The best way to prepare to address potential biothreats is to be aware of current medical intelligence assessed threats and well as surveillance data. This information on bio-threats, is used to augment Joint Health planning as described JP 4-02 and JP 3-11. Over time, the DoD has evolved procedures to prevent endemic infectious diseases from affecting operations during deployments which include:
These procedures apply to all potential biothreats whether they are biowarfare agents, endemic diseases, or emerging infectious diseases.
Medical personnel should have education managing biological casualties via courses such as the MCBC and U.S. Military Tropical Medicine (MTM) course. These and other relevant courses are listed in Appendix D.
Education and continued education of the Force with Command interest and unit level engagement cannot be emphasized enough and can reduce the impact of bioincidents on readiness/force posture. For example, in 2003, 44 U.S. Marines were evacuated from Liberia with either confirmed or presumed Plasmodium falciparum malaria. An outbreak investigation showed that only 19 (45%) used insect repellent,5 (12%) used permethrin treated clothing, and none used bed netting . Adherence with weekly mefloquine chemoprophylaxis was reported by 55%, but only 10% had serum levels high enough to correlate with protection.2 In contrast, 2,500 U.S. Service Members deployed to Liberia to support the response to the 2014 Ebola outbreak, and there were no cases of malaria detected during deployment . The lack of malaria cases can be attributed to education, Command emphasis on FHP measures, and unit-level leadership. Prior to deployment 99.3% of service members reported receiving education on malaria prevention, 53% reported using DEET on most days, 91% reported using treated uniforms, 96% using bed nets, and 96% taking malaria chemoprophylaxis pills every day (98% received atovaquone-proguanil; 1.5% doxycycline).3 This was supported by mandated twice daily unit-level Ebola monitoring (consisting of temperature checks and review of Ebola exposures and symptoms), individuals were asked about use of antimalarials. In addition, 45% of those surveyed indicated that their unit directly observed them taking their antimalarial daily.
The DoD BPR emphasized the need for improvements in biothreat intelligence collection, analysis, and sharing. It is recommended that medical personnel coordinate with their chain of Command, medical planner and J2 to ensure there is shared understanding of the biothreat environment and that relevant information is passed down to tactical level providers as appropriate. It is also important for medical personnel to have an understanding of medical intelligence and where to obtain it. Medical intelligence is produced by the National Center for Medical Intelligence (NCMI) and consists of the collection, evaluation, and analysis of information concerning the health threats and medical capabilities of foreign countries and non-state actors that have immediate or potential impact on policies, plans, or operations. More information on NCMI and how to access their intelligence products are contained in Appendix D.
Medical personnel should have a basic understanding of medical logistics and request additional MCMs based on mission threats from their Joint Logistician. A basic example is given in Appendix E utilizing TPOXX (tecovirimat). They should also have basic understanding of the Joint Deployment Formulary (JDF) which is a reference list of pharmaceutical items for support during the first 30 days of contingency operations . The JDF is intended to promote the standardization and sustainability of pharmaceutical items as components of medical assemblages and in planning and preparation for early sustainment of deployed forces.7