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U.S. Department of Defense
and International Public Health
LT Mazie Barcus
U.S. NAMRU 2
Jakarta, Indonesia
DoD Overseas Laboratories
OCONUS Medical Research Units
Central Coordinating Hub
WRAIR
NMRC
Egypt
Thailand
Kenya
Indonesia
Peru
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
DoD GEIS Initiatives
1. Enhance surveillance and response components
of international public health infrastructure
– Surveillance for drug-resistant malaria, antibioticresistant 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
DoD GEIS Initiatives
2. Enhance biomedical and behavioral
research efforts on emerging infectious
diseases
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Collaborate with Military Infectious Disease
Research Program
Use GEIS-generated surveillance data to
guide research efforts in areas like drug
development
DoD GEIS Initiatives
3. Expand formal training and outreach to
health care providers
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Support training of foreign scientists,
epidemiologists and technicians
Outbreak investigation courses, health care
provider courses, technology transfer
DoD GEIS Initiatives
4. 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
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Building bridges between international aid
agencies, donor agencies, foreign
governments, militaries and the UN.
GEIS at NAMRU-2
Surveillance for drug-resistant malaria
Palawan
Bitung
P. Nias
P. Gag
Armopa
Ketapang
Nabire
P. Sembilan
Timika
Maumere
Sekotong
CQRPM
CQRPF
CQRPV
PSRPF
Arso
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
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
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
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 reestablish malaria control infrastructure
– 32 year relationship with Ministry of Health partners
– Resident expertise in malaria
– Working relationships with international agencies
engaged in malaria control
Goals of the USAID/NAMRU-2
Collaboration
Capacity building along 5 tracks:
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Community Participation
Diagnosis
Treatment
Vector Control
Surveillance
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