Introduction We examine the current status of the military relevance of opioids, their use and misuse in military and veteran populations, the national security consequences of opioid use in our military age population, public health implications, and military, veteran, and government solutions for opioid addiction. Materials and Methods A literature search of recent published research, federal government, and related open source materials was conducted using PubMed, Google, and Google Scholar, and all materials retrieved were manually identified, screened, and evaluated for inclusion. A modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach was used for the selection of relevant articles. Heath policy literature and relevant demographic information published within the last 5 years was also included to provide current information and search for solutions to address the escalating national opioid crisis. Results Synthetic opioids are used for pain and trauma management, not readily substituted, and have exceptionally high addiction potential. Combat wounded veterans have greater potential for opioid misuse than civilian populations. Assessment, management, and treatment of opioid use in this population are essential. Veterans receiving synthetic opioids have been noted to have multiple overdose risk factors. Opioids are readily available nationally as “street drugs” and also in the form of fentanyl-contaminated heroin. The opioid crisis affects the military age population and the top states for military enlistments. Younger age males with lower education and income are at significant risk for opioid use disorder. Recently increased drug overdose deaths contribute to an increased U.S. mortality rate with a commensurate decline in life expectancy at birth. Opioid abuse contributes to increased incidence of infectious disease. Behavioral health programs directed at military and veterans to identify risk factors for opioid misuse have been introduced. Prescription drug monitoring initiatives continue for these populations with increased information exchanged between military and civilian healthcare. Lifesaving interventions for opioid addiction include methadone maintenance and fentanyl test strip accessibility. Newly implemented federal funding healthcare initiatives to the states are now directed at opioid use prevention and enhanced surveillance. Conclusions Given increasing rates of opioid addiction and death, viable solutions are universally needed. Successful intervention measures should be widely shared between military, veteran, and civilian healthcare and public health communities. Increased collaboration between these groups could inculcate successful programs to prevent and decrease opioid use. Results received from recent military and veterans’ programs for prescription and electronic medical record (EMR) monitoring and data sharing may also prove useful for civilian healthcare providers and hospital systems. Future evaluations from ongoing federally funded programs to the states for addiction surveillance and intervention may help create measures to address the proliferation of opioid addiction with increased death rates. Anticipated results from these federal efforts should help inform opioid programs in military and veterans’ health systems.

This study utilized modeling and simulation to examine the effectiveness of current and potential future COVID-19 response interventions in the West African countries of Guinea, Liberia, and Sierra Leone. A comparison between simulations can highlight which interventions could have an effect on the pandemic in these countries. An extended compartmental model was used to run simulations incorporating multiple vaccination strategies and non-pharmaceutical interventions (NPIs). In addition to the customary categories of susceptible, exposed, infected, and recovered (SEIR) compartments, this COVID-19 model incorporated early and late disease states, isolation, treatment, and death. Lessons learned from the 2014–2016 Ebola virus disease outbreak—especially the optimization of each country’s resource allocation—were incorporated in the presented models. For each country, models were calibrated to an estimated number of infections based on actual reported cases and deaths. Simulations were run to test the potential future effects of vaccination and NPIs. Multiple levels of vaccination were considered, based on announced vaccine allocation plans and notional scenarios. Increased vaccination combined with NPI mitigation strategies resulted in thousands of fewer COVID-19 infections in each country. This study demonstrates the importance of increased vaccinations. The levels of vaccination in this study would require substantial increases in vaccination supplies obtained through national purchases or international aid. While this study does not aim to develop a model that predicts the future, it can provide useful information for decision-makers in low- and middle-income nations. Such information can be used to prioritize and optimize limited available resources for targeted interventions that will have the greatest impact on COVID-19 pandemic response.

Given its potential to quickly spread internationally and initially uncontrollable nature, the 2014 to 2015 Ebola outbreak has implications for global biosecurity. The Defense Threat Reduction Agency's Technical Reachback provided near real-time analysis and recommendations as outbreak-relevant events unfolded. Our review of often-conflicting or incomplete information was required to answer policy decision makers about the expanding Ebola epidemic, and enable the formulation of best-possible U.S. Department of Defense and Government response. Challenging questions often did not have obvious information available from which to provide a definitive answer. Nevertheless, through use of best-practice science and medicine, we provided timely and scientifically accurate weekly review for decision makers. Our comprehensive analyses included the nature of the outbreak, its global and national impact, contributing factors to this and future Ebola outbreaks, the U.S. Government and international response, and continuing interventions. We also provided guidance for Ebola transmission outside of West Africa, medical countermeasures, challenges with the international response, lessons learned, major constraints, and considerations for future preparedness. We believe an assessment of these events may help an improved response for future infectious disease outbreaks with global and national security implications.

Epidemiological modeling and simulation can contribute cooperatively across multifaceted areas of biosurveillance systems. These efforts can be used to support real-time decision-making during public health emergencies and response operations. Robust epidemiological modeling and simulation tools are crucial to informing risk assessment, risk management, and other biosurveillance processes. The Defense Threat Reduction Agency (DTRA) has sponsored the development of numerous modeling and decision support tools to address questions of operational relevance in response to emerging epidemics and pandemics. These tools were used during the ongoing COVID-19 pandemic and the Ebola outbreaks in West Africa and the Democratic Republic of the Congo. This perspective discusses examples of the considerations DTRA has made when employing epidemiological modeling to inform on public health crises and highlights some of the key lessons learned. Future considerations for researchers developing epidemiological modeling tools to support biosurveillance and public health operations are recommended.

During emerging disease outbreaks, public health, emergency management officials and decision-makers increasingly rely on epidemiological models to forecast outbreak progression and determine the best response to health crisis needs. Outbreak response strategies derived from such modelling may include pharmaceutical distribution, immunisation campaigns, social distancing, prophylactic pharmaceuticals, medical care, bed surge, security and other requirements. Infectious disease modelling estimates are unavoidably subject to multiple interpretations, and full understanding of a model's limitations may be lost when provided from the disease modeller to public health practitioner to government policymaker. We review epidemiological models created for diseases which are of greatest concern for public health protection. Such diseases, whether transmitted from person-to-person (Ebola, influenza, smallpox), via direct exposure (anthrax), or food and waterborne exposure (cholera, typhoid) may cause severe illness and death in a large population. We examine disease-specific models to determine best practices characterising infectious disease outbreaks and facilitating emergency response and implementation of public health policy and disease control measures.