As sequestration strikes disease fighting efforts, Defense Department’s role in global health is little understood

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KFFMay16

At the Henry J. Kaiser Family Foundation, Thursday, from left to right: Jennifer Kates, Rabih Torbay, Peter J. Weina, Kate Almquist Knopf, David Smith, and Josh Michaud.

With a role in global health responses and research so extensive that a chart outlining its efforts looks a little like a maze, the United States Department of Defense has to ground itself in “institutional humility” to integrate the roles of fellow agencies and foreign partners in international disease-fighting efforts, as one speaker put it.

“Ours is a supporting role,” Kathleen Hicks, who is Principal Deputy Under Secretary of Defense for Policy at the DOD, said Thursday. She was speaking at the Henry J. Kaiser Family Foundation in Washington, DC prior to a discussion on the foundation’s report on The U.S. Department of Defense and Global Health, released in September 2012. She pointed to the military agency’s need to build “templates” to better coordinate its global health activities with those of other agencies, foster closer ties to foreign governments, and develop the capacities of countries where disease responses are most critical. Add that, then, to a list of efforts that includes responding to a Brazil nightclub fire with medicine to counter the effects of burning accoustic foam, responding to a measles outbreak in Tbilisis, Georgia with 75,000 emergency vaccinations, and a portfolio of HIV research and responses so vast that Kaiser will produce another report about that aspect of the DOD’s global health programs alone.

DOD GH Chart

Military and global health efforts are tied by the opportunities as well as the need to maintain the health of U.S. forces around the world, but also are tied to the military’s mission to promote security and stability, and help keep fragile states from becoming failed states.

But when the public considers issues of political instability, Kate Almquist Knopf, a visiting policy fellow at the Center for Global Development, noted, “health is not the first thing that’s identified.”

“We’re very proud to be part of what I consider an ecosystem,” Colonel Peter J. Weina, Deputy Commander of the Walter Reed Army Institute of Research, said. Weina, an infectious diseases physician with advanced degrees in zoology, pathology, and parasitology, added that he considers the department’s research laboratories “gems in the crown” of that global health ecosystem.

And while recognition of global health issues is widening now, the U.S. military’s involvement in disease research dates back more than a century, and includes both the discovery of the mosquito as the vector for malaria, and involvement in the launch of an HIV vaccine trial in Thailand, according to Kaiser Global Health Policy Associate Director Josh Michaud, lead author of the Kaiser report.

In the course of all of that, recognition of the agency’s global health role remains little recognized, little understood, and for those reasons, in danger of not being supported or replaced in the event that it is scaled back, panelists at the Thursday discussion said. And that possibility looms closer as a reality now, than it did when the report was released, before the March sequestration of U.S. government funding gave almost all agencies less money to work with.

The effects of sequestration arose in a humorously intended aside, when Rabih Torbay, vice president for international operations of the nongovernment International Medical Corps, described the critical role the DOD’s logistical capacities alone have played in getting medical aid, including health responders from his organization to earthquake shattered areas of Haiti in 2010. After Torbay said his organization still owed a check for “meals ready to eat,” supplied by the DOD in the course of the effort, Weina mentioned the check would be welcome, in the aftermath of sequestration.

“It would be disingenuous to say it hasn’t impacted us,” Weina said in answer to the question that followed. “It has impacted us. It has impacted everybody.”

That’s one of the ways being part of an ecosystem of diversely-funded efforts helps, Weina said. “The important work is still going to go forward,” he said. “It may go forward slower.”

“We only hope that this is not a sustained way of doing business,”  David J. Smith, Deputy Assistant Secretary of Defense for Force Health Protection and Readiness, added. Programs under his department were bolstered by previous savings he said. If across the board funding cuts are triggered again, he said, the process of prioritizing will be “gut wrenching.”

Weina, in turn, added that he looks forward to a time when the military’s role in global health is better understood.

“We’ve too quietly done things in the background for decades.”

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