A Hierarchy of Medical Countermeasures Against Biological Threats.

INTRODUCTION Emerging biological threats represent a serious challenge for force health protection (FHP). Against a novel biological threat, medical countermeasures are the first line of defense. However, as exposed by global pandemic conditions, there are significant complications when administering medical countermeasures against novel threats. One such limitation involved the lack of any guiding structure to discuss and deliberate upon the relative value of employing different countermeasures either alone or in tandem. For example, both personal protective equipment and prophylactic medication can provide some protection, but how are individual protections weighed against operational capabilities and FHP initiatives? The goal of this review is to provide a hierarchical organizing structure to the different medical countermeasures available in response to emerging biological threats. MATERIALS AND METHODS This review used no explicit inclusion or exclusion criteria for its literature review. References are provided for illustrative purposes to represent different components of the medical hierarchy. DISCUSSION The hierarchy presented here is organized around a resource-durability structure that functions as a push-pull mechanism. Specifically, lower levels of the hierarchy require more resources to sustain FHP conditions while also providing less durable protection. These countermeasures require continual reapplication, and so resources become conceived as much in time and effort to apply as in exhaustible supplies. Higher-order countermeasures require less resources investment as a single application can provide weeks, months, or years of protection. Moreover, higher-order protections are less likely to interfere with military operational capabilities, which further support their classification as superior countermeasures to sustain FHP. The five levels of the hierarchy are presented here as follows, organized from lowest to highest value as a medical countermeasure: (1) Sanitization, (2) personal protective equipment, (3) prophylaxis, (4) vaccines, and (5) optimized immune system. Rationale and descriptions identify how each higher-order countermeasure is superior to its lower-order counterparts while noting that optimizing FHP will likely require employing multiple countermeasures at different levels. The discussion concludes with an overview as to how different countermeasures were employed to various degrees during a novel global pandemic. CONCLUSIONS AND FUTURE USES Identifying medical countermeasures is important to optimizing FHP. Different countermeasures have different advantages, and the hierarchy distinguishes between inferior and superior countermeasures through the push-pull style mechanism of resource-durability assessment. Future deployment and development should focus on superior countermeasures to maximize medical protections and operational readiness while understanding the relative value and complications inherent with different countermeasures.