Wednesday, July 29, 2015

NATO's Role in Biological Defence: Vigorous Warrior 2015


surgery team
NATO MILMED VW15

Vigorous Warrior (VW15), a multinational NATO military medical exercise was run in June,2015 in Hradec Kralove, the Czech Republic. The primary aim of this excercise was to assess gaps in multinational medical deployments in areas such as diagnostics, decontamination, treatment and evacuation for casualties of biological and chemical exposure.The NATO Centre of Excellence for Military Medicine (MILMED COE) combined forces with the Czech Armed services to run this exceptional exercise. (see: http://www.coemed.org/news-a-events/news/325-vigorous-warrior-hradec). In addition to this NATO has published several reports and updates on Ebola. These reports can be accessed on line ( http://www.coemed.org/library/disease-surveillance).

Clearly NATO has a role in and consensus support for deploying forces to counter the threat of epidemic and pandemic disease. An article in Foreign Policy entitled: "The Ultimate Ebola Fighting Force" by Jack Chow which was actually published back in Sept. of 2014 long before the death tolls reached 11,00, lays out a substantial argument for NATO's involvement in the often contentious field of health security. Chow notes: 

"[  ] those brave people fighting the virus are doing so without the backing of any substantial medical reserve force that could come in with fresh supplies and trained personnel. Neither the cluster of industrial countries that gives health aid to poor countries, such as those in the G-7, nor international bodies like the World Health Organization (WHO) possess an at-the-ready, deployable battalion with trained health care teams, protective gear, and ample supplies of medicines." 

biodefence
NATO MILMED VW15

One of the immediate issues which NATO must address if it is to put up a battalion under a NATO command is that of strategic stockpiling. NATO thus far has not created a strategic stockpile of its own and relies on a virtual stockpile and contribution from its Member States. This structure so far has met with success but future epidemics and even those which might be deliberate may see widening gaps particularly if the contributing Member States must protect their own forces and nationals in country. This could change the dynamics and NATO surely must be flexible to deal with such changes. The Foreign Policy article notes: 

"Ebola's surprise attack against fragile countries, including Liberia, Sierra Leone, and Guinea, demonstrates the compelling need for a new international epidemic response corps that can go straight to a hot zone when needed. This 'medical NATO,' so to speak, would consist of a coalition of countries that would recruit specialty teams- comprised of doctors, nurses, and others--from respective national health agencies and systems. The alliance would appoint a doctor-in-chief, and all participating countries would jointly develop operational plans and conduct rehearsal exercises." (see full article here: http://foreignpolicy.com/2014/09/10/the-ultimate-ebola-fighting-force/). 

On both counts I would argue NATO already has an established medical corps and the expertise certainly of developing furthe such a force. COMEDS, the medical branch of NATO has a leader, the leadership is rotating and currently it is the French Surgeon General who oversees COMEDS, and MILMED COE has just conducted VW15 (this military medical exercise is run every two years). 

While Chow envisions these teams being deployed under a WHO declaration of an international health emergency, if NATO acquired a robust strategic stockpile with a composition of medical supplies and technologies at its disposal, the hot zone team could effectively engage where asked and avoid possible conflicts, which would arise legally if such deployments were made outside a NATO command structure. That 'teams would be deployed upon the WHO's declaration of a global health emergency [and] could be mobilized to suppress a disease either completely or to such a level that a country could then handle the crisis" is certainly a worthy goal, but as Chow goes on to explain "They would have the authority to directly provide treatment drugs and implement prevention measures without political interference from a a country in which an outbreak was happening." 

This, in my view, would not be possible under current NATO mandates and under  UN law.  While the author's concept that "The corps would be equipped with airlift capacity for rapid insertion into disease zones, and would receive support from a robust supply chain that could immediately push mobile hospitals, equipment, and essential drugs into areas in need. Corps members could follow WHO treatment guidelines and access that organization's disease-tracking systems"  (ostensibly GOARN), although NATO has its own disease tracking system (ASTER) and due to restrictions it would be unlikely NATO would integrate or coordinate with GOARN. At the minimum this would present problems within the classification and STANAG systems not to mention UN mandates. Its the opinion of this author that it would not be necessary, although its a tempting civil-military inter-operational concept model.

To addess the articles' contention that a NATO corps could simply go into a hotzone presents all kinds of security, policy and legal issues. Medecines sans Frontieres and I would imagine WHO as well, would be unlikely to shift their views and policy on military involvement, even in medical response. MSF in particular is sensitive to this issue and has vast experience with conflict medicine. While it would be nice to think NATO medical personnel would be welcome in a conflict zone where there is also an outbreak of a potentially pandemic disease, this clearly is not the case and they would have no mandate do so.  

While a 'global public health emergency corps" is absolutely needed and NATO, with its well established medical command has a role to play in health security, it is one which will require consensus to restructure and investment from its Member States. Creating a NATO strategic stockpile of medical supplies, and the acquisition of advanced technologies, which could be pushed within 24 hours to a hot zone, would serve well to augment the future capabilities of WHO, NGO's, MSF, CDC, but it is not a replacement, nor should it be under the command of any other civil institutions. 




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