Demonstrated Values and Obstacles in Global Health Engagements USPACOM UNCLASSIFIED//FOUO Demonstrated Values and Obstacles in Global Health Engagements USPACOM COL John Teyhen USPACOM Global Health 1 December 2016 John.teyhen@pacom.mil Overall classification of this brief is: UNCLASSIFIED//FOUO

UNCLASSIFIED//FOUO Disclosures The views and opinions expressed in this presentation are those of the author and do not necessarily reflect the official policy of the Department of Defense, U.S. Pacific Command, or the Department of the Navy. The presenter has no financial relationships to disclose. This continuing education activity is managed and accredited by Professional Education Services Group in cooperation with AMSUS. Neither PESG,AMSUS, nor any accrediting organization support or endorse any product or service mentioned in this activity. PESG and AMSUS staff has no financial interest to disclose. Commercial support was not received for this activity.

UNCLASSIFIED//FOUO Learning Objectives At the conclusion of this presentation, the participant will be able to: Gain a basic understanding of what the demonstrated values of conducting Global Health Engagements in the USPACOM are. Gain a basic understanding of what the demonstrated obstacles of conducting Global Health Engagements in the USPACOM AOR are. Have an understanding of characteristics of the USPACOM AOR.

USPACOM Characteristics UNCLASSIFIED//FOUO USPACOM Characteristics Over half of world population (3.43 B) 52% of Earth’s surface 36 countries 16 time zones Most populous nation Largest democracy Largest Muslim- majority Smallest republic 2 of 3 largest economies 9 of 10 smallest economies World’s 6 largest armed forces 5 of 7 U.S. Mutual Defense Treaties 5 declared nuclear nations Busiest international sea lanes 9 of 10 largest ports NORTHCOM EUCOM SOUTHCOM AFRICOM CENTCOM PACOM U.S. Forces (AC/RC) PACFLT PACAF USARPAC MARFORPAC SOCPAC DRUs / SUB-Us Total Forces: ~ 410K 2 of 3 largest economies (Based on GDP only - US $19 T, China $12 T, Japan $4.3 T. Source CNN.com) 9 of 10 smallest economies (among the smallest:Vanuatu, Samoa, Tonga, FSM, Palau, Marshall Islands, Kiribati, Tuvalu, Am Samoa? CNMI? New Caledonia? Source: World Bank 2014 data) World’s 6 of 9 largest armed forces (PRC, USA, India, DPRK, ROK, Vietnam. Russia, Pakistan, Iran, Israel). 5 of 7 U.S. Mutual Defense Treaties (ROK, Japan, Thailand, Australia/NZ, Philippines. NATO, Rio) 5 declared nuclear nations (USA, China, India, DPRK. Russia, Pakistan, UK, France) Busiest international sea lanes 9 of 10 largest ports The Pacific Ocean connects the United States to the region… it doesn’t separate us 4 UNCLASSIFIED//FOUO

USPACOM Vision and Mission UNCLASSIFIED//FOUO USPACOM Vision and Mission Vision: The Indo-Asia-Pacific region is stable, prosperous, and characterized by a rules-based international order with the United States as the security partner of choice. Mission: USPACOM protects and defends, in concert with other U.S. government agencies, the territory of the United States, its people, and its interests. With allies and partners, we will enhance stability in the Indo-Asia-Pacific region by promoting security cooperation, responding to contingencies, deterring aggression, and, when necessary, fighting to win.

Be Ready to Fight Tonight Lead the Rebalance Have Unity of Purpose UNCLASSIFIED//FOUO USPACOM Priorities Defend the Homeland Be Ready to Fight Tonight Lead the Rebalance Have Unity of Purpose Operationalize Theater Command and Control Optimize Our Organization Defend the Homeland – Defense of the Homeland and our citizens is “Job 1.” Be Ready to Fight Tonight – Readiness, presence, power projection, and resiliency NOW – across all domains. Lead the Rebalance – Maintain the momentum of the Nation’s commitment to the rebalance. Have Unity of Purpose – Drive activities in accordance with our strategy, Theater Campaign Plan, and Theater Campaign Order by aligning policies, plans, programs, and processes. Operationalize Theater Command and Control – Institutionalize a coherent, ready, and agile command structure to operate effectively from steady state through conflict. Optimize our Organization – Ensure organizational coherence and proper command climate exists at USPACOM headquarters.

USPACOM Command Surgeon’s Priorities UNCLASSIFIED//FOUO USPACOM Command Surgeon’s Priorities Support to the Warfighter Global Health Engagement Work with Components

USPACOM Health Lines of Effort UNCLASSIFIED//FOUO 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 GHE broken down into three 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 8 8 UNCLASSIFIED//FOUO

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 Slide representing how we partner with USG interagency on left, regional partners and allies and right, execution of majority of health engagements are conducted by the components (bottom).

USPACOM Health Engagements UNCLASSIFIED//FOUO USPACOM Health Engagements Oct 2013 to Oct 2016 Region # of Events Countries Northeast Asia 48 China, Japan, Mongolia, South Korea, Taiwan Southeast Asia 181 Brunei, Burma, Cambodia, India, Indonesia, Laos, Malaysia, Philippines, Singapore, Thailand, Vietnam South Asia Bangladesh, India, Maldives, Nepal, Sri Lanka Oceania 45 Australia, Fiji, FSM, Kiribati, New Zealand, PNG, RMI, Samoa, Solomon Islands, Tonga 322 in three 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, India, Japan, Malaysia, Philippines, South Korea, Singapore, Thailand, Vietnam Hosted SGs from India, Indonesia, PRC, Singapore, Taiwan, Thailand in last three years 322 engagements in three years from OCT 2013-2016. *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 10

Global Health Engagement Values Supports the USPACOM CDRs Priorities Mil to Mil Interoperability Builds Capacity Peacetime to Crisis mode preparedness Serves as a synchronizer between the components Supports the COMs priorities – By having a synchronized and matrixed Global Health Engagement program aligned under the USPACOM Commander’s priorities, we will enhance stability in the Indo-Asia-Pacific region by promoting and strengthening security cooperation Mil to Mil Interoperability – By working and engaging together with our partner nations, we should be better abled to be prepared to respond to any type of event and work in an interoperable type of environment. Builds Capacity – It benefits all to build up capacity. Example – by building capacity in the area of disease surveillance, it will help other nations by serving as a warning detector, preparedness to respond to an emergency, and prevent the disease from occurring in the first place. Peacetime to crisis mode preparedness – The more engagements, training events, exchange of ideas, the better we will be able to respond to an event if it were to occur. Serves as a synchronizer between the components – A Global Health Program will ensure that all of the health engagements within the region conducted by all parties will enhance each other and work towards a common and beneficial goal. Too often, engagements are held without coordination and they could have detrimental effects and go against country team objectives. This also provides for better use of limited resources. USPACOM hold a quarterly Health Theater Security Cooperation Planning Group Meeting to coordinate within the region. This helps ensure we are all on the same sheet of music.

Global Health Engagement Obstacles Synchronization Politics Travel – Distance Competing Interests Global Health Engagements values far outweigh the obstacles that might show up. Synchronization was mentioned in the previous slide and can have the opposite effect if not conducted. Valuable resources such as money and personnel can be wasted. Every so often we will have an surprise engagement in the region that was not coordinated. This can have a detrimental effect and undo long term planning conducted by the country team. Politics – As with anything, politics can shift and cause adjustments in planning. Travel – Distance – Traveling within the USPACOM Theater can be a challenge just because of the sheer distance. Competing Interests – While competing for funding to conduct health engagements, we are also competing against other non-medical events. This can have an impact on the numbers of funded health engagements.

Success Story - Asia Pacific Military Health Exchange UNCLASSIFIED//FOUO Success Story - Asia Pacific Military Health Exchange Asia Pacific Military Health Exchange (APMHE) 16 held in Malaysia in August 2016, co-hosted by PACOM Surgeon & Malaysia Armed Forces Health Services Director General 491 participants from 28 countries, E-4 to O-9 Plenary sessions included Multilateral Health Engagement, Global Health Security Agenda, and Recent Advances and Emerging Issues Service-specific Breakouts (Land Forces, Aviation, Maritime Forces) Corps-specific Breakouts (Medical-Dental, Nurse, Medical Service, Public Health, Veterinary, Medical NCO) APMHE 17 in Singapore, 23-36 May 2017 APMHE 18 in China, date TBD An example of success COL Teyhen will go further in the details on Thursday as a case study. Note upcoming APMHE events for the next two years. Opportunities for Bilateral discussions Combined component medical conferences Key leaders from most countries at the same event – great scenario from a resource standpoint

Success Story – Blood Program FY16 Cambodia Blood Safety Program: Grand Opening: Provincial Blood Transfusion Center, Honorable Guests: Cambodia Minister of Health; US Ambassador; USARPAC Deputy Commander; CDC Deputy Country Director; representatives from the US Navy Research Unit 2; and USPACOM Joint Blood Program Officer Site Visits: Preahket Mealea Military Hospital and National Blood Transfusion Center Workshops: Blood Transfusion Safety attended by Doctors, Nurses, and Medical Laboratory Technicians from across the country and various organizations FY16 Lao Blood Safety Program: Frozen Blood Technology introduction and training was successfully implemented which needs future assessments by the JBPO for continue support to improve process. Objectives: -Build host nation biosecurity and a sustainable blood program capacity in support of disaster response -Demonstrate DoD goodwill, while providing bilateral medical outreach and strengthening the maturing partnerships -Provide subject matter expertise in an educational forum for training and assistance in the host nation -Mitigate the harm caused by improperly collected, tested, stored, and administered blood products -Provide blood center processing, testing and blood storage capacity by building and handing over Blood Center facilities.

UNCLASSIFIED//FOUO Conclusion USPACOM Global Health Engagement Mission contributes to achievement of National Security End States Global Health Engagement Serves as a Critical Enabler for Security Cooperation Global Health Engagement values far outweigh obstacles In the end, a coordinated and synchronized Global Health Engagement plan will far outweigh any obstacles. It can help the Geographical Combatant Commander execute his mission. It also help the Country Teams also meet their objectives where a subject such as health has few boundaries.

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