Epidemiologic modeling in the department of defense: capability and coordination opportunities

INTRODUCTION Epidemiological models increasingly help to guide preparation for and response to public health emergencies. For example, the Secretary’s Advisory Council on Public Health Preparedness, in the U.S. Department of Health and Human Services (HHS), formed a smallpox modeling working group in 2002 to guide national bioterrorism planning. The White House consulted modeling groups supported by the National Institutes of Health to assess pandemic mitigation strategies when the influenza A(H5N1) and influenza A(H1N1)pdm09 strains emerged. In the United Kingdom, authorities used modeling results in establishing control measures during the 2001 foot-and-mouth disease outbreak. Real-time biosurveillance systems model epidemiologic patterns to identify possible disease outbreaks. Epidemiologic models also facilitate evaluation of epidemic control measures once used, such as HIV treatment as a prevention strategy. The U.S. National Strategy for Pandemic Influenza Implementation Plan, issued in 2006, requires the HHS, in coordination with the Department of Defense (DoD) and Department of Homeland Security, to establish a “modeling center with real-time epidemic analysis capabilities” to support policyand decision-makers. This center is currently under development in the HHS Office of the Assistant Secretary for Preparedness and Response/Biomedical Advanced Research and Development Authority (ASPR/BARDA). Within the DoD, various organizations support or conduct epidemiologic modeling, and could constitute part of the interagency network centered within HHS. However, in workshops held by the Armed Forces Health Surveillance Center (AFHSC) or the DoD Global Emerging Infections Surveillance and Response System (DoD-GEIS; now part of the AFHSC) in 2005–2010, and by U.S. Northern Command (USNORTHCOM) in 2005, participants noted that the DoD lacks formal procedures for coordinating across these programs. As a result, DoD decision-makers sometimes have received conflicting results from different models or modeling efforts, with no procedures in place to reconcile conflicts or ensure transparency of methods, assumptions, and data across efforts. As a step toward improved epidemiologic modeling capabilities and coordination in the DoD, the AFHSC convened the DoD Epidemiologic Modeling Coordination Working Group (WG) in February 2013 in an effort to identify, coordinate, and assess current DoD efforts, and provide recommendations for improving them.