USPACOM Global Health Engagement Strategy UNCLASSIFIED USPACOM Global Health Engagement Strategy RADM Colin Chinn USPACOM Command Surgeon 28 August 2014 Overall classification of this brief is: UNCLASSIFIED//FOUO

CDRUSPACOM Priorities UNCLASSIFIED CDRUSPACOM Priorities Maintain the Momentum of the Rebalance to the Asia-Pacific Region Enhance and Align Strategy, Resources, Capabilities, Posture and Plans Strengthen Relationships with Allies and Partners Optimize Staff Performance and Command Climate Complete Operationalization of the Theater C2 and PACOM Staffs UNCLASSIFIED

Regional Threats to Health UNCLASSIFIED Regional Threats to Health Emerging Infectious Diseases Antimicrobial Resistance Counterfeit Pharmaceuticals Water Quality Human Trafficking Animal Trafficking Non-Communicable Diseases PACOM 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 UNCLASSIFIED

Maturation of USPACOM Health Engagements UNCLASSIFIED Maturation of USPACOM Health Engagements PAST: Uncoordinated, unsynchronized events focused on direct patient care; components executing without COCOM oversight. PRESENT: Focus has shifted away from MEDCAPs/DENCAPs/VETCAPs & towards capacity building. Interoperability between our components and with the interagency in a whole of government approach. Health TSC is part of USPACOM TCP & provides guidance for planning and execution of health engagements. Health engagements are a strategic enabler that cuts across TCP sub-campaigns and contributes to national and regional security and stability.

USPACOM Command Surgeon Priorities UNCLASSIFIED USPACOM Command Surgeon Priorities Health Engagement with Partner Nations Malaria Elimination Efforts in Mekong Region Health Response to Disaster Emerging Infectious Disease and Biosurveillance The overarching TSC goals of J07 are: Complement host/partner nation health systems strengthening. Align medical activities with the Theater Campaign Plan (TCP) and Intermediate Military Objectives (IMO) to achieve Guidance for Employment of the Force (GEF) end-states. Health is one cog, albeit an important one, in the overall PACOM effort to achieve our GEF End-states. Synchronize PACOM health strategy with DoS, USG and international interagencies with DoD and Service efforts. Assess host/partner nation baseline health status and disease burden for engagement opportunities. By conducting valid and effective assessments and establishing healthcare baselines, we can identify shortfalls in healthcare capability, capacity and regional interoperability and conduct follow up engagement assessment to determine effectiveness and follow on sequential engagements. Create enduring regional health security by enhancing whole-of-society resiliency and interoperability. The end state is to increase theater health security by building whole-of-nation resiliency to handle crises on its own. UNCLASSIFIED

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) Unique Health Needs of the Female Servicemember Health System Strengthening Blood Safety Program Medical Education Support Maternal & Child Health 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. UNCLASSIFIED

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 Regional Partners: 1st Row: Allies: Australia, Philippines, Thailand, Japan, S.Korea 2nd Row: New Zealand, Indonesia, Laos, Singapore, Cambodia 3rd Row: Vietnam, Shri Lanka, Maldives, Brunei, Tonga We work with a wide array of organizations in DoD, the USG Interagency, international organizations like the WHO, and NGOs. HHS-Office of the Secretary Support of LMI sub-regional LMI workshops on IHRs Strategic partnership with Institute Pasteur-Lao Food and Drug Administration No country program. Routine food and supply monitoring Centers for Disease Control Country Lead, Dr. Andy Corwin at Embassy as CDC Influenza assignee FETP supported by CDC influenza and GDD Regional Centre in Thailand National Institutes of Health Research through multiple third party research entities on influenza, Non-Communicable Diseases and population health US Department of Agriculture Food for Education Program; in-country teams assess food, nutrition and farming Department of State Cook stove program, Bio-engagement Program on surveillance and lab Environmental Protection Agency Multilateral environmental performance enhancement projects

Thailand Health Engagement UNCLASSIFIED Thailand Health Engagement Med Support to HA/DR Aerospace Medicine/ Aeromedical Evacuation Shipboard Medicine First Responder/Trauma Casualty Care Malaria / EID (AFRIMS) Educational Exchanges (MoU with USUHS) International Health Regulations (IHR) Regional Leader ADMM-Plus EWG on Mil Med Co-chair Opportunities for Trilateral and Multilateral Engagement (Burma and China) UNCLASSIFIED

Vietnam Health Engagement Overview UNCLASSIFIED Vietnam Health Engagement Overview Dive/Undersea Medicine Aerospace Medicine PKO Level 2 Hospital First Responder / Trauma Casualty Care Med support to HA/DR Humanitarian Mine Action PAC PARTNERSHIP / PAC ANGEL Research Collaboration Blood Safety Program HIV – DoD PEPFAR Tropical Medicine / EID Burn Medicine Malaria International Health Regulations (IHR) UNCLASSIFIED

Vietnam: Interventional Burn Management SMEE UNCLASSIFIED Vietnam: Interventional Burn Management SMEE Program developed from PACIFIC PARTNERSHIP 2012 SMEE Dermatology, Plastic Surgery, Orthopedics and Pulmonary/Critical Care educational exchanges and patient care Working with National Institute of Burns in Hanoi Phase I-III in 2013 I: Planning/initial SMEE II: Advanced SMEE in Vietnam III: Vietnamese staff visited Navy Medical Center San Diego PACIFIC PARTNERSHIP 2014: continued care by US and Vietnamese specialists for young patient originally seen in 2012, skin-resurfacing laser to decrease scars Building partner nation capacity, capability & building strong relationships

China Health Engagement UNCLASSIFIED China Health Engagement Lines of Effort Pandemic Response Joint Pandemic Response Exercises Pandemic Data Sharing Infectious Diseases HIV/AIDS Prevention Malaria Eradication Scientific Educational Exchanges Medical Support to HA/DR Exercises and Exchanges Soldier Care Medical Education Exchanges Traditional Chinese Medicine Our China engagement is slightly different than our strategic framework with other countries in the AOR. UNCLASSIFIED

Singapore Health Engagement UNCLASSIFIED Singapore Health Engagement NMRC-A Research Collaboration Shipboard & Undersea Medicine HA/DR Collaboration Combined Exercises Aerospace Medicine Amputee Care Disease Surveillance/ Outbreak Response Regional Leader Past ADMM-Plus EWG Mil Med Co-chair Opportunities for trilateral/multilateral engagements Medical Educational Exchanges Dengue Expertise Key leader engagement is another important part of our engagements in the theater. Building strong relationships for ongoing partnership. UNCLASSIFIED

Japan Health Engagement UNCLASSIFIED Japan Health Engagement Operational Planning Cooperation on PACIFIC PARTNERSHIP & other HA missions Educational Exchanges (MoU with USUHS) HA/DR Collaboration Combined Exercises Aerospace Medicine/ Aeromedical Evacuation Shipboard Medicine Undersea Medicine

Malaria Elimination Efforts in the Mekong Region UNCLASSIFIED Malaria Elimination Efforts in the Mekong Region Artemisinin-Resistant Malaria increasing in Greater Mekong Area of SE Asia Focused in border areas, migrant and military populations USPACOM Surgeon working with international organizations (WHO, Global Fund, Gates Foundation, Presidential Malaria Initiative) to ensure programming & funds reach military health systems Speaker at June 2014 Global Fund “Malaria Control and Elimination in the Armed Forces” meeting in Vietnam Regional military malaria meetings, in partnership with AFHSC-GEIS and US military overseas labs in June 2013 (Thailand) and August 2014 (Cambodia) Working to establish pre-deployment screening for drug-resistant malaria before Peacekeeping Operations A priority for PACOM Surgeon is working to eliminate drug-resistant malaria in the Greater Mekong Subregion; this is critical because this drug resistant strain of malaria is currently limited to this region but the risk of spread elsewhere in the world is substantial, and would significantly reverse world-wide gains in malaria control. This issue impacts global health security. UNCLASSIFIED

USPACOM Blood Safety Program UNCLASSIFIED USPACOM Blood Safety Program Enduring program of Blood Safety in Lao PDR, Vietnam and Cambodia since 2009 Purpose: Builds host nation biosecurity and a sustainable blood program capacity in support of disaster response Brings together civilian and military blood program stakeholders in Partner Nations, paving the way for further civilian and military coordination Program progression to include frozen blood products, nursing training, and link with Blood Bank construction Partners Additional Points: 1-2 Blood Safety Workshops per year in each country program Funded through OHDACA HA for Laos and Cambodia, DoD PEPFAR in Vietnam In Cambodia and Laos primary partner is civilian (i.e. Red Cross); in Vietnam primary partner is MoD – invitations extended for civ-mil participation in all events in all countries Cambodian and Lao participants have attended events in both countries These programs have been lauded by country teams as model of interagency/international/civ-mil coordination Building blood banking/transfusion/testing capability enhances national preparedness for disasters In Lao PDR, this is one of the most successful programs in a country where engagement (especially mil-mil) is significantly limited; based on the success of the Blood Safety Program other opportunities are arising for more health and mil-mil engagement Partners: DoS, US CDC, USAID, National Blood Transfusion Center, Ministry of Health, US PEPFAR, Australian Red Cross, Laos Red Cross, World Health Organization, US Army Corps of Engineers and Armed Services Blood Program

Regional Disaster Response Capacity Building UNCLASSIFIED Regional Disaster Response Capacity Building RIMPAC 2014 MILMED: Conduct Mil-Mil Health Engagements through exercises (HA/DR) and Medical / Health Subject Matter Expert Exchanges in order to increase capacity, capability, and interoperability with 23 participating nations. I’d like to highlight some of the regional engagements that have happened this year and perhaps some of you were involved with. The ASEAN Defense Ministers’ Meeting Plus Expert Working Groups on HA/DR and Military Medicine conducted a large, multi-national exercise on HA/DR and Military Medicine in Brunei in June. This was an excellent opportunity for military personnel from 17 countries to come together and exercise, share experiences and lessons learned, and prepare for future disasters. Photos include Chinese Peace Ark Ship and a Philippine Air force C-130. UNCLASSIFIED

PACIFIC PARTNERSHIP 2014 UNCLASSIFIED Vietnam (6-15 Jun 2014) Restorative Medicine Summit, Burn Management, Blood Safety Workshop, Cardiac Life Support Cambodia (19-28 Jun 2014) Rheumatic Heart Disease Symposium, Surgery, Cardiology, Undersea Medicine, Dental, Veterinary Philippines (4-15 Jul 2014) Surgery, Cardiology, Women/Children Health, Care for the Caregiver UNCLASSIFIED UNCLASSIFIED UNCLASSIFIED UNCLASSIFIED Vietnam-(June 10, 2014) A Navy team, led by Cmdr. Peter Shumaker, the chairman of dermatology at Naval Medical Center San Diego, used laser-resurfacing technology to treat a severely burned mother and her daughter at the Da Nang General Hospital. The mother and her daughter are both being treated by an advanced skin-resurfacing laser, a skin substitute and surgery to treat the residual effects of the burn as well as alleviate the skin contractures. Phan Nguyen Thanh Thao was burned at the age of three along with her mother. Over 70 percent of her body was burned which left her unable to walk. Navy medical staff first saw Thao and her mother aboard the USNS Mercy as part of Pacific Partnership 2012. This treatment at the Da Nang General Hospital has been the fourth interaction since then. The exchange was with the Department of Plastic and Reconstructive Surgery of Da Nang General Hospital along with three surgeons from the National Institute of Burns in Hanoi. Indonesia (26 May-9 Jun 2014) UNCLASSIFIED Helping Babies Breathe, Nursing Skills, Dental, Ophthalmology, Veterinary, Infectious Diseases Timor Leste (11-25 Jun 2014 UNCLASSIFIED Safe Motherhood Course, Newborn Care, Basic Life Support, Emergency Medicine, Dental

UNCLASSIFIED Conclusion USPACOM Health Engagements have evolved over the last 5 years from largely direct patient care to enhanced focus on building capacity, capability and interoperability USPACOM Command Surgeon coordination with USG Interagency has expanded greatly USPACOM Health TSC Activities directly support the USPACOM Theater Campaign Plan USPACOM Health TSC contributes to achievement of National Security End States Global Health Engagement: Strategic Enabler for Security Cooperation

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