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Suggested Citation:"Front Matter." Institute of Medicine. 2001. Perspectives on the Department of Defense Global Emerging Infections Surveillance and Response System: A Program Review. Washington, DC: The National Academies Press. doi: 10.17226/10203.
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Perspectives on the Department of Defense Global Emerging Infections Surveillance and Response System

A Program Review

Philip S.Brachman, Heather C.O’Maonaigh, and Richard N.Miller, Editors

Committee to Review the Department of Defense Global Emerging Infections Surveillance and Response System

Medical Follow-Up Agency

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, D.C.

Suggested Citation:"Front Matter." Institute of Medicine. 2001. Perspectives on the Department of Defense Global Emerging Infections Surveillance and Response System: A Program Review. Washington, DC: The National Academies Press. doi: 10.17226/10203.
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NATIONAL ACADEMY PRESS
2101 Constitution Avenue, N.W. Washington, DC 20418

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

Support for this project was provided by Contract No. DAM17-00-P-0412. The views presented in this report are those of the Institute of Medicine Committee to Review the Department of Defense Global Emerging Infections Surveillance Response System and are not necessarily those of the funding agencies.

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Copyright 2001 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America.

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Suggested Citation:"Front Matter." Institute of Medicine. 2001. Perspectives on the Department of Defense Global Emerging Infections Surveillance and Response System: A Program Review. Washington, DC: The National Academies Press. doi: 10.17226/10203.
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“Knowing is not enough; we must apply. Willing is not enough; we must do.”

—Goethe

INSTITUTE OF MEDICINE

Shaping the Future for Health

Suggested Citation:"Front Matter." Institute of Medicine. 2001. Perspectives on the Department of Defense Global Emerging Infections Surveillance and Response System: A Program Review. Washington, DC: The National Academies Press. doi: 10.17226/10203.
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THE NATIONAL ACADEMIES

National Academy of Sciences

National Academy of Engineering

Institute of Medicine

National Research Council

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M.Alberts is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm.A. Wulf is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I.Shine is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M.Alberts and Dr. Wm.A.Wulf are chairman and vice chairman, respectively, of the National Research Council.

Suggested Citation:"Front Matter." Institute of Medicine. 2001. Perspectives on the Department of Defense Global Emerging Infections Surveillance and Response System: A Program Review. Washington, DC: The National Academies Press. doi: 10.17226/10203.
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COMMITTEE TO REVIEW THE DEPARTMENT OF DEFENSE GLOBAL EMERGING INFECTIONS SURVEILLANCE AND RESPONSE SYSTEM

PHILIP S.BRACHMAN (Chair), Professor,

Department of International Health, Rollins School of Public Health, Emory University, Atlanta, Georgia

RUTH L.BERKELMAN, Professor,

Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia

DONALD S.BURKE, Professor,

Department of International Health and

Director of the Center for Immunization Research,

Johns Hopkins School of Public Health, Baltimore, Maryland

KATHLEEN F.GENSHEIMER, State Epidemiologist,

Bureau of Health, Maine Department of Human Services, Augusta, Maine

C.JAMES HOSPEDALES, Director,

Caribbean Epidemiology Center, Pan American Health Organization, World Health Organization, Port of Spain, Trinidad, West Indies

ANN MARIE KIMBALL, Professor,

Health Services and Epidemiology, Adjunct in Medicine, University of Washington, Seattle, Washington

GUÉNAËL R.RODIER, Director,

Department of Communicable Disease Surveillance and Response, World Health Organization, Geneva, Switzerland

RONALD K.ST. JOHN, Executive Director,

Center for Emergency Preparedness and Response, Health Canada, Ottawa, Ontario, Canada

Project Staff

RICHARD N.MILLER, Study Director

HEATHER C.O’MAONAIGH, Program Officer

PAMELA RAMEY-McCRAY, Administrative Assistant

ANDREA COHEN, Financial Associate

Suggested Citation:"Front Matter." Institute of Medicine. 2001. Perspectives on the Department of Defense Global Emerging Infections Surveillance and Response System: A Program Review. Washington, DC: The National Academies Press. doi: 10.17226/10203.
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×

Preface

The U.S. Department of Defense (DoD) has historically defined its interest in infectious diseases almost exclusively in terms of “battle-stopper” illnesses—those resulting in acute effects that can directly affect military operations. Although this approach remains central to the U.S. military’s infectious disease doctrine, development of the DoD Global Emerging Infections Surveillance and Response System (GEIS) is part of an important transition in the way that the threat of infectious diseases— and, more specifically, the threat of emerging infectious diseases—is perceived and addressed by the U.S. military.

Emerging infectious disease surveillance is sustained globally through a network of activities maintained through the collective efforts of numerous governmental and nongovernmental agencies. It is through the contributions of many partners that surveillance for emerging infectious diseases is possible. The DoD possesses valuable resources that can be brought to bear in this effort. It maintains an extensive, diverse array of laboratory facilities, both within the United States and overseas. These DoD laboratories can perform routine diagnostic testing, but they also possess rare, sometimes unique, diagnostic capabilities. DoD overseas laboratories are located throughout the world in areas where the potential for the emergence of infectious diseases is high. Often, laboratories operate in regions where alternative laboratory resources are sparse or nonexistent (e.g., sub-Saharan Africa). No other organization or government in the world maintains such extensive or capable laboratory facilities and staffing internationally. DoD laboratory facilities represent medical re-

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Suggested Citation:"Front Matter." Institute of Medicine. 2001. Perspectives on the Department of Defense Global Emerging Infections Surveillance and Response System: A Program Review. Washington, DC: The National Academies Press. doi: 10.17226/10203.
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search, public health, and diplomatic resources that serve U.S. military, U.S. civilian, and global interests alike.

For more than a decade, formal DoD participation in emerging infectious disease surveillance has been encouraged by many in the U.S. public health community and within the DoD. In 1996, Presidential Decision Directive NSTC-7 (NSTC is the National Science and Technology Council of the Executive Office of the President) transformed these recommendations into a mandate. Thereafter, the National Intelligence Council declared emerging infectious diseases to be a threat to the national security of the United States, underscoring the importance of DoD participation in disease surveillance efforts. This role is not an altogether new one, as the DoD has been conducting various infectious disease surveillance projects (e.g., for influenza) for many years. Accommodation of its expanded role has led the DoD to implement GEIS. The committee recognizes this effort as a responsive and effective step toward addressing the problem of emerging infectious diseases.

We would like to thank the staff of the DoD laboratories, both domestic and overseas, and the staff of the GEIS Central Hub for the time and effort that they have invested in sharing with us information about the GEIS operations that they support. This review effort was very much a collegial one, and the report benefited from the openness of all those who provided us with documentation, presentations, and conversations. This study was also enriched by the insights that GEIS collaborators and associates provided regarding their views of GEIS from the outside looking in. Lists of the laboratory staff and GEIS collaborators and associates who shared their time with the committee can be found at the ends of Chapters 2 through 7 of this report. Any omissions are strictly the result of oversight.

The support provided by Institute of Medicine staff was instrumental in keeping this study moving apace. We extend our thanks to Richard Miller, Heather O’Maonaigh, and Pamela Ramey-McCray of the Institute of Medicine’s Medical Follow-Up Agency and to National Academies Travel staff, particularly Ann-Marie Walko, for their assistance. This study also benefited from the attention of Andrea Cohen, financial associate; Michael Hayes, consulting editor; and Linda Kilroy, contracting officer. Medical Follow-Up Agency staff members Phillip Bailey, Salem Fisseha, Lois Joellenbeck, and Karen Kazmerzak also helped along the way.

In addition, we are grateful to GEIS Central Hub staff members, particularly Joel Gaydos, Steve Gubenia, Patrick Kelley, Jennifer Rubenstein, and James Writer for their tireless assistance in preparing and compiling background documents and for helping to plan and negotiate the logistics of site visits. Likewise, we offer special thanks to Roxana Lescano, Lucy Rubio, and Trueman Sharp, Naval Medical Research Center Detachment,

Suggested Citation:"Front Matter." Institute of Medicine. 2001. Perspectives on the Department of Defense Global Emerging Infections Surveillance and Response System: A Program Review. Washington, DC: The National Academies Press. doi: 10.17226/10203.
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Peru; Andrew Corwin and John Sisson, Naval Medical Research Unit 2, Indonesia; Gaye Ruble, Armed Forces Research Institute of Medical Sciences, Thailand; Cole Church, Naval Medical Research Unit 3, Egypt; Ronald Rosenberg, U.S. Army Medical Research Unit, Kenya; and Leslie Henry, Naval Health Research Center, San Diego, for their help in putting site visits together.

This report is a testament to the hard work, patience, and resolve of many. We extend to all involved our appreciation and gratitude.

Philip S.Brachman (Committee Chair)

Ruth L.Berkelman

Donald S.Burke

Kathleen F.Gensheimer

C.James Hospedales

Ann Marie Kimball

Guénaël R.Rodier

Ronald K.St. John

Suggested Citation:"Front Matter." Institute of Medicine. 2001. Perspectives on the Department of Defense Global Emerging Infections Surveillance and Response System: A Program Review. Washington, DC: The National Academies Press. doi: 10.17226/10203.
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Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the NRC’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

JAMES BANTA, Adjunct Professor, International Public Health, International Health Policy, The George Washington University Medical Center

KENNETH BART, Director, Graduate School of Public Health, San Diego State University

DAVID BRANDLING-BENNETT, Deputy Director, Pan American Health Organization

SCOTT HALSTEAD, Adjunct Professor, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences

ROBERT HOLZMAN, Professor of Clinical & Environmental Medicine, New York University School of Medicine

JOSHUA LEDERBERG, Raymond and Beverly Sackler Foundation Scholar, The Rockefeller University

Suggested Citation:"Front Matter." Institute of Medicine. 2001. Perspectives on the Department of Defense Global Emerging Infections Surveillance and Response System: A Program Review. Washington, DC: The National Academies Press. doi: 10.17226/10203.
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JAMES W.LEDUC, Acting Director, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention

STEPHEN B.THACKER, Assistant Surgeon General and Director, Epidemiology Program Office, Centers for Disease Control and Prevention

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by Adel A.F. Mahmoud, President, Merck Vaccine Division, Merck & Co. Appointed by the National Research Council and Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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Suggested Citation:"Front Matter." Institute of Medicine. 2001. Perspectives on the Department of Defense Global Emerging Infections Surveillance and Response System: A Program Review. Washington, DC: The National Academies Press. doi: 10.17226/10203.
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Suggested Citation:"Front Matter." Institute of Medicine. 2001. Perspectives on the Department of Defense Global Emerging Infections Surveillance and Response System: A Program Review. Washington, DC: The National Academies Press. doi: 10.17226/10203.
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Suggested Citation:"Front Matter." Institute of Medicine. 2001. Perspectives on the Department of Defense Global Emerging Infections Surveillance and Response System: A Program Review. Washington, DC: The National Academies Press. doi: 10.17226/10203.
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Acronyms and Abbreviations


ADP

automated data processor

AFEB

Armed Forces Epidemiology Board

AFI

acute febrile illness

AFIERA

Air Force Institute for Environmental Safety and Occupational Health Risk Analysis

AFIP

Armed Forces Institute of Pathology

AFRIMS

Armed Forces Research Institute of Medical Sciences

AMREF

African Medical and Research Foundation

AFRESS

Air Force Reportable Events Surveillance System

AIDS

Acquired Immunodeficiency Syndrome


BSL

biosafety level


CAREC

Caribbean Epidemiology Center

CDC

Centers for Disease Control and Prevention (United States)

CHCS/CHCS II

Department of Defense Composite Health Care System (I and II)

CHPPM

Center for Health Promotion and Preventive Medicine

CINC

Commander-in-Chief, Unified Combatant Command

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CISET

Committee on International Science, Engineering, and Technology

CRDA

Cooperative Research and Development Agreement


DoD

Department of Defense (United States)

DMS

Department of Medical Services

DMSS

Defense Medical Surveillance System


EID

emerging infectious disease

ELISA

enzyme linked immunosorbent assay

EMRO

Eastern Mediterranean Regional Office, World Health Organization

ENSO

El Niño/Southern Oscillation

EWORS

Early Warning Outbreak Response System

ESSENCE

Electronic Surveillance System for Early Notification of Community-Based Epidemics


FSN

foreign service national

FETP

Field Epidemiology Training Program

FLUNET

WHO’s influenza surveillance system


GEIS

Global Emerging Infections Surveillance and Response System

GIS

geographic information system

GISP

Gonococcal Isolate Surveillance Project


HIV

Human Immunodeficiency Virus


ILRI

International Livestock Research Institute

IOM

Institute of Medicine

IT

information technology

IS

information systems

INS

Instituto Nacional de Salud (Peru)


JICA

Japanese International Cooperative Agency


KEMRI

Kenya Medical Research Institute


LITS

Laboratory Information Tracking System


MDR-TB

multi-drug-resistant tuberculosis

MEDCOM

Medical Command

MFO

U.S. Multinational Forces and Observers

Suggested Citation:"Front Matter." Institute of Medicine. 2001. Perspectives on the Department of Defense Global Emerging Infections Surveillance and Response System: A Program Review. Washington, DC: The National Academies Press. doi: 10.17226/10203.
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MHS

Military Health System

MIDRP

Military Infectious Disease Research Program

MoH

Ministry of Health

MOHP

Ministry of Health and Population (Egypt)

MSF

Médicins Sans Frontières; Doctors without Borders


NAMRID

Naval Medical Research Institute Detachment

NAMRU-2

Naval Medical Research Unit 2

NAMRU-3

Naval Medical Research Unit 3

NASA

National Aeronautics and Space Administration

NDRS

Naval Disease Reporting System

NEHC

Naval Environmental Health Center

NEPMU

Navy Environmental and Preventive Medicine Unit

NHRC

Naval Health Research Center

NIAID

National Institute of Allergy and Infectious Diseases

NMRCD

Naval Medical Research Center Detachment

NGO

nongovernmental organization

NIH

National Institutes of Health

NSTC-7

National Science and Technology Council, Executive Office of the President, Presidential Decision Directive NSTC-7

NSDD

National Security Decision Directive


OGE

Oficina General de Epidemiologia (Ministry of Health Office of Epidemiology, Peru)

OSTP

Office of Science and Technology Policy


PACOM

Pacific Command

PAHO

Pan American Health Organization

PHLIS

Public Health Laboratory Information System


RSD

Research Sciences Department


SEATO

Southeast Asia Treaty Organization

SOUTHCOM

Southern Command

STD

sexually transmitted disease


TAML

Theater Area Medical Laboratory

TB

tuberculosis

TEPHINET

Training in Epidemiology and Public Health Intervention Network

TMA

Tricare Management Area

Suggested Citation:"Front Matter." Institute of Medicine. 2001. Perspectives on the Department of Defense Global Emerging Infections Surveillance and Response System: A Program Review. Washington, DC: The National Academies Press. doi: 10.17226/10203.
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USAID

United States Agency for International Development

USAID-VIGIA

United States Agency for International Development-project Addressing Threats of Emerging and Re-emerging Infectious Diseases

USAMRIID

United States Army Medical Research Institute of Infectious Diseases

USAMRU-K

United States Army Medical Research Unit, Kenya

U.S. CDC

United States Centers for Disease Control and Prevention

USUHS

United States Uniformed Services University of the Health Sciences


VEE

Venezuelan Equine Encephalitis

VIGIA

Addressing Threats of Emerging and Re-Emerging Infectious Diseases project

VPHL

Virtual Public Health Laboratory

VOIP

Voice Over Internet Protocol

VSAT

very small apperature terminal


WHO

World Health Organization

WRAIR

Walter Reed Army Institute of Research

Suggested Citation:"Front Matter." Institute of Medicine. 2001. Perspectives on the Department of Defense Global Emerging Infections Surveillance and Response System: A Program Review. Washington, DC: The National Academies Press. doi: 10.17226/10203.
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GEIS Maps

Source: J.Writer, Department of Defense Global Emerging Infections Surveillance and Response System.

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Perspectives on the Department of Defense Global Emerging Infections Surveillance and Response System: A Program Review describes the capacity, quality, and effectiveness of the international and domestic facilities and programs that are a part of a DoD system to monitor and address emerging infectious diseases globally. The committee concludes that the goals of the system are in U.S. military, U.S. civilian, and global public health interests and that substantial progress has been made toward achieving system goals.

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