009, the White House released a National Strategy for Countering Biological Threats that blurred the distinction between emerging natural biological diseases and deliberately released biological warfare agents. This strategy also resulted in changes to the US military’s joint concept for biological-warfare defense in 2012, placing emerging infectious diseases in the same category as biological warfare. DoD redirected millions of dollars away from traditional CBRN defense programs and to global biosurveillance and a vaccine manufacturing plant that mirrored HHS efforts. Even as this funding shift occurred between 2010 and 2014, it represented a small portion of the total US government investment in biodefense.

Why does all this matter? Adm. Stavridis says that armies “train to operate in a world of bioweapons, and have the heavy equipment and personal protective gear necessary in an infected environment”—which is true only in a very general sense and doesn’t reflect their actual preparedness to lead the response to a health crisis. For one, biodefense is not the same as disease containment. Second, it’s the us military health professionals who address this threat, not the general forces. In addition, making DoD the lead—with the requisite resources—would take away authorities and resources of those government agencies that actually have the expertise.

Even our specialty forces have their limitations. The 48th CBRN Brigade deployed to West Africa in support of the Ebola response in 2015, but there was no real need for them to be there. They had the sophisticated equipment to operate in a contaminated environment, but they don’t train to be disease-containment specialists or to oversee medical treatment units. No doubt it was a good training opportunity for the troops and it always looked good for our CBRN professionals to be seen as participating in an overseas contingency operation. But let’s not kid ourselves. The military shouldn’t be in charge of these operations. As Adm. Stavridis notes, no one sees this as an ongoing military priority.

Outlining a New Approach

There are three important issues that need to be addressed prior to developing a new approach to responding to biological threats and thereby defining the military’s role. The first is largely definitional. The term “biodefense” is misused as a generic term. Definitional clarity must be achieved prior to the “good ideas” being implemented. We need the US government to standardize at least three terms:

  • Biodefense – those efforts required to protect US military forces against the deliberate use of biological weapons designed and employed by adversary nations (required protection that enables military operations in a contaminated environment).
  • Biosafety – those efforts required to protect US citizens from natural and manmade diseases (domestic surveillance and treatments for the general civilian populace).
  • Biosecurity – those efforts required to protect the nation from global biological threats such as pandemic disease outbreaks (to include biosurety efforts for research labs and agricultural businesses).

While these areas all address biological threats, they require specific policy attention and discrete funding to allow the US government to manage capabilities used for global health security effectively. A poorly defined lexicon means that calls for more “biosecurity” funding could just as easily yield more money to address “orphan diseases” as it could for potential bioterrorism threats. Policy should treat preparing for and protecting against a naturally occurring disease as different and distinct from measures taken to mitigate the effect of a weaponized organism that is released with intent. We don’t have that right now. Concepts for countering weapons of mass destruction should not be applied to be referencing infectious disease outbreaks, even if certain response capabilities are the same for both.

Second, we need to formalize a periodic assessment process from a government source as to where the US government is and where it’s going. Too often the blanket of security concerns slams down to obscure what capabilities need to be addressed, or the necessary funding challenge becomes too hard to overcome given other priorities within the Beltway. We cannot rely on “blue ribbon study panels” sponsored by Big Pharma groups to assess the US government’s capabilities to conduct biodefense. Industry should be part of the dialogue but we need independent assessments and, more critically, realistic agendas with adequate funding to improve US preparedness.

In particular, these assessments have to be specific to the agencies conducting the research. The Army’s Military Infectious Diseases Research Program focuses on naturally occurring biological threats, while DoD’s Chemical and Biological Defense Program focuses on validated biological-warfare threats. Both offices coordinate with HHS’s medical-research agencies, which have their own priorities. In addition, the funding to medical biological defense programs, which is significant, needs to be balanced against funding of nonmedical biodefense programs. Policymakers and resource managers need this information to make smart programmatic decisions that will advance US government priorities.

Lastly, I’m going to suggest that DoD should avoid doing anything different with regard to preparing its forces to support the US government through the next global pandemic. It provides forces as required to the federal response, with the DoD medical community providing technical assistance to its civil counterparts as required. But DoD has other operational priorities that may take precedence. Make no mistake, if DoD does redirect more funding into pandemic response, capabilities elsewhere will take the hit. It’s a zero-sum budget.

Adm. Stavridis accurately notes the US military’s involvement in epidemic response, but HHS and USAID must be the lead for global health security. It’s their job. The US military can be a great Swiss Army knife to have when dealing with complex security crises other than warfighting. It has lots of capabilities that can apply to all kinds of challenges. The problem is, it’s supposed to be a bayonet. And while bayonets can be useful for can-opening and erecting field-expedient shelters, we ought not make a practice out of dulling that edge because of misplaced concerns on the crisis of the day.

 

Al Mauroni is the director of the US Air Force Center for Strategic Deterrence Studies and author of the book, Countering Weapons of Mass Destruction: Assessing the U.S. Government’s Policy. The opinions, conclusions, and recommendations expressed or implied within are those of the author and do not necessarily reflect the views of the Air University, US Air Force, or Department of Defense.

 

Image credit: Staff Sgt. V. Michelle Woods, US Army