The term ‘Medical Intelligence’ or MEDINT has been in use since World War II, but assumed much prominence in the wake of the COVID-19 pandemic. Mainstream media outlets reported that despite routine collection of MEDINT, national intelligence services of certain developed countries fell short of predicting or preparing for a bio-hazard.

Outside the developed world, the concept of MEDINT eluded even the topmost national security planners, at least prior to COVID-19. It was beyond anyone’s imagination that a little known virus, spread in Wuhan (China), will expand globally through passengers’ transmission. Calling it short-sightedness would be somewhat unfair, since the threat of hybrid conflicts and nuclear wars took up most of the contingency planning and preparedness.

The threat of chemical, biological, radiological and nuclear (CBRN) attacks has been routinely factored into the training regimen of Pakistan Armed Forces and the National Disaster Management Authority, though a few may have imagined a scenario involving bio-hazards from disorganised/irregular carriers i.e. ordinary citizens who may or may not be aware that they are infected. This has severely complicated the threat analysis paradigm while also impacting overall relief efforts. Alternatively, this phenomenon has rejuvenated the debate about adequate priorities to non-traditional security threats.

To understand the rationale behind MEDINT, it is helpful to examine doctrinal definitions espoused by some of the world’s leading armed forces.

The definition of MEDINT in the US Department of Defence Dictionary, also mentioned in the 2017 Joint Publication 2-01 ‘Joint and National Intelligence Support to Military Operations,’ is:

“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. Also called MEDINT.”

Similarly, NATO’s 2019 Allied Joint Doctrine for Medical Support (AJP-4.10) defines MEDINT as:

The key difference we can observe in the doctrinal literature of the two trans-atlantic military camps is that while NATO countries include epidemiological information as part of MEDINT, the US does not.

“Medical intelligence is the product resulting from  the  directed  collection  and  assessment  (processing)  of  medical,  bio-scientific,  epidemiological,  environmental  and  other  information  related  to human   or   animal   health,   to   identify   threats   and   offer   opportunities for exploitation by decision-makers. Medical intelligence is not to be used, to take any advantage of medical vulnerabilities of any party as this would be a serious violation   of   fundamental   ethical   and   legal   conventions   and   likely   have deleterious effects.”

The key difference we can observe in the doctrinal literature of the two trans-atlantic military camps is that while NATO countries include epidemiological information as part of MEDINT, the US does not. This could provide an indication as to why the Chairman of the US Joint Chiefs of Staff General Mark Milley was unable to conclusively pin the blame for the outbreak on China. As always, accumulation of intelligence does not necessarily imply readiness; NATO’s own COVID-19 Task Force leader admitted the alliance was caught “a little off-guard.”

Existing methods of intelligence collection can be employed to obtain sensitive healthcare data or research work, a few scenarios that come to mind are as follows:-

• Human Intelligence (HUMINT): Field operators present in target states can be embedded within target organisations (government or private) and even industrial corporations to collect data, report unusual activities first-hand and recruit local assets, creating counterintelligence issues.
• Signals Intelligence (SIGINT): Tapping into classified communications of medical staff detained with a target state’s national leadership including personal medical doctors who conduct regular check-ups of military and intelligence top brass.
• Imagery Intelligence (IMINT): Conducting reconnaissance of national and especially military medical research institutes which are under construction.
• Open Source Intelligence (OSINT): Scouting the deep web to identify leading public health specialists of a country to map their social network or to retrieve sensitive healthcare records of government officials recklessly uploaded online without safeguards (such as login authentication).
• Cyber Intelligence (CYBERINT): Conducting social engineering or technical hacks on identified targets which could involve intrusion into official correspondences and sensitive records.

By and large, the MEDINT process involves a meticulous collection of credible information from different domain intelligence specialists which would then require proper analysis by subject-matter experts including biostatisticians, epidemiologists, microbiologists and regular data analysts working in tandem, not in silos.

It would be deeply imprudent if intelligence operators of these distinct domains are asked to perform their own analysis as the required ‘medical’ expertise can only come from people educated and trained in this specific context and who are able to assist in operations and forecasting through the ‘medical lens.’

By and large, the MEDINT process involves a meticulous collection of credible information from different domain intelligence specialists which would then require proper analysis by subject-matter experts including biostatisticians, epidemiologists, microbiologists and regular data analysts working in tandem, not in silos.

Once MEDINT has been acquired, it can be used for Preparedness, Coercion or Harm. To understand the negative implications better, consider the following hypothetical scenarios:

• Scenario I – Hostile actors manage to access sensitive healthcare data of a target state’s senior leader through OSINT-CYBERINT and silently distort/manipulate his record so that they are deemed unfit for further service. This scenario involves a silent ‘sneak-in-and-mess-it-up’ approach rather than leaking it for the public (customary of hackers).
• Scenario II – Hostile actors sabotage important counter-CBRN threat research work being undertaken at a top secret government facility through a combination of HUMINT, SIGINT and IMINT. As a consequence, the resistive capacity of frontline military units fighting against an enemy who could use bio-weapons becomes retarded, also impacting the durability of certain hardware and other equipment in a CBRN environment.
• Scenario III – Hostile actors acquire extremely sensitive medical records from military hospitals across a target state and hold it for ransom, enabling them to prompt favourable behavioural changes through coercion/blackmail of its senior leadership who are left helpless in the face of an unknown adversary.

Once MEDINT has been acquired, it can be used for Preparedness, Coercion or Harm.

A more harrowing scenario would involve the use of MEDINT to facilitate targeted assassinations of state leaders. While this may seem farfetched today, the US National Security Agency and Central Intelligence Agency considered hostile exploitation of MEDINT more than a decade ago; this process included the collection of DNA samples from different diplomats posted to the UN, including the ones from Pakistan.

COVID-19 has managed to disrupt the operational environment and alter strategic stability dynamics, prompting a global re-think of priorities. It would be prudent for Pakistan’s national leadership to shed-off the thick skin of its status quo and prepare for the future by investing in MEDINT. Efforts made now will yield results years later.