By Cheryl Pellerin
American Forces Press Service
WASHINGTON, June 5, 2013 – A new biosurveillance division at the
Armed Forces Health Surveillance Center here -- home to a unique serum
repository and database for service members and a global network of
military laboratories -- is working to fill gaps at the convergence of
battlefield biodefense and health surveillance.
Health surveillance involves monitoring human health to identify and
prevent infectious and chronic diseases. Biosurveillance, at least for
the Defense Department, is the process of gathering, integrating,
analyzing and communicating a range of information that relates to
health threats for people, animals and plants to help inform decisions
and provide for increased global health security.
The Armed
Forces Health Surveillance Center vision is to be the central
epidemiological resource and global health surveillance proponent for
the armed forces. Its mission is to provide timely, relevant and
comprehensive health surveillance information to promote, maintain and
enhance the health of military and associated populations.
Last
year Dr. Rohit Chitale became director of the fledgling Division of
Integrated Biosurveillance, which shares a building with the DOD Serum
Repository, the world’s largest, with more than 55 million serial serum
specimens dating back to the mid-1980s.
The specimens are linked
to the Defense Medical Surveillance System, a database that can be used
to answer questions at the patient level and in the aggregate about the
health of the armed forces and beneficiaries.
Also part of AFHSC
is the Global Emerging Infections Surveillance and Response System,
called GEIS, whose 33 partners include military laboratories, academic
institutions and nongovernmental organizations around the world that
support service members and population-based surveillance and capacity
building in 62 countries.
Leading the new biosurveillance
division, Chitale has a doctorate in infectious disease epidemiology
from the John Hopkins Bloomberg School of Public Health and a master’s
of public health in epidemiology from the University of California, Los
Angeles.
Before joining AFHSC last year, the 42-year-old
scientist was senior analyst in the Global Disease Detection, operations
center at the U.S. Centers for Disease Control and Prevention in
Atlanta.
Soon after the severe acute respiratory syndrome, or
SARS, epidemic in 2002-2003 sickened more than 8,000 people worldwide
and killed 774, Congress funded the GDD program at CDC in 2004. The aim
was to strengthen the global capacity to detect, identify and contain
emerging infectious diseases and international bioterrorism threats.
In 2006, Chitale was one of the first analysts to help establish the
GDD Operations Center at CDC. This epidemic intelligence and response
operations unit uses many sources of information about disease events,
including Internet-based media reports scanned for key words in more
than 40 languages.
“What I came to AFHSC to do,” he told American Forces Press Service during a recent interview, “was to take the next step.”
The new division is part of a multiagency effort to implement the
nation’s first U.S. National Strategy for Biosurveillance, released in
2012 by the White House to make sure federal agencies can quickly detect
and respond to global health and security hazards.
It’s also
part of a push to increase DOD diagnostics funding through the
department’s biodefense program, Andrew C. Weber, assistant secretary of
defense for nuclear, chemical and biological defense programs, told
American Forces Press Service in an interview last year.
Some of
the work is done by the Defense Threat Reduction Agency’s Joint Science
and Technology Office of the Chemical and Biological Defense Program, as
well as by the Joint Program Executive Office for Chemical and
Biological Defense.
In October 2009, Weber himself ushered the
Chemical and Biological Defense Program into the biosurveillance
business by signing a memorandum to the military department secretaries
announcing that emerging infectious diseases would become part of the
chemical and biological defense mission.
Chitale, who says he’s
spent the past 14 months building his division and learning about the
many separate biosurveillance efforts underway across the department and
the military services, is looking to better integrate these elements to
create a coherent, global picture of biological threats -- and
recommendations for action -- specific to the Defense Department.
“We now have a [memorandum of understanding] between Health Affairs,
where AFHSC is, and Nuclear, Chemical and Biological Defense Programs,”
Chitale said.
“Historically,” he explained, “NCB’s mission is
global security -- combating weapons of mass destruction writ large --
and our mission is the medical care and surveillance of the forces and
DOD populations.
They’re different missions, … [but] recently it has
become increasingly clear that they are converging.”
The memo,
signed last summer, describes how NCB and DOD Health Affairs will
collaborate on cooperative activities that contribute to U.S. national
security and to global health security.
“NCB and Health Affairs
will cooperate on activities that help counter weapons of mass
destruction, to include chemical, biological, or radiological events
that impact various domains significant to U.S. forces,” Chitale said.
“In effect, that’s the whole spectrum when it comes to health.”
His division helped to write a 50-page operational plan in December that
lists 61 actions that the two organizations will accomplish together.
“They will be things like facilitating training for more
preventive-medicine residents,” Chitale said. “We’re going to help
create and implement better algorithms for syndromic surveillance. We’re
working to create information management systems so we can all work
more smartly -- for example, a system that can bring multiple
high-quality information streams into one portal and refresh every 10
minutes, and be shared with trusted partners.”
The challenge for
DOD is that the biosurveillance mission is complex, he noted. “There are
three services that each do what we do here to some extent, but they do
it for their own service,” he said. “What added value do we have? One
thing, at least, is that we can bring it all together to get a complete
picture.”
Such an augmented system would use information from the
DOD agencies, the rest of the U.S. interagency including the CDC, the
World Health Organization, the World Organisation for Animal Health, the
AFHSC-GEIS network, the Internet-based Program for Monitoring Emerging
Diseases, or ProMED, and even more informal sources, such as Twitter.
Ultimately, Chitale said, he envisions being able to do for DOD what he
and his CDC colleagues did for global public health, but even more --
collect a broad range of data and information relating to human, animal
and plant health, work with partners and analyze it according to DOD
needs, and provide guidance, recommendations and reach back support to
the department’s leadership and DOD customers such as the six geographic
combatant commands, and especially their surgeons’ offices.
Chitale has initially organized his small division into teams that
include alert and response operations, coordination and engagement, and
innovation and evaluation.
“We haven’t said that we’re actually
creating an operations center,” he said. “But the Alert and Response
Operations team, ARO, is a term modeled after WHO’s Global Alert and
Response Operations [established in 2000], probably the world’s first
strategic health operations center. Others were since stood up around
the world, and under the vision and leadership of Dr. Ray Arthur, we
established one at CDC in 2006. In some ways, and based on the needs,
I’m trying to model several of our key activities after that.”
Already the AFHSC and the new division have relationships broadly across
the interagency, including the State Department, the Department of
Health and Human Services and the intelligence community, particularly
through the Defense Intelligence Agency’s National Center for Medical
Intelligence in Maryland.
NCMI is an intelligence organization,
while AFHSC is a preventive medicine and public health organization.
Yet, there is some overlap in methods and certainly in goals.
“Importantly,” Chitale said, “we are working with NCMI closer than ever
before, and are formalizing a MOU with them as well.”
Key areas
in which AFHSC and the new division can provide value for DOD
biosurveillance is in disease detection, preventive medicine guidance
and coordination with the interagency, he added. “We’re trusted across
the DOD and also domestic and international medical and public health
communities – a real value add in this new paradigm, this new normal,”
Chitale said.
“When it comes to something like disease
detection,” he added, “you need the ability, which we have, to pick up
the phone and call someone in Uganda who you trust -- a medical person,
U.S. government staff working in the host nation, even someone in the
Ministry of Health or WHO staff -- and ask them what’s going on. They
can talk to their people in the country, and you get high-quality
information back within minutes to hours.
“You get real, hard
information,” he continued, “and those are your boots on the ground --
those are your listening posts across the globe.”