have died since January 2004, either from the virus directly or as a result of culling efforts to contain the virus. H5N1 is already considered endemic in poultry in China, Vietnam, Thailand, Indonesia, and perhaps Cambodia and Laos (WHO, 2005).

The Executive Office of the President issued the Presidential Decision Directive NSTC-7 (National Science and Technology Council, Executive Office of the President, Presidential Decision Directive) in 1996, which declared that national and international capabilities for infectious disease surveillance, prevention, and response were inadequate to protect the health of U.S. citizens from emerging infectious diseases and called for a more robust national policy to improve these capabilities (IOM, 2001). This directive expanded the mission of the DoD to include support of global surveillance, training, research, and response to emerging infectious disease threats. In response to the NSTC-7 directive, DoD-GEIS was established in 1997 by the Assistant Secretary of Defense for Health Affairs to serve as the focal point for “initiating and coordinating the identification, reporting and responding to emerging infectious disease problems.” GEIS is a tri-service program, and its activities are implemented within all three branches (Army, Navy, and Air Force) of the armed forces, although GEIS has no direct command authority over the facilities that implement its activities. The DoD overseas laboratories provide forward sites for GEIS activities. At present the DoD has five overseas laboratories: the U.S. Naval Medical Research Center Detachment (NMRCD) based in Lima, Peru; the U.S. Naval Medical Research Unit No. 2 (NAMRU-2) in Jakarta, Indonesia; the Armed Forces Research Institute of Medical Sciences (AFRIMS) in Bangkok, Thailand; the U.S. Naval Medical Research Unit No. 3 (NAMRU-3) in Cairo, Egypt; and the U.S. Army Medical Research Unit Kenya (USAMRU-K) in Nairobi. These laboratories, varying in size and capability, have field activities that operate in nearby countries and beyond, often with limited facilities within their regions of operation. In conjunction with the two domestic laboratories, the Naval Health Research Center in San Diego, California (NHRC) and the Air Force Institute for Operational Health in San Antonio, Texas (AFIOH), they work together to address the four stated goals of GEIS:

• Surveillance and detection

• Response and readiness

• Integration and innovation

• Cooperation and capacity building

Beginning with its creation in 1996, DoD-GEIS has focused on influenza, well aware of its potential to grow to pandemic proportions. The DoD-GEIS surveillance network was established to monitor host-country populations in areas where little was known about disease epidemiology,