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