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Cordon sanitaire: Planning the military’s next pandemic response

West Virginia National Guard Soldiers and Airmen test Hopemont Hospital staff members for COVID-19 in Terra Alta, W.Va., April 23, 2020. Twenty West Viriginia Guardsmen with Task Force Chemical, Biological, Radiological, Nuclear and Explosive (CBRNE) Response Enterprise, (TF-CRE) East tested about 125 staff members in the first hour of testing. With four WVNG medical providers and assistants, the task force expected to test about 150 staff members by the end of the day. WVNG TF-CRE will continue to conduct testing at nursing homes and assisted living facilities throughout the state at the direction of the governor. Photo by Senior Master Sgt. Emily Beightol-Deyerle

“Planning to fight the last war” has been a catchphrase for unimaginative thinking, failing to understand emerging realities, and ineffective thinking stuck in an outdated paradigm. But perhaps effort is not wasted when we take the time to look back at the execution of past mission sets to see what can be improved.

Looking backwards is not always a waste of time, especially when we learn lessons; this is the value of the after-action review (AAR).

The goal of this discussion is not to attempt to achieve subject matter expertise in epidemiology or public health, but to begin the discussion of what military planning must take place to support overwhelmed civilian infrastructure in the case of an outbreak of contagious disease.

Defense Support of the Civil Authorities (DSCA) in a pandemic

Although demonstrating value in domestic crisis response has always been part of the National Guard’s brand, DSCA isn’t something the military particularly wants to do.

Rather, the position is that such missions decrement the military’s readiness for its primary, wartime mission. That said, the military’s capabilities are just that – capable and always available to the national command authority.

Civilian capacities are remarkably thin, especially when a surge capability is required. As much as Americans recoil from seeing uniformed military on the streets of the United States, sometimes that is where the capacity to solve the problem at hand lies.

Diversity in military assistance

The good news of the COVID-19 AAR was the successful use of the military to assist in so many diverse roles (bus drivers, medical workers, prison guards, teachers, and with mortuary affairs support). Further, the use of military bases as quarantine facilities is relatively uncontroversial, and parallels the use of military bases to house refugees.

Where America as a nation didn’t go — and other places like China did — was the use of significant state security or military forces to impose movement controls on civilian populations to constrain the propagation of the disease. Such small attempts were undertaken by civilian law enforcement and fell far short of full-blown cordon sanitaire. Although the technique was left unused for almost 100 years, we have seen examples of cordons sanitaire being imposed in the African Ebola outbreak in 2014-15.

During COVID-19, the American people — through their political leaders — made a choice to accept higher levels of disease fatality from COVID-19 in exchange for fewer restrictions on movement. An increased reliance on the dynamic development of vaccines was, instead, used to mitigate the risk of contagion.

This “Hail Mary” play seems to have worked, at least for those Americans who are still alive. That doesn’t excuse the American military from learning from the shortcomings in the military’s COVID-19 response or to address shortcomings in planning and execution that may be avoided with the collection and application of some learning.

‘Freedom and vaccines’

What if the same “freedom and vaccines” strategy is not viable in the event of a future pandemic?

The losses the American public were willing to accept in respect of COVID-19 — a high number, certainly, but many were in the “they are already pretty sick or old anyway” crowd — might not be so palatable with a more aggressive and less discriminating disease. In sum, we might have been able to go light on the military option during COVID-19, but perhaps a heavier hand will be required with, say, a hemorrhagic fever like Ebola.

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For a military with such a robust planning capability, there is a surprisingly low amount of contingency planning that takes actually place. Doing the unsexy — and, indeed, contemplating the unpalatable — stuff is the mundane slog of planning.

So why, then, do we not plan or rehearse cordon sanitaire operations?

First, this is not a mission that the military wants. It doesn’t drive budget allocations.

The domestic use of military force is something Americans like to think of as exceptional and bad. Even the relatively benign mask mandates and inoculation drives during the COVID-19 pandemic were met by significant domestic political and popular opposition in the United States.

The notion underlying the cordon sanitaire is a difficult one that interferes with the American notion of individual autonomy and is difficult to enforce against an individually-minded population: your movement away from an area of higher contagion risk into an area of lower contagion risk must be curtailed for the benefit of those in the area of lower risk. Not a particularly popular — or a particularly American — sentiment.

Third, the legal authority for cordon sanitaire is largely at the state level, and this makes whole of government planning difficult. The federal quarantine power is limited to matters involving the national or state borders. Practically speaking, cordons sanitaire will most likely be executed at the state and local level.

The legal authorities at the state level can, themselves, be problematic. From a military perspective, this implicates the use of National Guard forces in missions under state control. This, in turn, impedes coordination and national-level planning for the use of military forces in these roles. It certainly constrains the development of doctrine and best practices at the national level.

Fourth, it might be that with more developed health systems, a military response to an outbreak becomes unnecessary. This only works until it doesn’t (until the existing health care and public order systems are overwhelmed, they aren’t). Once they are overwhelmed it may be too late to formulate a plan.

Very similar to the situation the military faced with counterinsurgency operations (COIN), just because the military doesn’t want a particular mission set, doesn’t mean that the military isn’t going to get a particular mission set. Foregoing serious thought and planning for a mission, no matter how unloved, just means that the military has to wing it when it finally comes to execution. Easier to plan and, if the thing is taken seriously, rehearse.

Cordon Sanitaire ‘heartless but effective’

In common with all applications of force, cordon sanitaire can be misused. Nevertheless this “heartless but effective” mission is one of the tools in the authorities’ kit to address disease contagion. Preventing infected individuals from traveling from one place to another buys the medical authorities time to understand, fight and prevent the spread of contagious disease. It is for this reason outbreaks in or near travel hubs are exponentially more dangerous than outbreaks in remote areas.

What factors determine how a cordon sanitaire be implemented ethically and effectively? Some relate to protecting the participating troops, while many relate to demonstrating to the affected populations that the authorities are actively trying to help them (again, similar to COIN) and not just sacrificing their well-being for the greater good.

Cordons sanitaires are most effective when combined with military or other whole of government support for:

The foregoing must be combined with significant “contact tracing” capabilities to identify and quarantine exposed individuals. This is also a task where the military could potentially provide support. That said, drafting other public officials to support existing public health investigators — or a contractor-based solution — might be more cost-effective.

In the United States, the civilian authorities might be able to take many of these steps without military forces at all — and we saw attempts at this during the COVID-19 pandemic. It should be noted that there are some specialized National Guard assets around the country with the capabilities and equipment to intervene in the event of a biological hazard, but they would need to be supported by security forces sufficient to secure perimeters and actually implement any cordon (also, incidentally, a modest capability built into standing National Guard response packages). However, these existing, available, specialized forces would be insufficient to respond to a widespread outbreak.

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