ment of Defense with the planning of other Federal departments, including the Department of Health and Human Services, the Department of Homeland Security, the Department of Veterans Affairs, the Department of State, and USAID.
Collaboration (as appropriate) with international entities engaged in pandemic preparedness and response.
Before 1997 the DoD influenza surveillance program consisted largely of the surveillance program of the U.S. Air Force. With the establishment of GEIS in the late 1990s and, more recently, with the $39 million fiscal year 2006 avian influenza supplement, the program has grown to include efforts far beyond those of the historic air force program (see Figure 10-1). These efforts include multimillion-dollar programs at the five DoD overseas labs and at the Naval Health Research Center in San Diego.
Some of these new players have built enough independent laboratory capacity that they no longer are dependent on the laboratory services of the Air Force Institute for Operational Health (AFIOH). This has effectively moved AFIOH toward the margin. This independence from AFIOH and the difficulty that AFIOH experiences in directing and assembling timely data from a myriad of non-air force entities scattered around the world suggests that the overall DoD influenza effort should be administratively reorganized so as to effect better communications, direction, and data management.
RECOMMENDATION 10-1. The executive agency functions of the DoD influenza and respiratory disease surveillance program should be reexamined in light of the evolution of the program in response to the potential of pandemic influenza. DoD-GEIS headquarters should be formally charged with providing managerial and technical oversight (quality assurance, safety, etc.) of the multi-service influenza and respiratory disease program and of the revised structure, including a codified chain of accountability.
A key part of this recommendation would be to tie the funding source (GEIS headquarters) to the global oversight function by moving the executive agency from AFIOH (see Box 9-1) to GEIS headquarters. This tran-