Agroterrorism: the risks to the United States food supply and national security.
Congress took action to protect our national food supply in the wake of the terrorist attacks on September 11, 2001, by passing the Public Health Security and Bioterrorism Preparedness and Response Act, (4) signed into law on June 12, 2002. Title III of the Act directed that the President's Council on Food Safety, in consultation with other federal and state agencies, the scientific community, the food industry, and consumer and producer groups, develop a crisis communication plan and an educational program that takes proactive steps to protect the national food supply from intentional acts of contamination. It directed that this strategy address "threat assessments; technologies and procedures for securing food processing and manufacturing facilities and modes of transportation; response and notification procedures; and risk communications to the public." Nearly 10 years later, the Government Accountability Office (GAO) found that, despite the best intentions of the Bioterrorism Act, the expenditure of billions of food defense dollars was not well coordinated. Testifying before a Senate committee on the matter, Lisa Shames, the GAO Director of Natural Resources and the Environment, stated "There is no centralized coordination to oversee the federal government's overall progress implementing the nation's food and agriculture defense policy." (5) This lack of centralized coordination of work by different agencies means that we as a nation are unsure that our efforts, and billions of our tax dollars are not being used wisely to counter agroterrorism. It also seriously hinders the implementation of effective, well-designed strategies to reduce the vulnerabilities of our nation's agriculture to terrorists attacks. (5) In testimony before a senate subcommittee on counter-terrorism on September 14, 2011, John Hoffman, a former senior adviser in the Department of Homeland Security, made this sobering assessment: "We may be blindsided by an intentional food-based attack on this nation sometime soon.... At present, our primary detection capability is the emergency room." (5)
The Food Safety Modernization Act of 2011 is the first legislation aimed at preventing an attack rather than responding to one. (6) The Food and Drug Administration now has the challenge of shifting the perspective of protection from unintentional (food safety) contamination to that of prevention of the intentional adulteration (food defense) of human food and animal feed. This approach is quite different in many ways and is a paradigm shift in how our nation protects its food supplies. The FDA proposed rule on food defense would require that food facilities take a proactive, targeted approach within their establishments that focuses on the progression of food processes where the intentional contamination of product is most likely to occur. Effective efforts could then be implemented to best reduce those targets of opportunities. Finally, the proposed rule will require the largest food operations create and implement a food defense plan. (6)
Obviously, the US military is essential in defending this nation against threats from terrorists, whether in foreign environments or within our borders. As such threats have multiplied and evolved over the last decade, concerns about protection of the food supply of the US military have never been greater. Department of Defense (DoD) Directive 5200.08, (7) DoD Directive 6400.04E, (8) DoD Instruction 2000.12, (9) DoD Instruction 2000.16, (10) Homeland Security Presidential Directives 7 (11) and 9 (12), and Presidential Policy Directive 8 (13) are the framework within which the US Army Veterinary Service designs, implements, and operates specific food protection programs to protect our military personnel and their families. These programs include:
* Commercial food protection audits
* Installation food vulnerability assessments
* Food and water defense assessments for special events
* Food and water risk assessments overseas
These directives and programs established global organizational policy and support for the prevention of intentional contamination of our food supply and provide a framework from which we can provide the best possible protection for our food systems.
Production and distribution of the food supply in the United States is one of the most complex systems in the world. The United States imports food from many nations, some of which have ideologies that do not align with ours and may seek to do us harm. When this situation is paired with lax or nonexistent safety standards of some foreign countries, it clearly represents a potential threat to the US food supply. It is estimated that in 2010, more than 10 million food shipments were received from overseas manufacturers, and approximately only 1.6% received any type of federal inspection at the point of entry. (14) Imported foods make our food system vulnerable to terrorist attacks as these products may harbor disease or insect vectors that could spread and decimate our agricultural fields. One successful, grand scale attack on the US agriculture system could cause death and disease to Americans from coast to coast and result in devastating physical, economic, and, more importantly, psychological damage among our citizens. Terrorists realize that the strength of our nation is its economy, and they are focusing more of their efforts on attacks that yield the most economic damage.
The intentional contamination of food goes far beyond imported foods. To combat this threat, we must examine our food supplies from farm-to-fork. Farm-to-fork is the linear progression that food travels from the farm where it is grown and harvested, to the storage facilities while it waits for shipment, to the food manufacturers where it is processed and packaged, to retailers where it is sold, and finally to our dining tables. (15) Protecting such an extensive and complex system is a monumental task that requires diligence by professionals trained in food protection and hazard communications. Throughout this flow there exists the potential for contamination, and therefore the need for vigilance. In order to remain one of the safest food supply systems in the world today, we must employ at the local, state, and federal levels skilled professionals who are equipped to respond to and recover from the crisis of an agroterrorism event. Over the last decade, the federal government has launched numerous initiatives to provide enhancements to the defense of our national food supply.
Agroterrorism is not flashy and does not generally produce immediate results, so terrorists have traditionally considered it to be a secondary tactic. It does, however, have the ability to spread fear and anxiety, produce large economics losses, create social instability, and result in foodborne disease outbreaks. It is most often used as act of economic sabotage rather than a violent act against animals or mankind. However, the use of agroterrorism is a much cheaper and easier alternative to building a "dirty bomb," and would capture the attention of the entire nation for a long time. (16) Several factors have contributed to the belief that terrorists could begin targeting our food supply. First, Al Qaeda leadership has been reduced dramatically over the last decade, leaving mostly low to midlevel terrorists who lack the ability to mount large-scale attacks. Second, economic harm to the United States remains one of the pillars of Al Qaeda's network. Third, microorganisms are inexpensive and can be cultured in clandestine labs by nearly anyone with a microbiology background. (2) Methodologies for culturing these pathogens can easily be found on the internet. Furthermore, many potential biological weapons occur naturally in the environment and do not require the use of laboratories. (16)
Terrorists know that America's strength lies with its economy and a successful attack on our nation's food supply would be economically devastating for millions of its citizens. It could even affect our ability to project our military power abroad and lead to the overthrow of allied governments. Osama Bin Laden once bragged that the attacks on September 11, 2001, cost $500,000 dollars but caused more than $500 billion dollars in economic losses to the United States. (2) It is essential to understand what motivates an aggressor if we expect to generate effective risk mitigation strategies to stop acts of terrorism. The National Institute of Justice funded a research project to determine the extent a foot-and-mouth disease outbreak would have on the cattle industry in the state of Kansas. (17) The study found that those who would attack our agriculture fall into one of 4 categories (17) (p24):
1. International terrorists
2. Economic opportunists
3. Domestic terrorists (including unbalanced individuals and disgruntled employees)
4. Militant animal rights groups
Terrorists are typically politically or ideologically motivated and they may work alone or in small organized groups. Economic opportunists use agroterrorism to manipulate markets and exploit the situation for their personal financial gain. Disgruntled employees are motivated by a sense of revenge for some real or perceived wrongdoing, and they actually pose a greater risk than most other aggressors as they are likely to be less scrutinized due to their legitimate reason for being on the premises. Militant animal rights activists, such as the Earth Liberation Front, are motivated by a moral obligation to prevent animal abuse and have committed more than 2,000 crimes costing an estimated $110 million dollars in damage. Militant animal rights activists (or eco-terrorists as they are often called) ranked number 1 on the FBI's domestic terrorism threats in 2004. (18)
INCIDENTS OF AGROTERRORISM
There are many recorded examples of agroterrorism in history dating from the sixth century BC when Assyrian forces poisoned well water with rye ergot. During World War I, German forces attempted to infect horses bound for Europe from the United States with glanders (Burkholderia mallei) and anthrax (Bacillus anthracis) (2) While glanders is a bacterial disease that primarily affects horses, it and anthrax can spread to humans, donkeys, mules, and other mammals. (19) The single largest biological terrorist attack ever occurring on US soil was perpetrated in 1984 by a religious cult in Oregon who sought to influence the outcome of an election by poisoning their opponents and thereby causing a lower voter turnout. The cult did so by cultivating Salmonella typhimurium in a covert laboratory on their ranch and spreading the potentially dangerous pathogen on bathroom fixtures and salad bars in 10 restaurants in the local town of The Dalles. Just prior to election day, emergency rooms, hospitals, and clinics were overrun with people suffering from extreme nausea and diarrhea. The attack sickened 751 people, but fortunately there were no fatalities. (20,21)
In 1985, the USDA accused contract workers of intentionally introducing the Mexican screw worm (Cochliomyia hominivorax) to livestock farmed near the United States/Mexico border in an attempt to spread this parasitic problem and keep their jobs in a screw worm eradication program. (16)
In 1996, animal feed was the target of disgruntled workers at a rendering plant when a cow carcass was intentionally contaminated with the pesticide chlordane. The animal was ground with others to produce nearly 80,000 lbs of feed which found its way onto 4,000 dairy farms in 4 states, and resulted in a dairy food recall that cost the industry an estimated $250 million loss. (22)
In 1997, economic opportunists adulterated spent animal grease from local restaurants intended for chicken feed with a fungicide. This criminal act was perpetrated by a rival feed company owner, and the investigation and apprehension of the suspect required the concerted effort of law enforcement officials in 17 states. (22)
In 2003 a disgruntled meat department employee was arrested for intentionally contaminating an estimated 200 lbs of ground beef with a nicotine-based insecticide known as Black Leaf 40. The Centers for Disease Control and Prevention reported that 92 individuals became ill with symptoms including burning of the mouth, nausea, vomiting, and dizziness. (23)
In 2014 Japanese factory worker Toshiki Abe was sentenced to 3.5 years in prison for intentionally contaminating frozen food products with the pesticide malathion. Detected concentration levels of this poison were 2.6 million times higher than what is permitted by law. The processor of these frozen food products does not use the insecticide malathion, so the presence of this toxic substance at such a high concentration is proof of a deliberate act. Abe's actions sickened nearly 900 persons. This case is one of the largest proven acts of intentional food product contamination. (24)
The 2005 National Institute of Justice study categorized foot-and-mouth disease (FMD) as a "Primary threat to agriculture." (17) (p18) This viral disease is 20 times more contagious than small pox and causes painful sores on the hooves and mouths of cloven-hoofed animals such as cattle, pigs, sheep, goats, and deer. These sores are so debilitating that the animals are unable to walk, eat, and drink, until they finally succumb to the disease. Although humans are not affected by FMD, they can carry and transmit the disease for up to 48 hours from exposure, and the spread from animal to animal can extend as far as 50 miles. An outbreak of FMD in the United Kingdom in 2001 affected 9,000 farms and required the destruction and disposal of more than 4 million animals. That outbreak cost the United Kingdom an estimated $21 billion dollars. A similar outbreak in the United States would cost more than $60 billion dollars. Not only would such an event have a dramatic effect on the availability of meat products in the United States, it could also halt exports to other countries for years in the future. The loss of jobs would be devastating and result in billions of dollars in economic costs. (2)
The sequence for dealing with FMD as presented in the National Institute of Justice study (17) (p23) includes the use of law enforcement to establish a strict quarantine around the affected area, roadblocks established to exclude sick animals and prevent contaminated vehicles from leaving the area and spreading the infections, and sound crime scene investigation procedures. An outbreak of FMD would require a quarantine area 6 miles in radius and last at least 30 days. Roadblocks would have to be strategically placed along all thoroughfares leading from the point-of-origin of the outbreak outward in all directions. Law enforcement must conduct interviews with drivers to determine if the passengers had recently been in a contaminated area. If so, stations manned by trained personnel would have to be established close to the roadblocks to allow for the proper decontamination of both vehicles and persons. Crime scene investigators would be responsible for collecting tissue samples and identification of potential suspects. Finally, all cloven-hoofed animals in the affected area would have to be destroyed and disposed of properly. (25) This would be an enormous undertaking that not many of our local and state official personnel are properly prepared to execute. Clearly, the value of preventing FMD outbreaks using sound biosecurity measures far outweighs the monumental task of containing such an event.
According to the National Defense Research Institute, there are several key factors that make US agriculture particularly vulnerable to attack. (26) First, the farms that produce our food have become ever more concentrated and rely on old fashioned farming practices. This concentration of animals into relatively small areas greatly increases the infection rate and creates a very difficult containment situation. Second, livestock are more susceptible to disease infection due to husbandry tactics and the overuse of antibiotics. Such tactics include sterilization programs, dehorning, and even hormone injections. The overuse of antibiotics causes many pathogenic bacteria to develop resistance to therapy. Third, most farms are devoid of any real, organized surveillance detection systems. Animal feed lots and barns are often left unguarded and therefore indefensible. Fourth, the passive reporting system that farmers are expected to use when they discover an animal suspected of having a communicable disease relies on the farmer to self-report the suspected diseased animal to authorities. Such a system puts farmers in an awkward situation which can negatively impact their livelihood and forces them into a "shoot, shovel, and shut-up" mindset in fear the government may condemn their entire livestock if they ever found out. The last factor is the lack of veterinarians in the United States that have a sufficient level of training to recognize and properly diagnose animal diseases that are not commonly found in this country.
PROTECTION OF THE MILITARY FOOD SYSTEM
Ever since the terrorist attacks on the World Trade Center on September 11, 2001, our country's leaders recognized that an attack on our food supply could threaten our very existence. Much has changed to protect our national food supply since the then Secretary of Health and Human Services, Tommy Thompson, said in 2004 "I, for the life of me, cannot understand why the terrorist have not attacked our food supply, because it is so easy to do." (27) The Bioterrorism Act of 20024 supplied the impetus for DoD Directive 6400.04E, (8) which assigned to the US Army Veterinary Service the overarching authority to execute food defense programs within the DoD. DoD Directive 6400.04E also mandates the standardization of commercial food protection audits, installation food vulnerability assessments, food and water defense assessments, and food and water risk assessments. The Veterinary Services Portfolio of the Army Institute of Public Health is charged with providing a proactive approach to protect military food systems and deny terrorists the ability to attack those food supplies. It met this directive by creating specific procedures for assessing food establishments both on and off installations wherever military service personnel are stationed. These experts do so by working closely with the United States Department of Agriculture, Food and Drug Administration, local agricultural groups, contracting officers, and installation garrison commanders to identify potential weak areas in food systems and offer simple and cost-effective strategies to reduce or eliminate such vulnerabilities. Further, standardized inspections of food deliveries and storage areas are conducted on a regular basis by personnel who have been specially trained in food defense by the Army Medical Department Center & School. This determined effort is integral in preventing and detecting the intentional contamination of food systems by terrorists using conventional chemical, biological, radiological, nuclear, or physical agents.
The threat of the intentional contamination of the military food supply is much more complex in deployed environments and presents an increased level of danger in terms of possible nonbattle injuries and potential mission failures. The major challenge to preventing terrorists from using agroterrorism is that food distribution systems are quite expansive and therefore food protection programs designed to protect them are very expensive, both in terms of personnel and dollars. Such systems must protect nodes along a sizeable geographical area and take into consideration susceptibilities of food transported over potentially hostile territory with numerous handlers. It must also take into account food processes such as mixing of large batches, short product shelf-life, and global distribution. This is quite ambitious, even in the relative safety of the United States, and as author Tim Downs says, "The concern about an agricultural act of terrorism is we just can't defend a thousand-acre farm," he explains. "You can put up a metal detector in an airport--but how do you protect a thousand acres of corn or wheat?" (3)
The DoD has several initiatives in place to improve the defense posture of our food supply such as commercial food protection audits, installation food vulnerability assessments, food and water defense assessments, and food and water risk assessments. The food protection audit was enacted to systematically evaluate the food defense programs of commercial food facilities supplying subsistence to the DoD. These approved food facilities provide a large portion of the subsistence in the military food supply. Of particular significance were the efforts taken to prevent adulteration at Meals Ready-to-Eat plants, as these rations are vital to the Warfighter.
Installation food vulnerability assessments provide installation commanders and their antiterrorism officers (ATOs) with an overall picture of the food protection posture of all food facilities on an installation at any given time. The assessments are directly tied to current force protection condition measures and results are briefed to ATOs and installation commanders using the deliberate risk assessment model. Additionally, these results are used to develop the Veterinary Service annex to the installation emergency response plan. Incorporation of these assessments into the installation emergency response plan helps all key players understand the vital role that food defense personnel play during an actual emergency.
Food and water defense assessments at special events were designed specifically to reduce the vulnerability of food and water during large gatherings of DoD personnel. Veterinary Service personnel work closely with other public health entities and the installation ATO to identity vulnerabilities at these events and make recommendations that will effectively mitigate those hazards.
Food and water risk assessments were developed to address the insufficient number of approved food facilities in foreign countries hosting military exercises. In these situations, access to foods from approved sources is extremely limited, yet contracting officers must meet the intent of regulatory requirements. Highly-trained DoD public health specialists assess the risks associated with consumption of food from caterers, restaurants, and local host nation food facilities. These assessments are not inspections and do not produce a "pass" or "fail" but rather determine for operational commanders the expected overall risk exposure for their personnel if these establishments are used.
Thanks to the cooperative efforts of multiple local, state, and federal agencies across the country, we still have the safest food supply in the world. These public health professionals provide technical expertise throughout the continuum of the food supply chain from farm-to-fork. The defense of our nation's food and agriculture resources is now fully integrated in the day-to-day mission of US Army Veterinary Service personnel. The DoD mission will continue to change and budget constraints will inevitably challenge these professionals in their mission to ensure that critical resources are protected from those who mean us harm. Our collective national effort to support the safest food supply in the world will remain highly effective utilizing the systemic approaches developed by US Army Veterinary Service personnel to anticipate, detect, and mitigate our enemies' attempts to strike our food supply.
(1.) Oxford Dictionary [online]. Oxford University Press. 2014. Available at: http://www.oxforddic tionaries.com/definition/english/agroterrorism. Accessed December 11, 2014.
(2.) Olson D. Agroterrorism: threats to America's economy and food supply. Federal Bureau of Investigation Web site; 2012. Available at: http://leb. fbi.gov/2012/february/agroterrorism-threats-toamericas-economy-and-food-supply. Accessed December 11, 2014.
(3.) Downs T. Ends of the Earth. Nashville, TN: Thomas Nelson, Inc; 2009. Cited by: Homeland Security News Wire [serial online]. Agro-terrorism threat is real. September 3, 2009. Available at: http://www. homelandsecuritynewswire.com/agro-terrorismthreat-real. Accessed December 11, 2014.
(4.) Public Health Security and Bioterrorism Preparedness and Response Act, Pub L No. 107-188, 116 Stat 594 (2002). Available at: http://www.fda.gov/ RegulatoryInformation/Legislation/ucm155769. htm. Accessed December 12, 2014.
(5.) Bottemiller H. GAO: Lack of coordination for U.S. food defense. Food Safety News [serial online]. September 16, 2011. Available at: http://www.foodsafetynews.com/2011/09/gao-lack-of-coordinationfor-us-food-defense/. Accessed December 11, 2014.
(6.) FDA Food Safety Modernization Act, Pub L No. 111-353, 24 Stat 3885 (2011). Available at: http:// www.fda.gov/Food/GuidanceRegulation/FSMA/ default.htm. Accessed December 22, 2014.
(7.) Department of Defense 5200.08: Physical Security Program. Washington, DC: US Dept of Defense; May 2009. Available at: http://www.dtic.mil/whs/ directives/corres/pdf/520008r.pdf. Accessed December 22, 2014.
(8.) Department of Defense Directive 6400.04E: DoD Veterinary Public and Animal Health Services. Washington, DC: US Dept of Defense; June 2013. Available at: http://www.dtic.mil/whs/directives/ corres/pdf/640004E.pdf. Accessed December 22, 2014.
(9.) Department of Defense Instruction 2000.12: DoD Antiterrorism (AT) Program. Washington, DC: US Dept of Defense; September 2013. Available at: http://www.dtic.mil/whs/directives/corres/pdf/200 012p.pdf. Accessed December 22, 2014.
(10.) Department of Defense Instruction 2000.16: DoD Antiterrorism (AT) Standards. Washington, DC: US Dept of Defense; December 2006. Available at: http://www.dtic.mil/whs/directives/corres/pdf/200 016p.pdf. Accessed December 22, 2014.
(11.) Homeland Security Presidential Directive 7: Critical Infrastructure Identification, Prioritization, and Protection. Washington, DC: The White House. December 17, 2003. Available at: http://www.dhs. gov/homeland-security-presidential-directive-7#1. Accessed December 22, 2014.
(12.) Homeland Security Presidential Directive 9: Defense of United States Agriculture and Food. Washington, DC: The White House; January 30, 2004. Available at: http://www.gpo.gov/fdsys/pkg/PPP2004-book1/pdf/PPP-2004-book1-doc-pg173.pdf. Accessed December 22, 2014.
(13.) Presidential Policy Directive/PPD-8: National Preparedness. Washington, DC: The White House. March 30, 2011. Available at: http://www.dhs.gov/ presidential-policy-directive-8-national-prepared ness#. Accessed December 22, 2014.
(14.) Racino B. Flood of food imported to United States, but only 2 percent inspected. NBCNEWS.com [serial online]. October 3, 2011. Available at: http:// www.nbcnews.com/id/44701433/ns/health-food_ safety/t/flood-food-imported-us-only-percent-in spected/. Accessed December 22, 2014.
(15.) Oxford Dictionary [online]. Oxford University Press. 2014. Available at: http://www.oxforddictionaries.com/us/definition/american_english/ from-farm-to-fork-or-table-. Accessed December 22, 2014.
(16.) Keremidis H, Appel B, Menrath A, Tomuzia K, Normark M, Roffey R, Knutsson R. Historical perspective on agroterrorism: lessons learned from 1945 to 2012. Biosecur Bioterror. 2013;11(suppl 1):S17-S24. Available at: http://online.liebertpub. com/doi/pdf/10.1089/bsp.2012.0080. Accessed December 11, 2014.
(17.) Knowles T, Lane J, Bayens G, Speer N, Jaax J, Carter D, Bannister A. NIJ Research Report: Defining Law Enforcement's Role in Protecting American Agriculture from Agroterrorism. Washington, DC: National Institute of Justice; June 30, 2005. Available at: https://www.ncjrs.gov/pdffiles1/nij/ grants/212280.pdf. Accessed December 23, 2014.
(18.) Masters J. Militant extremists in the United States [internet]. Council on Foreign Relations Web site. February 7, 2011. Available at: http://www.cfr.org/ terrorist-organizations-and-networks/militant-ex tremists-united-states/p9236#. Accessed December 22, 2014.
(19.) Centers for Disease Control and Prevention. Glanders. CDC Website. Available at: http://www.cdc. gov/glanders/. Accessed December 22, 2014.
(20.) Zaitz L. Rajneeshees in Oregon--the untold story [internet]. The Oregonian. February 14, 2014. Available at: http://www.oregonlive.com/rajneesh/ index.ssf/2011/04/part_one_it_was_worse_than_ we.html. Accessed December 22, 2014.
(21.) Torok TJ, Tauxe RV, Wise RP, et al. A large community outbreak of salmonellosis caused by intentional contamination of restaurant salad bars. JAMA. 1997;278(5):389-395.
(22.) What are some examples of agroterrorism?. Extension.org Website. April 26, 2010. Available at: https://www.extension.org/pages/37146/what-aresome-examples-of-agroterrorism. Accessed December 22, 2014.
(23.) Center for Disease Control. Nicotine poisoning after ingestion of contaminated ground beef Michigan, 2003. MMWR Morb Mortal Wkly Rep. 2003; 52(18):413-416. Available at: http://www.cdc. gov/mmwr/preview/mmwrhtml/mm5218a3.htm. Accessed December 22, 2014.
(24.) Lui M. Frozen foods in pesticide recall sicken 900 in Japan, NHK says. Bloomberg News [serial online]. January 17, 2014. Available at: http://www. bloomberg.com/news/2014-01-08/frozen-foodsin-pesticide-recall-sicken-900-in-japan-nhk-says. html. Accessed December 22, 2014.
(25.) Schmitt G. Agroterrorism-why we're not ready: a look at the role of law enforcement. NIJ Journal. June 2007(257). Available at: http://www.nij.gov/ journals/257/pages/agroterrorism.aspx. Accessed December 22, 2014.
(26.) National Defense Research Institute. Agroterrorism. What is the threat and what can be done about it? [internet]. Rand Corp Web site. 2003. Research Brief. Available at: http://www.rand.org/content/ dam/rand/pubs/research_briefs/2005/RB7565.pdf. Accessed December 22, 2014.
(27.) Branigin W, Allen M, Mintz J. Tommy Thompson resigns From HHS. WashingtonPost.com [serial online]. December 3, 2004. Available at: http://www.washingtonpost.com/wp-dyn/articles/ A31377-2004Dec3.html. Accessed December 22, 2014.
SFC Gill is a Veterinary Services Senior Noncommissioned Officer, Food Protection Program, Army Institute of Public Health, US Army Public Health Command, Aberdeen Proving Ground, Maryland.
|Printer friendly Cite/link Email Feedback|
|Author:||Gill, Kevin M.|
|Publication:||U.S. Army Medical Department Journal|
|Date:||Jan 1, 2015|
|Previous Article:||US Army public health: one health, one medicine, one team.|
|Next Article:||Evaluation of the US Army Institute of Public Health Destination Monitoring Program, a food safety surveillance program.|