U.S. Department of Defense and International Public Health

1. U.S. Department of Defenseand International Public Health LT Mazie Barcus U.S. NAMRU 2 Jakarta, Indonesia

2. DoD Overseas Laboratories OCONUS Medical Research Units Central Coordinating Hub WRAIR NMRC Egypt Thailand Kenya Indonesia Peru

3. Mission of the Overseas Labs • Conduct scientific research on infectious diseases of military importance • Overlap between military relevance and host-nation public health priorities • Technology transfer to host nation • Global Emerging Infections System • 1996 Presidential Directive • Surveillance of emerging and re-emerging infectious diseases • Host-nation capacity building

4. DoD GEIS Initiatives • Enhance surveillance and response components of international public health infrastructure • Surveillance for drug-resistant malaria, antibiotic-resistant enteric organisms, influenza, and unexplained febrile illness • Partnering with international aid organizations and foreign health ministries to improve their ability to participate in an international surveillance network

5. DoD GEIS Initiatives • Enhance biomedical and behavioral research efforts on emerging infectious diseases • Collaborate with Military Infectious Disease Research Program • Use GEIS-generated surveillance data to guide research efforts in areas like drug development

6. DoD GEIS Initiatives • Expand formal training and outreach to health care providers • Support training of foreign scientists, epidemiologists and technicians • Outbreak investigation courses, health care provider courses, technology transfer

7. DoD GEIS Initiatives • Encourage high priority status for emerging infectious diseases and support WHO and other bodies in playing a stronger role in the surveillance, prevention, and response to emerging infectious diseases • Building bridges between international aid agencies, donor agencies, foreign governments, militaries and the UN.

8. GEIS at NAMRU-2 Surveillance for drug-resistant malaria

9. NAMRU-2 Organized an Intervention • Address the immediate threat of epidemic malaria in the Menoreh Hills • Ministry of Health: CDC and NIHRD • Provincial Health Officers • District Health Officers • WHO in Geneva • Effective therapy • USAID/Jakarta • US$500,000 via WHO

10. NAMRU-2’s Direct Role in the Intervention • Provided plan of action for the intervention • Engaged international agencies for monetary support • Training and infrastructure for post-marketing surveillance of Coartem • Monitored the impact of the intervention • monitoring passive surveillance data • pre- and post-intervention prevalence surveys • Operational research in the Intervention Area • Vector bionomics • Clinical trial of CQ + S/P • Malaria KAP study

11. NAMRU-2’s Continued Efforts Against Malaria on Java Transition from unsustainable intervention to sustainable capacity building Incubate and nurture a NGO that can partner with USAID and other donors to re-build the infrastructure for malaria control

12. USAID/NAMRU-2 Partnership • Agreement to bring long-term USAID resources to bear on malaria problem on Java • $4 million over 4 years • Utilize NAMRU-2’s assets in the region to re-establish malaria control infrastructure • 32 year relationship with Ministry of Health partners • Resident expertise in malaria • Working relationships with international agencies engaged in malaria control

13. Goals of the USAID/NAMRU-2 Collaboration Capacity building along 5 tracks: • Community Participation • Diagnosis • Treatment • Vector Control • Surveillance

15. International Public Health and the DoD • Mission: infectious disease research of military importance • Convergence of purposes with developing countries’ public health threats • Technology transfer to host nation • GEIS: fully-sanctioned platform for capacity building in infectious disease surveillance and control