Civil-Military Collaboration for Health Emergency Preparedness
The role of military assistance in responding to natural and environmental disasters, including incidents related to chemical, radioactive and nuclear accidents or deliberate events, has been long established. While the military has historically not been regarded as a primary partner in responding to disease outbreaks, the engagement of the military in the response to the Ebola virus disease outbreak in West Africa in 2014–2016 and the Zika virus disease outbreak in 2016 illustrated some of the benefits of civil– military health collaboration in the context of an epidemic.
Most recently, during the COVID-19 pandemic, the scale and complexity of the pandemic has reinforced that partnership and demonstrated that collaboration with other sectors beyond the health sector is essential when preparing for and responding to public health threats and risks. National military assistance in countries during the COVID-19 pandemic has so far included supporting logistics and supply chain management; providing additional medical or other personnel as surge capacity; delivering part of the response, such as supporting contact tracing, testing or vaccination; and contributing to the security agenda by reinforcing border controls at points of entry. However, the optimal contribution of the military health services in responding to or preparing for disease outbreaks requires further assessment.
Under the WHO Thirteenth General Programme of Work 2019–2023, which includes the strategic priority to better protect 1 billion more people from health emergencies, emergency preparedness plays a crucial role in building and sustaining the national, regional and global capacities required to keep the world safe from health emergencies. The IHR (2005) require the 196 signatory countries and territories to detect, assess, report, and respond to potential public health emergencies of international concern in a timely manner at all levels of government. Improving collaboration between public health and military health services has been identified by WHO as an area with the potential to realize substantial gains in health emergency preparedness, emphasizing the need to identify synergies for future collaboration.
In May 2018, pursuant to the decision of the Seventy-first World Health Assembly on implementation of the IHR five-year global strategic plan to improve public health preparedness and response, 2018–2023, the WHO Secretariat affirmed the need for innovative multisectoral approaches to implementation of the IHR (2005). In November 2020, World Health resolution WHA73.8 – “Strengthening preparedness for health emergencies: implementation of the International Health Regulations (2005)” – stressed the importance of adopting an all- hazards, multisectoral, coordinated approach in preparedness for health emergencies.
Emergency response benefits from building and strengthening alliances and partnerships between the public health sector and non- traditional health stakeholders, such as the military health services, well before the need for a response to a public health emergency arises. Thus, instead of aiming for multisectoral engagement only at the time when a response to a public health emergency is necessary, effective public health emergency management requires preparing together for a better response through multisectoral coordination for emergency preparedness and health security.
WHO recognizes that countries would benefit from guidance on how to involve military actors in supporting health interventions across the continuum from developing the capacities needed to implement prevention and preparedness to the response to and recovery from health emergencies. Stakeholders need not only to consider the country-specific context to choose the best form of engagement but also to identify the national capacities that can and should be complemented by the military health services. National military health services are often well equipped to play a supportive and complementary role in this endeavour.
While there is a long-standing history of military involvement in humanitarian interventions related to natural disasters, the engagement of national militaries in preparing for and responding to disease outbreaks in the domestic context is relatively recent. Since 2009, all declared public health emergencies of international concern have highlighted the importance of multisectoral collaboration beyond the health sector. While militaries might not immediately associate health epidemics or pandemics with their mandate (for various reasons, including legal, historical, political, cultural and socioeconomic factors specific to the country context), national military health services have a range of specialist resources that can be brought to bear in managing public health events, including disease outbreaks, and consensus on technical standards for health-related interventions and activities can be reached by all military.
Many examples exist of military health assistance that helped to mitigate and ease the impact of natural disasters such as earthquakes, cyclones, droughts, floods, and chemical, biological, radiological and nuclear (CBRN) emergencies. With the increase ¬¬in the number and magnitude of health emergencies (such as the 2014–2015 Ebola outbreak in western Africa and the 2015– 2016 Zika outbreak in Brazil), exemplary case studies of health-related activities delivered by the military during epidemics are gradually emerging. In particular, the Ebola outbreak in Guinea, Liberia and Sierra Leone illustrated that “civil–military collaboration proved necessary and helped the affected countries to contain the virus sooner and saved lives ”. Most of the research on civil–military collaboration in the context of disease outbreaks offers qualified support for greater collaboration between the two sectors, with the caveat that the need for comprehensive guidance on civil–military health-related interventions and activities remains.
Even more prominently, the COVID-19 pandemic has shed light on the role that national military actors and services can play in public health emergencies, including disease outbreaks. Acknowledging their sheer lack of capacity to respond to the devastating impacts of the pandemic caused by the novel virus SARS-CoV-2, many countries have increasingly engaged the national military in support of the COVID-19 response. The efforts of the national military typically focus on the following activities: support for physical infrastructure, logistics and supply chain management; providing military health workforce surge capacity for civilian hospitals; isolation and quarantine and border control; testing and contact tracing and distribution of protective equipment; and managing cases. According to the European Observatory of Health Systems and Policies, “governments used their militaries as a source of supplementary logistical, infrastructural, and medical capacity and as a source of infrastructure and in some cases policing duties for isolation and quarantine but did not broaden its role”
The aim of the National Civil-Military Collaboration Framework for Strengthening Health Emergency Preparedness is to provide the public health sector and military actors and services at the national level with guidance for establishing, advancing, and maintaining collaboration and coordination, with the focus on country core capacities required to effectively prevent, detect, respond to, recover from and build back better after health emergencies.