Q&A: Colonel Joseph M. Palma, M.D.
Medical Champion:
Leading the OSD’s Medical Defense Against Chemical and Biological Threats
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Colonel Joseph M. Palma, M.D.
Acting Deputy Assistant to the
Secretary of Defense for Chemical/
Biological Defense
Joseph M. Palma, MD, MPH, is a colonel in the United States Air Force, currently serving as the acting deputy assistant to the secretary of defense for chemical/biological defense. In this position he is charged with leading the department's chemical and biological defense medical and non-medical programs and contributes to the development of defense capabilities for the Department of Homeland Security and National and Homeland Security Councils in support of the national civilian defense.
Palma entered the Air Force in August 1979. After receiving his medical degree from the University of Salamanca, Spain, in 1979, he completed his internship at David Grant USAF Medical Center. He then became an operational flight surgeon and later completed a residency in aerospace medicine in 1988. He holds a Masters of Public Health and a Doctor of Medicine degree, and is boarded by the American Board of Preventive Medicine. He served as chief of aeromedical services twice, chief of professional services once, consultant to the 12th Air Force commander, air transportable hospital commander, and was deployed to Operation desert Storm as flight surgeon and as aeromedical evacuation liaison.
He was subsequently assigned to the HQ, USAF Office of the Surgeon General where he served as chief of clinical and aeromedical readiness and later as medical director for the Directorate of Medical Readiness. He represented the Air Force and the Air Force surgeon general at NATO and NATO medical working parties, the Chairman, Joint Chiefs of Staff Vision 2010 panels, and numerous other tri-service working groups in Washington. He was also charged with developing the clinical guidelines, scopes of practice, and deployment modules for all the Air Force expeditionary medical and surgical capabilities and establishing the training criteria for the emerging Air Force medical service expeditionary deployment system. He was also assigned as a student at the Air War College in residence and also was commander, 90th Aerospace Medicine Squadron. He also served as vice chair, Department of Military and Emergency Medicine at the Department of Defense’s only medical school and led the development of the standards for military medical education for the post Cold-War era. He also was the scientific chair for the International Congress of Military Medicine, the international flag level and surgeon general forum for military medicine for its over 100 member countries and then joined OSD in June 2003.
Palma's military awards include the Defense Meritorious Service Medal, U.S. Air Force Meritorious Service Medal (4 OLC), U.S. Air Force Commendation Medal, Aircrew of the Year for 1999, National Defense Service Medal, Southwest Asia Medal with one device, Kuwait Liberation Medal, and the Outstanding Unit Award (2).
Interviewed by MMT Editor Jeff McKaughan.
Q: Could you start by talking about some of what you consider major accomplishments in defending against the CBRN threat?
A: We in the department have been diligent in identifying all the potential threats and designing our response capability. We have also prioritized our funding streams to support development of modernized technology solutions utilizing the expert advice of the Joint Staff, our Science and Technology office at the Defense Threat Reduction Agency and have identified solid solutions for development or purchase and fielding through the auspices of our Joint Program Executive Officer. These components are the key areas of the Chemical and Biological Defense Program, which we are responsible for integrating. We have a world-class team of experts in their fields.
Q: How difficult is it to coordinate and ensure that there is no duplication of research and procurement efforts with so many organizations, agencies and offices involved in various aspects of chemical and biological defense?
A: This is a key area of concern for the department, and just as importantly, it is a key area of concern for the executive branch and interagency. I am privileged to participate in many of these. There are numerous interagency coordinating groups established across the executive branch to coordinate our research so that, for example, if the National Institutes of Health or the Department of Homeland Security or our own Defense Advanced Projects Agency are engaged in specific areas of chemical and biological defense, we both know about it, do not duplicate each other’s work; or, if similar, they are specifically designed not to duplicate. The issue here to remember, though, is that we in the Department of Defense develop defensive equipment, medications and other CB defense items that are specifically tailored for field conditions and for operations under a set of conditions encountered in war. This is in some cases distinctly different than the civilian needs, so there are times when we adapt technologies for field conditions. This is not undue duplication but instead is the leveraging of technology solutions to support the soldier, sailor, airman or marine.
Q: What is your office’s role in supporting Project Bioshield?
A: Bioshield is the project which set aside approximately $5.6 billion over 10 years in order to provide medical countermeasures for the national stockpile. We in DoD participate in a high-level interdepartmental working group whose role it is to assure we all provide our different or similar requirements for pharmaceuticals under that law. These requirements, from each of our departments, are then vetted with the scientific community in order to identify technology solutions or available countermeasures that can be purchased with bioshield funds. The Department of Health and Human Services then has the responsibility to obtain approval for purchase in accordance with the law. They then will go out and usually publish an announcement and receive bids to fill the requirement. Contracts are usually let, in accordance with both the Bioshield legislation and Federal Acquisition Regulations after that process is finished.
Q: Can you describe the capabilities-based approach to the CBRN strategy—as opposed to any previous strategies that were followed? As a follow-on, within the capabilities-based approach “serve, shape, shield and sustain” have been mentioned. Can you go into a little detail about what this means?
A: Capabilities for the program in defense against chemical and biological defense requires a rational manner by which to array our development of solutions. These solutions to our challenges are called capabilities, which simply means that we need the capability to do something. The something is the “sense, shape, shield and sustain.”
Sense, just as it sounds, refers to the capability or ability to identify the threat. Therefore, detection and diagnostic capabilities give you a “sensing” ability, so any instruments and similar capabilities we develop, we array under this rubric.
Shape [is] those capabilities which impart knowledge and awareness of the environment in which we operate and provides us with the ability to both recognize the threat [chemical, biological and radiological] and respond.
Shield refers to those capabilities—for example, boots and suits—for protection of military personnel that constitute protection items, hence the title “shield.”
Sustain [is] those things we need to continue to operate, such as the decontaminants we develop or some of the medical countermeasures or antidotes with which we deploy, which allow us to continue operations in an environment where these agents are used.
Q: What role does your office play in targeting research funding towards specific requirements and programs?
A: Our role is to assure we establish the strategic direction and target our funds, approximately $10.2 billion over our five-year funding cycle, toward programs that field specific solutions tied directly to the requirements.
Q: FY06 funding seemed characterized primarily by increased emphasis on test and evaluation infrastructure and novel biodefense initiatives. Have you been satisfied with the progress in these areas so far, and can you give our readers a peek ahead to what some of the key focus areas in FY07 will be?
A: Over the past several years the program has very successfully created significant capabilities in the four areas of sense, shape, shield and sustain in the non-medical areas that we feel reasonably well about our ability to prepare and defeat the use of these agents. We have, however, identified a need to increase our investment in two areas not prioritized in recent years, and those are in the recapitalization of the infrastructure, both physical and intellectual, and in assuring we keep pace with the rapid changes and emerging challenges presented by biotechnology. Therefore, we have increased our emphasis in these areas.
Q: What areas of research and development should we be focusing on? Are there some technology areas that have, or should have, a higher priority than others?
A: Currently, we will be emphasizing biotechnology development, especially in the shorter term. The concept is not just to continue our emphasis on the excellent vaccine candidates DoD has developed over the many decades but also will be applying molecular science to create the new solutions to these challenges of the future.
Q: Are you satisfied that the U.S. pharmaceutical/vaccine infrastructure is large enough and robust enough to react to either naturally occurring or man-made chemical and biological threats to humans in an urgent manner?
A: I am satisfied that the United States has a premier pharmaceutical industry. This includes world-class intellectual and physical infrastructure in the civilian section and in the U.S. government itself. Examples of the latter [include] the National Institutes of Health and, throughout the history of the 20th century to today, in the Army, starting with Dr. Walter Reed and his breakthroughs in infectious diseases early in the 20th century. Whether the capability is large enough is a judgment. My personal judgment is that we have sufficient capability today for today’s challenges. Increasing capacity and capability for a changing environment is what our recent increased DoD investment in infrastructure is about.
Q: Various program offices and research facilities are working on equipment and technologies against contemporary CBRN threat. Who is watching over everything and ensuring that there is a maximization of efforts without duplication?
A: Our office has responsibility to integrate all chemical and biological defense activities uniquely in this area. The department has one centralized budget for these defenses, and responsibility for it lies in our office. The department funds no duplicative efforts since we, by design, review all efforts to assure we don’t double-fund projects.
Q: Is the way in which state and local agencies charged with preparing for chemical and biological threats adequate, and is there sufficient guidance from the federal government and DoD?
A: The DoD has, since 9/11, established a requirement for Civil Support Teams [CST] embedded in the National Guard in all states and territories. This is the way in which DoD intends to support state and local agencies charged with preparing and responding to chemical and biological threats. It is not the role of the DoD to duplicate the state responsibilities in local preparedness nor response, but, through the CSTs, we provide capabilities to the states.
Q: Is there anything you would like to add?
A: It is a privilege to provide this interview and more importantly to answer these important questions as they relate to this program. The Chemical and Biological Defense Program has been in existence since [it was] established by Congress in 1994. During that time the dedicated people in the program have endeavored to both identify the needs and increase the funding appropriately in order to mitigate this terrible threat our military may find in a distant land. 9/11 has taught us that we must be proactive and have heightened awareness of this threat. We must be prepared against any and all possible challenges, and the government, from the department’s leadership to the executive branch and to the Congress who funds this activity, I have to admit, we have received support to address every capability need. Americans should thank our leadership for their foresight and unity of purpose to solve these very difficult problems. ♦