The National Center for Medical Intelligence (NCMI) is a component of the US Defense Intelligence Agency (DIA), the intelligence branch of the US Department of Defense (DoD). It is headquartered at Fort Detrick, Maryland, historically known as the home of the US Army Biological Warfare Laboratories (1943-1969). With its sole focus on the analysis of health information, it is the main producer of medical all-source intelligence in the United States. It presents its intelligence product to decision-makers in the US and allied partner nations.
1 What is Medical intelligence?
The DoD defines medical intelligence (MEDINT) as:
“That category of intelligence resulting from collection, evaluation, analysis, and interpretation of foreign medical, bio-scientific, and environmental information that is of interest to strategic planning and to military medical planning and operations for the conservation of the fighting strength of friendly forces and the formation of assessments of foreign medical capabilities in both military and civilian sectors.” [source]
Thus, MEDINT informs decisions by analysing potential foreign health threats to armed forces, tracking and predicting global health issues, monitoring bioterrorism threats, assessing the health of foreign leaders, and evaluating medical capabilities of foreign nations, including their impact on military operations.
At the strategic level, MEDINT identifies broad trends in foreign biomedical research and development. The goal is to assess threats to national security, such as technologies with dual-use capabilities (e.g., a pharmaceutical facility that can also produce chemical weapons components). On the operational and tactical levels, MEDINT detects threats to deployed personnel. Examples include infectious diseases, environmental hazards, and chemical and biological agents. [source]
2 NCMI: Historic background
The NCMI traces its roots to a MEDINT section within the U.S. Army Surgeon General’s Office during World War II. Its goal was to support military governance in occupied German territories.
With the beginning of the Cold War, the need for MEDINT continued to rise. This lead to the establishment of the U.S. Army Medical Information and Intelligence Agency in 1956. This agency underwent multiple transformations, ultimately becoming the Armed Forces Medical Intelligence Center (AFMIC) in 1982. In 1992, AFMIC was permanently transferred to the DIA. This marked an important evolution of intelligence components of medical nature into the broader spectrum of national security and defense. [source]
In 2008, AFMIC was officially set up as the NCMI. This reflects its expanded role in producing all-source medical intelligence to protect U.S. interests globally and its responsibility of linking defense strategies with health protection. [source]
3 Structure of the NCMI
While other countries conduct similar intelligence, the NCMI stands out as being the only specialised MEDINT center of its kind.
The NCMI is organized into multiple divisions responsible for various aspects of MEDINT: [source]
- Epidemiology and Environmental Health Division: Focuses on identifying and evaluating environmental risks and infectious disease threats that can affect mission effectiveness and long-term health implications.
- The Medical Capabilities Division: Assesses foreign military and civilian medical capabilities, treatment facilities, medical personnel, and emergency and disaster response logistics.
- Life Sciences and Biotechnology: Evaluates foreign biomedical and biotechnological developments, as well as civilian and military pharmaceutical industry capabilities.
- Global Health Systems Division: Examines the medical capabilities of countries worldwide. This division maintains a Department of Defense (DoD) database on foreign military and civilian medical infrastructures, including all medical facilities, laboratories, blood banks, and pharmaceutical plants
3.1 MEDINT Methods
Contrary to other agencies such as the CIA or DIA, the NCMI usually does not deploy its officers to foreign countries for intelligence collection. The NCMI gathers the bulk of the necessary information through open-source intelligence (OSINT). Sources include newspaper publications (e.g. local reports about unknown disease spreading in a certain region) and social media (e.g. scientists posting about their work). [source]
To conduct an interdisciplinary analysis, the NCMI employs a variety of subject matter experts – toxicologists, (veterinary) epidemiologists, chemical engineers, virologists, microbiologists etc. The NCMI also relies on other agencies for classified intelligence products – satellite imagery, intercepted communications, and samples or documents collected by operatives abroad – to further analyse them from a medical perspective. [source]
The cooperation with other agencies is crucial for its role as not all information is publicly available and sometimes deliberately obscured (e.g. a foreign government can embellish its response to a health crisis). This helps it to create a more accurate picture of how certain hazards might impact adjacent US troops or how a disease is affecting the local population. [source]
The access to classified data streams and extensive collaboration with multiple agencies is what sets it apart from other sources of medical information, such as the World Health Organisation (WHO) or the Center for Disease Control and Prevention (CDC). The NCMI provides predictions and analyses on issues before they become public, tying it to its national security mission.
U.S. Army National Guard photo by Pfc. Isaiah Matthews.
4 MEDINT in Practice
Despite working in a specific niche within the intelligence world, NCMI’s expertise and insights from MEDINT are important for decision making in various scenarios.
4.1 Prediction and Assessment of Health Crises
In 2009, the NCMI foresaw the pandemic potential of the H1N1 virus months before the WHO and CDC declared it a pandemic. [source]
During the Covid-19 pandemic, the NCMI played a major role in navigating the health response, assessing foreign reporting of the pandemic, and informing health-related decisions. Its analyses were reportedly part of the president’s daily briefings. [source]
A timely analysis of pandemics and health crises is paramount for any government to maintain its combat capabilities as sickness can be more devastating than casualties to military readiness. [source]
In 2020, a Covid-19 outbreak exacerbated by the close-quarter living conditions on the US aircraft carrier USS Theodore Roosevelt led to a major quarantine of a significant part of its crew, decreasing its combat readiness during this time. [source]
4.2 Assessing the Health of Foreign Leaders
Understanding the health conditions of foreign leaders can provide diplomatic leverage and exploitation opportunities, while also helping to predict future trends in a country’s policy.
In the US, the CIA, next to the NCMI, also has a medical intelligence unit. Their goal is to assess the health conditions of foreign officials and thereby predict how leaders might act or react in different scenarios. For example, certain medication can affect cognitive (and thus decision-making) abilities. In authoritarian countries, knowing about the deteriorating health conditions of a leader can help predict a possible succession and shifts of power. [source]
Overtly, an official’s health can be assessed by analysing open-source photo and video material. Changes in physical appearance, weight, hair loss, skin color, walking patterns etc. can provide insights into health changes. Covertly, medical intelligence can be gathered by obtaining travel plans, recruiting assets with access to sensitive medical information or hospital records, obtaining hair and urine samples or by securing information on drug use. This information can add valuable health insights in conjunction with intelligence gathered through other means. Such collection has also led some world leaders, like Russian President Vladimir Putin, to institute countermeasures to conceal ailments, including guards who collect his urine and fecal matter produced during trips outside of Russia. [source, source]
4.3 Biological and Chemical Warfare
MEDINT plays an important role in identifying potential man-made biological threats, but also by providing early warning of naturally-occurring foreign diseases. Diseases can spread through many channels, including imported food, animals and livestock, immigration waves, or returning military troops.
The US herbicidal warfare against Vietnam, the Anthrax attacks from 2001, and the use of chemical weapons in Syria are all reminders that biological and chemical agents can be weaponised against civilian populations or used in combat. [source, source, source]
MEDINT is part of the response to identify and mitigate such threats and inform policy makers and military leaders.
4.4 Military
Medical information is important for decisions in a military theaters and during military operations. All components of a military rely on medical services and all components need intelligence of a medical nature as part of their common operating picture (COP) to plan and execute operations.
MEDINT is also informs military planners about host nation support and medical facility locations. Through the analysis of foreign medical capabilities, planners can identify vulnerabilities in adversaries’ medical supply chains and combat ineffectiveness among enemy troops, improving operational awareness. [source]
4.5 Assessing Capabilities of Foreign Powers
The NCMI takes part in evaluating foreign medical capabilities and biotechnology industries. It helps to gain insights into chemical and biological weapons facilities and in understanding disease transmission patterns. Additionally, it supports the analysis of foreign advances in responding to chemical, biological, radiological and nuclear (CBRN) threats.
The study of such countermeasures can provide insights into adversaries’ intentions. For instance, information about medical research conducted in Iran involving human exposure to chemicals and pesticides allowed for an assessment of Iran’s medical response capabilities to chemical and biological threats. [Source]
5 Conclusion
MEDINT plays a critical role in supporting national security and military operations, informing public health interventions, and assessing biological threats. Despite its importance, it is often overlooked, especially among the “bigger” types of intelligence such as HUMINT or SIGINT, with which MEDINT often works in conjunction.
In the US, the NCMI is the premier dedicated institution for medical intelligence. Its importance is likely to increase in the future. Climate change poses an increasing health risk to troops and civilian populations. Natural disasters and rising temperatures can facilitate the spread of diseases. Many countries, including US adversaries China and Russia, maintain robust chemical and biological warfare capabilities.
The NCMI and its MEDINT expertise will continue to be essential in addressing these emerging challenges.
