Jordan Seriously Engaging on Avian Influenza

UNCLAS SECTION 01 OF 03 AMMAN 009093 SIPDIS STATE PASS USAID FOR GLOBAL HEALTH/K HILL, D CARROLL USDA FOR APHIS SENSITIVE E.O. 12958: N/A TAGS: TBIO KHIV AMED EAGR ECON PGOV PREL JO SUBJECT: Jordan Seriously Engaging on Avian Influenza Preparedness and Prevention Refs: A) State 209622 B) Amman 8696 C) Amman 8041 ¶1. (SBU) Summary: The Government of Jordan (GOJ) and other national players are engaging in a committed effort to prepare for pandemic flu and to prevent the spread of H5N1 avian flu within Jordan should it appear. Human, financial and capital resources are adequate for the current situation, but could be quickly overwhelmed if the crisis expands. Rumor control will be a problem, despite official efforts at public awareness. The presence of a USAID health team and Regional Medical Office at Embassy Amman has given post crucial windows into Jordan's avian flu preparedness. End summary. Preparedness and Communication -------------- ¶2. (U) Governmental Committees: The GOJ has created three entities to manage preparation and response to avian and pandemic influenza: a National Steering Committee (chaired by the Prime Minister),a National Committee (minister level),and a National Technical Committee for Pandemic Influenza Preparedness (ref B). The Prime Minister heads the National Steering Committee, which includes the Ministers of Agriculture, Health, Environment, Public Security, and Civil Defense. ¶3. (U) Jordan created the National Committee as their initial mechanism for managing avian influenza, but it was superseded in authority by the creation of the Steering Committee when the avian flu crisis continued to escalate elsewhere. The National Committee is chaired by the Minister of Health, and includes the Secretaries-General of all related ministries. ¶4. (U) The National Technical Committee is chaired by the Minister of Health, and includes all members from the National Committee, plus the Jordan University Hospital, Jordan University of Science and Technology, the Royal Medical Services, USAID, the Association of Physicians, and the Association of Veterinarians. Consultants are added ad hoc to meet specific needs. Leadership, Key Personnel, Truthfulness -------------- ¶5. (SBU) Given the competing demands in Jordan's current security milieu, avian flu has gotten a surprisingly high level of attention and support from the top levels of the GOJ. A generous budget allocation of $8.5 million was quickly made (Ref B) despite record deficits, and government officials at the working level appear to have political support from the country's leadership to engage on avian flu. ¶6. (SBU) Post believes that GOJ reporting on avian flu in poultry, and on pandemic flu in humans, would be transparent and open, and more limited by capacity to report information than by willingness. Larger obstacles to transparent reporting would be found among private poultry farmers and others in the poultry industry. The Ministry of Agriculture has created a plan to reimburse farmers for losses due to avian flu. These financial incentives would reduce but not eliminate this problem. Post needs to examine this plan in detail and get reaction from the farmers themselves. ¶7. (U) In the event of a widespread outbreak of avian flu among poultry or of pandemic influenza, King Abdullah would be the ultimate decision maker, with the Prime Minister and Health Minister being the likely key advisors. The Prime Minister would be the central figure in implementing the policy. Preparedness Plan -------------- ¶8. (SBU) The National Technical Committee (NTC) is drafting an emergency preparedness plan. ESTH FSN spoke to NTC spokesman Khalid Abu Rumman from the Ministry of Health's Disease Surveillance Department on November 17; Abu Rumman agreed to provide draft documents in Arabic to the Embassy. Note: The promised documents had not arrived as of November ¶23. End note. He said that Jordan does not intend to produce an English version of the preparedness plan. The document has not yet been approved for public release, and there is no electronic or Internet version at this time. Post is not aware of any obstacles in Jordan's legal system that pose a barrier to avian influenza, reporting and response. Hospital Capacity, Vaccinations and Vaccines -------------- ¶9. (SBU) The GOJ has designated three hospitals (one in northern Jordan, one in central Jordan, and one in the south) as quarantine facilities in the event that pandemic influenza should occur. Jordan does not have a large-scale, public flu vaccination program. Flu vaccinations are done by private physicians at the expense of the recipient. We do not have an estimate of the total number of vaccinations, but it would represent a small fraction of the population. Jordan does not have indigenous capacity for producing either human or animal vaccines, although it does have a successful pharmaceutical industry and good laws for protection of intellectual property rights. International Engagement -------------- ¶10. (U) Jordan has been proactively reaching out to its immediate neighbors, including Israel, Syria, and the Palestinian Authority for coordination talks on managing avian influenza (Ref B). GOJ officials are well connected with international health officials at the WHO and with animal health officials at World Animal Health Organization (OIE). Post's USAID Mission and Regional Medical Office have numerous strong contacts around the health field in Jordan. Post feels that multilateral engagement with Jordan through the WHO and the International Partnership on Avian and Pandemic Influenza (IPAPI) would be the most effective means of support. Public Communication -------------- ¶11. (U) The National Steering Committee has been proactive in providing factual information on avian flu to the public through the media and the Internet and, through the Technical Committee, to doctors and farmers. USAID has a specific project on public health communications where Johns Hopkins University works directly with the Ministry of Health. That project has generated a website on avian influenza (http://www.healthcomm.gov.jo/aindex.asp). Jordan is a small country with roughly 40% of its population in greater Amman. Media penetration to all but the most isolated rural residents is rapid and widespread. Surveillance and Detection -------------- ¶12. (SBU) Surveillance Systems and Lab Capacity: Jordan has good capacity in human health surveillance, assisted by CDC's Field Epidemiology Training Program. Animal health reporting systems are somewhat weaker but are still fair to good. Points of excellence exist within both animal and human health systems, but the overall quality level is uneven. The spottiness would affect Jordan's ability to quickly and accurately report and respond to an animal or human health emergency. Jordan does not have the lab capacity to determine virus subtypes, although it does have the capacity to do diagnosis. Jordan has relationships with the WHO and with OIE reference labs in Italy for the most sophisticated types of lab work. This need to go elsewhere for high-end lab services would add time to any evaluation and response. ¶13. (SBU) Gaps: Jordan has small numbers of well-trained individuals in animal and human health surveillance systems, but lacks capacity at the lower levels. The same is true for its laboratories: Jordan has a small number of well- equipped, well-staffed labs but not many of them, and they cannot handle the highest level of analysis. Response and Containment -------------- ¶14. (SBU) Medical Capacity: The GOJ is behind the curve on procurement of Tamiflu. It has ordered one million courses of Tamiflu (10 million 75 mg capsules) to cover 20% of the expected epidemic, but delivery times are estimated in the fourth quarter of 2006. The Jordan Armed Forces approached post's Defense Attache Office for Embassy assistance in obtaining 10,000 courses of Tamiflu for its personnel, particularly those in locations overseas where avian flu is endemic. DAO responded by telling the Jordan Armed Forces to handle their procurement issues through the Ministry of Health. Post is not aware of large stockpiles of personal protective gear in Jordan. ¶15. (SBU) The Ministry of Agriculture has guidelines for culling, vaccination and disinfection. We are not aware of quarantine systems in place for animals. However, given Jordan's geography, post believes that animal quarantine systems could be put in place rapidly. Post also believes that the GOJ is willing and capable of imposing human quarantines and other social controls if necessary. ¶16. (U) Comment: Jordan has among the most effective, well- trained and well-equipped health systems in the region, but it lacks the "bench" of numerous, qualified personnel and effective systems that integrate at all levels. Post's view is that Jordan would be able to respond well to a small- scale emergency by throwing its top assets at the problem, but that these people and resources would quickly be overwhelmed by a larger crisis. RUBINSTEIN