The GEIS program’s funded activities are organized into 3 focus areas: antimicrobial-resistant infections, febrile and vectorborne infections, and respiratory infections. All GEIS-funded surveillance activities across those focus areas center strictly around infectious diseases that are relevant to force health protection (i.e., relevant to military health in support of operational readiness). The antimicrobial resistant infections focus area surveils for multidrug-resistant organisms detected in nosocomial infections, community-acquired infections, and wound and trauma settings; sexually transmitted infections; and enteric infections. The febrile and vectorborne infections focus area provides surveillance and support for causes of undifferentiated acute febrile illness; vectorborne and zoonotic pathogens, vectors, and reservoir hosts of relevant infections; insecticide resistance; and the effectiveness of malaria countermeasures (e.g., antimalarials, rapid diagnostic tests). The respiratory infections focus area surveils for known and unknown respiratory pathogens and supports studies of vaccine effectiveness and potential shift and drift within influenza subtypes that might be associated with increased severity and transmission of respiratory infections.

Figure

Figure. Interconnectivity of laboratories across the GEIS Program network. 18 OMRS, 18 Operational Medical Readiness Squadron (Okinawa, Japan); BDAACH, Brian D. Allgood Army Community Hospital (Pyeongtaek, South Korea); DCPH-A, Defense Center for Public Health—Aberdeen...

The DoD overseas laboratories, many of which have been in existence for decades, maintain critical, long-standing relationships with allied militaries and partner nations, enabling collaborative detection and reporting of known, novel, and emerging infectious disease threats and bidirectional information exchange. To complement capabilities of the overseas laboratories, the GEIS program funds US-based reach-back laboratories for next-generation sequencing, bioinformatics, external quality assurance, species confirmation, and other supporting functions. The network connections among the US-based DoD laboratories, the overseas laboratories, and other partners contribute to the global footprint of the GEIS program (Figure) and ensure that the DoD can quickly detect, understand, and respond to emerging threats as they arise anywhere around the world where service members might be located. The geographic reach of the GEIS program enables an adaptable response to evolving threats wherever they may emerge worldwide, provides a robust source of biosurveillance data and information, and leads to more relevant insights for decision-makers, better protecting the health and readiness of our armed forces.

The GEIS program has formed and maintained flexible and scalable capabilities (e.g., personnel, equipment, and the supplies and reagents needed for sample collection and basic pathogen identification) for pandemic preparedness and response with guidance and coordination through its role as a central hub. An example of this centralized network coordination is GEIS’ Next Generation Sequencing and Bioinformatics Consortium (12), which is composed of subject matter experts from DoD laboratories around the world working to promote standardization and best practices, ultimately increasing the quality and utility of microbial genomic surveillance data. This high-quality and timely genomic surveillance data enables earlier detection and more rapid communication of novel and emerging infectious disease threats, enabling earlier interventions to support force health protection.

The long-standing regional partnerships between DoD laboratories and host-nation collaborators, combined with decades-long investment from the GEIS program, have advanced health diplomacy and global health security. Support from the GEIS program enables the surveillance of high-consequence pathogens and the collection of associated data, which are shared with local countries for public health decision-making. The partnerships between GEIS-supported DoD laboratories and local militaries and Ministries of Defense are also a unique tool for maintaining strong alliances with partner nations and strengthening global health security. Local surveillance capabilities and laboratory expertise have been built and sustained through GEIS-funded activities that are conducted by host-nation scientists and professionals in the partner countries where surveillance is conducted. This ensures expertise and infrastructure exist so that resources are in place to respond rapidly when an emerging threat is detected.

Data and downstream products routinely generated by the GEIS program are distributed to a multidisciplinary audience of decision-makers, clinicians, infection control preventionists, veterinarians, and other public health authorities. GEIS staff and subject matter experts ensure that data generated from surveillance activities are contextualized and capable of contributing to harmonized, military-relevant guidance. The infectious disease surveillance activities and subsequent reports and informational products result in data and information used to inform routine surveillance, countermeasure development, infection-control practices, force health protection posture, public health policy, outbreak detection and investigation, clinical practice guidelines, and more (Table).

As part of its coordinating role, the GEIS program also shares surveillance data generated from funded projects to inform DoD’s medical research and development pipeline (e.g., therapeutics, vaccines, diagnostics, etc.). Although the GEIS program does not provide funding for conducting research for countermeasure development or testing and evaluating diagnostics, it does maintain active surveillance sites and laboratory testing capabilities through funding to DoD overseas laboratories and other DoD sites. Those sites generate data and pathogen isolates that are stored in repositories that can later be used to evaluate medical countermeasures and diagnostics. The GEIS program also coordinates closely with the Centers for Disease Control and Prevention and others through information sharing and programmatic reviews. Activities and portfolios across those programs are shared for visibility, opportunities for collaboration, and to reduce redundancy.

Recognizing that humans, animals, and our environment are all interconnected, the GEIS program conducts surveillance across One Health domains (15), leading to a more comprehensive understanding of how infectious diseases emerge and are transmitted. In addition, the GEIS network performs pathogen-agnostic sequencing (16) when the causative agent of a disease is unknown or when a genome has not been previously characterized. GEIS also conducts wastewater surveillance (17) as a tool to detect pathogens circulating in a given location. The GEIS program is seeking to leverage its One Health, pathogen-agnostic sequencing, and wastewater surveillance capabilities to support biodefense and biosecurity efforts aimed at preventing the next pandemic (18).

The GEIS program recognizes the growing importance of data stewardship and modernization and is invested in technology solutions to streamline management of surveillance and programmatic data. The GEIS program has begun an initiative to deploy a centralized health information system for collection, management, analysis, and reporting of standardized data from the DoD overseas laboratories. Data collected in the field and input into the health information system would then feed into a central, DHA-hosted data lake for additional access, curation, and analysis by DoD and GEIS personnel. Lowering the manual entry, analytic, and reporting burdens on GEIS partners will lead to a more efficient use of GEIS program funds and improve the transparency of the results of GEIS activities. In addition, to overcome the challenges of sharing, storing, and analyzing genomic data, the GEIS program is partnering with other organizations in the DoD to implement a secure, accessible, cloud-based solution for storing and analyzing genomic data submitted by partners across the globe. The GEIS program continues to refine its approach to data collection, storage, analysis, transfer, and reporting to improve communication and improve early warning of emerging threats for informed decision-making.

Since 1997, the GEIS program has been the only DoD organization coordinating global surveillance for emerging infectious disease threats, focusing on those likely to affect military operations and the health and readiness of service members. The emergence and spread of pandemic-level pathogens has illustrated the need for continued, well-resourced programs focused on detecting those threats and providing early warning for public health decision-making. The GEIS program has built, supported, and maintained a coordinated, responsive network of geographically diverse laboratory capabilities that can quickly pivot in response to an emerging threat. The GEIS program continues to evolve and expand its approach to surveillance by implementing pathogen-agnostic sequencing, wastewater surveillance, and increasing the value of traditional disease surveillance activities. The success of the GEIS program is due in large part to the long-standing partnerships, relationships, and agreements between the DoD overseas laboratories and their host countries. Those continued long-term efforts enhance larger health diplomacy efforts between the United States and ally nations abroad by supporting collaborations on infectious pathogens of relevance for both the host nations and the US military. The expertise the GEIS program has cultivated has become a vital tool within the DoD and US government for expeditiously and comprehensively identifying, characterizing, and reporting data on military-relevant pathogens that threaten the health and readiness of US forces.