USPACOM Efforts in the Pacific Consortium of Universities for Global Health RDML Brian Pecha U.S. Pacific Command Surgeon 31 August 2016 Overall classification of this brief is: UNCLASSIFIED

Regional Threats to Health UNCLASSIFIED Emerging Infectious Diseases Antimicrobial Resistance Counterfeit Pharmaceuticals Water Quality Human Trafficking Animal Trafficking Non-Communicable Diseases PACOM (This slide to show PACOM AOR, but mostly focus on health issues.) There are many threats to health in the Asia-Pacific region, most are transnational and require collaborative approaches to address. These health security issues impact overall security within the region; working together to address these issues will improve security and stability. Natural Disasters Climate Issues High Population Densities Territorial Disputes

Joint Health Value to PACOM UNCLASSIFIED//FOUO Lead Rebalance Operationalize Theater C2 Drive Activities in TCO Fight Tonight Organizational Coherence/Climate Defend the Homeland J07 Priorities COM’s Priorities J07 Priorities Defend the Homeland Support the Warfighter Joint Health Value to PACOM Fight Tonight Lead the Rebalance Global Health Engagement Drive the TCO Operationalize C2 Work with Components Command Climate UNCLASSIFIED//FOUO

USPACOM Health Lines of Effort UNCLASSIFIED USPACOM Health Lines of Effort Operational Medicine First Responder Training/Trauma Casualty Care Medical Support to HA/DR Naval / Undersea Medicine Aerospace Medicine Patient Movement: CASEVAC, MEDEVAC, AIREVAC Public Health / Force Health Protection Malaria/Dengue Emerging Infectious Disease Biosurveillance/Lab Capacity Building One Health (Animal, Human, Environmental) Health System Strengthening Blood Safety Program Medical Education Support Maternal & Child Health (Different week to speak to the strategic framework / lines of effort) types of engagements binned into three HLOE with corresponding health functional areas: Operational Medicine line of effort encompasses our mil-to-mil engagement on military health topics. Public Health / Force Health Protection may include mil-to-mil as well as mil-civ and whole of government. Addressing these issues in our partner nations will improve US Force Health Protection, as well as that of our partner nations. Health System Strengthening may be mil-mil or mil-civ, and focuses on building partner nations’ health systems. Direct patient care activities tend to fall in this line of effort 4

USPACOM Partners for Health UNCLASSIFIED USPACOM Partners for Health Whole of Government Regional Allies & Partners Australia Philippines Thailand Japan S. Korea New Zealand Indonesia Laos Singapore Cambodia Vietnam Malaysia China Nepal India Bangladesh Sri Lanka Maldives Brunei Tonga We work closely with our interagency partners to synch and de-conflict; ideally our whole of government health efforts support each other. Most of our engagements are executed by our service components, represented at bottom. 5

USPACOM Health Engagements UNCLASSIFIED//FOUO USPACOM Health Engagements Oct 2013 to Oct 2015 Region # of Events Countries Northeast Asia 26 China, Japan, Mongolia, South Korea, Taiwan Southeast Asia 119 Brunei, Burma, Cambodia, India, Indonesia, Laos, Malaysia, Philippines, Singapore, Thailand, Vietnam South Asia 32 Bangladesh, India, Maldives, Nepal, Sri Lanka Oceania 21 Australia, Fiji, FSM, Kiribati, New Zealand, PNG, RMI, Samoa, Solomon Islands, Tonga 198 in two years Types of Engagements Blood Program Disaster Response Exercise & Exchange Malaria Reduction Field Training Exercise Pacific Angel / Pacific Partnership / Pacific Pathways Senior Leader Visit Subject Matter Expert Exchange First Responder Training Veterinary Workshop / Seminar / Meeting J07 Engagements Asia Pacific Military Health Exchange (APMHE) International Committee of Military Medicine (ICMM) Center for Strategic and International Studies (CSIS) Uniformed Services University of Health Sciences (USU) Naval War College Association of Military Surgeons of the United States (AMSUS) Regional Malaria Meeting (Cambodia) Global Fund Malaria Meeting (Vietnam) Visits to Australia, Burma, Cambodia, China, Indonesia, India, Japan, Laos, Malaysia, Papua New Guinea, Philippines, RMI, South Korea, Singapore, Thailand, Vietnam Hosted SGs from India, Indonesia, PRC, Singapore, Taiwan, Thailand 198 engagements in two years from OCT 2013-2015. *Does not include multilateral events that were attended in other countries (these numbers under-represent Northeast Asia engagement on a day to day basis between our forces in Japan and Korea and their counterparts) PHOTO: meeting with Lt Gen Chopra, Director General Armed Forces Medical Services (April 2016). Multiple levels of engagement opportunities with military and civilians during international or US domestic events. Key senior leader engagements build relationships and open doors 6

Global Health Security Agenda (GHSA) Presidential-level initiative with primary aim of stopping pandemics before they start PREVENT-----------DETECT------------RESPOND Focus on building capacities of resource- constrained countries through 11 action packages Uses new tools to enhance the needs for countries to meet International Health Regulation (2005) obligations Military role can vary in each country lessons leaned from Ebola -A few words on the larger, strategic effort to tackling the health security threats throughout the world. The IHR of (2005) was signed on my all 195 Member States of the World Health Assembly of the WHO. -We continue to see where countries are challenged to meet these minimum standards. -The Global Health Security Agenda is an effort to work with not only WHO but also agriculture and animal health authorities to stop pandemics before they start -Early detection and rapid response are still important but with a new emphasis on the need to PREPARE at all level across the many systems. -We are still working very closely with counterparts to determine where the military fits into this construct in each country. Suffice it to say, Ebola taught us that the military plays a critical role in both detection and response and will continue to do so as new threats emerge. 7

UNCLASSIFIED Conclusion Provide Health Service Support guidance to PACOM in support of the PACOM Commander and mission Health Engagements have evolved over the last 5 years from largely direct patient care to enhanced focus on building capacity, capability and interoperability Health TSC Activities directly support the USPACOM Theater Campaign Plan Health TSC contributes to achievement of National Security End States 8