Meeting on “Managing Future Global Public Health Risks by Strengthening Civilian and Military Health Services”, Indonesia, 24-26 October 2017
The Government of Indonesia, with the support of WHO, organized the first global meeting on “The Managing Future Global Health Risk by Strengthening Civilian and Military Health Services”, in Jakarta on 24- 26 October 2017. The meeting brought together over 160 public health and military representatives from 44 countries, International Organizations, partners and donors. In line with G20 commitments to strengthen global health security and accelerate the implementation of the IHR, and as current Chair of the International Committee of Military Medicine (ICMM), Indonesia convened the meeting with the aim of identifying a shared vision between the two sectors on global, regional and national health security. The meeting was opened by the President of Indonesia, H.E. Joko Widodo.
Over the course of two days, two table-top exercises on a flooding and outbreak scenario and a deliberate event scenario prompted participants to think critically about the nature of their own national collaboration between civilian and military health services in the context of health emergencies. The exercises and discussions underlined the varied nature of military–civilian collaborations.
Almost 60% of participant countries have a comprehensive emergency preparedness and response plan in place for health emergencies, and almost 75% of participant countries have a centralized coordination to lead any response to large-scale health emergencies. In terms of field-level coordination, around 60% of participant countries have plans in place to deploy multi-sectoral response teams, compared with 20% of participant countries in which the armed forces would take the lead in field coordination.
Over half of participant countries have an integrated surveillance system or formal agreement in place to share information between human and animal health. However, only 24% have a formal agreement to automatically share info between the public and animal health sectors and security sectors. In the event of a potential deliberate release of an infectious agent, law enforcement would take the investigatory lead in almost 40% of countries, compared with 45% of countries who would designate a joint investigation team including representatives from public health. 67% of countries would set up a joint communications team to control messaging to the public.
Different models of civilian-military collaboration are often driven by contingency, including proximity to conflict zones, need for access to remote populations, and need to respond to recurring epidemics and natural disasters such as floods. Countries chose as a top priority the need to identify national stakeholders and develop and implement a national framework between public health and military health services for outbreaks and disasters and during suspected or confirmed deliberate health emergencies, and the establishment of notification mechanisms between public health, agriculture, veterinary medicine, and military services. Agreements, policies and MoUs need to be established or further explored between the health and security sectors.
It was clear that there is no one-size fits all approach to strengthening collaboration between military and civilian health services, but it is possible to agree on a shared vision to guide these efforts. A call to action for Member States to develop tailored priority actions to strengthen collaboration between sectors was made. These actions will feed into National Action Plans for Health Security (NAPHS) to accelerate the implementation of the IHR (2005).
The meeting recommended that countries should develop a national framework for collaboration based on the common goal of global health security, and in line with the principles set forth in the IHR; National stakeholders should be capacitated to effectively manage public health risks and events including in areas such as disease surveillance and reporting, preparedness, biosafety and biosecurity, and response between the two sectors; and countries should take a holistic multisectoral approach including across human health, animal health, and environmental health and security sectors, in developing their NAPHS and in the strengthening of strategic partnerships; existing policies and SoPs should be reviewed and updated between the public health and military/security sectors, to enable optimal collaboration before, during, and after public health emergencies.