AVIAN FLU: GHANA'S PLAN OF ACTION

UNCLAS SECTION 01 OF 03 ACCRA 002402

SIPDIS

SENSITIVE

OES FOR DR. DANIEL SINGER AND REBECCA DALEY
STATE PASS USAID

E.O. 12958: N/A
TAGS: AMED CASC CMGT KHIV TBIO XA GH SENV ECON EAGR EAID PREL XX SEC
SUBJECT: AVIAN FLU: GHANA'S PLAN OF ACTION

REF: A. STATE 209622


B. STATE 206588

Summary
--------------

1. (SBU) The GoG's response to the threat of an Avian Flu
outbreak has so far been measured and pro-active. The
Ministries of Health and Agriculture are working closely with
USAID/Ghana and the World Health Organization (WHO) to create
a comprehensive preparedness plan, which includes an
assessment of the GoG's capacity to execute the plan in the
event of an outbreak. In response to reftels, post submits
answers to the questions posed in Ref A regarding the GoG's
current state of preparedness. End Summary.


2. (SBU) Question posed in Ref A and Post's responses.

A) PREPAREDNESS/COMMUNICATION

-- DOES THE GOVERNMENT HAVE A PREPAREDNESS PLAN/STRATEGY FOR
PREVENTING AVIAN FLU FROM BECOMING A PANDEMIC AND CONTAINING
A PANDEMIC ONCE IT OCCURS? IF THE COUNTRY HAS A STRATEGY,
HOW CAPABLE IS IT OF IMPLEMENTING IT? PLEASE PROVIDE A COPY
OF THE PLAN OR THE INTERNET ADDRESS FOR THE PLAN.

USAID/Ghana, FAO and the WHO have formed a technical working
group with Ghana's Ministries of Health (MoH),Food and
Agriculture (MinAg),and Forests and Land Development to
finalize a plan by the end of November in accordance with WHO
Avian Flu guidelines. Two USAID-funded consultants have
completed an assessment of the needs and capabilities of the
GoG to respond to an outbreak. The consultants submitted
their draft plan to the technical working group, and also
provided a set of suggested tripwires for the Embassy EAC.
The Ministers of Health and Agriculture will present the plan
to the Cabinet November 30, and brief President Kufuor and
other donors by December 7. (NOTE: USAID's consultants
believe the GoG would have difficulty implementing the plan
as drafted without assistance. END NOTE.)

-- HOW TRUTHFUL WILL THE GOVERNMENT BE IN REPORTING THE SCOPE
OF ANY DISEASE OUTBREAK AMONG PEOPLE? AMONG ANIMALS? WHAT
INCENTIVES COULD BE OFFERED THAT WOULD LIKELY RESULT IN MORE
TRANSPARENCY?

The GoG would be as truthful about an outbreak in the human
population as it is technically capable of being. Years of
capacity building in rural health make it more capable than
its neighbors. USAID's contractors reported that an outbreak
in the animal population would be much more difficult to
detect, and local chicken producers would likely be reluctant
to forward information to MinAg because they are skeptical
about the GoG's ability to compensate them for their losses.
Donor commitments to support financially the culling of
domestic birds would be a strong incentive to ensure truthful
reporting (although no donor has announced any plans to do
so). There is no reason to believe the GoG would withhold
any information it has about an outbreak in either the human
or animal population.

-- WHERE DOES PREPARING FOR AN AVIAN FLU HUMAN PANDEMIC RANK
AMONG GOVERNMENT PRIORITIES? WHO AND WHAT WOULD MOST
INFLUENCE THE COUNTRY TO GIVE THE ISSUE A HIGHER PRIORITY?
WHO IS THE KEY "GO-TO" PERSON, OFFICE OR DEPARTMENT (I.E.
MINISTER FOR HEALTH, PRIME MINISTER, ETC.) FOR USG OFFICIALS
TO ENGAGE ON THIS ISSUE?

The GoG's willingness to cooperate with bilateral and
international donors as well as the speed with which it has
responded to the threat of an outbreak shows that Avian Flu
is a top priority at this time. USG officials should engage
Minister of Health Courage Quashigah, in coordination with
USAID/Ghana and the Avian Flu technical working group, on any
issues related to Avian Flu. (NOTE: USAID-Ghana's Health
Team Leader, BethAnne Moscov, is the Coordinator of Post's
Avian Influenza Task Force, which the DCM chairs and is
comprised of officers from Econ, RSO, Heath Unit and other
agencies. END NOTE)

-- HAVE NATIONAL LAWS BEEN REVIEWED TO ENSURE THAT THEY ARE
CONSISTENT WITH THE INTERNATIONAL HEALTH REGULATIONS AND DO
NOT POSE BARRIERS TO AVIAN INFLUENZA DETECTION, REPORTING,
CONTAINMENT, OR RESPONSE?

USAID's contractors reviewed Ghana laws and found no barriers
to Avian Flu detection, reporting, or response.

-- IS THE HOST COUNTRY ALREADY WORKING WITH INTERNATIONAL
ORGANIZATIONS OR OTHER COUNTRIES ON THE AVIAN FLU ISSUE? ARE
GOVERNMENT LEADERS LIKELY TO ASK FOR ASSISTANCE FROM THE US
OR OTHER COUNTRIES? WOULD GOVERNMENT LEADERS BE RECEPTIVE TO
MESSAGES FROM US LEADERS THROUGH A BILATERAL APPROACH, AT A
MULTILATERAL FORUM SUCH AS THE UN (WHO, FAO, ETC.) OR APEC,
OR THROUGH BILATERAL CONTACTS BY A THIRD COUNTRY? WHAT WOULD
THE COUNTRY WANT FROM THE US IN RETURN FOR ITS EFFORTS?

The GoG is working closely with the WHO and FAO on this
issue. GoG leaders will likely ask for assistance once the
response plan has been adopted and gaps in capacity and
resources have been identified. Ghana's donor community will
review requests in close coordination to eliminate
duplication of effort. GoG leaders are always receptive to
messages from U.S. leaders on a bilateral approach. USAID's
involvement in the planning process makes it the best conduit
for communication with the GoG on this issue.

-- DOES THE COUNTRY CURRENTLY ADMINISTER ANNUAL FLU SHOTS?
IF NOT, MIGHT IT CONSIDER DOING SO? WHAT IS THE PRODUCTION
CAPABILITY (I.E. HOW MANY DOSES OF THE ANNUAL TRIVALENT FLU
VACCINE CAN THE COUNTRY MAKE) FOR HUMAN INFLUENZA VACCINES IN
THE COUNTRY? DOES THE COUNTRY PRODUCE INFLUENZA VACCINE FOR
POULTRY AND IF SO HOW MUCH? IF THE COUNTRY IS DEVELOPING AN
H5N1 VACCINE, WHERE IS IT IN PRODUCTION AND TESTING? ANY
LICENSING ISSUES? IS THERE A LIABILITY SHIELD FOR FOREIGN
MAKERS/DONORS OF VACCINES? IF NOT, ANY PROSPECTS OF ONE
BEING ENACTED?

Ghana does not administer annual flu shots. Ghana would
consider administering flu shots if funds were made available
for distribution and supplies. Post is not aware of any
capacity to produce human influenza or poultry vaccines in
the country. There is no liability shield for foreign makers
or donors of vaccines, although the GoG has been quick to
enact legislation in the past when it was clearly in its
favor to do so.

--HOW WELL INFORMED IS THE POPULATION ABOUT THE AVIAN FLU
THREAT AND ABOUT MEASURES THEY SHOULD TAKE TO MITIGATE THE
THREAT? WHAT MECHANISMS ARE AVAILABLE FOR PROVIDING
ADDITIONAL INFORMATION TO THE POPULATION, PARTICULARLY IN
RURAL AREAS AND HOW EFFECTIVE ARE THESE MEASURES?

The GoG has already begun to inform the population through
print and radio reports about Avian Flu since the banning of
poultry from affected areas. This information has sensitized
the population and laid a good foundation for the future.
The information has been accurate and comprehensive. A
formal public relations plan is expected to be part of the
overall response plan currently being drafted. UNICEF and
other donors can further disseminate information through
their health workers in rural areas if the need arises.

B) SURVEILLANCE/DETECTION

-- HOW CAPABLE ARE THE MEDICAL AND AGRICULTURE SECTORS OF
DETECTING A NEW STRAIN OF INFLUENZA AMONG PEOPLE OR ANIMALS
RESPECTIVELY? HOW LONG MIGHT IT TAKE FOR CASES TO BE
PROPERLY DIAGNOSED, GIVEN OTHER ENDEMIC DISEASES? CAN
INFLUENZA VIRUSES BE SUBTYPED IN THE COUNTRY, IF SO BY WHOM,
AND IF NOT WHERE ARE THEY SENT? DOES THE COUNTRY SEND
SAMPLES TO A WHO/EU/US REFERENCE LABORATORY?

Ghana's medical sector is much more capable of detecting a
new strain of influenza than the agricultural sector. The
capacity and presence of donor and MoH health workers in
rural communities enhances this capability. The chances of
detecting a new strain in the south -- where it is estimated
one could be detected in two to four weeks -- are higher than
in the sparsely populated northern regions, where it would be
possible for a new strain to go undetected for a much longer
period. It may be possible for Ghana's Noguchi Medical
Research Institute to detect a new strain. A researcher from
the U.S. Naval Medical Research Unit (NAMRU) works full-time
at the Noguchi institute and is involved in the Avian Flu
technical working group. It is possible that samples could
be tested at NAMRU's facility in Cairo if the need arises.


-- WHAT ARE THE CRITICAL GAPS THAT NEED TO BE FILLED IN ORDER
TO ENHANCE THE COUNTRY'S DISEASE DETECTION AND OUTBREAK
RESPONSE CAPABILITIES? WHAT IS THE COUNTRY'S GREATEST NEED
IN THIS AREA FROM THE US OR INTERNATIONAL ORGANIZATIONS?

Ghana needs more trained medical personnel in its sparsely
populated northern regions, to enhance detection. Any
personnel deployed to the north will need access to
communications equipment to overcome the lack of telecom
infrastructure. Ghana's greatest needs will be funding for
training of health workers and financial backing for culling
activities and the compensation of farmers. USAID will host
a meeting to brief donors next week, which will help raise
greater awareness and identify potential needed areas for
donor support.

C) RESPONSE/CONTAINMENT

-- DOES THE COUNTRY HAVE A STOCKPILE OF MEDICATIONS,
PARTICULARLY OF ANTIVIRALS, AND IF SO HOW MUCH? IF SOME HAS
BEEN ORDERED, HOW MUCH AND WHEN IS IT EXPECTED?

Although Tamiflu and Relenze are prescribable antiviral
medications in Ghana, there are no stockpiles of them or any
other antiviral medications and no funds to acquire them with.

--DOES THE COUNTRY HAVE A STOCKPILE OF PRE-POSITIONED
PERSONAL PROTECTIVE GEAR?

Ghana has no stockpile of personal protective gear.

--WHAT IS THE RAPID RESPONSE CAPACITY FOR ANIMAL AND HUMAN
OUTBREAKS? ARE GUIDELINES IN PLACE FOR THE CULLING AND
VACCINATION OF BIRDS, DISINFECTION OF FACILITIES, AND
LIMITATIONS ON ANIMAL MOVEMENT?

Ghana's capacity to respond to a human outbreak is low, but
growing as plans are finalized and donors coordinate with the
GoG. Ghana has no capacity to respond to an animal outbreak
at this time. Although the MinAg recently announced its
plans to compensate farmers for the cost of culling and
replacing animals in an outbreak, no provision was made in
the annual budget presented last week to parliament. Both
USAID and the Econ Section believe that any culling activity
would be stopped once it becomes known that the GoG has no
money set aside to fund it. Moreover, USAID's contractors
reported that MinAg is not technically capable of culling the
estimated 29 million domesticated chickens in Ghana itself,
or monitoring their destruction by owners if it is ordered.

-- HOW WILLING AND CAPABLE IS THE GOVERNMENT OF IMPOSING
QUARANTINES AND SOCIAL DISTANCING MEASURES (CLOSING SCHOOLS,
PUBLIC GATHERINGS, MASS TRANSIT)? WOULD ITS MILITARY ENFORCE
QUARANTINES?

The GoG is very willing to impose quarantines and social
distancing measures. Government's capability will be higher
in the south. Porous land borders and the incentives to
smuggling brought on by quarantines will make enforcement
difficult to impossible in northern regions. If Ghana's
National Security Council decided a quarantine was necessary,
the first line of enforcement would fall to the Police, and
the second line to the Ghana Armed Forces.

Comment
--------------

3. (SBU) The GoG has responded quickly to the threat of an
outbreak, despite the fact that it may never happen. Many of
the plans being developed are building upon the work the GoG
did to develop an emergency preparedness plan to respond to
SARS. Coordination at the technical working group level has
been good, and this same group will work together in the
event of an outbreak. Once the technical working group's
plan is finished, a second-level inter-agency working group,
consisting of a larger number of concerned Ministries and
donors, will be convened to review the plan. All the
coordination and work underway should result in the GoG being
capable of handling a limited outbreak of Avian Flu. Ghana's
geography and resource constraints, however, make it unlikely
that a major outbreak could be contained. End Comment.

BRIDGEWATER