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Identifier
Created
Classification
Origin
05ALMATY4159
2005-11-23 04:32:00
UNCLASSIFIED//FOR OFFICIAL USE ONLY
US Office Almaty
Cable title:  

KAZAKHSTAN: RESPONSE TO AVIAN AND PANDEMIC

Tags:   TBIO  SENV  ECON  EAGR  EAID  PREL  PGOV  KZ 
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						UNCLAS  ALMATY 004159 

SIPDIS


DEPARTMENT FOR EUR/CACEN (JMUDGE), OES (DSINGER, RDALEY)
TASHKENT FOR ESTH (EPUTNAM)
DTRA FOR CTB
CDC FOR SLBOUNT, EMCCRAY

SENSITIVE
E.O. 12958: N/A
TAGS: TBIO SENV ECON EAGR EAID PREL PGOV KZ
SUBJECT: KAZAKHSTAN: RESPONSE TO AVIAN AND PANDEMIC
INFLUENZA RFI

REF: STATE 206992



1. (SBU) Summary: This cable responds to Reftel. The
Embassy assesses that the Government of Kazakhstan (GOK)
appreciates the severity of the threat of avian and pandemic
influenza and is taking rational, concrete steps to address
that threat. The GOK is realistic and basically transparent
in its actions and public statements. However, the
country's preparation for and response to avian and pandemic
influenza are somewhat hampered by considerable material
needs in the health sector (both human and veterinary) that
will not be fixed immediately, and a slow, inefficient
bureaucratic process. End summary.



2. (SBU) Answers to the questions in paragraph 4 of Reftel
follow:

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.

Answer: The GOK has a basic preparedness plan and is
developing a more comprehensive plan in collaboration with
CDC and the World Bank, utilizing other national
preparedness plans as models, particularly Thailand's.
Broadly speaking, Kazakhstan has good prospects for
preventing isolated incidents of avian influenza from
developing into a human pandemic and to contain a possible
pandemic, not least because of the considerable distances
separating virtually all human population centers from one
another. These distances serve to increase the
effectiveness of quarantine measures.

-- 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?

Answer: The GOK has been truthful in reporting the scope of
human AI disease. There was one suspected human case in
Kazakhstan during the August 2005 outbreak. USG personnel
from the Centers for Disease Control and Prevention (CDC)
and Naval Medical Research Unit 3 (NAMRU-3) had access to
the patient and all diagnostic samples taken from him.
Official public reporting of the patient's condition and
infection status, which was ultimately negative, was
accurate and truthful.

The GOK would likely be truthful in reporting outbreaks on
large poultry farms or of mass deaths among migratory birds.
However, it is likely that outbreaks on small farms would
not be detected by the government and would therefore go
unreported.

-- 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?

Answer: The GOK has made avian flu preparedness a priority.
A standing interagency commission chaired by the Ministry of
Emergency Situations exists, and includes the Ministries of
Health, Agriculture, Interior, the security services and
Customs. The GOK would likely base its sense of urgency in
a given situation on what it observes happening in Russia
and/or China, although that is not to say that Kazakhstan
views either of those countries' surveillance capabilities
or preparedness as better than its own. The Ministry of
Health (the Minister and the Deputy Minister responsible for
the Sanitary and Epidemiology Service) are the "go to"
people on this issue, followed by the head of the veterinary
service of the Ministry of Agriculture. All of these
individuals are Embassy contacts.

-- 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?

Answer: The Embassy is not aware of any prospective changes
to legislation that are responsive to the August incidents
of avian influenza. However, changing legislation under any
circumstances in Kazakhstan is a time-consuming and opaque
process. We do not know of any active laws that serve as
barriers to avian flu detection, reporting, containment or
response. In fact, the GOK was willing to share the strain
of H5N1 AI collected in Kazakhstan with very little
bureaucratic fanfare, while it has resisted transfer or
sharing of strains in other circumstances.

-- 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?

Answer: The GOK has been open to cooperation with
international organizations working on the avian flu issue.
WHO and OIE (the international epizootic bureau) have both
sent representatives to observe Kazakhstan's response and
have contributed advice to the GOK.

-- 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?

Answer: Flu shots are widely available to the public through
the private sector. The national government recommended that
the oblast governments administer flu shots to high risk
individuals, but vaccine was only available for 50% of those
deemed to be high risk.

There is currently no vaccine production capability in
Kazakhstan.

--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?

Answer: The population is generally well-informed about
avian influenza. There is no sense of panic. The GOK went
to considerable lengths to get officials out to the poultry-
raising regions of the country to educate farmers about the
danger of the disease and proper prophylaxis. We consider
these measures to be basically effective.

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?

Kazakhstan's medical, veterinary and wildlife sectors are
capable of detecting and suspecting disease based upon
clinical signs and history. However, the medical sector
does not have a well-formed capability to detect a new
strain of influenza by laboratory testing. Current
diagnostic procedures and equipment can detect cases of
influenza, but cannot differentiate particular strains. DTRA
is planning to provide the Ministry of Health with equipment

and test reagents to detect avian influenza virus H5N1 by a
specific polymerase chain reaction (PCR) test that will
provide results within 1 to 2 hours. DTRA will also provide
the training that Kazakhstani specialists will need to
operate this equipment.

The National Veterinary Center (NVC, located in Astana) of
the veterinary service of the Ministry of Agriculture, as
well as the Scientific Research Agricultural Institute
(SRAI, located in Otar in southeastern Kazakhstan) of the
Ministry of Education and Science both have polymerase chain
reaction (PCR) equipment that was provided by DTRA.
Reagents and training to detect avian influenza H5N1 virus
have been provided by DTRA to both organizations.

The PCR tests specific to H5N1 are not yet approved by the
United States Food and Drug Administration, the Department
of Agriculture or by Kazakhstani entities for diagnosis of
the disease in people or animals. Samples from cases
identified by PCR could be sent to NAMRU 3, CDC or USDA for
further testing by classical means and to determine the
genetic sequence of the influenza virus. However, no
standing agreement with the Government of Kazakhstan for
transferring specimens to any of these organizations is
currently in place. These tests cannot be performed in
Kazakhstan at this time.

During the outbreak in August, SRAI provided animal
specimens and the Republican Sanitary Epidemiological
Service provided human specimens to the NAMRU-3 laboratory
in Cairo. CDC collected 175 specimens from individuals in
the village where H5N1 was identified (Golubovka village in
Pavlodar oblast). These specimens were subsequently sent to
CDC in Atlanta through an agreement with the Government of
Kazakhstan. The DTRA and CDC offices in Almaty are
facilitating collaboration between Ministry of Health and
the Ministry of Education and Science to perform joint
research on human diagnostics at SRAI.

-- 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?

Answer: The critical gaps include: strengthening the
surveillance systems for both animals and humans; the lack
of avian and human vaccines; and medications. In response
to the avian influenza situation, DTRA is expediting
delivery of a PCR to the Ministry of Health that was ordered
under the Threat Agent Detection Response (TADR) program.
The Government of Kazakhstan, through the Ministry of
Health, has already requested and received assistance from
CDC in developing preparedness plans, improving regulatory
policies, conducting outbreak investigations, strengthening
surveillance activities, and improving human capacity for
laboratory diagnosis.

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?

Answer: The Government of Kazakhstan allocated money from
the 2005 budget to create a stockpile of antivirals.
However, the amount is only enough to treat 30,000 cases.
While this money has been allocated, the orders for the
medications have not yet been placed.

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

Answer: Yes. The government purchased large quantities of
personal protective gear as well as disinfectants, during
the August outbreak.

--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?


Answer: Based on the outbreaks in August, the GOK's rapid
response capability appears adequate, if yet untested by a
truly widespread epidemic.

-- 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?

Answer: The GOK is definitely capable of imposing
quarantines, and the natural geographic sparseness of the
country is an added advantage. The GOK imposed effective
quarantines in several oblasts (main regional subdivisions)
during the August outbreak. The GOK is undoubtedly capable
of restricting travel between cities if necessary, as both
rail and air transport are fully or partially under state
control. The Kazakhstani military would not be likely to
participate in quarantine enforcement; however, the
paramilitary formations of the Ministry of Internal Affairs
would undoubtedly play a role. However, there is no bar to
the military participating if the GOK desired.



3. (U) Minimize for Dushanbe considered.

Ordway


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