1. Medical Engagement: A Strategic Enabler RADM Mike Mittelman, SHCE, USN USPACOM J07 Command Surgeon 16 March 2011

2. Outline Partners Levels of Capability Commander’s Focus Areas The Strategy PI/EID Programs Pacific Partnership Pacific Angel Challenges and Opportunities Questions

3. Partners Components: Army (USARPAC), Navy (PACFLT), Air Force (PACAF/13 th AF), Marines (MARFORPAC) and Special Operations Command (SOCPAC) Other Governmental agencies such as Defense Threat Reduction Agency (DTRA), Center for Disease Control (CDC), USAID, Armed Forces Research Institute of Medical Sciences (AFRIMS), Defense Institute for Medical Operations (DIMO), Global Emerging Infections Surveillance (GEIS) and others Non-governmental organizations such as Family Health International, Red Cross and The Hope Foundation

4. Levels of Capability Internal Regional Expeditionary

5. Commander’s Focus Areas Strengthen and advance alliances and partnerships Mature the U.S.-China military-to-military relationship Develop the U.S.-India strategic partnership Remain prepared to respond to Korean peninsula contingency Counter transnational threats

6. Overarching Strategy Promote regional stability and security Build trust & sustain partnerships Build capacity & capability Build resiliency Promote coalition and joint medical interoperability and capabilities Develop military public health capacities & capabilities Improved health surveillance Increased transparency Must be coordinated & focused effort

7. Specifically Increase military to military medical engagements with China Increase regional military partnership events with India Increase demonstration of interoperability with Allies and Partners during exercises Increase military health engagement events in or with specified Nations to counter transnational threats Establish a working group to develop Strategic and Operational Measures of Effectiveness (MOEs)

8. Emerging Infectious Disease/Pandemics

9. Emerging Disease Surveillance/Mitigation Overview Mil-Mil Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) Civilian World Health Organization (WHO) PACOM Surgeon’s Office Force Health Protection monitoring Mil-Mil/Mil-Civ Infectious Disease capacity building engagements

10. APAN The All Partners Access Network fosters information exchange and collaboration between the United States Department of Defense (DOD) and any external country, organization, agency or individual that does not have ready access to traditional DOD systems and networks.

11. Pandemic Influenza BILAT PI workshop and SMEE - 2008 MUTILAT PI workshop and SMEE - 2009 PI TTX- 2010 Surveillance and Response - 2011 PI FTX- 2012?

12. PACIFIC PARTNERSHIP 10 (USNS MERCY) Scheme of Maneuver 139 Day Deployment CMO/TSCP 61 days U/W 60 days QOL/PAX VST 18 days Dates are Arrival-Departure days Calculated using 14 kt SOA Pearl Harbor Westbound: 08-10 May Eastbound: 08-10 Sep San Diego Deploy: 01 May Arrive: 17 Sep Indonesia 11-31 Jul (10-30 Jul U.S.) QOL PVST: Darwin 02-07 Aug (01-06 Aug U.S.) Guam Westbound: 21-24 May (20-23 May U.S.) Eastbound: 27-30 Aug (26-29 Aug U.S.) Timor Leste 09-22 Aug (08-21 Aug U.S.) BSP: Jakarta 06 Jul (05 Aug U.S.) QOL PVST: Singapore 01-04 Jul (30 Jun -03 Jul U.S.) Cambodia 15-28 Jun (14-27 Jun U.S.) Vietnam 31 May -12 Jun (30 May - 11 Jun U.S.)

13. Pacific Angel 2010: Philippines, Vietnam, Bangladesh, Sri Lanka

14. Challenges and Opportunities Synchronization and coordination –Between ourselves –With the Interagency –With host nation –Amongst multitude of other players (NGO’s, WHO, etc.) Transparency Documentation and application of best practice Measures of effectiveness vs. measures of performance Capacity and capability building vs. direct health care provision –Long term vs. short term –Nation enhancing vs photo opportunity Managing expectations –Internally and externally

15. Conclusion Health Engagement can be a potent strategic enabler in any AOR Success facilitates: –Local, regional and global responses to most contingencies –Increased trust and cooperation –Increased responsiveness of local governments –Increased mil-mil interoperability within the AOR –Quick identification/isolation of emerging diseases Strategic Health Engagement directly supports the U.S. National Security Strategy by promoting peace and stability in the Asia-Pacific region

16. Questions

17. BACK-UP SLIDES

18. Surfaces that are Most Likely to be Sources of Contamination 18 Influenza virus can be spread when a person touches something that is contaminated with the virus and then touches his or her eyes, nose, or mouth (fomites). Frequent hand washing reduces chance of getting contamination from these common surfaces.

19. Overarching Strategy Promote partner nation and regional stability and security –Build trust and sustain partnerships –Health can go where others cannot Build capacity and capability Build resiliency throughout the AOR Promote coalition and joint medical interoperability and capabilities through exercises and subject matter expert exchanges. Development of military public health capacities to collaborate with host nations in planning for and containing infectious disease threats. –Improved health surveillance –Increase transparency between nations – eliminate “Viral Sovereignty” Must be a focused effort – not spread thinly around AOR

20. Influenza A Virus Hemagglutinin (H) 16 (3) Forms Attachment/Penetration Neuraminidase (N) 9 (2) Forms Viral release RNA (genetic material) 8 strands Gene sequences

21. 21 Diagnosis of Human H1N1 Infections Identification of the H1N1 influenza virus is by laboratory testing (PCR). No rapid test yet. The influenza A/B rapid tests are unreliable for H1N1. During current pandemic, meeting clinical case definition is sufficient for diagnosis.

22. 22 Medicines to Treat H1N1 US CDC recommends the use of two antiviral drugs, oseltamivir (Tamiflu®) and zanamivir (Relenza®) for the treatment and/or prevention of infection with these swine. If you get sick, antiviral drugs can make your illness milder and may prevent serious flu complications. For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of onset of symptoms).

23. 23 Herd Immunity 90% rule for vaccinations and herd immunity…