As the world continues to grapple with the COVID-19 pandemic, the federal government has established new policies in 2021 addressing global health security and the use of global health engagement to mitigate the current pandemic, as well as emerging and future biosecurity threats.
Infectious diseases do not respect geopolitical borders. COVID-19 underscored how individuals’ human security and the economic and national security of countries around the globe are inextricably linked. As the pervasive impacts of the pandemic rippled through all dimensions of society, second and third order effects created delays in industrial supply chains, spikes in violent crime, and setbacks in educational progress for a generation of children. Global health security is a major component of national security and cannot be overlooked.
In January 2021, President Joseph Biden restored the National Security Council’s Directorate for Global Health Security and Biodefense and signed the National Security Memorandum – 1, addressing the need to develop COVID-19 response in an international context.
It states, “My Administration will treat epidemic and pandemic preparedness, health security, and global health as top national security priorities, and will work with other nations to combat COVID-19 and seek to create a world that is safe and secure from biological threats.” It lists directives aimed to “make strategic use of multilateral and bilateral channels and institutions, and assist developing countries in preparing for, preventing, detecting, and responding to COVID-19 and other infectious disease threats.”
The National Defense Authorization Act for Fiscal Year 2021 included a similar emphasis on expanding the use of global health engagement to strengthen global health security. In Section 732, Congress directed the Department of Defense to review the placement and use of global health engagement liaisons and increase the scope of global health activities.
Global Health Engagement Making a Difference
When the COVID-19 pandemic hit Croatia in early 2020, hospitals were overwhelmed as demand for health care spiked. The Croatian armed forces rapidly deployed a field hospital to expand the capacity of a primary civilian hospital. The expeditionary medical support system had full base operating support – laundry, showers, latrines, and even hot meals. The Croatian armed forces did this in a record-breaking 72 hours, shaving four days off of the normal seven-day timeline and saving critical time in responding to the COVID-19 outbreak within their community.
Senior Master Sgt. Melvin Morena, a U.S. Air Force International Health Specialist, attributed this success to long-term, strategic health engagement with Croatia. Throughout the pandemic, the U.S. Air Force’s past and ongoing medical security cooperation activities proved valuable in enabling rapid response to the COVID-19 pandemic.
“Between 2017 and 2019, [the U.S. Air Forces in Europe – Air Forces Africa International Health Specialist team] developed and coordinated engagements with Croatian counterparts to assess and build the Croatian armed forces’ expeditionary NATO Role Two medical treatment facility logistics, mass casualty response, and base operating support capabilities,” Morena said. “Over the last few years, we invited the Croatians to Ramstein Air Base (Germany) and they participated in [large training events] to get first-hand experience building these types of medical systems.”
While pre-pandemic capability building efforts have proven effective to increase partner nations’ response capabilities, the Defense Department also engaged with partner nations during the COVID-19 pandemic to support response capabilities in real time.
The Trauma, Burn and Rehabilitative Medicine partnership with the United Arab Emirates provided opportunities for U.S. and Emirati personnel to care for COVID-19 patients collaboratively.
Likewise, the Nebraska and Texas National Guards engaged with Czech Republic medical partners, sharing best practices and lessons learned on COVID-19 management.
Finally, the African Partnership Outbreak Response Alliance – a network that partner nations and the U.S. Africa Command originally established in response to Ebola – became a valuable forum to share COVID-19 outbreak data, coordinate regional response, and share best practices.
The Defense Department employs global health engagement collaboratively with allies and partners to meet mutually shared national security objectives.
At the service level, policy changes are reflecting the new emphasis on global health. In mid-2021, the Air Force Medical Service updated its strategic framework and goals.
“Increasing the effectiveness of Air Force global health engagement is critical to supporting national security policies,” said U.S. Air Force Surgeon General Lt. Gen. Robert Miller. “As a strategic goal of the Air Force Medical Service, it is important our internationally minded Airmen execute long-term, sustainable, and impactful medical security cooperation.”
To meet this goal, international health specialists are operationalizing assessment, monitoring, and evaluation of significant, long-term global health engagement investments aimed at building partner nation capabilities, capacity and increasing interoperability.
This will enable the Air Force to consistently track progress and measure outcomes of its global health engagement efforts across geographic combatant commands and Air Force components. It will ensure that multi-year programs, like the U.S. Air Force’s support of Croatia’s development of a NATO Role Two expeditionary medical capability, are continually evaluated for progress toward established objectives. Measuring these complex health investments will provide powerful insight to leverage and expand the use of medical security cooperation tools.
In October, Joint Staff Surgeon Maj. Gen. Paul Friedrichs, addressed U.S. Air Force international health specialists and U.S. Navy global health specialists at an orientation event for Navy and Air Force global health engagement specialists. He emphasized their role in rethinking and expanding how military medicine is applied as a security cooperation tool to support national security.
“The global health engagement career path provides an opportunity to leverage our tremendous military medics to augment what combatant commands do in support of Department of Defense strategic objectives,” Friedrichs said. “It also provides an opportunity to think differently about how we leverage all military medical capabilities to support national security strategy. International health specialists and global health specialists must view their work through this lens as they build interoperability with allies and partners and help the U.S. to navigate a multipolar world.”
Re-alignment of the AFMS strategic framework to best match shifting global health policies provides clear direction and impetus for global health engagement leaders to sustain their efforts. Continued focus on global health and global health security will ensure that the U.S. and its partners are able to respond to COVID-19, other emerging infectious disease threats, and any unexpected international crises of tomorrow.
