Battling the Bug: The Army's Response to Epidemics and Pandemics

  • October 01, 2014
  • Dr Conrad C Crane, Dr Michael E Lynch, Dr James D. Scudieri

Numerous Ebola outbreaks have devastated West African communities. Beginning in March 2014, 7,470 people contracted the virus and 3,431 died in Liberia, Sierra Leone, Guinea, Senegal, and Nigeria. The disease has since spread to the United States and Europe. In the U.S., the disease has claimed one life and two more have become infected.2 Previous Ebola epidemics occurred in West and Central Africa in 1976, 1995, 2000, and 2007. The 2014 outbreak is by far the deadliest, already approaching ten times the number of cases of the 1976 outbreak, the previous worst in history and the year of the virus’ discovery.3 The magnitude of the epidemic has caused a global crisis and evoked a powerful response from the United States Government. On September 16, speaking at the Centers for Disease Control and Prevention headquarters in Atlanta, Georgia, Pres. Barack Obama resolved to “make [Ebola] a national security priority.” The President’s strategy comprises four elements: containing the spread, countering negative economic and communal ramifications, coordinating a global response, and developing public health systems in affected countries for the future. Further, President Obama announced the establishment of a military command center and field hospitals in Liberia, a healthcare training center in Senegal, and an “airbridge” to the region for supply and personnel transfer.4 President Obama’s actions initiate a trend: military operations specifically targeting disease containment. This approach is comprehensive, but not new. Moreover, viruses such as Ebola emphasize the unpredictable nature of disease, emerging sporadically, without warning, and potentially virulently. Early planning for the aftermath of an outbreak is an essential component of containment and mitigation. The U.S. military has encountered disease on a large scale throughout its history. This latest deployment benefits from centuries of combined wisdom in disease control. From 1776 until 1918, the so-called “Disease Era” of American conflict, the microbe, rather than the enemy combatant, was the Soldier’s most lethal adversary. Indeed, all casualty counts must include a “disease and non-battle injury” (DNBI) category to include those who succumb to such maladies. Scientific and medical advancements have since learned the causes of various diseases, provided treatments, improved sanitation, and promoted hygiene. Disease rates in the military subsequently plummeted.5 Despite those successes, and the now-universal use of vaccines to protect the military and civilian workforce, their families, and retirees, disease remains a constant and growing threat. “Old” diseases thought to be eliminated, such as typhoid fever, or at least controlled, such as influenza, have returned, sometimes in new and more virulent form. Diseases such as Ebola, previously thought to be limited to developing nations, have appeared in more modern societies. “New” diseases, such as Severe Acute Respiratory Syndrome (SARS), have emerged. This survey provides three case studies from American history in which epidemic disease affected U.S. Army operations. The Yellow Fever in Havana, Cuba in the 1890s and in Panama in the early 1900s demonstrates a case in which disease eradication required multiple Army control measures. Success was critical to complete the Panama Canal. The 1918-19 Spanish influenza demonstrates a case in which pandemic swept through the Army, taking advantage of mass mobilization as it devastated civilian populations as well. Diseases as debilitants during World War II and later conflicts demonstrate scenarios in which medicine taken according to a precise regimen drastically reduced mass infection. These examples demonstrate how military forces have fought or contained disease of epidemic proportions. Although the diseases in these case studies use different vectors and vary greatly from Ebola in numerous respects, the Army’s response to them provides some similarities. The nature of Ebola, its speed of transmission, and the regions in which it is currently rampant provide the commander with significant challenges. The challenges to protect the force are much more complex under the threat of widespread infectious disease. This study offers some considerations for the commander and staff planning operations in support of mitigating the Ebola outbreak.