When the nation calls, the military answers. So it is with COVID-19. In this case the military responded by sending two Navy hospital ships, medical supplies, equipment, field hospitals, and scores of medical personnel to assist numerous communities in the fight against this invisible enemy. While our military has appropriately supported pandemic demands, the complexities of a pandemic such as COVID-19 highlight the need to review our military medical force structure and rebalance it to adequately meet needs in a rapidly and constantly changing health security environment.
The U.S. death toll from COVID-19 has exceeded 160,000, more than twice the total killed in action from the Vietnam War and far above the losses from Iraq and Afghanistan. By June this year, the unemployment rate was 11 percent, from a high of 14.7 percent in April, including cutbacks across the defense industries supporting the fighting force. The Brookings Institution adds: “How will we keep our military combat-ready, and thus fully capable of deterrence globally, until a vaccine is available to our troops?”
All in all, the coronavirus has degraded the readiness of the military, even if only temporarily. We are fortunate that the virus likely has degraded the capabilities of the nations that compete with our national interests and threaten national security. Plagues, and wars, are disorienting events that have biological as well as political and social consequences. The coronavirus has alerted us that warfare in the 21st century has changed and catapulted military medicine into another dimension. The battle against the virus presents an opportunity to recalibrate as well as advance our practices and policies.
Traditionally, the military’s primary role has been to deter war and protect the security of our country, overseas as well as domestically. While not primary, the military also has a role in supporting crises and disasters when the nation calls. One reason the military’s medical assets were called to respond to the pandemic is that the military has what the civilian sector lacks — a readily deployable, integrated health care system. This health care system has unique expertise in three areas that are useful in response to this pandemic: rapid deployment of treatment structures, a supply chain and logistics expertise, and a complement of personnel, trained and ready, to man large and small complex health care organizations.
However, U.S military medical assets are primarily funded and organized to support the fighting force. Medical structure typically is embedded and arrayed around and in support of the combat force. As such, the stuff (supplies and equipment), staff (personnel) and structure (facilities) are primarily designed for battlefield conditions and care of combat casualties.
Confounding the medical response to COVID-19 is the recent direction by Congress to reduce the military’s medical force by 18,000 providers, reduce the capacity to care for the enrolled population, and to streamline service lines to focus on combat casualty care, e.g., trauma care. Clearly this is not the type of medical expertise required in a viral pandemic.
The military’s medical force must balance this domestic response with the requirement to stay ready to deploy globally in response to a state or a non-state actor who threatens our national security interests. Additionally, America’s military medical force serves as a force-multiplier in diplomatic efforts as a “soft power” to win the hearts and minds of individuals around the world. They must stay ready. The Reserve Components are an integral part of the military’s medical assets, with over 50 percent of the Army’s medical deployable capability residing in the Army Reserve.
Those reservists also provide medical care in their local communities. Mobilizing them to help care for Americans requires a careful balancing act to ensure local health care delivery is not jeopardized. Concurrently we learned that many civilian health care providers were furloughed because of a lack of personal protection equipment and a patient population demanding care. In hindsight, did the military need to be called to respond? And although our military can respond, should they be called?
A fresh look by the Pentagon and Congress is required to enable our medical force to support our national and health security and to be able to respond in a “two-war scenario” to meet both combat and domestic needs. Money cut from budgets must be reinstated, force structure must be reorganized and training must be expanded to allow for readiness to support health security, infectious disease scenarios and combat trauma — with the caveat that there may be future scenarios where the combat force may need to be arrayed in such a way to support the medical force.
Peggy Wilmoth, Ph.D., R.N., a retired U.S. Army major general and former Deputy Surgeon General, U.S. Army Reserve, is executive vice dean and associate dean for academic affairs The University of North Carolina at Chapel Hill School of Nursing. She was inducted into the Army Women’s Foundation Hall of Fame in March 2020. The views expressed here are hers alone. Follow her on Twitter @mcwilmot.