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