Medical Intelligence Center Monitors Health Threats

By Cheryl Pellerin American Forces Press Service FORT DETRICK, Md., Oct. 10, 2012 – From a windowless building behind barriers and fences here, scientists, physicians and other experts monitor a range of intelligence and open-source channels for threats to the health of U.S. forces and the homeland. But the Defense Intelligence Agency’s National Center for Medical Intelligence, known as NCMI, is an intelligence organization, not a public health organization. The job, NCMI Director Air Force Col. (Dr.) Anthony M. Rizzo told American Forces Press Service, is not to tell the public what is happening. “It is our responsibility to tell policymakers and planners … what we believe is going to happen,” he explained. The center’s intelligence targets are medical and scientific issues. Its products, like those of the rest of the intelligence community, are predictive analysis and products for warning, produced in four divisions whose experts follow developments in infectious disease, environmental health, global health systems and medical science and technology. NCMI is the primary source of medical intelligence in the federal government, Rizzo said, “so as a consequence, we have to write for all levels, all customers, … from the president down to the most tactical intelligence officer or surgeon in the field.” In the hallways and offices of the nondescript NCMI building are a broad range of scientists, many with multiple advanced academic degrees, many of them leaders in their fields. “We take these very smart people,” Rizzo said, “and turn them into intelligence officers.” Downstairs is a typical operations center -- multiple desks and computer monitors face large, wall-mounted screens that carry news reports from around the world. Also at work in the building are scientists from many partner organizations. “We are an all-source organization, and thus we have to use every means available to get our data. And the intelligence community partners who provide national technical means are physically located here,” the director said. “But we also have responsibility for intelligence for homeland health protection,” he added, “[and] we could not do that job without a large number of non-intelligence-community partners who are also resident here -- fully cleared and full-up members of the organization.” Resident partners include organizations like the National Geospatial Intelligence Agency and the Agriculture Department. And Rizzo said he has NCMI experts embedded at other intelligence agencies. Each NCMI division needs a certain amount of baseline data to do its job, the director explained. “In the Infectious Disease Division, the baseline requirement is to understand the risk of every type of [endemic] infectious disease in every country. You can imagine why,” Rizzo said. “If an outbreak of mystery disease occurs in a country, we need to be able to say that we know in that country that Ebola, malaria and dengue are very common, so my people can look at the symptoms of mystery disease and know” the most likely suspects, Rizzo said. “If mystery disease doesn’t fit the things that are most likely,” he added, “then we have to start looking really differently.” At NCMI, every division also has a baseline product in addition to alerts and threat forecasts. In the Infectious Disease Division, it’s the Infectious Disease Risk Assessment, a predictive product, Rizzo noted, “that says if you go to a place unprotected, we predict these are the diseases your people will get, and … these are the numbers of cases.” Every federal organization that sends Americans overseas uses this product, along with baseline products from the other divisions. Also at NCMI is a cross-divisional pandemic warning team that spends all its time monitoring highly pathogenic H5N1 avian influenza and other potential pandemic diseases. In April 2009, two months before the World Health Organization and the U.S. Centers for Disease Control and Prevention officially declared the global outbreak of H1N1 influenza a pandemic, NCMI published an intelligence product for senior U.S. policymakers that predicted H1N1 would be a pandemic. “That does not make us better than [CDC],” Rizzo said, “What it does do is make us different, because [CDC] has to be right. We in the intelligence community love to be right, but we also know that in order to provide timely warning, warning in time for the customer to take action to mitigate what we’ve predicted, we have to be early. And the earlier we predict, … the less certainty we have.” At NCMI, the Environmental Health Division monitors toxic industrial chemicals, materials and facilities worldwide. Its baseline product is the Environmental Health Risk Assessment, which addresses the quality of air, food, soil, water and risk from chemical exposure worldwide. The division also does what Rizzo calls predictive hazard area modeling. “We can tell you with 99 percent accuracy,” the director said, “if this thing that’s full of chemicals leaks next Thursday, here’s where the hazard area is, here’s where you should not be standing, and here’s where it’s OK to stand.” The division monitors several facilities around the clock and can forecast dispersion events at those places immediately, but it also can do similar forecasts for any chemical or nuclear facility on the planet, Rizzo said. Every day of the year, the director said, “there is a biological or chemical event somewhere in the world, sometimes many of them. And we own the responsibility of assessing whether or not those events … are manmade or naturally occurring, and then making predictions about them.” The Global Health Systems Division is responsible for understanding the medical capabilities of every country in the world, and it monitors the quality of every nation’s blood supply. The division’s baseline product is the Medical Capabilities Assessment for each country, and it is responsible for maintaining Defense Department databases that characterize overseas medical facilities, including hospitals, clinics, labs, blood banks and pharmaceutical production facilities. “If you’re a planner,” the director said, “and I don’t care who you’re a planner for, you’re using that Infectious Disease Risk Assessment, you’re using that Medical Capabilities Assessment, you’re using the Environmental Health Assessment to decide, ‘What do I use to protect my people? What do I have to bring? What can I leave home?’” The NCMI Science and Technology Division is responsible for understanding every nation’s medical defense capabilities against chemical, biological, radiological and nuclear weapons. “If you understand a country’s medical defense capabilities, that can very much help you understand what their other capabilities might be and what their intent is,” Rizzo said. “People plan medical defense based on what they think is going to happen to them or what they think they can do.” Along with the baseline products that come out of each NCMI division, all produce warnings, alerts and special products during crises. “When it comes to a crisis such as the earthquake in Haiti or an invasion of a country or a NATO bombing campaign against a country, … we have to tailor products to support the U.S. government and the governments of our allies,” Rizzo said. “So while we are writing all the time, we’re also very responsive to world events. When the earthquake in Haiti occurred, we put out close to 100 products.” Most products start out in a classified version, but the director said his people are very good at writing products to be shared with NCMI’s non-intelligence community partners. “We don’t get credit,” Rizzo added, “but that doesn’t matter.” NCMI itself is an important partner in the multiagency effort to implement the nation’s first U.S. National Strategy for Biosurveillance, released this summer by the White House to make sure that agencies can quickly detect a range of global health and security hazards. “When we think of the word biosurveillance, we think of the kinds of things that the public health community does -- collecting cases, taking cultures, deciding which disease is which,” Rizzo said. “But we in the intelligence community are looking way before that to determine [if there are] threats on the horizon.” When the experts at NCMI communicate a threat to the public health community, the director added, “they can focus … their public health efforts, and so we are very much involved in biosurveillance, but … at the front end of the process.” The whole world deals with limited resources, Rizzo added, and CDC, the World Health Organization and other public health organizations can’t look at everything all the time. “But if we in the intelligence community, especially we in medical intelligence, are able to say, ‘Here’s a threat on the horizon that we perceive,’ … then it’s up to our customer to decide whether or not they will think about it,” the director added. “We have very good, nonadversarial, very supportive relationships with our partners,” Rizzo said, “and typically if we say we’re concerned, they respond.”