U.S. Department of Defense and International Public Health LT Mazie Barcus U.S. NAMRU 2 Jakarta, Indonesia

OCONUS Medical Research Units Central Coordinating Hub DoD Overseas Laboratories WRAIR NMRC Peru Kenya Egypt Thailand Indonesia

Mission of the Overseas Labs Conduct scientific research on infectious diseases of military importance –Overlap between military relevance and host-nation public health priorities –Technology transfer to host nation Global Emerging Infections System –1996 Presidential Directive –Surveillance of emerging and re-emerging infectious diseases –Host-nation capacity building

DoD GEIS Initiatives 1.Enhance surveillance and response components of international public health infrastructure –Surveillance for drug-resistant malaria, antibiotic- resistant enteric organisms, influenza, and unexplained febrile illness –Partnering with international aid organizations and foreign health ministries to improve their ability to participate in an international surveillance network

DoD GEIS Initiatives 2.Enhance biomedical and behavioral research efforts on emerging infectious diseases –Collaborate with Military Infectious Disease Research Program –Use GEIS-generated surveillance data to guide research efforts in areas like drug development

DoD GEIS Initiatives 3.Expand formal training and outreach to health care providers –Support training of foreign scientists, epidemiologists and technicians –Outbreak investigation courses, health care provider courses, technology transfer

DoD GEIS Initiatives 4.Encourage high priority status for emerging infectious diseases and support WHO and other bodies in playing a stronger role in the surveillance, prevention, and response to emerging infectious diseases –Building bridges between international aid agencies, donor agencies, foreign governments, militaries and the UN.

GEIS at NAMRU-2 Surveillance for drug-resistant malaria

NAMRU-2 Organized an Intervention Address the immediate threat of epidemic malaria in the Menoreh Hills –Ministry of Health: CDC and NIHRD –Provincial Health Officers –District Health Officers WHO in Geneva –Effective therapy USAID/Jakarta –US$500,000 via WHO

NAMRU-2’s Direct Role in the Intervention Provided plan of action for the intervention Engaged international agencies for monetary support Training and infrastructure for post-marketing surveillance of Coartem Monitored the impact of the intervention –monitoring passive surveillance data –pre- and post-intervention prevalence surveys Operational research in the Intervention Area –Vector bionomics –Clinical trial of CQ + S/P –Malaria KAP study

NAMRU-2’s Continued Efforts Against Malaria on Java Transition from unsustainable intervention to sustainable capacity building Incubate and nurture a NGO that can partner with USAID and other donors to re-build the infrastructure for malaria control

USAID/NAMRU-2 Partnership Agreement to bring long-term USAID resources to bear on malaria problem on Java –$4 million over 4 years Utilize NAMRU-2’s assets in the region to re- establish malaria control infrastructure –32 year relationship with Ministry of Health partners –Resident expertise in malaria –Working relationships with international agencies engaged in malaria control

Goals of the USAID/NAMRU-2 Collaboration Capacity building along 5 tracks: –Community Participation –Diagnosis –Treatment –Vector Control –Surveillance

International Public Health and the DoD Mission: infectious disease research of military importance –Convergence of purposes with developing countries’ public health threats –Technology transfer to host nation GEIS: fully-sanctioned platform for capacity building in infectious disease surveillance and control