US forces and civilian personnel are projected and mobilized in and out of a diverse array of operational settings and environments. The DoD must be aware of, and be able to protect and respond to, threats to health and readiness. Not only should the DoD support protection and prevention against routine diseases common within the continental United States,6 it must also be able to provide agile medical and S&T responses to “surprise” in any location worldwide. Thus, programs to address those diseases that are intentionally caused, endemic or presenting elsewhere in the world where DoD operates, need to be incorporated into CBDP planning, resourcing, and delivery. While every new disease cannot be anticipated, a system and capabilities must be in place for CBDP to respond effectively and in a timely manner. This applies to medical treatment approaches as well as diagnostics, biomarkers to exposure, and biosurveillance.
One aspect of this is to consider health monitoring in the context of “One Health,”7 which considers human health in the global context of animals (domestic and wild) and includes all reservoirs and vectors (e.g., mammals, birds, ticks, mosquitoes, etc.). This implies increased global biosurveillance of both human and animal baselines to determine what is currently endemic so that new pathogens with pandemic potential can be more rapidly detected and characterized, ideally before they are spread widely via global air transportation. Effective health monitoring implies the development and use of a broad hierarchy of diagnostics that includes not only inexpensive point-of-care presumptive diagnostic kits (akin to home pregnancy tests), but also sensitive and precise multiplex confirmatory diagnostics (symptomatic panels such as respiratory, fever, enteric, encephalitis, etc.; also panels for food-borne pathogens, zoonotic pathogens, etc.), broad-spectrum microarray diagnostics (as a safety net to cover unusual/unexpected known single pathogens or combinations), and finally, sequencing to detect and begin to characterize unknown pathogens. It is important to note that global biosurveillance cannot consist of merely the high-consequence pathogens that the United States is most concerned with. It should offer real benefit to both the local communities and the US warfighters who may be serving there, in terms of diagnosing endemic pathogens of local concern. To be effective, the
6 Traditionally, force protection against natural health threats was primarily addressed by WRAIR, and force protection against biological weapons was the main focus of USAMRIID; recently, however, biothreat agent funding has been approved for use in addressing pandemic threats, such as H1N1. The committee recognizes that this decision has broad implications, but believes that an examination of this issue is beyond the scope of this report.
7 Also called “species-neutral.”