Medical Intelligence How security & global health issues intersect

Medical intelligence is a critical capability for monitoring and assessing health risks‭, ‬operating within a framework that prioritizes military considerations‭, ‬and constituting an important element of national security‭.‬

Over the years‭, ‬the fields of medical intelligence‭, ‬security and global health have become interconnected‭, ‬with a long history of growth after infectious diseases‭, ‬vaccines‭, ‬environmental threats‭, ‬zoonotic diseases‭, ‬medicines‭, ‬and laboratories began impacting global security agendas in various ways‭. ‬Intelligence‭, ‬security and global health are distinct yet interrelated domains‭, ‬with a long history of overlapping priorities and often conflicting interests‭. ‬In recent years‭, ‬the impacts of these sectors have been particularly prominent on the international stage‭, ‬as disease and insecurity have become increasingly intertwined‭, ‬as a result of the spread of the covid-19‭ ‬pandemic and its repercussions on the world‭. ‬The role of medical intelligence in securitizing diseases and epidemics has been especially prominent‭, ‬given how the characteristics of infectious diseases can spur the spread of‭ ‬contagions affecting military operations and strategic or political interests of societies and countries‭. ‬This new idea suggests that contagious diseases can not only prolong conflicts but also accelerate them‭. ‬Additionally‭, ‬they shape policymakers‭’ ‬consideration of health as part of security agendas‭.‬

The rationale for securitizing disease has been largely based on the ability of disease outbreaks to undermine the relative power of the state‭, ‬especially during periods of conflict‭. ‬Thus policymakers have recognized the destabilizing threat posed by infectious diseases and the impact that the failure of health systems can have on peace and global stability‭. ‬This rationale adds another layer of complexity to the standard definitions of security as a form of power that largely aligns with definitions of global health‭. ‬By this definition‭, ‬practically any state of poor health could warrant securitizing disease due to its ability to weaken human capabilities‭, ‬especially given that health risks to individuals can swiftly become risks to entire populations‭. ‬However‭, ‬in practical application‭, ‬the security rationale does not focus on disease-affected communities but rather its perceived threat to the international community‭, ‬geopolitics and national security‭. ‬This is consistent with the Copenhagen school’s definition‭ ‬of security threats as the existential threat to some object such as states‭, ‬populations‭, ‬or global networks of power‭.‬

A useful term can be borrowed from the World Health Organization‭ (‬WHO‭) ‬to identify health threats that should be incorporated into the security dimension‭, ‬where a public health emergency of international concern refers to an extraordinary‭, ‬unusual or unexpected event‭, ‬with a serious and potentially international impact on public health‭. ‬This definition allows for ignoring common and expected diseases‭, ‬focusing instead on deadly diseases that can cause collective harm at the international level‭.‬

The Concept of Medical Intelligence

Medical intelligence is a type of intelligence information‭. ‬It comes from collecting‭, ‬evaluating‭, ‬analyzing‭, ‬and interpreting medical‭, ‬biological‭, ‬and external environmental data‭. ‬This information is important for strategic planning‭, ‬military medical planning‭, ‬and operations that aim to maintain the health readiness of friendly forces‭. ‬It also helps assess the medical capabilities‭ ‬of adversaries in both military and civilian sectors‭. ‬In this framework‭, ‬intelligence on diseases and epidemics constitutes a part of intelligence‭, ‬which is why the United States places its National Center for Medical Intelligence within its Defence Intelligence Agency‭. ‬Moreover‭, ‬disease surveillance activities fall strongly within the jurisdiction of military organizations‭. ‬This differs from NATO’s definition of medical intelligence‭, ‬which defines it as an intelligence rather than a medical function‭, ‬and thus can be operationalized for the benefit of national strategic interests‭. ‬This definition primarily focuses on evaluating health infrastructure‭. ‬While this is a relatively small domain within national intelligence structures‭, ‬it is nonetheless important‭ ‬for its role in global surveillance systems‭. ‬Furthermore‭, ‬this sector engages in activities directly relevant to global health‭, ‬yet maintains consistent priorities in line with strategic security interests‭.‬

This reinforces the utility of intelligence gained from studying every aspect of natural and human-made external environments that could impact the health of military forces‭. ‬It can be used not only to anticipate the medical vulnerabilities of an enemy but‭ ‬also to provide adequate medical protection to friendly forces‭. ‬Medical intelligence includes terrorist threats that have been‭ ‬applied in the civilian sectors‭, ‬as it involves information used for the identification‭, ‬characterization and management of risk‭ ‬applied to countermeasures in the civilian and military sectors against biological terrorism‭. ‬Moreover‭, ‬medical intelligence involves information related to threat detection and identification within the operational context and characteristics in the theatre of operations‭. ‬Any individual operational detail could enable the commander to successfully execute the mission‭. ‬Thus information useful for countermeasures‭, ‬threat mitigation‭, ‬and maintaining force health is classified as high intelligence priorities‭.‬

Medical intelligence typically derives information from various risk assessments‭ (‬environmental‭, ‬industrial‭, ‬health‭, ‬infectious‭ ‬diseases‭) ‬from classified and open sources‭, ‬public health centres‭, ‬medical reports‭, ‬and publications‭. ‬While it may be difficult‭ ‬to distinguish between medical information and medical intelligence‭, ‬the former tend to maintain a higher degree of certainty and be more firmly rooted in authoritative knowledge from health authorities and medical advisors‭.‬

On the other hand‭, ‬medical intelligence refers to information containing more uncertainty‭. ‬This information is more predictive in nature and is framed in the context of a specific process‭, ‬to help leaders and policymakers assess potential repercussions of‭ ‬their decisions and avoid pitfalls‭. ‬Thus medical intelligence turns into medical information when it is validated‭.‬

Wars‭ & ‬Pandemics

Pandemics have drained and destroyed armies’‭ ‬ability to fight‭, ‬halted military operations‭, ‬and brought death and disaster to civilian populations of warring and non-warring‭ ‬states‭. ‬The geographic spread of infectious diseases associated with wars throughout history raises the issue of how the distribution of diseases in epidemics has been affected by military operations‭. ‬Historically‭, ‬contagious diseases spread more during wartime and had a major impact on the course of operations‭. ‬In 430‭ ‬BC‭, ‬when battles were raging between Sparta and Athens for dominance of Greece‭, ‬Athens faced the plague in addition to Sparta‭. ‬In the late Middle Ages‭, ‬disease contributed to the fall of the‭ ‬Venetian Empire‭. ‬During Napoleon’s wars‭, ‬eight times as many people died in the British army from disease than from battle wounds‭. ‬In the American Civil War‭, ‬more than two-thirds of soldier deaths were due to pneumonia‭, ‬typhoid‭, ‬dysentery and malaria‭. ‬The‭ ‬1918-1919‭ ‬Spanish flu pandemic killed more than World War I‭, ‬with the death toll estimated at 20‭ – ‬40‭ ‬million people‭. ‬This was‭ ‬the highest recorded mortality rate for any epidemic and included 675,000‭ ‬dead American soldiers who were crowded into trenches‭ ‬to hold the Western Front‭. ‬As sick fighters returned‭, ‬the epidemic spread like wildfire in the United States and affected a quarter of the population‭. ‬On the Eastern Front‭, ‬typhus‭, ‬which was equally deadly for caregivers on the battlefield‭, ‬caused 3‭ ‬million deaths in Russia‭, ‬Poland and Romania between 1918‭ ‬and 1922‭. ‬By the end of World War II‭, ‬more soldiers had died from epidemics‭ ‬in wartime than from enemy actions‭. ‬In 2014‭, ‬medical intelligence was heavily involved in the rapidly deteriorating security and‭ ‬health situation assessments following the unprecedented Ebola outbreak in West Africa‭. ‬Thus the role of medical intelligence structures was to assess the likelihood of the virus spreading‭, ‬what that spread pattern would look like‭, ‬what strategic threats‭ ‬were associated with it‭, ‬and what the appropriate response should involve‭. ‬NATO Medical Intelligence Centre‭ (‬NMIC‭) ‬participated‭ ‬in this activity and called for the incorporation of threats from non-governmental and non-human actors into its collective defence doctrine‭, ‬specifically in response to the unfolding Ebola emergency‭. ‬This constituted an important measure because it legitimized the use of NATO’s‭ “‬collective response‭” ‬which usually starts after specific‭ “‬threats to peace‭” ‬to support NATO force interventions‭.‬

A Small Domain with a Large Impact

Government actors have increasingly embraced the concept of disease securitization‭, ‬encouraging the development and establishment of national medical intelligence bodies within military and civilian organizations‭. ‬For instance‭, ‬during the sustainable development goal-setting process‭, ‬a proposal for a goal related to global health security was put forward as follows‭: ‬“Take appropriate steps to limit the exposure of people around the world to new‭, ‬acute or rapidly spreading risks to health‭, ‬especially those that cross international borders‭.‬”‭ ‬Although this proposal was not adopted‭, ‬it highlights the growing agenda of incorporating security into modern concepts of health‭. ‬The work of medical intelligence includes epidemic diseases‭, ‬environmental health‭, ‬global health systems‭, ‬medical science and technology‭, ‬as well as health capabilities and capacities‭, ‬which are categorised into the following four key areas‭:‬

‭ ‬Environmental Health‭:‬

•‭ ‬Identifying and assessing environmental hazards that could lead to degradation of force health or effectiveness including chemical and microbial pollution of the environment‭, ‬toxic industrial‭, ‬chemical and radiological accidents‭, ‬and terrorism/environmental warfare‭.‬

•‭ ‬Assessing the impact of external environmental and public health issues and trends on environmental security and national policy‭.‬

‭ ‬Epidemiology‭:‬
•‭ ‬Identifying‭, ‬assessing‭, ‬and reporting on infectious disease risks that could lead to degradation of the deployed force mission‭ ‬effectiveness and/or cause long-term health effects‭.‬

•‭ ‬Alerting military and political leaders to disease outbreaks with national security implications‭, ‬including intentional introductions‭.‬

‭ ‬Life Sciences and Biotechnology‭:‬

•‭ ‬Assessing foreign basic and applied biomedical and biotechnology developments of military medical significance‭.‬

•‭ ‬Assessing foreign civilian and military pharmaceutical industry capabilities‭.‬

•‭ ‬Assessing external scientific and technological medical progress for defence against nuclear‭, ‬biological and chemical warfare‭.‬

•‭ ‬Enhancing awareness of foreign technology‭.‬

•‭ ‬Preventing the proliferation of dual-use equipment and knowledge‭.‬

‭ ‬Medical Capabilities‭:‬

•‭ ‬Assessing foreign military and civilian medical capabilities including treatment facilities‭, ‬medical personnel‭, ‬emergency and disaster response‭, ‬logistic services and medical/pharmaceutical industries‭.‬

•‭ ‬Maintaining an integrated‭, ‬updated database on all medical treatment‭, ‬training‭, ‬pharmaceutical‭, ‬research and production facilities‭.‬

American Medical Intelligence

The global health and medical landscape is not transparent‭. ‬Part of the mission of the United States National Center for Medical‭ ‬Intelligence is uncovering this reality‭, ‬enabling military leaders and policymakers to make fully informed decisions just like‭ ‬other analytical centres within the Defence Intelligence Agency‭.‬

The need for medical intelligence emerged in World War II when the U.S‭. ‬Army Surgeon General established a medical intelligence‭ ‬Division to support planning for military governance in new territories‭, ‬by providing detailed guidelines on civilian public health and sanitation‭.‬

Medical intelligence products were part of formal war planning with health data integrated into the Department of Defence strategic surveys‭.‬

In 1956‭ ‬the Medical Intelligence Division transformed into the U.S‭. ‬Army Medical Information and Intelligence Agency which became part of the Defence Intelligence Agency in 1962‭.‬

After the Vietnam War and through the Cold War the role of medical intelligence diminished until it resurfaced again in 1992‭ ‬as‭ ‬part of the Defence Intelligence Agency‭.‬

In 2000‭ ‬the U.S‭. ‬National Intelligence Council issued a unique report entitled‭ ‬“The Global Infectious Disease Threat and Its Implications for the United States‭,‬”‭ ‬which it quickly followed with a White House statement declaring HIV/AIDS and emerging and re-emerging infectious diseases a threat to national security‭, ‬then naming diseases like Ebola‭, ‬HIV/AIDS and multidrug-resistant TB and staph as direct threats to the United States‭. ‬On July 2‭, ‬2008‭, ‬medical intelligence became the purview of the National Center for Medical Intelligence where‭ ‬it remains until today‭, ‬providing information on foreign health threats and capabilities including infectious diseases‭, ‬CBRN threats‭, ‬health infrastructure‭, ‬health systems and sciences‭, ‬life sciences‭, ‬biotechnology and countermeasures‭. ‬This centre examines long-term threats to DoD interests as well as opportunities‭. ‬At the Center’s inauguration‭, ‬its director Michael Mapples stated‭: ‬“The National Center for Medical Intelligence is the vital link between protecting our forces and protecting the larger domestic‭ ‬health and this underscores the vital contribution medical intelligence makes to public health security‭.‬”

In April 2020‭, ‬ABC News reported in an unconfirmed report that the White House had been warned of the impending COVID-19‭ ‬outbreak in Wuhan‭, ‬China‭, ‬through a report by the National Center for Medical Intelligence‭.‬

During this pandemic‭, ‬medical intelligence helped close knowledge and policy gaps related to COVID-19‭ ‬by developing and delivering daily intelligence briefs on four main areas‭: ‬epidemiology and infectious diseases‭; ‬health care capabilities and infrastructure‭; ‬policies and regulations‭; ‬and diagnostics and therapeutics‭. ‬All of this information contributed to decision-making and domestic policy development in responding to the pandemic‭. ‬The use of medical intelligence in the strategy for responding to a future‭ ‬pandemic has proven to mitigate threats from epidemics more effectively and improve force health protection‭. ‬The United States‭ ‬places its National Center for Medical Intelligence within its Defense Intelligence Agency‭. ‬Placing disease surveillance activities strongly within the jurisdiction of military organizations‭, ‬this trend toward militarization raises questions challenging the intertwining of medical and security issues and foreign policy‭.‬

»‬‬By‭: ‬Retired Colonel Eng‭. ‬Khaled Al-Ananzah‭ ‬‭(‬Advisor and Trainer in Environmental and Occupational Safety‭)‬

Al Jundi

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