JOINT RESEARCH ON HEALTH/ENVIRONMENTAL EFFECTS OF

UNCLAS SECTION 01 OF 08 HANOI 000923 SIPDIS SENSITIVE BUT UNCLASSIFIED DEPT FOR EAP/BCLTV (EDUNLAP),OES/STC (BPERRY), STAS (GATKINSON),EAP/RSP, EAP/PD, AND OES/PCI DEPT PASS HHS FOR OGHA/STEIGER; NIH/FIC/GKEUSCH; NIH/NIEHS/KOLDEN, ASASSAMAN; CDC/OGH/BLOUNT; CDC/CEH/SINKS, BARRETT, NEEDHAM; FDA/OIA/WBATTS DEPT PASS USAID FOR G/ENV, G/H DEPT PASS EPA FOR ORD/WFARLAND DEPT PASS OSTP FOR WGAINES BANGKOK FOR REO SECDEF ALSO FOR ISA/AP/LSTERN AND ES/WVAN HOUTEN USDA FOR FAA/AO/SSAP/HEUTE, ITP/ODA/SHEIKH NSC FOR BEARDSWORTH E.O. 12958: N/A TAGS: SENV PREL TBIO VM SUBJECT: JOINT RESEARCH ON HEALTH/ENVIRONMENTAL EFFECTS OF AGENT ORANGE/DIOXIN - UPDATED STATUS REPORT SENSITIVE BUT UNCLASSIFIED - PLEASE PROTECT ACCORDINGLY REF: USDAO U-066-04, dated 01 March 2004 ¶1. (U) This is an action cable. Embassy recommends that the USG Agent Orange/Dioxin Interagency Working Group meet to review and discuss the contents of this cable. ¶2. (SBU) SUMMARY: More than two years after the March 2002 signing of a Memorandum of Understanding (MOU) to address joint research on health, environmental and ecological effects of dioxin and Agent Orange in Vietnam, U.S. and Vietnamese researchers have made some tangible progress in the one environmental research project being conducted at a dioxin "hot spot" in Da Nang Airbase. The only progress in health research, however, has been to budge the Vietnamese bureaucracy to review, but not yet approve, the one small pilot case control study to evaluate some birth defects. Highlights of activities and events over the past 12 months include the following. --Environment: Since October 2001, the U.S. Environmental Protection Agency (USEPA) and the Vietnam Academy of Science and Technology (VAST) (formerly, the National Center for Natural Sciences and Technology - NCST) have been engaged in a collaborative program. The program is designed to characterize the nature of dioxin contamination in soil and to select remediation methods suitable to the task as well as to GVN budget constraints and the target 2,3,7,8-tetrachlorodibenzo-p-dioxin (2,3,7,8- TCDD) concentrations in soil established by the GVN. To date, the collaboration is moving forward with the installation of the Gas Chromatograph/Mass Spectrometer (GC/MS) at VAST planned for spring 2004 and development of the site characterization plan for the dioxin "hot spot" in Da Nang. --Health: In January 2003, NIEHS approved funding for the State University of New York at Albany (Albany University) in collaboration with Vietnam's Ministry of Health (MOH) to conduct a small pilot case control study to evaluate some birth defects with respect to maternal and paternal serum 2,3,7,8-TCDD concentrations. As of March 2004, the research proposal had undergone "expert" review by the MOH, but had not yet reached Vietnam's National Steering Committee 33, the interagency entity that controls/approves all activities related to Agent Orange. Post expects a long delay in receiving the approval from Committee 33. In fact, we would not be surprised if the Vietnamese make substantive changes to the proposal that will be unacceptable to NIEHS. In January 2004, NIEHS conveyed to MOH and to Minister of Natural Resources and Environment Mai Ai Truc, who serves as Chairman of Committee 33, that NIEHS may not be able to hold the funds targeted for this project much longer. The funding, approximately USD 3,000,000, has been set aside but not released to the vendors. (COMMENT: In March 2003, Embassy's assessment was that the GVN would attempt to control, disrupt, or block any research project that could potentially produce scientific evidence that refuted the GVN's allegations of broad, catastrophic damage to the health of Vietnamese citizens, especially birth defects. One year later, this assessment has not been proven wrong. Committee 33's response/comments on the health research project will provide valuable insights into Vietnamese attitudes and intentions. END COMMENT.) -- Lawsuit and Intensified Media Campaign: In conjunction with a lawsuit filed in a New York City court in January 2004 by the newly created "Vietnam Association for Agent Orange Victims" (VAAOV),the state-run media has been running a series of reports about Agent Orange "victims" and showing pictures of children and adults with obvious mental and physical disabilities attributing the disabilities to Agent Orange. These and other articles directly state or imply that the USG should provide "compensation" or "take responsibility" for actions taken during the war, including supporting disabled children deemed victims of the war. The media also now is reporting on an online petition sponsored by the Britain-Vietnam Friendship Association calling upon the U.S. President, government and responsible chemical companies to compensate Vietnamese victims of Agent Orange. (COMMENT: The GVN continuously publicly calls upon for the U.S. to provide support for alleged Agent Orange victims, which it identifies without the backing of scientific evidence. These scientifically disingenuous comments may make it difficult for the GVN to support results of studies which may show these repeated statements false, the GVN's health system seriously flawed, and its use of the disabled for propaganda cynical. END COMMENT.) --Ministry of Defense (MOD) Proposal to U.S. DOD: Reftel describes Vietnam MOD's proposal for U.S. DOD cooperation to "clean up and decontaminate toxins" - AO/dioxin and CS - used during the Vietnam War. Embassy recommends that, if DOD decides to offer any assistance with AO/dioxin "hot spots," this assistance should be coordinated with USEPA and NIEHS and be focused on supplementing the ongoing program at the Da Nang site. MOD has been a participant in that activity, and must continue to participate since the site is located on military property. MOD's proposal for cooperation on disposal of CS is not within the scope of ongoing programs related to AO/Dioxin and should be considered as a separate issue. END SUMMARY ¶3. (U) Provided below is a detailed review of the status of the joint research initiatives and programs conducted by USEPA and NIEHS with Vietnamese counterparts, as well as opinions/attitudes expressed by key Vietnamese players. -------------- -------------- U.S.-Vietnam Scientific Workshop on Methodologies of Dioxin Screening, Remediation and Site Characterization -------------- -------------- ¶4. (U) From November 3-5, 2003, a workshop titled "U.S.- Vietnam Scientific Workshop on Methodologies of Dioxin Screening, Remediation and Site Characterization" was held in Hanoi. The meeting was sponsored by the VAST (formerly (NCST) and NIEHS, USEPA, University of California at Davis (UC-Davis),Department of Civil and Environmental Engineering, Michigan State University (MSU),Office of International Studies and Programs, Michigan State University and the Ford Foundation. Its purpose was to focus on three avenues of research: (1) development of bioanalytical and analytical methods to detect and/or estimate the relative biological and toxicological potency of samples containing dioxins and related chemicals; (2) examination of remediation methods to degrade and/or detoxify soil containing dioxins and related chemicals; (3) characterization of sites contaminated with dioxins and related chemicals; (4) and, development of safety and health guidelines to protect individuals working at contaminated sites. Attendance was limited to U.S. and VN participants and invited guests. Participants from VN included individuals from VAST, Hanoi National University, Ministry of Defense (MOD),Ministry of Health (MOH),Office 33, Vietnam Veterans Association, and Ministry of Science and Technology. Participants from the U.S. included individuals from USG agencies, universities and private industry. ¶5. (U) During the workshop participants described analytic methods suitable for detection or measurement of dioxin in soil or other media including immunoassays, cell-based assays and chemical methods. These methods may be used for screening for the presence of dioxin, measuring dioxin concentration in environmental and biologic media, and assessing conger-specific profiles. All may be applied to characterize the concentration and location of soil contamination. Remediation approaches appropriate to reducing the concentration of contaminants include thermal, chemical, or biological degradation or containment and may involve one or a combination of methods. The Government of Vietnam expressed more interest in remediation methods that are less costly and somewhat less effective versus methods known to more completely clean up. They are also willing to apply less well tested/studied methods, e.g., biodegradation and isolation (less well studied and thought to be less costly) versus incineration (which has been determined to be effective and well-studied). ¶6. (U) The workshop recommendations noted that to identify the location(s) and concentration of dioxin in soil of the contaminated sites, the Vietnamese scientific and laboratory infrastructure must be augmented. The necessary improvements include acquisition of appropriate instruments, identification of suitable and cost effective analytical methods and training in these methods. In addition, some needs could be met by using existing programs that train individuals at the graduate level, e.g., U.S. AID programs and the Fogarty International Center. Development of an academic consortium to aid in this process was thought to be instrumental in this process. Recommended members of the consortium include UC-Davis, MSU, VAST, Institute of Biotechnology, universities and other organizations based in Vietnam. This group would be structured to collaborate on research projects, the results of which would be published as joint publications in the international peer reviewed literature. ¶7. (U) Noteworthy recommendations and comments relevant to analytic methods and site characterization included the following. USEPA would provide guidance on geostatistics and the selection and purchase of publicly available software for site characterization. USEPA would also assist VAST in the development of the experimental design for logical bench/pilot testing. Development of a good bioassay, validated by well known analytic methods, is critical to be able to analyze larger numbers of samples at lower cost. Selection of remediation technologies should take into account both cost and effectiveness and that multiple treatment regimens could be utilized to obtain the desired treatment effect. The types of treatment technology may differ based on the concentration and dispersal of contamination, e.g., concentrated (localized) contamination versus dispersed contamination. An international conference to describe and discuss the array of the most appropriate remediation technologies is necessary for the planning process. The areas targeted for remediation are Da Nang airport, Bien Hoa Airport and Phu Cat. USEPA and others would provide to Vietnamese partners occupational safety and health technology and information from publicly available websites, e.g., NIOSH, OSHA, ILO, WHO, and others; evaluate the possibility of translating suitable information and training materials into Vietnamese; and develop training and evaluation programs for researchers and site workers. This will require working with partners in Vietnam - these individuals have not yet been identified. Share existing technology for protecting workers employed to clean up contaminated waste sites. ¶8. (U) The remediation cleanup standard accepted by GVN is 1000 ppt (parts per trillion) for non-agricultural use (military or industrial) and is 100 ppt for agricultural or residential use. The GVN has agreed that the targeted goal for "cleanup" for Da Nang is 1000 ppt, 2378-TCDD, and that the target for completion of the clean up/remediation of Da Nang is 2005. -------------- -------------- USEPA Collaboration with Vietnam Academy of Science and Technology (VAST) -------------- -------------- ¶9. (U) Since October 2001, the USEPA has collaborated with VAST to transfer analytical technologies and training and to build laboratory capacity at VAST. These activities included assistance in the selection of appropriate analytical techniques to detect concentration of dioxin in soil, provision of training to VAST scientists in Hawaii on the selected analytic techniques, and the transfer of a functioning high resolution GC/MS from the United States, glassware and reagents to Vietnam at no cost to VAST or the Government of Vietnam. ¶10. (U) In a follow-up meeting on November 7, 2003, with Dr. Dang Vu Minh, President of the Vietnam Academy of Science and Technology, Dr. William Farland, Acting Deputy Assistant Administrator for Science, Office of Research and Development, USEPA, described the status of the USEPA-VAST collaboration. He reported that USEPA is installing the CALUX Assay at VAST and that USEPA is providing VAST capacity (financial support) to purchase 1500 CALUX tests over the next 2 years and the necessary training and consultations. USEPA is purchasing a license for the CALUX Assay. The CALUX assay is a short-term test that can identify the presence of 2,3,7,8-TCDD in soil. Once obtained, the license will be transferred to VAST. There is precedence for a U.S. agency to award such a contract for the benefit of another country. The license will also include training of Vietnamese scientists on the CALUX and expert consultation for two years. Although the USEPA will provide 2 years of support and sufficient capacity to analyze 1500 soil samples with CALUX, they will not act as mediator once the license is obtained for VAST. In January 2004, USEPA awarded the contract for the installation and calibration of the GCMS. If all goes according to plan, the GCMS should be operational by the middle of April 2004. ¶11. (U) USEPA is also working with VAST to design the site characterization plan for sampling at the Da Nang Airport site. The following activities are to be completed prior to finalization of the plan: complete analysis and preparation of the report on ten soil samples for dioxin levels analyzed in Vietnam and U.S.; develop Da Nang Site Characterization Plan; obtain site Access and permission to sample; obtain site Map with GPS coordinates; develop sampling design and sampling grid; develop plans for sampling and analysis (phased design),quality assurance/quality control, health and safety program (heat, chemical, UXO hazards); develop plans for sample preparation/archiving, sample analysis, data analysis, evaluation and interpretation of results. Currently, the tasks listed above are being developed but have not been completed or vetted by all collaborating parties. The next steps in the process include: identification of mechanisms for further training/experience with analytical techniques; transfer of CALUX Assay capability including further training and sampling capacity and training of VAST staff on the GC/MS. ¶12. (U) Discussions about how and where to take samples at the Da Nang site identified the following issues: USEPA volunteered to identify and provide new GIS software to map the contaminated site and to accurately position sampling locations. Surface sampling and sampling of streams flowing from the site was more important than deep sampling because, although dioxin contamination may be as deep as one meter, streams move contaminated surface soil from the site to other areas, including lakes. Deep contamination is less likely to be disturbed. Before any samples can be taken at any site it is necessary to obtain permission from the MOD. Dr. Minh indicated that he would help smooth the way. We do not know if this has happened. USEPA and NIEHS representatives suggest that Vietnam consider preserving a part of the contaminated area as a "natural resource". This area would not be part of the remediated area, but would be used to pilot test new remediation methods as they are developed. ¶13. (U) A number of reputable laboratories have developed validated techniques for analysis of dioxins and related chemicals contained in a variety of media, e.g, soil, serum, tissue, plant material. Dr. Minh said VAST will focus first on gaining expertise for techniques for the analysis of dioxin in soil, food or other media where dioxin concentrations are moderate. He indicated that analysis of medium containing low concentration of dioxins, such as in human serum, is difficult to conduct and takes considerable experience. In addition, prior to analyzing the concentration of dioxins, it must be abstracted from the medium. Currently, VAST does not have the facilities to extract dioxin from soil and need to have more extensive extraction process for analysis by GCMS. Dr. Farland indicated that USEPA might be able to bring someone to Vietnam from the USEPA who is knowledgeable in extraction methods to train the Vietnamese scientists in the methodology. Dr. Minh also noted that he wants VAST to build capacity at the remediation site, e.g., Da Nang that is to establish a mobile testing lab. The CALUX assay has been validated under field conditions, and, thus can be performed at the site. ¶14. (U) In 2002, VAST and USEPA scientists took soil samples from the Da Nang site to begin the characterization process and to begin training VAST scientists on the short- term assays, e.g., CALUX and immunobioassays. Split samples were shipped to the U.S. and analyzed by GCMS for a number of analytes including dioxins and furans. The USEPA produced a complete report. VAST was supposed to have the split samples kept by the Vietnamese analyzed at an independent laboratory; however, this was not accomplished due to the lack of funding. ¶15. (U) VAST and USEPA set a tentative date for the inauguration of the HRGC/MS and site characterization at the Da Nang airport for the first week in April 2004. This may not happen in this time frame for several reasons. The installation and calibration of the HRGC/MS was delayed due the refusal of the installation contractor to travel to Vietnam due to the Avian Influenza outbreak and the need for extra paperwork to import a pump oil. -------------- -------------- Request from Committee 33 for Report of Past and Proposed Activities of USEPA and VAST -------------- -------------- ¶16. (SBU) On March 4, 2004, Dr. Ha informed Embassy Health Attache, that Minister Truc requested an accounting of all work that had been accomplished on Project 2, the site characterization and remediation methods development project, and what was planned, including the amount spent on the project and the amount planned to be spent. Scientists from the USEPA are preparing the U.S. report based on detailed project meeting reports. VAST scientists also explained that the funding information from the U.S. would permit the GVN to provide similar funding to VAST. The date for completion of the report is open. However, it appears that Committee 33 might not permit the Da Nang project to move forward until this document is received. -------------- -------------- Activities related to NIEHS-funded Birth Defects Study -------------- -------------- ¶17. (SBU) On November 8, 2003, Dr. Anne Sassaman, Director, Extramural Grant Program, NIEHS, and Embassy Health Attache, and Embassy EST Officer met with Minister Truc, Minister of Natural Resources and the Environment and Chairperson of Committee 33. Dr. Sassaman requested the meeting because of the very long delays in the GVN review of the proposal and the resulting delay in the start of the study. Minister Truc said he has the responsibility to coordinate all stakeholders in order to have a scientific assessment of the consequences of Agent Orange in Vietnam. He continued by saying, "Everything must be done on a scientific basis," and expressed appreciation for the contribution of U.S. scientists. Dr. Sassaman said that the USG wanted to make progress on the activities specified in the MOU, specifically regarding the health study. One issue was the lack of the establishment of a Joint Committee, which was included in the MOU per the request of the Vietnamese negotiators. The U.S. has named members to the Joint Committee; Vietnamese have not appointed their members. Minister Truc said that the lack of a joint committee was a stumbling block but that the key question was how to organize the research in an effective way. One problem he saw was that people were waiting for answers and that the research took too long and that the research time should be shortened. Dr Sassaman reiterated that the U.S. was anxious to get the birth defects study started and wanted to know if there were any problems that the Vietnamese had with the study. He did not seem to know the answer. Mr. Truc did not give an indication that he would facilitate the MOH and Committee 33 review process, which may prove to a stumbling block in the progress of the project. ¶18. (SBU) On November 11, 2003, Dr. Sassaman, NIEHS official Dr. Christopher Portier, and Embassy Health Attache met with Dr. Nguyen Van Tuong, GVN co-investigator of the human birth defects study in order to review the progress of the human health study of selected birth defects to be funded by NIEHS. (NOTE: As background, Dr. David Carpenter of the State University of New York at Albany (University at Albany) submitted a short proposal to conduct a pilot case control study to evaluate selected birth defects in relation to maternal serum dioxin concentrations. The proposal was reviewed according to NIH guidelines, revised accordingly and approved in late 2002; after which, NIEHS signed a cooperative agreement with Dr. Carpenter. Dr. Tuong received the proposal in September 2002 and, in January 2003 requested that four more Vietnamese scientists be added to the study and that four additional hospitals be added to the proposed two. END NOTE.) A key reason for the meeting was determine the reason for the long delay in receiving approval from the GVN to proceed with the pilot study. Dr. Tuong described the lengthy GVN review process, which is largely due to the number of ministries, agencies and committees that are separately involved, specifically: Committee 33; MOH Science and Bioethics committees; MOH; Vietnamese Experts; MOH; Committee 33. To date, the pilot study proposal has undergone review through the Vietnamese Expert Committee and is now waiting the review and approval of Vice Minister of Health Prof. Le Ngoc Trong; the final review and approval is completed by Committee 33. How long Committee 33 will hold onto the proposal is unknown. So far, the GVN has had the proposal for more than one year and has known its contents for longer than that. ¶19. (SBU) A key component of the study is the verification of the serum 2,3,7,8-TCDD levels of both the mother and the father of the cases and controls included the study. Without these data, exposure assessment would be not be as strong and would weaken any results of the epidemiologic study. The serum 2,3,7,8-TCDD levels are a more objective measure of environmental exposure than personal histories or residential history. Given the lawsuit of the VAAOV and the attendant worldwide propaganda campaign (see Paragraph 20 below),self-reported exposure history for both the cases and controls will most likely be highly biased. USG has pressed Dr. Tuong for assurances that the serum 2,3,7,8-TCDD samples will be analyzed by laboratories both within Vietnam and in an accredited laboratory outside the country. Dr. Carpenter has already contracted with an accredited laboratory in Canada. There is concern, because in the past, the GVN has not permitted human serum 2,3,7,8-TCDD from leaving the country and, currently, there are no laboratories within Vietnam that have the expertise, equipment or facilities to measure low concentrations of 2,3,7,8-TCDD in the picogram per gram of lipid range. -------------- -------------- Lawsuit by the Vietnam Association for Agent Orange Victims -------------- -------------- ¶20. (SBU) On January 30, 2004, the newly created "Vietnam Association for Agent Orange Victims" (VAAOV) - an entity sanctioned by, and probably directed by, both the GVN and the Communist Party of Vietnam - filed suit against U.S. chemical companies. The suit was on behalf of three individuals from Vietnam contending that they or their offspring suffered health affects of exposure to Agent Orange. The lawsuit demanded compensation from the companies that produced Agent Orange. Former Vice-President Nguyen Thi Binh and the Vietnam Red Cross Director have been identified as key players in VAAOV. In conjunction with this legal suit, the Vietnamese media has intensified, after a lull, its propaganda campaign on the AO issues. The press has printed weekly, if not daily, articles on this issue. Many of the articles appear aimed at soliciting donations for the support of alleged victims of Agent Orange. The reports show pictures of individuals, children and adults, with all types of disabilities attributing them to the last effects of Agent Orange, regardless of the all the possible causes of the many types of birth and congenital disabilities. (COMMENT: Birth defects may be caused by a host of factors some related to the parents and others relating to the developing fetus. These factors may include the age of the mother and father, genetic factors, viral infections, maternal nutrition - both before and during pregnancy, environmental exposures, such as heavy metals and pesticides (both parents and during pregnancy),conditions during the birth process, e.g., anoxia, maternal health, e.g., preeclampsia, and others. END COMMENT.) -------------- -------------- MINISTRY OF DEFENSE PROPOSAL TO U.S. DEPARTMENT OF DEFENSE -------------- -------------- ¶21. (SBU) Reftel relays a MOD proposal to DOD for cooperation in remediation of suspected AO/dioxin "hot spots" in three former military bases, including the site at Da Nang where USEPA and VAST are engaged in planning for the site characterization and pilot remediation project. When presenting the proposal verbally to DATT and EST Officer, MOD personnel made no reference to the ongoing USEPA-VAST Da Nang project. EST Officer explained the ongoing project and asked if MOD intended for its proposal to DOD to be an integral part of the ongoing activity, or to be an independent endeavor. The MOD interlocutors, reluctantly acknowledging the ongoing activity, stated that MOD-DOD cooperation could supplement it. (COMMENT: MOD's cooperation is vital for the success of the EPA-VAST project. MOD owns the property and thus controls access. END COMMENT) Embassy recommends that if DOD is willing to engage MOD on the AO/dioxin issue by supporting remediation efforts, that engagement should be carried out in a coordination with EPA to support EPA's program in Da Nang. At this time, all USG efforts in environmental research related to AO/dioxin should be focused on the Da Nang project. PORTER