WASHINGTON—While news of the spread of the H1N1 influenza virus has caused widespread concern around the world, medical leaders in the military health system are confident that years of pandemic planning will help it deal with H1N1 or any other flu virus. “Infectious diseases are a big problem for the Department of Defense. We have an ongoing surveillance system to pick up any type of infectious disease that might impact either our operational capability or our dependent population. With that in mind, we have been doing pandemic medical planning for well over a decade,” said Lt. Col. Wayne E. Hachey, DO, MPH, director of Preventive Medicine and Surveillance in the Office of the Assistant Secretary of Defense for Health Affairs.

For the military, keeping a constant eye on flu outbreaks year round and around the world is critical to protecting troops. “Flu can have a major impact,” he said. “There is a flu season in the northern hemisphere and a flu season for the southern hemisphere. The problem is that DoD does not stop at the equator as far as where we put people.”

Dr. Hachey said that a testament to the fact that DoD’s worldwide surveillance system for infectious diseases is working is that it identifi ed the first cases of the recent H1N1 that appeared in both California and Texas. “DoD is actually responsible for identifying the first two cases of the H1N1 that appeared in California, one in a dependent of an active duty member and the other in a civilian that was picked up through some surveillance activity at the California-Mexico border,” he explained. “Our involvement isn’t something that starts and stops, but it has been in place for years now.”

In the four cases of H1N1 that first appeared in California and Texas, three of these were military dependents that went to a military clinic with influenza-like symptoms. “As part of our routine surveillance, we cultured them and sent that to our DoD hub, which identified that this was a new virus. In the fourth case, there was a surveillance system in cooperation with the CDC looking at influenza activity on the California-Mexico border. We got that sample through that surveillance system,” he said.

The first cases of H1N1 that started appearing sparked concern within the agency. “We put everyone on a high alert even before we knew this was going to be the problem that it is,” he said. “We pulled that trigger fairly early with the first few cases in California, we put everyone on a heightened alert. A heightened alert is not all that different from our normal posture. Again, we are always worried about different infectious diseases that may just look just like flu.”

Preparing for Pandemic

DoD has been preparing for a flu pandemic for years. “What we did a number of years ago is stockpile at our medical treatment facilities for our providers to give them protection for up to 80 days,” Dr. Hachey said. “So we have established a stockpile of our own at each MTF so we don’t have to rely on resupply that may not be there during a pandemic.”

The stockpile includes items like needles and syringes for vaccination. “When vaccines come out you need to get it into people, and needles and syringes are normally made just in time. So as people use them, the manufacturer makes them,” he said. “If you have to immunize a couple of million people, that production capacity isn’t going to be there, so we have stockpiled needles and syringes.”

Antivirals are also in place at MTFs. “We prepositioned a relatively small amount of antivirals, enough to treat 10% of the population of what is enrolled at each MTF. We have that right on the shelf at each hospital,” Dr. Hachey said. “We have a larger stockpile in three separate geographic areas: one in the US, one somewhere in the Pacific, and one somewhere in Europe. So we can resupply the medical treatment facilities, or those folks out in the field, as they exhaust their local stockpile.”

In addition, the MTFs have gowns, gloves and masks, and antibiotics stockpiled. “In 1918, about half of DoD deaths were people getting bacterial infections after they got influenza,” he said. “Because of our experience in 1918, we have gone ahead and stockpiled antibiotics at each of our medical facilities in case that happens again.”

Linking with Other Agencies

The agency has also been involved with pandemic flu planning with other federal agencies. In 2005 the White House issued the federal government’s National Strategy for Pandemic Influenza, which lays out a federal strategy to deal with a flu pandemic. Following that document, the White House released the Implementation Plan for the National Strategy that translates the Strategy into more than 300 actions for federal departments and agencies and sets expectations for state and local governments and other non-federal entities.

Overall, DoD’s main responsibility in responding to a pandemic will be to protect US interests at home and abroad. “It assigns about 300 different tasks to different areas of the federal government. Within that 300, DoD has 116 specific tasks. So we are kind of woven into the whole national response system. Of those 116, we [DoD] are the lead of 31. For the 116, it is fairly weighted towards the medical side, with Health Affairs responsible for 71 of the 116 and the lead agency for 23 of those tasks. So we have that national plan that DoD is a part of and the DoD plan is built on the national plan.”

Each combatant command in DoD is also responsible for developing its own pandemic plan that is built on the national pandemic plan. “The Northern Command was tasked with making sure that all of the combatant commands are not only consistent with the DoD plan, but are consistent with one another,” he said. “Also, the Services have their own plan that is consistent with the DoD plan. The installations have plans that are based on the Service plans.”