1. Emerging and Re-emerging Infectious Diseases Challenges and Opportunities for Militaries LTC (Dr) Vernon Lee MBBS, PhD, FAMS, MPH,MBA Singapore Armed Forces Biodefence Centre

2. 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

3. 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

4. "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

5. 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

6. Principal Considerations Comprehensive risk management approach All-hazard Multisectoral Multidisciplinary Community resilience Sustainable development Ethical

7. Principal Considerations Comprehensive risk management approach All-hazard Multisectoral Multidisciplinary Community resilience Sustainable development Ethical

8. 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

9. 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

10. 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

11. 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

12. 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

13. Ho et al, MMJ 2014

14. 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

16. 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

17. 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

19. 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

20. SAF Approach CAPABILITYDESCRIPTION Early WarningSurveillance programs ProtectionMedical, Physical, Public Health Protection DiagnosisDecisive Identification, Rapid Screening ContainmentBreaking the Chain of Transmission RecoveryResuming Operations, Medical Treatment and Decontamination

22. Thank You