The Bug Stops Here: Force Protection and Emerging Infectious Diseases - Disease through History, Preventable Disease and Non-Battle Injuries, Regional Combatant Commands, From Black Death to Malaria

Throughout history, emerging and reemerging infectious disease have plagued human populations. From the earliest recorded epidemics of bubonic plague and smallpox more than 2,500 years ago to the deadly 1918 pandemic of the Spanish Flu, infectious diseases have helped to shape human history. Despite significant advances in medical research and treatment in the past century, infectious diseases remain among the leading causes of death worldwide. These diseases are appearing in places they have never been seen before or were thought to have been eradicated, are spreading faster and more frequently, and are posing an increasing global health threat that will affect national and international security in both the near- and long-term future, even affecting the success of U.S. military missions and operations.

Force health protection is an urgent priority for the Department of Defense (DOD), as increasing threats of natural outbreaks of infectious disease could seriously undermine mission readiness and success. U.S. national security might be impacted by military operations in regions with endemic and epidemic occurrences of infectious disease, where disease activity may prevent the successful completion of a mission or operation or may even result in infected soldiers carrying a contagious disease back to the United States. Changing military doctrine and tactics call for a fresh approach to force protection. Rapid deployment of military forces, revised distribution of medical resources in theater, improved body armor, and modern combat casualty care efforts are leading to different illnesses and injuries from those seen in previous conflicts. Emerging infectious diseases in the context of urban warfare, low-intensity conflict, and the rapid movement of service members and civilians, have made a new approach to military medical support imperative. Despite improvements in combat-injury protection and wound management, disturbing trends are developing in infectious diseases in military forces.

The purpose of this paper is to review important lessons that have been learned in the past, and to revisit the older but proven principles of force protection that are in danger of being forgotten in today's technology-focused military environment. Recognizing that infectious diseases could have a significant impact on military operations, this report provides a series of case studies that analyze health threats to each regional combatant command and presents both tactical and strategic recommendations that will better prepare the entire DOD for future outbreaks of disease. These recommendations focus on procedural changes that will allow the U.S. military to regain its competitive advantage.

Introduction * Infectious Disease through History * Emerging Infectious Diseases * Infectious Disease and Force Protection * Preventable Disease and Non-Battle Injuries * Force Protection Measures * Emerging Infectious Diseases and Regional Combatant Commands * United States Central Command * United States European Command * United States Northern Command * United States Pacific Command * United States Southern Command * Special Operations Command & Transportation Command * Strategic Recommendations for Worldwide Force Protection * Environmental Surveillance and Mitigation * Surveillance and Management * Clinical Diagnosis and Treatment * Historical Perspective * Conclusion