TURKEY: AVIAN INFLUENZA AND PREPAREDNESS RAPID

UNCLAS SECTION 01 OF 03 ANKARA 006481

SIPDIS

STATE FOR EUR/RUS, OES/STC, EB/TPP/ATP, EB/TPP/BTA
STATE ALSO PASS USAID FOR BLANCHET AND CARROLL
HHS FOR WSTEIGER/PBUDASHEWITZ
FAS FOR ITP/MACKE/THOMAS, CMP/DLP/WETZEL
FAS PASS FSIS AND APHIS
VIENNA PASS APHIS
BRUSSELS PASS APHIS/FERNANDEZ
GENEVA PASS HEALTH ATTACHE

SENSITIVE

E.O. 12958:N/A
TAGS: ETRD EAGR KPAO TBIO AMED
SUBJECT: TURKEY: AVIAN INFLUENZA AND PREPAREDNESS RAPID
ASSESSMENT

Ref: (A) ANKARA 6430 AND PREVIOUS SIT-REPS
(B) ANKARA OCTOBER 19 E&E INITIAL RESPONSE ON AI

Sensitive but unclassified. Not for Internet Distribution.


1. (SBU) Summary. Turkey experienced one confirmed
outbreak of the H5N1 strain of Avian Influenza in Balikesir
in northwestern Turkey in early October without reports of
human illness or deaths. The Ministry of Health has taken a
leadership role in contingency planning for a potential
pandemic, but inter-agency coordination may be a weak area.
Turkey could use technical assistance and training in
laboratory testing capacity and kits and surveillance as the
first line of defense. According to the Health Ministry,
the GOT would welcome cooperation from USID or the CDC. End
summary.

Planning and Preparedness:
--------------


2. (SBU) Turkey is located on a major bird fly-way between
Africa, Russia and the Black Sea. The Turkish Ministry of
Agriculture and Rural Affairs (MARA) has the lead for
surveillance and containment of potential avian influenza
cases, and has received good marks for its containment,
culling, and quarantine procedures implemented in the one
outbreak so far discovered in the Balikesir area, located
near the Sea of Marmara in northwestern Turkey . The
Ministry of Health (MOH) coordinated with MARA on
prophylaxis, surveillance, and treatment of workers. The
two agencies are working closely with private industry to
implement regular controls and tracking for industry
workers. MARA has only one reference lab near Izmir and
does not have capability to test for H5N1.


3. (SBU) In a meeting on October 20, MOH official Yildirim
Bayazit described a newly drafted national plan for a
potential pandemic. It was developed under close
supervision with the WHO. According to Beyazit, the plan
provides for the following key elements:

-Creation of a 70-member multi-agency (Health, Agriculture,
Universities, Military, Pharmaceuticals, etc.) task force.
In the event of a crisis, he said MOH would take the lead
with the National Crisis Center which is under the Prime
Ministry (per normal disaster assistance procedures).
-Action plan for providing information to the public.
-Action plan for provision and coordination of health
services, including surveillance, protection, isolation,
precautions, triage, anti-viral measures, and extraordinary
measures, such as increasing hospital bed capacity and/or
identifying special hospitals for isolation or care (and
closing public institutions, etc.)


4. (SBU) Comment: While the task force exists in draft on
paper, it is not clear whether it has been approved more
broadly within the Turkish government, let alone tested.
Key spokespeople are not yet clearly designated. MOH
appears engaged, but admits that there are deficiencies and
need for drills to hone the national plan. MOH said it
would welcome technical support, testing kits, training,
and/or information sharing on surveillance and laboratory
testing capacity. The Turkey Emergency Management Agency
has not been involved in the drafting of the MOH plan,
indicating it may be more of a MOH, rather than, national
plan. (TEMA, under the Prime Ministry, would normally lead
crisis management in Turkey.) End Comment.

Surveillance and Diagnosis:
--------------


5. (SBU) MARA has first level responsibility for
surveillance for AI outbreaks in animals. While MARA has
told the Embassy that it has implemented active
surveillance; it is difficult to assess the quality of the
surveillance. (Are no new outbreaks discovered based on no
new AI cases, or does it reflect inadequate surveillance?)
The GOT has been quick to investigate and then dismiss false
outbreaks elsewhere in the country (Ref A). MOH also told
Embassy that it is actively carrying out surveillance; it
has two virology labs (Ankara National Influenza Center and
Istanbul Medical School Viral Institute). Both MARA and MOH
have extensive regional networks, but their level of inter-
agency coordination may be weak and/or untested. Both
agencies could use more laboratory and testing capacity, as
well as testing kits. There is no capacity to test for H5N1
in Turkey.

Communications:
--------------


6. (SBU) Both MARA and MOH have identified communications
and public awareness as a critical area. Both have told
Embassy that they are actively engaged in communicating with
the public, farmers, and poultry workers on education,
surveillance, and precautions. The general public is very
concerned about the threat of avian influenza and has a
lingering distrust of the government. Poultry consumption
is sharply down and the industry is asking for government
assistance. Communications is a key aspect of MOH
contingency planning. In the event of a pandemic, MOH would
distribute posters, brochures, and other materials. MOH
aims to establish a regular internet-based AI bulletin as of
November 7.

Response
--------------


7. (SBU) The GOT responded quickly to the Balikesir
outbreak, establishing a 3 km quarantine zone and culling
about 6000 birds (Refs). Farmers were compensated for their
birds and the GOT has announced increased funding for
contingency compensation reserves. In the event of multiple
AI outbreaks the adequacy of the funds might be tested and
the capacity of the MARA and MOH to respond and coordinate
may be challenged. The GOT has not employed wide animal
vaccination as a containment measure, relying instead on
surveillance. The MOH has generated a national pandemic
plan, but in the event of a public health crisis would
likely not have adequate surge capacity. The MOH aims to
identify potential high risk groups and stockpile adequate
masks, antivirals, and other medicines, including special
protective equipment for health workers. There are plans to
work with the Red Crescent to increase hospital bed capacity
and mobile units. The GOT currently has 5,000 boxes of
Tamiflu and has written a letter of intent to Roche to seek
to acquire one million treatments. WHO has announced
support to Turkey, but the nature of this support has not
been determined.

Other Partners
--------------


8. (SBU) The GOT at first did not seek any foreign
assistance after the AI outbreak. Soon after, however, the
GOT accepted an EU expert team to visit the outbreak site.
The generally good marks given to the GOT for its
containment are at least partly due to earlier cooperation
with the EU on training and testing. Part of the credit of
the discovery of the outbreak was good awareness in the
poultry industry. The GOT has sought to work with private
companies to improve surveillance capacity. In many parts
of the country, there are many smaller, less-organized
family farms, where birds are kept outside, sometimes under
limited control. It is not clear whether the GOT has
actively reached out to other NGO's or civil society, other
than universities. An MOH official attended the recent
International AI and Pandemic Partnership meeting in
Washington D.C. MOH applied to the World Bank to receive
funding for posters and brochures on AI under the WB's
Health Transformation Project in Turkey. MOH official
Bayazit said the Ministry would be particularly interested
in help from the USG and/or CDC for technical assistance to
increase lab capacity, to procure more test kits, and to
exchange and gain training, information, and experience.
MCELDOWNEY