Navy Pandemic Influenza Policy


Not so readable text below…

WASHINGTON DC 20350-2000
SEP 18 2009
From: Chief of Naval Operations
Ref: (a) CJCS Planning Order (PLANORD) of 14 Nov 05
(b) Strategic Planning Guidance (SPG) , Fiscal Years 20082013,
of 1 Mar 06 (NOTAL)
(c) CDRUSNORTHCOM Concept Plan (CONPLAN) 3551-09,
Pandemic Influenza, of 23 Mar 09 (NOTAL)
(d) National Strategy for Pandemic Influenza
Implementation Plan of May 06
(e) DoD Implementation Plan for Pandemic Influenza of
May 06
(f) CDRUSNORTHCOM CONPLAN 3591-09, Pandemic Influenza, of
13 Aug 09 (NOTAL)
(g) CDRUSNORTHCOM Global Synchronization Planning
Directive (NOTAL)
(h) CJCS PLANORD of 20 Apr 07 (NOTAL)
(i) DoD Directive 6200.3 of 12 May 03
(j) DoD Directive 6200.04 of 9 Oct 04
(k) CNO WASHINGTON DC 101814Z Nov 05
(1) CNO WASHINGTON DC 182335Z Dec 02
(m) BUMEDINST 6220.12B
(n) CNO WASHINGTON DC 141910Z Nov 05 (NOTAL)
(0) OPNAVINST F3100.6H, Chapter 4, Section I (NOTAL)
(p) SECNAVINST 3030.4B
(q) OPNAVINST 3030.5A
(r) SECNAV M-5210.1
(s) SECNAV M-5214.1
Encl: (1) List of Acronyms
1. Purpose. To issue policy, identify responsibilities, and
set forth standards for pandemic influenza (PI) planning within
the Navy.
SE? 18 2009
2. Organization of Instruction. The Navy’s PI instruction is
separated into the following six sections: purpose, situation,
mission, execution, administration and logistics, and command
and control (C2). The situation section covers the background,
higher level guidance, impact, threat, and planning assumptions
of an influenza pandemic. The mission section describes the
Navy’s primary responsibility during a pandemic. The execution
section provides a detailed list of responsibilities for Navy
component commands to meet in order to comply with the Navy’s PI
instruction. The last two sections provide detailed information
on administrative and logistics and C2 authorities during an
influenza pandemic.
3. Situation
a. General
(1) An epidemic is a widespread disease attacking or
affecting many individuals in a given community and/or
population. A pandemic is a worldwide, global outbreak of
disease (e.g., a novel influenza virus), which has the potential
to be catastrophic. In light of current concerns, the focus of
this planning effort is PI.
(2) Current models estimate that an influenza pandemic
may cause 30 to 40 percent work absenteeism and the deaths of two
hundred thousand to two million people in the United States.
(3) The 1918 PI outbreak had a detrimental effect on the
U.S. military’s ability to prosecute World War I. More troops
died as a result of the disease than died of combat-related
injuries. One of the lessons learned from the 1918 Pandemic was
that the Army Staff’s failure to act on advice from the Army
Surgeon General had devastating effects. Spread of the disease
was increased in troops due to close quarters and transit time
from Continental United States (CONUS) to the European Continent.
In the face of a future pandemic, advance planning will establish
lines of authority, support and coordination to provide for the
protection, and continuing operability of the force.
b. Higher Level Guidance
(1) Reference (a) directed combatant commanders (CCDRs)
to conduct execution-level planning for Department of Defense
(000) response to an influenza pandemic. The planning order
SEP 18 2009
directs CCDRs to address force health protection (FHP) and
defense support of civil authorities in each geographic
combatant commander’s (Gee) area of responsibility (AOR), as
well as support to humanitarian assistance/disaster relief
(HA/OR) operations to prepare and respond to the effects of an
influenza pandemic.
(2) Reference (b) directed Commander, United States
Northern Command (CDRUSNORTHCOM) and the other CCDRs to develop
individual plans to respond to an influenza pandemic. Chairman
of the Joint Chiefs of Sta~f Instruction (CJCSI) 3110.01F, Joint
Strategic Capabilities Plan Fiscal Year 2006, of 1 September
2006 (superseded by CJCSI 3110.01G) directed CDRUSNORTHCOM to
prepare a concept plan (CONPLANl to synchronize worldwide
planning to mitigate and contain the effects of an influenza
pandemic. Reference (c) directly supports references (dl and
(el for PI. It is designed to coordinate the DoD PI planning
effort and synchronize the decentralized execution of the GCCs’
theater campaign CONPLANs as the supported commanders. The
functional CCDRs, Services, and DoD Agencies are supporting
commanders or agencies. Reference (fl outlines overarching
guidance for mitigating and containing the effects of a PI.
Specific tasks, based on the task list in reference (e), are
listed in reference (g).
(3) Preparing and responding to PI will require an
active, layered defense. This active, layered defense is
global, and integrates U.S. capabilities seamlessly in the
forward regions of the world, the approaches to the U.S.
territory, and within the United States. It is a defense in
depth which includes assisting partner countries to prepare for
and detect an outbreak, respond, and manage the key second-order
effects that could lead to an array of challenges. The top
priority is the protection of DoD forces, comprised of the
military, DoD civilians, and contractors performing critical
roles, as well as the associated resources necessary to maintain
mission readiness and the ability to meet our strategic
objectives. Priority consideration is given to protect the
health of DoD beneficiaries and dependents. Reference (el
assigns tasks to primary and supporting offices within the
Department of Defense to accomplish tasks specified in reference
(dl. The Department of the Navy will incorporate references (cl
and (f) tasks appropriate to their respective geographical and
functional responsibilities in their planning efforts.
SE? 18 <009
(4) Reference (h) designated CDRUSNORTHCOM as the lead
CCDR responsible for planning and synchronizing the DoD global
response to an influenza pandemic, in conjunction with CCDRs,
Services, and DoD Agencies.
(5) United States Government (USG) stages are trigger
points that reflect geography driven triggers tied to when
potential Federal responses will take effect. These stages are
outlined in diagram 1.
(6) World Health Organization (WHO) phases reflect virus
driven trigger points. The WHO has defined six phases, before
and during an influenza pandemic, that are linked to the
characteristics of a new influenza virus and its spread through
the population. This characterization represents a useful
starting point for discussion about Federal Government actions,
and true to its international acceptance, links overseas 000
networks to partner nation understanding of the virus. These
phases are outlined in diagram I.
(7) The 000 Global CONPLAN to synchronize planning for
PI phases.
(a) Reference (c), the CCDR, Service and 000 Agency
plans will be synchronized to follow a six-phased construct.
The six phases are shape, prevent, contain, interdict,
stabilize, and recover. Each plan developed under reference (c)
construct must describe the process for enabling a transition
back and forth between phases as multiple waves occur. As
stated in the coordinating instructions of CDRUSNORTHCOM’s
CONPLAN, a CCDR must consult with the Secretary of Defense
(SecDef) prior to declaring a phase change within AOR.
(b) Diagram 1 aligns the critical elements of the
WHO and the USG (see diagram 1) to align portions of these plans
with reference (c), as appropriate. Reference (c) phases,
depicted on the left of this diagram, is the phase structure
that the Department of Defense will use in their planning
efforts. The six phases are detailed in references (c) and (f)
Since WHO phase definitions may change often, visit the
following for current WHO phases: influenza/phase/en/index.html.
SEP 18 2009
DOD Global COlfPLAH to Pederal Government Response
Synchronize Response to PI NBO Phases
(Virus Drivan)
(Geography Driven)
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D1agram 1
SEP 1B ,”{)9
c. Potential Impact of a PIon the United States Navy
(1) Overall. The potential 30 to 40 percent absenteeism
projected by current models (due to illness, caring for the
sick. or unwillingness to risk exposure) would have tremendous
impact on the Navy’s ability to execute current plans. It can
be assumed that military movements will be constrained and host
countries may limit or prevent freedom of movement or transit of
sick personnel through their country. Navy plans must focus on
remaining dominant across the full spectrum of military
operations, preserving combat capabilities in order to engage
adversaries in any theater around the world.
(2) Environment. The Navy must view PI as an
environment to operate within, vice an event or a traditional
enemy. This environment, which may last more than a year, will
have significant operational consequences. The impacts of an
influenza pandemic across the nation and the world will limit
support usually provided by the Federal Government and
Department of Defense to nations, states and communities,
especially when balanced with protection of military
capabilities through FHP.
(3) Personnel. Large portions of the overall Navy
population may contract the (influenza) virus over the lifespan
of the pandemic. Competing demands for low-density units (e.g.,
medical, mortuary) will decrease the range of options available
for support. Limited civilian and military medical care options
for military forces and their dependents (both CONUS and
(outside the Continental United States (OCONUS») will increase
the stress upon the Navy.
(4) Transportation. There will likely be a significant
reduction in transportation capacity affecting Navy
acquisition/distribution capabilities. Civil aviation support
to strategic deployment will be reduced. Interstate transport
of material and equipment to aerial ports or sea ports of
Debarkation (APOD/SPOD) and international land crossings may
decrease. Access to goods OCONUS may be reduced. Therefore,
Navy assets may be asked to offset private sector shortfalls at
ports, in transportation, or providing security. Movement
restrictions imposed by national, state or local public
health/medical personnel, or national policies, to slow the
spread of a PI may have the potential to impact operations.
SEP 1B 1009
d. Threat
(1) The primary characteristics of the threat during an
influenza pandemic are the virus’s ability to reproduce within a
host. its relatively indiscriminate attack rate, its ability to
mutate quickly, and its ability to easily transmit from humanto-
human. The high transmissibility and rapid onset of severe
morbidity can result in large numbers of people becoming sick or
absent simultaneously.
(2) Impact of the primary threat may cause political,
social, and economic instability as well as the degradation of
military readiness_ While adversarial forces will be infected,
their readiness and operational capability may not be impacted
in the same manner or at the same time as U.S. and allied
forces. The degree to which countries can mitigate morbidity
and mortality during an influenza pandemic will have a
considerable impact on military force capabilities. Countries
with more advanced and robust health care systems will be better
able to mitigate many of the PI effects.
(3) Key security concerns that would arise from the
political, social. and economic instabilities as discussed above
include opportunistic aggression, opportunities for violent
extremists to acquire weapons of mass destruction, reduced
partner capacity during and after an influenza pandemic,
instability resulting from a humanitarian disaster. and
decreased production and distribution of essential commodities.
The prevalence of an influenza pandemic coupled with political,
social, and economic instability may result in reduced security
capabilities, providing an opportunity for international
military conflict, increased terrorist activity, internal
unrest, political and/or economic collapse, humanitarian crises,
and dramatic social change.
e. Planning Assumptions
(1) Pandemics travel in waves; not all parts of the
world will be affected at the same time or affected to the same
degree (i.e., multiple waves).
(2) An influenza pandemic outbreak will last between 6
to 12 weeks in one location, with multiple PI waves following
for a period of 12 to 24 months.
SEP 18 2009
(3) A vaccine (PI specific strain) will not be available
for distribution for a minimum of 4 to 6 months after the
laboratory confirmation of sustained human-to-human PI
transmission. Foreign manufacturers are not expected to support
U.S. demand. Prioritization will be required.
(4) Developed countries will be quicker in preparing
for, detecting, and responding to outbreaks than less developed
(5) Some coalition partners, allies and host nation (HN)
governments will request military assistance and training from
the USG for PI preparedness, surveillance, detection, and
(6) International and interstate transportation will be
restricted to contain the spread of the virus.
(7) Infected people, confirmed (when possible) or
suspected, will not be transported to any facilities beyond the
affected area unless their medical condition demands movement.
(8) If an influenza pandemic starts outside the United
States, it will enter the United States at multiple locations
and spread quickly to other parts of the country.
(9) PI in the United States will result in 30 to 40
percent of the population being absent, 3 percent of those
infected being hospitalized, and a case fatality rate of 0.2 to
2.0 percent over the course of the pandemic.
(10) A layered mix of voluntary and mandatory
individual. unit, and installation-based public health measures,
such as limiting public gatherings, closing schools, social
distancing, personal hygiene measures, and masking can limit
transmission and reduce illness and death if implemented before
or at the onset of the event. Quarantine, isolation, and other
movement restrictions are essential for a successful containment
(11) State, local, and tribal jurisdictions will be
overwhelmed and unable to provide or ensure the provision of
essential commodities and services.
SEP 18 1009
(12) DoD reliance on “just-in-time” procurement will
compete adversely with u.s. and foreign civilian businesses for
availability of critical supplies.
(13) 000 Title 10 Reserve Component forces will need to
be quickly mobilized to provide surge capabilities, especially
in the areas of transportation, C2. communications, engineering,
logistics, force protection, maintenance, aviation, and
security. (See Service tasking.)
(14) The Department of State (DOS) Shelter-in-Place
policy will be followed unless other conditions (e.g., civil
disturbance or political instability) force an evacuation. If a
shelter-in-place policy is not feasible, the Department of
Defense will be called upon to assist in the transportation of
American citizens living abroad if deemed necessary.
(15) DOS will request DoD support for selective noncombatant
evacuation (NED) of designated non-infected
individuals from areas abroad experiencing outbreaks. This will
only be conducted after all other methods of extraction have
been exhausted by DOS and only when directed by Secretary of
Defense. As stated in reference (el, this will only cover areas
experiencing outbreaks (outbreaks being defined in reference (d)
as an epidemic limited to a localized area) _
(16) Department of Defense will support security and
possibly staffing of national critical infrastructure at all
levels (e.g., air traffic control, security for national
critical infrastructure, etc.).
(17) Navy can expect requests from International Agency
(IA) partners to support civilian mortuary affairs operations.
(18) Susceptibility to the PI virus will be universal.
(19) The influenza incubation period (time from exposure
to signs and symptoms of disease) is typically 2 days. Persons
who become infected may shed the virus and can transmit
infection for one-half to one day before the onset of illness.
Viral shedding and the risk of transmission will be greatest
during the first 2 days of illness.
SEP 18 2009
(20) National Guard forces, minus those subject to the
needs of national security (e.g., chemical biological
radiological nuclear and high yield explosives, Consequence
Management Response Force) units called to Title 10 status, will
remain in place to provide support to the governors of the
individual States.
(21) OCONUS operational commitments will continue at
current levels through the next several years, and troop
rotations will be impacted.
(22) There will be no increase 1n overall programmed 000
force structure.
(23) Military treatment facilities will potentially be
overwhelmed by DoD patients. dependents and beneficiaries.
necessitating outsourcing and alternate care facilities after
outsourcing. DoD treatment of military personnel and other
beneficiaries may be prioritized, with changes in priorities and
altered standards of medical care during an influenza pandemic.
(24) HN support to U.S. forces will be impacted by an
influenza pandemic at a rate proportional to the impact of an
influenza pandemic on the HN’s general population.
(25) DOS/United States Agency for International
Development will request support from Department of Defense to
provide HA/DR support to the international community.
(26) Some military movements, basing, over flight. and
support to coalition operations may be restricted by other
countries. If DOS is going to request DoD support for NEO
operations, DOS will obtain diplomatic clearances and country
access required for military support of NEO operations.
(27) A surge in private demand for consumer goods
(stockpiling) will cause DoD shortfalls.
(28) A significant reduction in civilian transportation
capacity could affect DoD acquisition and distribution.
(29) An influenza pandemic environment will minimize the
patient evacuation effectiveness of the National Disaster
SEP 18
Medical System (NDMS) due to limited movement and a wide
of pandemic impact (see annex Of appendix 2 of reference
(c) ) .
4. Mission. To protect and preserve the operational
effectiveness of our forces throughout the globe. In addition,
attempt to prevent/inhibit an overwhelming epidemic within the
Navy by providing sufficient personnel, equipment, facilities,
materials, and pharmaceuticals to care for Navy forces, civilian
personnel, dependents, and beneficiaries (including contractors
overseas) .
S. Execution
a. General. Success in an influenza pandemic environment
will depend greatly on how well the installation level PI plans
are written, exercised, and executed. Echelon II commands will
develop PI instructions that address all key tasks for each
phase defined in reference (c) and appropriate Navy component
command (NCe) PI plans. Echelon II commands will direct their
components to develop installation PI plans using appendix 32
and annex C of reference (c). Installation level plans will be
reviewed by the Navy Judge Advocate General to ensure plans
comply with annex E, appendix 4, of reference (c) and
appropriate laws.
b. SecDef Decision Support Template (DST). The DST is a
graphic record of the PI operation along the phased timeline and
is illustrated in reference (cl. The DST depicts nine key
SecDef GCCs’ strategic decision points and timelines associated
for the movement of forces, capabilities or critical supplies
and the flow of the operation, and other key items of
information required to execute a specific course of action.
The DST includes the anticipated time period and critical
information required by the Secretary of Defense in conjunction
with the execution of reference (c). Each decision and its
applicable DoD objectives, priority effects, and commanders
critical information requirements (CCIRs) are amplified and
linked in appendix 28 of reference (f) _ The DST and its
associated decision framework will assist the CCDRs and Chairman
of the Joint Chiefs of Staff to identify and analyze the
applicable decision CCIRs in order to take timely action against
the PI threat or staff the applicable decision up to the
Secretary of Defense for approval. Supporting PI plans will
need to incorporate these SecDef decisions within their decision
SEP 18 ~000
support process. The SeeDef DST and appendix 28 of reference
(f) are provided to Navy commanders for situational awareness of
the strategic level decisions that will impact CCDRs during an
influenza pandemic event and require SeeDef briefings by the
Chief of Naval Operations (eNO). As a Title X force provider,
these references will be used to develop CNO level decisions
that affect the Navy’s overall mission. It is paramount that
echelon II and III commanders understand the SeeDef DST and can
articulate events at their commands that may impact overall Navy
readiness. Key CNO decisions by phase:
(1) Phase 0 – Realign essential supplies.
(2) Phase 1 – Allocate resources for PI planning.
(3) Phase 2 – Distribute and preposition antivirals,
personal protective equipment (PPE) and medical treatment equipment
for containment.
(4) Phase 3 – Targeted release of antivirals.
(5) Phase 4 – Close entry level training facilities/
movement of Service members at their projected rotation date (PRO).
(6) Phase 5 – Re-open entry level training facilities/
movement of Service members at PRO.
c. Responsibilities
(1) Director, Operations and Plans (OPNAV (N31»
(a) Coordinate and synchronize the Navy’s PI plans
and policy.
(b) Develop and maintain service level PI
instruction and ensure it is synchronized with reference (c).
At a minimum, this plan will provide the necessary guidance to
enable the development of installation-level plans that ensure
FHP and Continuity of Operations (COOP) per references (i) and
(j) .
(c) Assist Service Components in synchronizing
support plans with CCDRs.
SEP 18 ‘r)
Cd) Coordinate with CDRUSNORTHCOM to ensure that
guidance and installation plans are developed, updated, and
synchronized with reference (e).
(e) In conjunction with Chief of Information,
communicate/disseminate common public affairs (PA), themes, and
messages consistent with Assistant Secretary of Defense (Health
Affairs), Assistant Secretary of Defense (Homeland Defense and
Americas’ Security Affairs) and Assistant Secretary of Defense
(Health Affairs) guidance, National and 000 policy and guidance.
(f) Review plans every 6 months in accordance with
reference (f), with an emphasis on refinements necessary due to
significant changes in strategy, risk and/or tolerance of risk,
assumptions, u.s. capabilities, enemy and/or adversary intent or
capabilities or resources.
(g) Provide daily situation reports as directed by
the Joint Staff.
(h) Establish reporting procedures for NCCs and
ensure Navy compliance with references (c) and (f).
(i) Identify personnel, equipment or logistical
shortfalls immediately to the Joint Staff; components should
report through their component commander.
Ijl Prioritize mission essential U.S. Forces for
(2) Commander, Navy Installations Command (CNIC)
(a) Plan, coordinate and synchronize all Navy
installation PI plans, to include the Navy extended community
(such as, civilian workforce, contractors, retirees, etc.). PI
plan execution and response will be conducted at the regional
and installation level under the operational direction of the
respective NCCs.
(b) Execute the NCC specific resource requirements
for Navy regional manning, training, and equipping requirements.
SEP 18 :J’iJ
(e) Provide training and equipping resources for
Navy regions on protective measures against the [threat viral
subtype] strain.
(d) Maintain COOP in an influenza pandemic
environment. including provisions for increased staff, emergency
training of volunteer staff, and/or second or third order
(e) Ensure installation-level plans, as a minimum,
contain the following sections: references, tasked
organizations. situation, threat, key assumptions, mission,
execution, administration, logistics, and C2, and the
appropriate annexes listed in reference (f).
(f) Ensure installation plans include potential
second and third order effects of a pandemic, incorporate FHP
measures by phase, include personal protective measures (PPM),
and are shared across Service Components, as necessary.
(9) Submit resource requirements, as directed,
within 180 days of reference (c) approval considering the
following common framework: biennial installation planning
conferences, biennial installation PI table top planning
exercises, and biennial installation coordination visits.
(h) In conjunction with the Naval Supply Systems
Command and Defense Logistics Agency (DLA), identify critical
commodities, goods or services that require priority delivery
from industry/suppliers to ensure COOP and sustainment of key
(i) Coordinate with private sector and other
government organizations to promote efforts to assure continuity
of Defense critical assets, and, thus, ensure availability of
sufficient military capability to execute the national military
strategy during an influenza pandemic.
(j) Exercise plans biennially in coordination with
the NCC to include other DoD Components and the lA, including
state, local and international organizations.
(k) Report costs during all phases of a pandemic for
the ultimate reimbursement from the primary agency.
SEP 18 “‘Ill
(1) Identify resource shortfalls as directed to
ensure execution of phases 0 and 1 and to begin preparation for
remaining phases.
(m) Develop religious support plans as specified in
appendix 6 to annex E of reference (f).
(n) Per references (k) and (1). ensure that Navy
regional commanders monitor and coordinate arrangements for
visits to the United States by foreign sovereign immune vessels
to ensure respect for the sovereign immune status of those
vessels. Official U.s. policy for foreign sovereign immune
vessels visiting the United States is to accord these vessels
the same sovereign immunity that the United States claims for
its sovereign immune vessels. This privilege includes, in
relevant part, not requiring these vessels to provide either a
crew list or any form of liberty log for those persons debarking
the sovereign immune vessel in U.s. ports.
(0) Prioritize mission essential U.s. Forces for
(3) Chief of Navy Reserve (CND (N095»
(al In conjunction with Chief of Naval Operations,
Director Augmentation (DPNAV (N313» and Assistant Secretary of
the Navy (Manpower and Reserve Affairs), establish guidelines
for the recall of Navy Reserve personnel regarding call-up of
reserves for emergency response during an influenza pandemic.
(b) Monitor Reserve Component readiness and training
policies for domestic and overseas PI preparedness.
(c) Review Reserve Component forces semi-annually to
determine which personnel would not be available for activation
given an influenza pandemic situation due to the critical nature
of their civilian occupations (first responders, health and
medical professionals, transportation industry, critical
infrastructure sustainment etc.). At a minimum, this study
should be broken out by state. category of recall and skill
sets, and specifically addresses the impact on anticipated PI
operations. Results of these analyses will be shared with Joint
Staff, Joint Forces Command and Service Headquarters (HQ).
SEP 18
(d) Prioritize mission essential U.S. Forces for
(4) Bureau of Medicine and Surgery (BUMED)
(a) Plan, coordinate, and synchronize all medical
treatment facilities (MTFs) PI plans. MTF PI plan execution and
response will be conducted at the Navy Medical Region
(NAVMEDREG) and local MTF level in support of operational
direction of the respective Nee.
(b) Direct NAVMEDREGs to be the supporting commander
to the respective Navy region and Nee for operational execution
of PI response.
(c) Develop FHP program elements consistent with the
FHP measures aligned by phase and any supplemental CCOR FHP
(d) Ensure threat medical surveillance is provided
in support of Service activities, facilities, and key
(e) Provide FHP and community mitigation guidance to
affected regions.
(f) Maintain COOP in a PI environment. Prioritize
mission essential U.S .. Forces for vaccinations.
(g) In conjunction with DLA, identify critical
medical supplies, goods or services that require priority
delivery from industry/suppliers to ensure COOP and sustainment
of key population.
(h) Exercise plans biennially In coordination with
(i) Conduct exercises and rehearsals with other DoD
Components and IA (state, local and international)
(j) Report costs during all phases for the ultimate
reimbursement from the primary agency.
SEP 18 “””.
(k) Identify resource shortfalls to Office of
Secretary of Defense, as applicable, to ensure execution of
phases 0 and 1 and to begin preparation for remaining phases.
(1) Collect data daily at each point of care.
Points of care include established MTFs, operational units with
organic medical capability, and any non-medical facility
designated or re-missioned for use as an alternate
care/treatment facility. Data collection and reporting
processes and requirements will surge during a pandemic.
Commanders must assure their access to surveillance information
and adequate staff and resources to conduct effective
(m) Coordinate health service support planning and
execution through respective surgeons general, including
appropriate Gce coordination and cross-leveling of medical
assets and capabilities.
(n) Initiate immunization of military units once a
licensed vaccine is available and supplies and distribution are
adequate. Department of Defense will direct the immunization
program via 000 issuances and its executive agent, Military
Vaccine (MILVAX) Agency. BUMED will provide service
implementation guidance in support of 000 guidance.
(0) Ensure DoD laboratories that are Laboratory
Response Network (LRN) reference laboratories will conduct rule
in/rule out testing for the pandemic virus per LRN guidance.
(p) Public health emergency officers (PHEOs) will
advise Service chiefs, surgeons general, and commanders, and
coordinate the FHP portion of PI preparation and response
efforts with GCC PHEOs.
(q) Provide Service medical assets to support PI
contingency operations as directed by the GCC.
(r) Ensure any adverse events are tracked and
reported following vaccine and/or antiviral administration in
accordance with existing policies and guidelines, including GCC
command surgeons among report addressees.
(s) Ensure all MTFs perform daily influenza like
illness surveillance and trend analysis in accordance with DoD
policy to monitor for evidence of an emerging pandemic. Ensure
appropriately trained public health or preventive medicine
professionals monitor Electronic Surveillance System for the
Early Notification of Community-based Epidemics (ESSENCE) at
each military installation. Installations without qualified
personnel to monitor ESSENCE must coordinate with a nearby
installation, regional medical HQ, or the Service-specific
surveillance hub to ensure coverage. All will report
significant medical events (disease outbreaks) to the Navy’s
Medical Event Reporting System, MERS, as directed per reference
1m) .
(t) Be prepared to establish and/or support
appropriate PI related medical operations in accordance with
Department of Health and Human Services (HHS) guidelines and
screening criteria at aeromedical evacuation hubs and
(u) Identify MTFs receiving antivirals and vaccine
by unit identification code.
(v) In accordance with service doctrine, include
medical material management and biomedical maintenance as a
Service responsibility until each GCC Single Integrated Medical
Logistics Management, SIMLM, or any successor system, is
(w) In coordination with CNIC, preposition or have
ready access to a lO-day supply of approved antivirals and other
essential medical supplies to support the key populations at
each installation. The population supported will be determined
and prioritized by the Services, Service Components, and
installation commanders.
(x) Ensure adequate supply and sourcing of materiel.
The following are recommended PPE for responding to an influenza
pandemic: face shields/protective goggles, disposable gloves
for clinical use (small. medium and large), reusable gloves for
cleaning, hair cover, high efficiency particulate air filter
respirator (N-95) for medical staff and others coming into
contact with PI patients, disposable surgical masks for
patients, disposable long-sleeved gowns, and disposable plastic
aprons. See annex Q of reference (f).
(y) Meet the respective hospital bed requirements as
computed by the Joint Medical Analysis Tool, JMAT, or estimated
based on population at risk and severity risk and projected
affected population factors.
(z) Ensure healthcare facilities are prepared for
administrative measures for the detection of PI, preventing its
spread and managing its impact on the facility and staff.
(aa) Build on the existing preparedness and response
plans for bioterrorism events, Severe Acute Respiratory
Syndrome, and other infectious disease emergencies.
(ab) Incorporate planning suggestions from state,
local, and HN health departments, and other local and regional
healthcare facilities and response partners.
(ac) Measure compliance with response procedures
(e.g., infection control practices, case reporting, patient
placement and healthcare worker illness surveillance) .
(ad) Review and update inventories of supplies that
will be in high demand during an influenza pandemic.
(ae) Review procedures for the receipt, storage, and
distribution of assets received from federal stockpiles.
(af) Include mechanisms for periodic reviews and
(ag) To the extent feasible, ensure medical
evaluation for patients suspected of having PI will include
routine evaluation to determine influenza type (i.e., type A or
not type A) and applicable laboratory and radiological
evaluation as required.
(ah) Ensure occupational environmental health survey
assessments are conducted as appropriate.
SEP 18
(ail Ensure Service activities are coordinated
through Armed Forces Health Surveillance Center.
(aj) Ensure PHEOs, while under SUMED operational
control, forward health surveillance data to Armed Forces Health
Surveillance Center.
(ak) Develop guidance for allocating scarce medical
resources during mass casualty events.
(all Establish medical C2 architecture.
(am) Identify and coordinate medical credentialing
requirements as required.
(an) Support HHS in the global effort by, among
ether things, conducting medical and laboratory surveillance and
diagnostic testing through DoD members of the LRN, and by
participating in the Food and Drug Administration Vaccines and
Related Biologic Products Advisory Committee and the Center for
Disease Control Advisory Committee on Immunization Practices as
influenza vaccine recommendations are formulated.
(ao) Ensure awareness of bed capacity across
respective AORs. Obtain surge capacity data with NOMS partners,
as applicable, on a recurring basis, while also pursuing ways to
incorporate community/HN efforts that are not included in this
(ap) Coordinate with United States Fleet Forces
Command (USFFC), Pacific Fleet Command (PACFLT), United States
Transportation Command (USTRANSCOM), and NOMS service
coordinators, as applicable, in patient movement planning
(aq) In coordination with CNIC, USFFC and PACFLT,
incorporate exercises and training to evaluate FHP measures for
completeness and to determine/evaluation of gaps (i.e.,
determine need for altered FHP requirements and potential
disconnects) within and among 000, USG, and other governmental
and non-governmental organizations.
(ar) Review and evaluate existing MTF PI plans,
guidance, and programs to include PPM, identification of PPE
0′ 18
requirements, targeted layered containment, and community
mitigation strategies. Provide guidance to MTFs on modifying
standards of care to respond to possibility that system may be
(as) In coordination with CNIC, prepare to provide
mass immunization and care.
(at) In coordination with CNIC, USFFC, and PACFLT
recommend screening, isolation, and quarantine strategy options
for personnel leaving affected regions.
(au) In coordination with National Center for
Medical Intelligence (NCMI), employ exposure surveillance to
conduct retrospective analysis in order to improve the FHP of
future operations, prepare/protect potentially non-impacted
areas, and support follow-up medical care to previously deployed
(av) Be prepared to quickly augment clinical staff
of MTFs overwhelmed with influenza patients.
(aw) Ensure that public health and disease outbreak
emergency response policies, plans, procedures, and guidelines
are supported by sufficient C2 capabilities and other equipment
to respond properly to disasters, public health emergencies, and
disease outbreaks.
(ax) Maintain continuity of care operations in an
influenza pandemic environment including provisions for
increased staff, emergency training of volunteer staff, and/or
second or third order effects_
(ay) Provide training and equipping resources for
Navy medicine regions on protective measures against the [threat
viral subtype] strain.
(az) Develop religious support plans as specified 1n
appendix 6 to annex E of reference (f).
vti 18 j
(5) NCCs
(a) Develop FHP program elements consistent with the
FHP measures aligned by phase and any supplemental CCDR FHP
(b) Maintain COOP 1n a PI environment.
(c) Re-deploy and reconstitute the PI response
forces between PI waves.
(d) In conjunction with DLA, identify critical
supplies, goods or services that require priority delivery from
industry/suppliers to ensure COOP and sustainment of key
(e) Exercise plans biennially in coordination with
appropriate CCDR.
(f) Conduct exercises and rehearsals with other DoD
Components and the lA, including state, local, and international
(g) Capture costs during all phases for the ultimate
reimbursement from the primary agency.
(h) Identify resource shortfalls to Chief of Naval
Operations, Director Antiterrorism/Force Protection (OPNAV
(N314», as applicable, to ensure execution of phases 0 and 1
and to begin preparation for remaining phases. Keep USFFC and
PACFLT informed.
(i) Properly position forces with the required
numbers, skills, and materiel support to respond and meet the
projection of forces in the changing PI environment.
(j) Develop and evaluate existing PI plans,
guidance, and programs to include PPM, identification of PPE
requirements, targeted layered containment, and community
mitigation strategies.
(k) Ensure that public health and disease outbreak
emergency response policies, plans, procedures, and guidelines
are supported by sufficient C2 capabilities and other equipment
to respond properly to disasters, public health emergencies, and
disease outbreaks.
(1) Develop religious support plans as specified in
appendix 6 to annex E of reference (f).
(m) Ensure compliance with u.s. sovereign immunity
and related policies regarding provision of crew lists and other
information of military and non-military personnel on board u.s.
sovereign immune vessels to foreign governments as outlined in
references (k), (l) and (nl. Early engagement with the u.s.
embassy country team for the HN is essential to resolving
potential difficulties in a timely manner.
(n) Prioritize mission essential U.s. Forces for
(6) Naval Facilities Engineering Command
(a) Maintain COOP in a PI environment.
(b) In coordination with CNIC and BOMED, maintain
essential utilities and facility services, and provide
contingency engineering support as tasked
(c) Prioritize mission essential U.S. Forces for
(7) Naval Supply Systems Command
(a) Maintain COOP in a PI environment.
(b) In coordination with CNIC and DLA, and within
the confines of existing policy and law, develop and execute
region sustainment plans with the installations to begin
identifying sufficient quantities of critical PPE to ensure
mission assurance during a PI response. These plans should
include the purchase, storage, management, and distribution of
identified PPE.
(c) Prioritize mission essential u.S. Forces for
(8) Defense Intelligence Agency/NCMI
(al Maintain COOP in a PI environment.
(bl Per reference (fl, provide intelligence
information on the OCONUS spread of PI and the latest
information on the nature of the threat, current mutative state,
personnel, and casualty information.
(c) Prioritize mission essential u.s. Forces for
6. Administration and Logistics
a. Concept of LogistlCS Support for PI operations, to
include deployment, sustainment, and combat service support
(CSS) efforts, will be flexible and tailored to support the
mission requirements.
b. LoglStics. The CCDR’s NCCs are responsible for
administrative, logistical, medical, and communication support
for forces employed in PI operations. Component commanders will
comply with respective Service instructions, existing plans,
agreements, and legal authorities. DLA, Defense Contract
Management Agency, USTRANSCOM, and other government/Defense
Agencies will continue to provide the logistics backbone in the
Joint operating agreements to include: supply, maintenance,
transportation, civil engineering, health services and other CSS
to DoD forces. Efforts must be directed at leveraging the
existing infrastructure, contracts, and support relationships
with civilian services through innovative information
coordination and management, business practices, contracting,
and operating procedures. A coordinated effort to match
prioritization of effort and resources with each operational
phase is essential to the success of providing PI support.
(1) Civil Engineering. See annex D of reference (fl
(2) Environmental Considerations. Significant
environmental actions are not expected in support of 000 PI
operations. Commanders are responsible to employ environmental
practices that minimize adverse impacts to human health and the
environment as follows. All DoD forces employed in PI operation
will be briefed on their responsibilities for protection of our
environment. During all phases of operations, strategies will
be developed to avoid, reduce or eliminate negative impacts on
the environment. Emergency exemptions may be needed for
disposal of contaminated and hazardous material.
(3) Environmental Responsibilities. Department of
Defense will be in support of a primary agency. Environmental
responsibilities remain with the primary agency. However, this
does not release Department of Defense from responsibility to
plan and conduct operations in a manner responsive to
environmental considerations. Timely response in crisis
circumstances may make it necessary to take immediate action
without preparing the normal environmental planning documents.
Close coordination with local, state, federal agencies, and HNs
during operations is needed to avoid negative environmental
consequences. DoD’s goal is compliance with all applicable
(4) Environmental Conditions and Transfer to Civil
Authorities_ Documenting conditions and actions as soon as
possible before, during, and after operations will facilitate
resolution and closure of environmental issues_ An active
environmental review of 000 operations should be accomplished to
identify possible environmental issues before a negative impact
occurs. Environmental impacts will be addressed as soon as
possible once operations have stabilized. 000 forces should
direct efforts to properly identify, contain, document, and
transfer environmental issues to civil authorities as soon as
(5) Personnel. Upon SecDef direction, Commander, United
States Joint Forces Command will source Joint Staff validated
requirements and notify the CCDRs of augmentee information and
arrival dates. The designated C2 HQ will be responsible for
coordinating the Joint Reception Center, maintaining
accountability of deployed 000 personnel, and reporting
personnel information.
(6) PA. Proactive communication efforts are essential
prior to and during a pandemic. Early dissemination of
information and aggressive PA (educational) programs support the
USG’s effort to prevent/inhibit or mitigate the spread of the
virus, and instill confidence in the key population. Successful
communications will lead to reduced fear and panic at the onset
of a pandemic. It is imperative that Navy speak with one voice
and ensure the themes and messages from HHS are nested in
subordinate plans. The Office of the Assistant Secretary of
Defense (Health Affairs) is overall responsible for coordinating
the 000 PA response by providing PA’s guidance to CCDRs.
Services, and DoD Agencies. Delegation of release authority to
the CCDR, Services, and 000 Agency PA office and, in turn, the
appropriate C2 HQ, is allowed in support of this plan.
Installation level plans should utilize annex F of reference (f)
for specific guidance.
(7) Medical Services. During PI operations, maintenance
of the medical and public health infrastructure will be a
significant challenge. Department of Defense has a critical
role at the national level in fUlfilling its National Response
Plan responsibilities and an equally critical role at the
installation level. Commanders, working through their
respective PHEOs, should consider using the full spectrum of
their resources to assist local governments in providing
essential services to their citizens. DoD medical capabilities
should be requested if it is determined necessary to augment or
sustain the local response in order to save lives and minimize
human suffering. The time sensitive nature of the requirements
necessitates early and rapid IA coordination to be effective.
Restrictions on the use of military medical stockpiles and
provisions of direct military care to civilians by military
personnel may need to be addressed in mission planning.
7. Command and Control. Per the CJCSI 3110.01F (superseded by
CJCSI 3110.01G), CDRUSNORTHCOM is the lead CCDR for planning and
synchronizing reference (c), until directed otherwise. GCCs
will have command for execution within respective AORs.
a. Command Relationships
(l) CDRUSNORTHCOM is the supported commander for the
synchronization of Global PI planning. CCDRs, Services, and
Defense Agencies are supporting commands/departments/agencies
for coordination and synchronization of Global PI planning.
(2) GCCs are the supported commanders within their
respective AORs. All other component commanders are supporting
commanders for PI response operations.
o 3
(3) The Department of the Navy is a supporting
organization, and its PI plans will conform to Gee plans in case
of conflict.
(4) OPNAV (N31) will coordinate and synchronize the
Navy’s PI plans and policy.
(5) All NCCs supporting Gees are responsible for PI
planning and execution in their Gee’s AOR. NCCs are responsible
to inform USFFC and PACFLT on all man, train. and equip issues.
All echelon II commanders are supporting commanders to their
respective Nee wherein located for pandemic influenza planning
and execution.
(6) USFFC and PACFLT retain responsibility to train and
equip the force on protective measures against virus strains.
USFFC is the supported commander, and PACFLT is the supporting
commander for all units administrative control to PACFLT
operating in the CDRUSNORTHCOM AOR, with respect to addressing
training and equipping shortfalls. PACFLT will keep USFFC
informed of uncorrected deficiencies.
b. Reporting Reguirements
(1) All Navy echelon II commands will report outbreaks
of PI per reference (0), including BUMED and the Navy and Marine
Corps Public Health Center (NMCPHC).
(2) CCDR’s reporting guidance will apply within
respective AORs.
(3) Deputy Chief of Naval Operations, Operations, Plans
and Strategy (CNO (N3/N5) guidelines on classification
pertaining to operational readiness information will not change
due to the onset of an influenza pandemic.
(4) Echelon II commanders shall utilize annex K of
reference (f) to ensure an effective communication strategy has
been developed and is ready to be exercised during a PI event.
(5) Submit Operational Report (OPREP) 3 Navy Blue to
chain of command, to include Office of the Chief of Naval
Operations (OPNAV), USFFC, PACFLT, BUMED, and NMCPHC, if an
outbreak will significantly impact the command’s operational
ability to perform its mission. Commanders will report
degradations in unit operational readiness and adverse impacts
to mission accomplishment caused by a PI outbreak via the
Defense Reporting Requirement System (DRRS)/Status of Resources
and Training System (SORTS).
Note: It is not required nor desired that commanders report
each case of suspected or confirmed viral strain infection via
situational report/OPREP.
(6) Medical reporting:
(a) The NMCPHC at Portsmouth, Virginia, will be the
central point of contact for receipt on pandemic pathogen data
from ships, shore installations and deployable units. NMCPHC
will also provide regular reports, as required, on Navy-wide
pandemic pathogen status to OPNAV via electronic mail (e-mail)
to the CNO battle watch. All units with non-secure Internet
protocol router (NIPRNET) access will be required to use the
Navy Disease Reporting System Internet (NDRSI) for reporting
influenza and other notifiable diseases. NDRSI is a Web-based
reporting system and commands will be required to obtain an
account at: medicine/reportingtools.aspx.
(b) For further information on NDRSI, contact the
NDRSI helpdesk via e-mail at or by
calling 757-953-0954. Units without NIPRNET access may report
using alternate methods or tools as described in reference (e)
The return to routine disease reporting does not alter the
continuing requirement for submission of weekly disease nonbattle
injury data. All lab confirmed cases must also be
reported by medical event reports to NMCPHC. Submit other
reports in accordance with immediate superior in command
(1) In accordance with references (p) and (q), all
Secretary of the Navy offices and OPNAV echelon I and echelon II
organizations are required to have a COOP program and supporting
plan. Continuity planning facilitates the performance of
mission essential functions (MEFs) during all-hazards
emergencies or other situations that may disrupt normal
operations. Traditional COOP planning efforts focuses on a
component’s ability to accomplish their MEFs while deferring
remaining functions for up to 30 days.
(2) During COOP execution, key personnel are relocated
away from the impacted area to an emergency relocation site in
order to continue the component’s MEFs utilizing either prepositioned
records or remote access capabilities to vital
systems. PI presents a different environment in which Navy
components may be forced to operate. The traditional concept of
COOP, relocating to a readied alternate site, may no longer be a
viable option. In addition, the estimated duration of the
pandemic dictates that Navy components will be required to
perform more than just MEFs during this period. Previously
deferred functions may have to be prioritized and performed by
significantly diminished staffs. Existing COOP programs have to
be expanded to incorporate this prioritization of effort, hence
changing work procedures in a PI environment. Approaches such
as alternate work schedules and alternate locations, tele-work,
cross training of employees. job sharing, social distancing, and
devolution will all need to be considered and adopted as
appropriate to the component’s situation and functional
(3) In anticipation of a potential occurrence of a PI
outbreak, components should review and modify current cooP plans
to ensure their ability to continue operations during a PI event
is not compromised.
(4) Due to the unique USFFC responsibilities delineated
1n SECNAVINST S3030.5, DON HQ Continuity of operations Plan,
USFFC should be copied on all PI reports made to the CNO.
8. Records Management.
regardless of media and
with reference (r).
Records created by this instruction,
format, must be managed in accordance
9. Reports. Reporting requirements with1n this instruction are
exempt from report control symbols per refere,:n~c~-4~’)
dmiral. U.S. Navy
Director, Navy Staff
Electronic only, via Department of the Navy Issuances Web site
Area of Responsibility
Aerial Ports of Debarkation
Bureau of Medicine and Surgery
Command and Control
Combatant Commander
Commanders Critical Information Requirement
Commander, United States Northern Command
Chairman, Joint Chiefs of Staff Instruction
Chief of Naval Operations
Commander, Naval Installations Command
Concept Plan
Continental United States
Continuity of Operations
Combat Service Support
Defense Logistics Agency
Department of Defense
Department of State
Disaster Relief
Defense Reporting Requirement System
Decision Support Template
Early Notification Community-based Epidemics
Force Health Protection
Geographic Combatant Command
Humanitarian Assistance
Department of Health and Human Services
Host Nation
Joint Medical Analysis Tool
International Agency
Laboratory Response Network
Mission Essential Function
Military Vaccine
Medical Event Reporting System
Medical Treatment Facility
Navy Medical Region
Navy Component Commander
National Center for Medical Intelligence
National Disaster Medical System
Non-Combatant Evacuation
Non-Secure Internet Protocol Router
Enclosure (1)
Navy and Marine Corps Public Health Center
Navy Operations Center
Navy Disease Reporting System Internet
Outside the Continental United States
Office of the Chief of Naval Operations
Operational Report
Public Affairs
Pacific Fleet Command
Public Health Emergency Officer
Pandemic Influenza
Personal Protective Equipment
Personal Protective Measure
Projected Rotation Date
Secretary of Defense
Single Integrated Medical Logistics Management
Status of Resources and Training System
Sea Ports of Debarkation
United States Fleet Forces Command
United States Government
United States Transportation Command
World Health Organization
2 Enclosure (1)

About the author


Jeffry John Aufderheide is the father of a child injured as a result of vaccination. As editor of the website he promotes well-educated pediatricians, informed consent, and full disclosure and accountability of adverse reactions to vaccines.