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superseded in authority by the creation of the Steering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