CRDAMC is one of 16 distinct locations designated as a pilot site for the Pfizer BioNTech COVID-19 vaccine, following a Department of Defense announcement in December. CRDAMC provides weekly reports to the DoD regarding lessons they have learned.

Saying that we are “at war” frames the significance and high stakes in America’s response to the COVID-19 pandemic. But those that haven’t been to combat may not realize how current circumstances replicate war – not symbolically or hyperbolically – but pragmatically.  The past decades have been fertile times for combining contemporary technology with classic learning to create modern military theory. It makes sense for military, civic and hospital leaders to appropriate these concepts to confront the COVID-19 dilemma. War-tested lessons regarding the spectrum of war and the phases of war provide paradigms worthy of exploration.

Conflict exists on a spectrum from peace, to counterinsurgency, to conventional warfare (with other types of conflict in between). In January and February of 2020, America envisioned COVID-19 as an aggressor and prepared for a conventional invasion. To do so, it restricted foreign travel and rerouted flights from high-risk areas to eleven airports deemed capable of detecting the illness. Such measures were designed to prevent the entry of the virus into the American homeland. The military term used to define protecting one’s borders is area defense. It shares many parallels with the containment strategy described by epidemiologists to halt a pandemic. In both, the enemy is assumed to be identifiable by tell-tale characteristics. Its attacks are detected, isolated, and neutralized at the border. In mid-March 2020, in an alarming point of inflection, America acknowledged that it had not – and could not – keep COVID-19 out. The virus had seized the initiative, was moving invisibly amongst the populace, and was gaining power. In military terms, the conventional war had transitioned to a counterinsurgency. Insurgencies are characterized by an invisible and elusive enemy, recognizable sometimes only by its devastating effects. One must be suspicious of all and self-protection becomes more important than border security. Epidemiologists call this posture “mitigation” and social distancing is its main feature.

In war, these distinctions are more than academic. Knowing what conflict you are fighting is important – because each must be fought with a different mix of offensive, defensive and stability capabilities. Furthermore, it is better to direct transitions from one end of the spectrum to the next rather than react as the enemy does so. We are at such a decisive point and should seize the initiative, this time with offense as the dominant form of maneuver. Operation Warp Speed has given us the ammunition we need to reverse the momentum in the COVID-19 war.  Offensive options are available to us in the form of vaccines that are both safe and over 90% effective in protecting their recipients.

While the spectrum of war describes types of conflicts, the phases of war illustrate how an offensive force should behave chronologically over the course of a war.  The phases of war include Shape (phase 0), Deter (I), Seize the Initiative (II), Dominate (III), Stabilize (IV), and Enable Civil Authority (V). In January of 2021, armed with the vaccine, the world stands on the threshold of phase II.  How does the vaccine provide an offensive capability? It does so by definitively denying the virus the resources it needs to exert its harmful effects. The non-immune physical bodies of the community itself provide the virus the “key terrain” it needs to spread. From its residence in the “herd,” COVID-19 maneuvers to attack and kill the most vulnerable. Arguably, we will begin to “Dominate” (Phase III) when we vaccinate enough of society to achieve “herd immunity,” denying the virus the sanctuary of our healthy bodies. Because the vaccine is not mandatory, America will once again rely on volunteerism and patriotism to defeat its enemies.

Unfortunately, early signals are concerning for some young Americans choosing to opt-out of the vaccine. While some have legitimate concerns, others are may simply be indecisive. To those I would ask, “Why would you not suffer the small pinch of the vaccination needle to protect our vulnerable population, defeat the virus, and win the COVID-19 war?”

These opinions or assertions contained herein are private and are not to be construed as official or reflecting the views of Carl R. Darnall Army Medical Center, the Army Medical Department, Fort Hood, III Corps, or the U.S. Army.