Interview: Martin Bricknell

The NATO response to the COVID-19 pandemic – Interview with Brigadier General Dr. Dirk-Friedrich Klagges

This is one of a series of interviews conducted by the Editor-in-Chief with key medical leaders within the NATO health system to record their experiences and insights from the COVID-19 crisis.

Date: 22/09/2021

Interviewer: Lt Gen (Rtd) Prof. Martin Bricknell, Editor-in-Chief, military-medicine.com

Interviewee: Brigadier General Dr. Dirk-Friedrich Klagges, Director NATO Centre of Excellence for Military Medicine

Bricknell, Martin:

What is your current role? Photo

Dr. Dirk-Friedrich KLAGGES: 

I am the Director of the NATO Centre of Excellence for Military Medicine (MILMED COE). The MILMED COE assists the NATO Alliance in its goal of continuous transformation in the medical field by providing subject matter expertise for the planning, execution, training, and transformation of the multinational military medical support functions.  We are also an institution of higher learning, providing education to develop knowledge and enhance the quality of medical support to operations. Like all NATO Centres of Excellence, we assist in doctrine development, the identification of Lessons Learned, improving interoperability and capability, and the validation of concepts through experimentation.    

Bricknell, Martin: 

Thank you and what's been your involvement in the military response to the COVID pandemic and how have you supported NATO?

Dr. Dirk-Friedrich KLAGGES: 

Although the MILMED COE does not have a specific role in  pandemic response, we supported many NATO activities. Our Force Health Protection Branch is infectious disease and biodefense focused.   The same skillsets and knowledge needed in dealing with a biodefense threat were of great use in addressing this natural global health emergency.  The branch staff collected and processed large amounts of information and data on the evolving global crisis, which was consolidated and distributed within NATO and to national representatives, to ensure that clinicians and decision-makers had the most up-to-date information on the virus, therapeutics, and public health measures being undertaken around the world to counter the threat.  To facilitate information sharing within NATO, weekly video teleconferences were organized involving scientists, public health and medical specialists, and policy makers. In addition, the Force Health Protection Branch identified a critical capability gap – the lack of a real-time disease surveillance tool to enable the early detection of disease outbreaks among deployed forces.  While there are plans to incorporate such a tool into a future NATO medical information management system, such a system is years away from being fielded.  The branch developed, within months, a functional system that could be utilized now.  Experience gained in developing this interim tool will be of value in the development of the future NATO disease surveillance system.
The COVID-19 pandemic provided a unique opportunity for our Lessons Learned and Innovation Branch to collect observations and develop lessons in pandemic response.  At the request of the Committee of the Chiefs of Military Medical Services (COMEDS), the branch staff assisted in the development of a national survey that was used to identify gaps in response to the first wave of the pandemic. The responses to the survey and COVID-19 observations collected were used to generate a report to NATO and the nations of recommendations for dealing with the second wave of the pandemic. Observations collected were also utilized to develop a set of pandemic-related Lessons Identified and associated recommendations for improving NATO pandemic preparedness.  On the innovation side, information on new technologies and novel approaches to pandemic management were shared on our newly established “Innovation Portal” and through an innovation newsletter. 

In-person courses could not be conducted during the pandemic.  The Training Branch focused its efforts on transitioning the MILMED COE to an e-learning institution.  Online education offers a more resilient way of delivering the specialized medical training that the centre provides and, at the same time, has the potential to expand our training audience.  Utilizing an online format for courses has also opened the possibility of collaborating with other institutions in delivering courses.  In the end, we think that this approach will not only expand our training audience but will be more effective and more cost-effective.

Bricknell, Martin: 

What have you seen as the contribution that military medical services have made towards the response to the pandemic?

Dr. Dirk-Friedrich KLAGGES: 

In March 2021, the MILMED COE held a meeting that was focused on pandemic response.  Representatives from across NATO discussed national responses to the pandemic, including utilization of military medical services.  The support provided varied considerably by nation and was wide-ranging.  It included augmentation of civilian medical treatment facilities and assisting living facilities, contact tracking, patient movement, vaccine administration, and the establishment of field medical facilities.  In a number of instances, external support was provided to countries with high case numbers.  Coordination of logistics for medical supply  was also very important, as was support for testing. Additionally, support that military medical services provided early in the vaccination campaign was critical to rapidly achieving high vaccination levels among the most vulnerable.   

Bricknell, Martin: 

What do you think are the lessons from the pandemic for national military medical services?  

Dr. Dirk-Friedrich KLAGGES:

Among the main lessons from the pandemic is the importance of basic public health and hygiene measures in controlling spread of infectious diseases.  To this point in the pandemic, the success or failure of military forces and nations in managing the pandemic has largely been determined by the public health guidance issued and the degree to which adherence to those measures has been achieved.  While diagnostic testing tools, therapeutics, and vaccines take time to develop, measures to reduce transmission can and must be effectively implemented at the onset of an outbreak.  For respiratory viruses, this includes the use of masks.

Several other key lessons fall in the logistics realm.  Early in the pandemic personal protective equipment (PPE) and medical supply requirements could not be met due to increased consumption and disruption of the global supply system.  A dependence on “just in time delivery” of items critical for containment of an outbreak created vulnerability.  It is now clear that military hospitals and deployed forces must have on hand enough PPE and other medical supplies for initial management of an infectious disease outbreak, be it natural or human engineered.  Further, stockpiles of supplies must be maintained to enable resupply until production can be expanded.  Maintaining a geographically diverse and geopolitically reliable supply network, including local sources of supply, when possible, would further mitigate risk, as would having contracts in place to ensure the ability to rapidly expand production of critical pandemic and wartime consumable medical supplies. 

There are additional lessons to be learned regarding the design and preparedness of Military Medical Facilities to deliver care during an infectious disease outbreak.   In an outbreak, not only does the capacity for care delivery need to expand, there is also a need to maintain separation of patients based on their infection status.  The design of existing field and fixed military Medical Treatment Facilities greatly limits the extent to which expansion can occur and the degree to which patient separation can be maintained.  The likelihood of future pandemics and outbreaks  needs to be taken into consideration in the design of future medical facilities.  For facilities that already exist, a plan needs to be developed, maintained, and exercised for how care would be delivered under pandemic conditions.   

The final lesson identified that I want to highlight is the importance of civilian and military cooperation in pandemic response.  The tremendous resources and capabilities of military services, including medical capabilities, were leveraged heavily in national responses to the pandemic.  The range of medical support provided varied tremendously from nation to nation, as was highlighted in your analysis of national responses to the COVID-19 pandemic.  Military services need to recognize that they will be called upon to provide a broad range of support in future public health and other emergencies and must be prepared.  Similarly, civilian hospitals and other critical civilian services must recognize the important role that they may be called upon to perform in times of conflict and other future crises.  The development of scenario-based contingency plans and the exercising of those plans is needed to achieve and maintain readiness.  

Bricknell, Martin: 

So, what do you think of the lessons from the pandemic for international military alliances?

Dr. Dirk-Friedrich KLAGGES:

For international military alliances, I think there is a simple lesson: infectious diseases don't know any border.  It also highlighted the fact that infectious diseases pose a substantial threat, not only to public health and economies but to military operational readiness.  To maintain operational readiness, military alliances need to be prepared to defend against infectious disease threats, both natural and human engineered.

While the response to disasters may be viewed as a national responsibility, it is in the interest of alliances to develop mechanisms for increasing collective readiness and for providing reinforcing support when and where it is needed.  Such measures would, at the same time, increase the Alliance’s ability to operate during times of armed conflict, which could involve large numbers of infectious disease casualties. 

Measures that could be taken by military alliances to increase resilience against infectious disease threats would include: 

  • Developing plans for transitioning quickly to maximal remote work 
  • Maintaining stockpiles of consumable medical supplies 
  • Having contracts in place to ensure the ability to rapidly expand production of critical pandemic and wartime consumable medical supplies 
  • Creating rapidly deployable outbreak investigation teams 
  • Establishing a body of infectious disease and public health subject matter experts to identify emerging infectious disease threats and for consultation 
  • Maintaining an organic mass testing capability for screening of deploying and returning service members and for surveillance testing
  • Ensuring that a deployable testing capability exists to supports missions 
  • Developing a near real-time disease surveillance system for early identification of a disease outbreak among deployed forces

Bricknell, Martin:

Are there any risks to military medical services arising from the pandemic?

Dr. Dirk-Friedrich KLAGGES:

As I mentioned previously, military medical services were heavily utilized in national pandemic response.   Military medical services are resourced to meet the readiness and operational needs of the military services that they support.  Utilization of service medical capabilities and personnel in support of national needs could leave the military health services support mission under-resourced.  At the same time, reliance on military medical services to support national emergency response creates vulnerability.  War and infectious disease threats can occur simultaneously, as was the case during the 1918 influenza pandemic.  An assumption that military medical resources will be available to support the response to the next pandemic, as they were during this pandemic, may prove to be a costly false assumption.  

The next pandemic could be one that is human engineered, unleashed to provide a military advantage or cause social disruption.  It is incumbent upon military medical services to be prepared to respond to this very real threat.  This requires not only that we be able to deliver care in such a threat environment but that we have the expertise, training, resources, and capabilities needed to meet the associated health services needs of the military forces that we support.  The pandemic has highlighted an area of vulnerability.  A future adversary may take advantage of that vulnerability if it persists. 

Bricknell, Martin:

The final question is, do you think there are any specific implications from the pandemic for the COMEDS community?

Dr. Dirk-Friedrich KLAGGES:

An honest assessment of the early months of the pandemic response would conclude that, without exception, the nations of the world and their military medical services were not adequately prepared.  The events of the past two years should serve as a warning of what we can expect in the future.  The growth of the world population, deforestation,  and global travel make future pandemics inevitable and of increasing frequency.  And the next pandemic agent may be much more lethal. Military medical services must be prepared - not only to manage natural disease threats but to support military forces that are the targets of biological as well as conventional weapons.    It is imperative that we learn the lessons of this current pandemic and be prepared to apply them without warning.



Date: 01/04/2022

Source: Martin Bricknell