1. DoD Global Health Engagement: The Strategic Perspective
Dr. J. Christopher Daniel
Senior Advisor for Global Health Engagement to the Assistant Secretary of Defense for Health Affairs
November 2016

2. Disclosures 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.

3. Learning Objectives:
At the conclusion of this activity, the participant will be able to:
Understand what is meant by Global Health Engagement and how these activities benefit the Department of Defense
Understand why and how the DoD supports the Global Health Security Agenda
Understand efforts underway to better measure and demonstrate the value of GHE to the DoD

4. DoD Global Health Engagement (GHE)
Humanitarian and
Civic Assistance
Interactions between individuals or elements of DoD and those of a partner nation’s armed forces and/or civilian authorities
in coordination with other USG departments and agencies
to build trust and confidence, share information, coordinate mutual activities, maintain influence, and achieve interoperability
in health related activities which support national security policy and military strategy
GHE activities establish, reconstitute, maintain, or improve the capabilities or capacities of the PN’s military or civilian health sector, and/or those of DoD.
Theater Security
Cooperation
Building Coalition &
Partner Military
Medical Interoperability
Defense HIV-AIDS Prevention Program
Humanitarian
Assistance (HA)
Medical Support to
Stability Ops
Operational/
Contingency Plans
Building Partner
Mil Med Capacity
Civ-Mil
Emergency
Planning
Biosurveillance
Ebola Response
Global Health Security Agenda
Disaster Preparedness Program
International Military Education & Training
Disaster Relief (DR)
Subject Matter Expert Exchanges
Interaction between individuals or elements of the Armed Forces of the United States and those of a partner nation (PN)’s armed forces and/or civilian authorities, in coordination with other USG departments and agencies, to build trust and confidence, share information, coordinate mutual activities, maintain influence, and achieve interoperability in health related activities which support national security policy and military strategy. DoD GHE activities establish, reconstitute, maintain, or improve capabilities or capacities of the PN's military, civilian health sector, and/or those of DoD.
Cooperative Biological Engagement Program
Research & Development on Select Agents: Detection, Countermeasures, Vaccines
Cooperative Threat Reduction 4

5. Spectrum of DoD Global Health Engagement
Force Health Protection
Humanitarian Assistance & Disaster Response
Nuclear, Chemical, & Biological Defense Programs
Building Partner Capacity/ Interoperability
Medical Research
& Development
Public Health
Preventive
Medicine
Building Partner
Civilian Med Capacity
Humanitarian and
Civic Assistance
Theater Security
Cooperation
Building Coalition &
Partner Military
Medical Interoperability
Defense HIV-AIDS Prevention Program
Humanitarian
Assistance (HA)
Medical Support to
Stability Ops
Operational/
Contingency Plans
Building Partner
Mil Med Capacity
Civ-Mil
Emergency
Planning
Biosurveillance
Ebola Response
Global Health Security Agenda
Disaster Preparedness Program
International Military Education & Training
Disaster Relief (DR)
Subject Matter Expert Exchanges
Cooperative Biological Engagement Program
Research & Development on Select Agents: Detection, Countermeasures, Vaccines
Cooperative Threat Reduction 5

6. Remarks by President Obama to the people of Cuba March 22, 2016
Force Health Protection – A Key Driver for DoD Global Health Engagement
DoD has been involved in global health issues for over a century
Traditional view of global health engagement through a force health protection lens
Established first overseas medical research laboratories after WWII
Remarks by President Obama to the people of Cuba March 22, 2016

7. Force Health Protection
GHE is integral to our force health protection efforts while directly supporting security cooperation with our partner nations
A number of DoD assets and investments support the force health protection mission
Vaccine and medical countermeasure research (Malaria, Dengue, HIV, Ebola, MERS-CoV, Zika)
Global biosurveillance network including overseas labs working collaboratively with host nations to identify and mitigate public health threats around the world
Regional partnerships like the Joint West Africa Research Group, helping to build mutual biosurveillance, clinical and research capacities
U.S. Army Spc. Chris Springer contributes to the development of a Zika vaccine candidate at the Walter Reed Army Institute of Research
A military medical professional administers an experimental vaccine candidate to a volunteer at the Walter Reed Army Institute of Research’s Clinical Trials Center 7

8. DoD: The Frontline in Global Biosurveillance
Biosurveillance activities conducted through the DHA Armed Force Health Surveillance Branch’s Global Emerging Infections Surveillance and Response (GEIS) System
162 Projects
in 57 Countries
(Fiscal Year 2016)

9. Security, Stability, and Healthy Capable Partners
Increasing recognition of links between global health and security
Infectious disease crises have caused severe disruption and instability
HIV, SARS, H1N1, MERS-CoV
Ebola, Zika
Not in our interest to allow that instability to grow, especially when we have capability to mitigate
Healthy, capable partners are one of the most effective ways to mitigate health security threats
U.S. Army engineers assist
Liberian military
in the construction
of an Ebola treatment unit
during
the 2014 West African
Ebola epidemic.
Feb 2016 – Army Maj. Gen. Todd McCaffrey, deputy commanding
general of U.S. Army Pacific Command, cuts ribbon at the new Provincial Blood Transfusion Center located in Kampong Cham, Cambodia. The Armed Services Blood Program assisted the Cambodian government in opening the center.

10. Building Partner Capacity & Interoperability
Building partner nation health capacity and interoperability results in more capable partners:
That can better contribute to national and regional health security
That are less likely to need assistance from the U.S.
Are better able to work with DoD in providing health service support during conflicts or disasters
Importance of global partners noted in Joint Health Concept for Health Services
Bi-lateral and multi-lateral military exercises provide opportunities to practice and test interoperability in battlefield and disaster medicine processes and procedures. 10

11. Humanitarian Assistance & Disaster Response
Participation in humanitarian assistance and relief efforts during disasters helps reduce disruptions to regional stability
Have responded to crises like tsunamis in Indonesia and Japan, earthquakes in Pakistan, Peru, Costa Rica, Haiti, and Nepal, and typhoons in Philippines
Annual humanitarian civic assistance, medical outreach and disaster response training missions promote interoperability and resilience/self-reliance
The Congressional appropriation “Overseas Humanitarian, Disaster and Civic Aid” (OHDACA) allows DoD to:
Build Schools and Clinics
Distribute Excess DoD property
Provide Transportation of Privately Donated Goods
Nepalese service members offload supplies from a U.S. Marine Corps MV-22 Osprey in the aftermath of the 2015 Nepal earthquake 11

12. Nuclear, Chemical, and Biological Defense
Mission: Drive capability to prevent, protect against, and respond to nuclear, chemical, and biological threats.
Requirements determined by the Services, but parts of the OASD/NCB mission space aligns with the goals of the Global Health Security Agenda and the WHO’s International Health Regulations (IHR):
WHO IHR 2005: Prepare for and respond to “…public health emergencies of international concern, irrespective of origin or source, whether they involve the natural, accidental, or deliberate release of biological, chemical, or radionuclear materials.” 12

13. The Global Health Security Agenda (GHSA)
A world safe and secure from global health threats posed by infectious diseases, whether naturally occurring, deliberate or accidental
PREVENT
avoidable epidemics
DETECT
threats early
RESPOND
rapidly and effectively

14. Why Does DoD Care About the GHSA?
The effectiveness of security forces across all mission areas relies on their staying healthy
Disease crises can erode trust in government and destabilize regions
Bioterrorism is a global concern, the same capabilities required to mitigate natural outbreaks are needed to address bioterrorism
“While the U.S. Department of Defense has the responsibility of protecting the health and readiness of its armed forces, we are also prepared to help respond to outbreaks of infectious disease that may threaten the stability of nations…and regions.”
Former Secretary of Defense Hagel GHSA Ministerial
September 26, 2014

15. Overview of DoD’s Role in the GHSA
In the U.S., DoD is in supportive role with other elements of USG
DoD supports the GHSA through existing missions and activities such as force health protection, threat reduction, cooperative health security engagements and biodefense
DoD has a long history of global health security activities that are resourced and conducted to meet national security objectives which also provide benefit toward the achievement of GHSA targets
The GHSA aligns with national strategic guidance and offers DoD and other militaries a framework within which to engage and better coordinate with interagency (other ministries) and international partners

16. Nuclear, Chemical, and Biological Defense Cooperative Biological Engagement Program Country Engagements
GHSA Phase 1
Cameroon
Cote D’Ivoire
Ethiopia
Guinea
India
Indonesia
Kenya
Liberia
Mali
Pakistan
Sierra Leone
Senegal
Tanzania
Uganda
Vietnam
GHSA Phase 2
Cambodia
Georgia
Jordan
Laos
Malaysia
Thailand
Ukraine
Kazakhstan
Additional
Afghanistan
Armenia
Azerbaijan
Iraq
Philippines
South Africa
Uzbekistan

17. How does Global Health Engagement contribute to DoD objectives?
A powerful national security instrument that supports DoD and USG efforts around the world
through:
STABILITY
GHE contributes to social well-being, rule of law, governance, economics, and security
COOPERATION
GHE enhances collaboration with foreign ministries and civil structures
CAPACITY
GHE is leveraged to develop partner capabilities to increase self-reliance

18. Ongoing Efforts to Demonstrate Value
Defining GHE
DoD Instruction, Joint Publication 1-02
Defining Requirements, Shortfalls and Solutions
“GHE Activities enable the Geographic Combatant Commanders to accomplish Theater Campaign Plan objectives and achieve strategic end states in support of U.S. interests…” (Capabilities Based Assessment)
Improving Awareness
DoD GHE Council
Measuring Effectiveness and Impact
USUHS Center for Global Health Engagement
Assessment, Monitoring and Evaluation in Security Cooperation
DoD Instruction

19. Summary
GHE is not a mission, but a diverse set of DoD activities that collectively establish, reconstitute, maintain, or improve the capabilities or capacities of a partner nation’s military or civilian health sector, and/or those of DoD
GHE activities are a powerful theater security cooperation tool
Enhancing Force health protection
Building partner capacity and increasing interoperability
Working cooperatively to identify and mitigate health threats
Crises from infectious disease outbreaks can destabilize governments and cascade to regional & global insecurity. Health security throughout the world means security at home.
The Global Health Security Agenda requires a “whole of government” and “whole of society” approach. While DoD GHE activities are resourced and conducted to meet national security objectives, many also contribute to the achievement of GHSA targets. GHSA offers DoD and other militaries a framework within which to engage and better coordinate with interagency/other ministries and international partners.
A series of policy and AM&E efforts are underway to optimize the value of GHE to DOD

20. Obtaining CME/CE Credit
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21. Dr. J. Christopher Daniel
Contact Information
Dr. J. Christopher Daniel
Senior Advisor for Global Health Engagement, Office of the Assistant Secretary of Defense for Health Affairs