Military Participation in Health Security: Analysis of Joint External Evaluation Reports and National Action Plans for Health Security

Abstract

Militaries around the world play an important but at times poorly defined and underappreciated role in global health security. They are often called upon to support civilian authorities in humanitarian crises and to provide routine healthcare for civilians. Military personnel are a unique population in a health security context, as they are highly mobile and often deploy to austere settings domestically and internationally, which may increase exposure to endemic and emerging infectious diseases. Despite the role of militaries, few studies have systematically evaluated their involvement in global health security activities including the Global Health Security Agenda. We analyzed Joint External Evaluation ( JEE) mission reports (n = 94) and National Action Plan for Health Security plans (n = 12), published as of July 2020, to determine the extent to which military organizations were involved in the evaluation process, military involvement in health security activities were described, and specific recommendations were provided for the country's military. For JEE reports, descriptions of military involvement were highest in 3 of the 4 core areas: Respond (76%), Prevent (39%), and Detect (32%). Similarly, National Action Plan for Health Security plans mentioned military involvement in the same 3 core areas: Respond (58%), Prevent (33%), and Detect (33%). Only 28% of JEE reports provided recommendations for the military in any of the core areas. Our results indicate that military roles and contributions are incorporated into some aspects of country-level health security activities, but that more extensive involvement may be warranted to improve national capabilities to prevent, detect, and respond to infectious disease threats.

Civil–military cooperation in the management of infectious disease outbreaks: a scoping review

“…Ongoing planning, exercising and capacity building activities require binding civil–military agreements for all civil and military stakeholders involved 30 31 34. Yet, regarding the International Health Regulations notification agreements (IHR 2005),37 this can jeopardise operational security and might be a reason for military troops not to comply 38. Legal restrictions or reluctance of civil stakeholders towards civil funding of military engaged projects can also limit military involvement in global health security activities 38.…”

“…Yet, regarding the International Health Regulations notification agreements (IHR 2005),37 this can jeopardise operational security and might be a reason for military troops not to comply 38. Legal restrictions or reluctance of civil stakeholders towards civil funding of military engaged projects can also limit military involvement in global health security activities 38. On the other hand, military financial flows provide an opportunity for bolstering civil–military capacity building programmes 34 35.…”

“…However, programme discontinuity due to lack of money or inconsistent funding remains challenging,29 34 35 as insufficient funding is for effective preparedness planning and exercising 31. In relation to preparedness plans, opportunities for accessible military capacity are mentioned in two papers 38 39. Although armed forces are seen as self-sustaining and holding relevant expertise on command and control, as well as being able to rapidly deploy trained personnel,38 39 the importance to adhere to already dedicated resources of civil agencies, except under extreme scenarios, is clearly argued 39.…”

“… 38 Legal restrictions or reluctance of civil stakeholders towards civil funding of military engaged projects can also limit military involvement in global health security activities. 38 On the other hand, military financial flows provide an opportunity for bolstering civil–military capacity building programmes. 34 35 However, programme discontinuity due to lack of money or inconsistent funding remains challenging, 29 34 35 as insufficient funding is for effective preparedness planning and exercising.…”

“… 31 In relation to preparedness plans, opportunities for accessible military capacity are mentioned in two papers. 38 39 Although armed forces are seen as self-sustaining and holding relevant expertise on command and control, as well as being able to rapidly deploy trained personnel, 38 39 the importance to adhere to already dedicated resources of civil agencies, except under extreme scenarios, is clearly argued. 39 This is in line with the UN Office for the Coordination of Humanitarian Affairs (UNOCHA) policy for defence as a last resort option.…”