Prescription for Success

FORUM Staff

The unprecedented challenges posed by the coronavirus pandemic have highlighted the military medical profession’s vital role in ensuring the well-being and readiness not just of armed forces, but also of the broader society. From developing vaccines for COVID-19 to navigating global supply chain disruptions and delivering lifesaving supplies, military health practitioners and planners across the Indo-Pacific region have pivoted and partnered to prevail in a volatile public health environment.

“These are truly challenging times — the COVID-19 pandemic has spread around the globe at remarkable speed and has had a devastating impact,” Rear Adm. Pamela Miller, then Command Surgeon at United States Indo-Pacific Command (USINDOPACOM), said in her welcome message for the Indo-Pacific Military Health Exchange (IPMHE) in March 2022. “The pandemic has reshaped all of our lives and underscored the importance of partnerships, shared best practices and working together to meet the next challenge in this quickly changing world.”

The event, hosted by USINDOPACOM and India’s Armed Forces Medical Services, brought together military medicine experts from more than 30 nations in a virtual setting to review lessons learned from battling a pandemic and to delve into established and emerging topics such as trauma and field surgery, gene therapy, telemedicine, robotics, and nursing support in humanitarian assistance and disaster relief (HADR) operations. “This event is pivotal to fostering relationships and exchanging valuable talent and expertise in the medical space to benefit the entire region,” Miller told FORUM. “It also affords the opportunity for follow-on engagement regarding research, collaboration and subject matter expert exchange in the scientific or operational medicine environment.”  

Commissioned as an ensign in the U.S. Navy Reserve Nurse Corps in 1989, Miller earned bachelor’s and master’s degrees in nursing from the University of Iowa and a master’s in health care administration and doctorate in osteopathic medicine from Des Moines University, also in her home state of Iowa. She completed her transitional internship and residency in emergency medicine at Naval Medical Center San Diego, California. Miller has served as a nurse corps officer and medical corps officer, including deploying to Iraq in support of Operation Enduring Freedom, where she was officer in charge of the mobile shock trauma platoon.

Prior to her assignment as USINDOPACOM command surgeon, Miller held leadership roles including senior medical executive; force surgeon; operational medicine specialty leader; commanding officer; deputy chief of staff; reserve fleet surgeon, U.S. Fleet Forces Command; and deputy commander, Naval Medical Forces Atlantic, reserve component. She has been awarded the Legion of Merit twice, the Meritorious Service Medal four times, the Navy Achievement Medal twice and the Military Outstanding Volunteer Service Medal.

In an interview with FORUM shortly after IPMHE, Miller highlighted future areas of focus for military health systems, discussed some of the profession’s successes in combating COVID-19 and addressed the synergy in advances in the military and civilian health care arenas. “The whole-of-society approach is the most critical element to have an effective and efficient counter to any regional or global emergency, including health care-related emergencies,” she said.

The IPMHE theme was “Military Healthcare in a Volatile, Uncertain, Complex and Ambiguous World.” How is the incredible volatility of the COVID-19 pandemic shaping military health care in the Indo-Pacific region and globally? Where do you anticipate additional training, expertise, resources or focus will be needed in the coming years?

The virulence and transmissibility of the SARS-CoV-2 virus clearly demonstrated the broad spectrum of human-to-human interactions. COVID-19’s effects on military overseas base installations can be closely equated to effects on island nations, island states and island territories. The base can be secluded, and traversing can be limited and monitored, but bases do not have organic sustainment resources. Food, water and daily consumables need to be delivered or shipped in, increasing the risk of spreading COVID-19 infections. 

Additional training, expertise and resources in the health care setting will need to focus on health care workers and facilities having standard operating procedures for COVID-19 and other communicable diseases that include areas such as personal protective equipment [PPE] procedures, designating and creating isolated units, necessary equipment to limit exposure, and management of the logistics supply chain.

Biosurveillance will require proactive communication and coordination with international experts and military committees to identify and monitor key indicators in early phases of a possible communicable disease. Force health protection and biosurveillance need to be coordinated and integrated with international partners for earliest detection and warning.

The COVID-19 pandemic has seriously affected health systems across the globe. Future efforts to improve health care systems, including the military health system, should focus on: 

• Improving hospital surge capacity to handle significant increases in health care demands associated with a large-scale pandemic.
• Ensuring sufficient numbers of front-line health care personnel are available to support workers who are overtaxed by the demands of the pandemic or who become sick themselves. 
• Improving surveillance, data collection, case investigation and dissemination of information.
• Accelerating research and development of tests, vaccines and therapeutics.

How has the current public health crisis affected the interoperability of military health care among allies, partners and like-minded nations? For example, how have those partners collaborated to resolve supply chain issues relating to PPE, medications and other critical items?

Partners increased mutual awareness and understanding of communicable disease indicators and potential strategies to employ in future pandemics. Throughout the area of responsibility [AOR], countries have registered requirements as they evolved, whether it was for PPE, medications, ventilators or other items. The embassy processed the requests and — through the normal preexisting processes — the U.S. Defense Department partnered when asked to perform particular tasks or provide specific resources. Key partners throughout the AOR stood ready to support those in need, and through communication and collaboration we were able to maximize support to those in need. We all potentially have a better understanding as to how each health care system responds in a time of crisis based on the individual system nuances.

Across society, the pandemic response has highlighted challenges and opportunities. What are some of the lessons learned in the military health care arena? What do you consider to be the successes and gaps in the military response to COVID-19?

Lessons learned: 

• The ability to further define the problem set and understand the outcomes associated with adding a combination of equipment and personnel or considering either equipment or medical professionals as resourcing solutions.

Successes:

• In addition to universal lessons learned about health care systems, there are universal lessons learned about preparedness. Pandemics affect all sectors of society, and planning a country’s strategic response requires looking beyond health care to things like procurement systems, supply chains, operational support and logistics. The military has experience with these facets of preparedness and this contributed to some of the military’s successes during the pandemic. For example, the force is spread across the globe, including to austere environments. In spite of this, the [U.S.] military has been able to vaccinate 97.8% of the active-duty personnel. This represents a true success in our response to the pandemic. 

Opportunities: 

• Areas that we need to improve include the ability to merge public health data with data related to other factors that drive pandemics, including environmental and meteorological determinants. Data modernization and innovative approaches to the use of data and information, including the use of artificial intelligence, will improve our ability to manage future pandemics.

Can you tell us about the incorporation of advances in military health care into civilian health care and vice versa? In light of COVID-19, how important is a whole-of-society approach in countering regional and global public health emergencies?

The whole-of-society approach is the most critical element to have an effective and efficient counter to any regional or global emergency, including health care-related emergencies. Funding and trained manpower are always the major limitations to any response, especially if it’s a global response. An example of an advance in military health care that will reach across society is the work that the [U.S. Defense Department’s] Walter Reed Army Institute of Research (WRAIR) is doing on COVID-19 vaccines. WRAIR is developing a COVID-19 vaccine that provides an immune response to a variety of SARS-CoV-2 variants. This could prevent the need for new vaccines as new variants emerge.

A whole-of-society approach emphasizes social values and community engagement as well as trusted and transparent leadership. Only through a whole-of-society approach will we be able to ensure that the lives and livelihoods of the most vulnerable are protected.

The pandemic has demanded an immense commitment of time, energy and resources by the military health care profession for more than two years. What are some of the important developments during this same period in other areas of military health care, such as HADR?  

HADR is an area of expertise in the Department of Defense. The Center for Excellence in Disaster Management and Humanitarian Assistance is a direct reporting unit to USINDOPACOM and the principal agency to promote disaster preparedness and societal resiliency in the Indo-Pacific region. COVID escalated its opportunities to engage countries in our AOR to facilitate regional knowledge and expertise in HADR. During COVID, these programs persisted and flourished in the virtual space.

How has the COVID-19 era prepared the military health care profession to respond to the next pandemic?

COVID-19 clearly demonstrated the need for the health care community to communicate, coordinate and collaborate at all levels. This allowed for individuals, teams, organizations, institutions, governments and the military to network with each other, developing and updating concepts of operations, plans and operations. 

COVID-19 demonstrated society’s — and the military’s — reliance on goods and consumables that are integrated into critical infrastructure of supply and shipping, and the overreliance on foreign supply. COVID-19 has been immensely educational. We have learned both how to prevent and treat a completely novel virus. We have also learned how to better organize a multifaceted, whole-of-society response to threats through communication and cooperation.

What were the logistical challenges of organizing a multilateral event during a pandemic?

Organizing IPMHE was a monumental task, especially with the ever-changing dynamics of COVID-19. Initially, the event was to be in person. The conference location and lodging were determined early to ensure funding support. USINDOPACOM was sponsoring over 25 delegates from around the world to participate, and this remained in a state of flux while monitoring COVID with our partners in India. 

With the recent omicron surge, and three weeks until execution of the event, it was changed to all virtual. This required setting up virtual environments and multiple simultaneous rooms to accommodate all of the presentations and speakers. Some of the presentations needed to be prerecorded in order for the topic to be accessed by multiple users and across multiple time zones. Collecting and preparing the prerecorded presentations was an added necessity.

What did you learn at IPMHE that most excited you about developments in military health care?

Military medicine applications regarding artificial intelligence, wearables and technology that advance the ability to monitor health and enhance surveillance, as well as performance.

How valuable are events such as IPMHE in enhancing the expertise, effectiveness and interoperability of allied and partner military health care organizations in the Indo-Pacific and beyond? How do you anticipate IPMHE evolving in the coming years, given such factors as widening adoption of virtual technologies?

Multinational and multilateral large events and conferences such as IPMHE and the Military Civilian Health Security Summit build upon U.S. and foreign partnerships and relationships within the medical community to enhance each other’s capabilities to effectively and efficiently provide care not only to our military but also to all citizens.

This event is pivotal to fostering relationships and exchanging valuable talent and expertise in the medical space to benefit the entire region. It also affords the opportunity for follow-on engagement regarding research, collaboration and subject matter expert exchange in the scientific or operational medicine environment. This platform also affords the opportunity for all countries, large and small, to showcase the talent and expertise that resides in their country.  

We have proved over and over again in the past few years that these engagements can go on in the virtual space. However, the resounding feedback is that nothing can replace events for the value of personal engagement and relationship building that can only be optimized in an in-person venue.