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AFRICOM Activities

U.S. AFRICOM's programs and activities support the development of capable, professional partner military forces, and are integrated and coordinated with the DOS, U.S. Chiefs of Mission, and our international partners. U.S. Africa Command conducts several categories of activities to support our four primary goals and address current security challenges that threaten stability.

AFRICOM Mission Statement

U.S. AFRICOM, in concert with other U.S. government agencies and international partners, conducts sustained security engagement through military-to-military programs, military-sponsored activities, and other military operations as directed to promote a stable and secure African environment in support of U.S. foreign policy.

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Operational Environment

4,885 Miles Western Europe

Northern Africa Western Africa Eastern Africa

Argentina 4,365 Miles

United States

Middle/Central Africa

· Tyranny of Distance · Diversity of Population o 400 ethnic groups o 2,000 languages/dialects o Wide variety of religious traditions · Health Status


Southern Africa

Five Regions REC


Command Structure

President Secretary of Defense

Established 1 OCT 08

CJTF-HOA: Camp Lemmonier, Djibouti SOCAFRICA: Stuttgart, Germany AFAFRICA: Ramstein AB, Germany USARAF: Vicenza, Italy NAVAF: Naples, Italy MARFORAF: Stuttgart, Germany US Africa Command


Title 10 · Man · Train · Equip

CJTF Horn of Africa

Special Ops Command Africa

US Air Forces Africa

US Army Africa

US Navy Africa

Marine Forces Africa

Subordinate Combined JTF/Unified Commands Command Title 10 Authority

Service Component Commands




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Command Surgeon

Deputy Command Surgeon Col John Andrus Command Surgeon Col Robert Miller

SPS-SG (J00-SG) Special Staff

Dr. Refaat Hanna Epidemiologist

Mr. Vince Holman Executive Director

Mr. Lonnie Mitchell Executive Assistant

Theater Security Objectives Studies/Research PI/ID and PRP Planning

Strategic Medical Synch Staff Action/Coordination Office Management HQ Joint Exercises

All Administrative Matters Travel Coordination Command Surgeon Portal Document Archive

PI=Pandemic Influenza ID=Infectious Disease PRP=Pandemic Response Program

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Medical Division

Medical Division

Col John Andrus Ms. Crystal Ajeel Mr. Dennis Sasser

OPL-MD (J47) OPLOG Directorate

Long Range Planning (LRP) LTC Chris Richards Lt Col Brenda Koiro Maj Wes Palmer Capt Eric Stringer GS12 Plans Specialist -VACANT

Med Operations (MOB) Lt Col Steve Cusack LCDR Jason Darby MAJ Mick Kramer Maj Amanda Krbec Capt Angela Okroi

Force Health Protection (FHP) LTC Jose Nunez Maj Rob Holmes Maj Randi Hamm MAJ Hugh Bailey MAJ Clayton Chilcoat Ms. Pamela Davis

AOR Medical Footprint TSC Steady State Process Maintain Pertinent CONPLANS

TSC-Theater Security Cooperation CONPLANS=Contingency Plan JOC=Joint Operations Center SME=Subject Matter Expert Vet=Veterinary ID=Infectious Disease MIO= Medical Intelligence Officer PH=Public Health Env=Environmental

Support current activities JOC Liaison Health Programs Liaison Maintain Pertinent Plans Individual Mobilization Augmentees (IMAs) CAPT Tong (USN) LtCol Hussain (USAF) LCDR Puipong (USN)

FHP Message/Guidance Travel Readiness Support Medical Intelligence SME ­ Vet, ID, MIO, PH, Env

Mission, Vision, Motto

Mission US Africa Command medical team synchronized with global partners to preserve the health and well-being of our forces, support ongoing operations and activities, and build partner military medical capacity fostering a stable and secure African environment.

Vision: Innovative team taking the lead in shaping medical stability operations through partnership building.


Infectious Diseases

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Burden of Disease in Africa

In the African Region, 72% of all deaths are from communicable diseases, such as HIV/AIDS, tuberculosis, malaria, respiratory infections and the complications of pregnancy and childbirth; compared to 27% in all other WHO Regions combined.

"Facts about health in the African Region of WHO"

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Leading Cause of Death Africa Region*






2,797,334 1,437,322




259,113 159,309

Nutritional deficiencies

Infectious and Noncommunicable parasitic diseases diseases

*Global Burden of Disease , WHO Report 2004

Respiratory infections

Perinatal conditions

Maternal conditions

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Mortality Rate/100,000 Population Due to Communicable diseases, maternal and perinatal conditions and nutritional deficiencies*

1,000 900 800 700 600 500









*Global Burden of Disease , WHO Report 2004

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HIV/AIDS The African Region has 11% of the world's population, but an estimated 60% of people with HIV/AIDS. HIV/AIDS is the leading cause of death for adults in the Region. Malaria Malaria is endemic in 42 of the 46 countries of the SubSaharan African Region. More than 90% of the estimated 300­500 million clinical cases of malaria that occur across the world every year are in Africans. Tuberculosis An estimated 2.4 million new tuberculosis cases ­ 24% of all notified cases worldwide ­ and half a million tuberculosis deaths are reported in the African Region each year.

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Regional HIV and AIDS statistics- 2009

Adults and children living with HIV Adults and children newly infected with HIV 1.8 million 75,000 270,000 82,000 92,000 17,000 130,000 31,000 70,000 4,500 Adult prevalence (1549) *%+ Adult & child deaths due to AIDS

Sub-Saharan Africa Middle East and North Africa South and South-East Asia East Asia Central and South America Caribbean Eastern Europe and Central Asia Western and Central Europe North America Oceania

22.5 million 460,000 4.1 million 770,000 1.4 million 240,000 1.4 million 820,000 1.5 million 57,000

5.0% 0.2% 0.3% 0.1% 0.5% 1.0% 0.8% 0.2% 0.5% 0.3%

1.3 million

24,000 260,000 36,000 58,000 12,000 76,000 8,500 26,000 1,400


33.3 million

2.6 million


1.8 million

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Global Distribution of Malaria

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Estimated numbers of malaria cases, by WHO Region, 2008



150,000,000 100,000,000 50,000,000 AFR SEAR EMR WPR AMR EUR

Estimated numbers of deaths due to malaria by WHO Region, 2008

1,000,000 800,000


400,000 200,000 AFR SEAR EMR WPR AMR EUR

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Tuberculosis (TB)

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Estimated TB prevalence and mortality by WHO region 2009 (Excluding HIV)

500 450 400 350 Rate/100,000 300 250 200 150 100 50 0 Africa Prevalence Rate/100,000 Mortality Rate/100,000 450 50 South-East Asia 280 27

Eastern Mediterranean 180 18

Western Pacific 160 13

Europe 63 7

The Americas 37 2

Data Source: WHO Global tuberculosis control 2010

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HIV and TB

HIV and TB form a lethal combination, each speeding the other's progress. HIV weakens the immune system. Someone who is HIVpositive and infected with TB bacilli is many times more likely to become sick with TB than someone infected with TB bacilli who is HIVnegative. TB is a leading cause of death among people who are HIV-positive. In Africa, HIV is the single most important factor contributing to the increase in the incidence of TB since 1990.

Data Source: WHO Global tuberculosis control 2010

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Health & Stability in Africa

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Health and Security

Large disease outbreaks could quickly overwhelm local governments and ignite a large exodus of infected victims across international borders causing a serious public health and security risks.

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Example of Disease outbreak and security

Cholera outbreak killed nearly 4,000 people and infected almost 87,000 in Zimbabwe

The refugees had fled a cholera outbreak in Zimbabwe and many hoped to seek political asylum in South Africa. South African government said the refugees would be transferred to a military base, but aid officials criticised the move. "BBC News, March 5, 2009"

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HIV/AIDS and Security

It is important to underscore that HIV/AIDS is not only a security threat but has far reaching economic and social consequences that are of primary concern to Africa.

"African Union, Addis Ababa, Ethiopia, March 2005"

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Impact of HIV/AIDS on Peacekeeping Operations

The HIV/AIDS pandemic is affecting African military troops' ability to defend their countries and operate peacekeeping missions on the continent, The UN Department of Peacekeeping Operations (DPKO) has adopted a number of HIV/AIDS policies. Soldiers are not required to undergo HIV testing before deployment, but a medical exam excludes individuals displaying active symptoms of infection. All peacekeeping missions have either an HIV/AIDS policy adviser or, for smaller missions, an AIDS focal point responsible for developing awareness and prevention programs.

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Prevention & Response Programs

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Department of Defense HIV/AIDS Prevention Program (DHAPP)

Mission: Reduce the incidence of HIV/AIDS among uniformed personnel in selected African nations and beyond.


­ Assist in developing and implementing military-specific HIV prevention programs. ­ Integrate with other US government, nongovernmental organizations, and United Nations programs. ­ Support the mission of the President's Emergency Plan for AIDS Relief (PEPFAR).

U.S. Africa Command supports DHAPP through its Partner Military HIV/AIDS Program (PMHAP). PMHAP's activities and capacity building efforts support partner nations' policy development to help ensure sustainable programs and implementation of Prevention, Care and Treatment.

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Pandemic Response Program (PRP)

U.S. Africa Command's Strategy, Plans and Programs Directorate (SPP) and Operations and Logistics Directorate-Medical Division have created the Pandemic Response Program (PRP) which works with partner militaries in Africa to assist in developing military pandemic response plans and assuring integration into the overall national response plan.

U.S. Africa Command entered into partnership with The Center for Disaster and Humanitarian Assistance Medicine (CDHAM) to develop and execute PRP activities. The intent of PRP is to strengthen national militaries capacities to plan for and respond to a pandemic disaster in support of a national and regional level preparedness and response plans.

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Examples of Science & Technology Needs in Africa


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Challenges with Malaria Diagnosis

Malaria diagnosis, particularly in remote areas lacking laboratory support, frequently relies on the patient's symptoms. The first symptoms of malaria (fever, chills, sweats, headaches, muscle pains, nausea, and vomiting) are not specific to malaria

While clinical diagnosis is inexpensive and can be effective, clinicians often misdiagnose malarial infection.

Misdiagnosis often leads to the unnecessary prescription of malaria medications which are becoming increasingly expensive as drug resistance grows globally and new medicines are required for effective treatment. Thus, increasing the accuracy of malaria diagnosis is becoming more important and will continue to be so in the future.

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Challenges With TB Diagnostics

Current TB diagnostics, TB skin testing (TST), sputum smear and culture and radiology have remained the mainstay of TB diagnostics since 1882.

In Africa the majority of adults have already been exposed to TB and in those with advanced HIV infection, who are at highest risk of disease progression, the test has low sensitivity with up to 50% false negatives.

Sputum smear microscopy has high specificity in high TB prevalence settings. The overall sensitivity for identifying TB infection is 35 - 70%, but the sensitivity in HIV-infected cases can be as low as 20%.

There is an urgent need to develop an easier-to-use diagnostic tools capable of detecting sputum smear negative, extra-pulmonary, pediatric, and/or multidrug resistant TB.

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AFRICOM SG Information

Office of the Command Surgeon: DSN 312-421-4012 COM +49 711 729-4012 [email protected] Medical Division: DSN 312-421-4019 COM+49 711 729-4019 [email protected]





US AFRICOM Science and Technology Conference Stuttgart, 2011

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