AVIAN AND PANDEMIC INFLUENZA INFORMATION - COLOMBIA

UNCLAS BOGOTA 010967

SIPDIS

SENSITIVE
SIPDIS

STATE FOR OES/IHA (SINGER/DALEY)
HHS FOR INTERNATIONAL STEIGER/BUDASHEWITZ

E.O. 12958: N/A
TAGS: TBIO SENV ECON EAGR EAID PREL CO
SUBJECT: AVIAN AND PANDEMIC INFLUENZA INFORMATION - COLOMBIA

REF: STATE 209622

Sensitive but unclassified. Not for internet distribution.


1. (U) In response to reftel, Embassy provides the following
responses regarding avian and pandemic influenza preparedness
in Colombia.

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PREPAREDNESS/COMMUNICATION
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2. (SBU) 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.

The Government of Colombia (GOC) issued a Prevention and
Mitigation Plan Against the Impact of an Influenza Pandemic
in September 2005 (September 2005 Plan or Plan). The Plan
was written by the Ministry of Social Protection, which has
responsibility for public health issues. The September 2005
Plan is more of a framework or a "to do" list than a concrete
plan of action. Since issuing the Plan, the GOC has taken
few steps to implement it, but has determined that it will
cost more than 10 billion Colombian pesos (approximately USD
4.5 million). The GOC has not yet allocated these funds.
The September 2005 Plan can be found at the Ministry of
Social Protection,s website in Spanish:
www.minproteccionsocial.gov.co. An English translation of
the Plan has been e-mailed to OES/IHA and WHA/AND.


3. (SBU) 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?

Recent experience indicates that the GOC is truthful in
reporting disease outbreaks. In early October 2005, the GOC
announced the discovery of a strain of H9 avian flu (later
confirmed to be H9N2, which has a low pathogenicity and is
not harmful to humans) on three farms in Tolima Department.
The Minister of Agriculture immediately sent letters to his
counterparts in the Andean region; the GOC made a general
announcement, which also was carried by local and
international news, a few days later. GOC representatives
told Poloff that they would follow a similar procedure should
there be a human disease outbreak: immediate notification of
neighboring countries followed by a more general announcement.

According to APHIS representatives at post, however, the
international response to Colombia's expeditious and
transparent announcement has caused the poultry industry,
which funds most avian flu surveillance, to be wary of
sharing information about future outbreaks. Within a week of
the Colombian announcement, all neighboring countries closed
their borders to Colombian chicken imports -- before the
scientific assessment of the Tolima strain had been
completed. At a meeting with Poloff and USAID officers,
representatives from several GOC Ministries expressed concern
(and frustration) about the economic effects of announcing
disease outbreaks. They said such consequences would chill
international transparency and asked for U.S. assistance in
encouraging countries not to make major trade decisions
without full scientific information.


4. (SBU) 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?

Given Colombia's ongoing efforts to restore peace and
security after more than 40 years of internal conflict,
demobilize illegal armed groups and control narcotics
trafficking, preparations for an avian flu human pandemic are
not among the GOC's top priorities at this time. In initial
conversations about avian and pandemic influenza with Poloff
in August/September 2005, GOC representatives were concerned,
but considered the possibility of an outbreak in South
American unlikely. The possibility of a pandemic has been
given more attention since the Tolima outbreak and recent
discovery of the H5N1 virus in Europe.

According to GOC representatives, the "go-to" person for the
USG/Department is Minister of Social Protection Diego PALACIO
Betancourt.


5. (SBU) 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?

According to the GOC, the September 2005 Plan is consistent
with strategic measures for dealing with all phases of an
influenza pandemic -- before, during and after -- recommended
by the World Health Organization (WHO). The Plan calls for
the harmonization of national legislation with "international
sanitation regulations" and the on-going adaptation of the
Plan to ensure consistency with any new WHO recommendations.
In addition, the Plan calls for the evaluation and
modification of existing laws to facilitate emergency
measures, which could include the declaration of sanitary
alerts, quarantines, the use of private infrastructure (such
as hospitals) and travel restrictions. To date, the GOC has
not started work on this aspect of the September 2005 Plan.


6. (SBU) 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 U.S. OR OTHER COUNTRIES? WOULD
GOVERNMENT LEADERS BE RECEPTIVE TO A MESSAGE FROM U.S.
LEADERS THROUGH A BILATERAL APPROACH, AT A MULTILATERAL FORUM
SUCH AT THE UN (WHO, FAO, ETC.) OR APEC, OR THROUGH BILATERAL
CONTACTS BY A THIRD COUNTRY? WHAT WOULD THE COUNTRY WANT FROM
THE U.S. IN RETURN?

The GOC is working with regional and international
organizations, as well as the USG, to improve its avian and
pandemic influenza preparedness. The GOC receives most
assistance on avian flu surveillance and detection issues
from the Pan-American Health Organization (PAHO) and the USG,
primarily through APHIS. In addition, APHIS provides support
to the Colombian Agricultural and Livestock Institute (known
by its initials in Spanish, ICA) to improve surveillance of
animal diseases. This support is provided under a bilateral
agreement signed by the U.S. Secretary of Agriculture and the
Colombian Minister of Agriculture. Under the terms of this
agreement, APHIS provides about $800,000 per year toward the
purchase of vehicles, computers, GPS equipment, as well as
operational support. At present, most of this assistance is
focused on foot and mouth disease (FMD). Embassy APHIS
representatives said some funds may be reprogrammed for avian
flu surveillance assistance because the incidence of FMD has
declined in recent years. (APHIS has also heard that the
Inter-American Development Bank is considering giving
Colombia USD 500,000 toward technical assistance for animal
surveillance.)

On a regional level, the GOC is a leading partner in the
Andean Technical Committee for Animal Health, which is
comprised of Bolivia, Colombia, Ecuador, Peru and Venezuela.
This Committee has established a set of technical norms to
analyze samples and interpret results. The Committee has
also funded training. On October 21, 2005, Health Ministers
from six countries (Bolivia, Chile, Colombia, Ecuador, Peru
and Venezuela) met in Lima to prepare an Andean Contingency
Plan for avian influenza. According to GOC sources, the
discussion focused on a coordinated plan to prevent the entry
of avian influenza into the region, as well as joint measures
to be taken in the event of a pandemic.

The GOC has expressed a preference for handling avian and
pandemic influenza issues through multilateral fora. The GOC
sent a representative, from its Embassy in Washington, to the
International Partnership for Avian and Pandemic Influenza
(IPAPI) Senior Officials Meeting (SOM) in early October more
to observe the proceedings than to show support for the
undertaking. While the GOC agrees with the core principles
of IPAPI, the GOC is concerned that such efforts will
undermine the authority of international organizations
already working on avian and pandemic influenza issues,
derail efforts to develop a coordinated international
response and confuse countries as to the source of
authoritative information about preparedness and disease
transmission. GOC representatives told Poloff they were
comforted by the participation of many multilateral
organizations, including the WHO, at the IPAPI SOM.

Embassy believes, however, the GOC would welcome offers of
bilateral assistance, from the USG and others, as it fleshes
out the September 2005 Plan. Various Ministry
representatives told Poloff and USAID officers that the GOC
would welcome both technical assistance and more training
from the United States. To date, there has been no official
GOC request for USG assistance.


7. (SBU) 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?

The GOC offers annual flu shots; vaccination centers are
located throughout the country. The September 2005 Plan
calls for the immunization of all children between 6 and 24
months of age and 5 percent of all senior citizens over the
age of 65 through the administration of 5.4 million doses of
influenza vaccine from 2005-2008. The Plan also calls for
the eventual vaccination of other people, including high risk
populations such as health care workers. The September 2005
Plan does not specify the source of these doses.

Colombia currently does not produce influenza vaccines for
humans or poultry. According to INVIMA (the Colombian FDA
equivalent),there is no liability shield for drug companies,
foreign or domestic. However, in the event of an emergency,
Colombian law permits, under Decree 677 of 1995, the
commercialization of medications and vaccines that have not
been approved by INVIMA, as long as the medication or vaccine
has been approved and registered in its country of origin.


8. (SBU) 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?

The Tolima outbreak has served to highlight the potential
threat of avian influenza in Colombia. Following the Tolima
outbreak, national news coverage of the issue increased
dramatically. Despite this increased awareness, the GOC has
not made efforts to educate civil society about avian and
other pandemic influenza preparedness or mitigation measures.


The national federation of chicken producers (known as
FENAVI) funds ICA seminars to train poultry producers on
reporting and handling bird infections. There are no
GOC-sponsored programs designed to educate or inform other
target populations. GOC representatives have identified this
as a critical gap in the Plan.

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SURVEILLANCE/DETECTION
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9. (SBU) 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 WHO,
AND IF NOT WHERE ARE THEY SENT? DOES THE COUNTRY SEND SAMPLES
TO A WHO/EU/US REFERENCE LABORATORY?
According to the September 2005 Plan, the GOC recognizes the
importance of surveillance and early detection of influenza
and calls for intensified surveillance of atypical
respiratory illness as well as atypical or unexplained
mortality associated with at risk populations groups
(including health workers and workers in the poultry or pork
industries).

Based on conversations with the GOC and human and animal
health experts at the Embassy, the GOC has the technical
capability to detect new strains of influenza among people
and animals. On the human health side, the GOC has employed
a sentinel watch surveillance strategy to detect influenza
outbreaks (with a specific focus on respiratory illness)
since an outbreak of Type A influenza (H3N2) in 1996. The
sentinel watch surveillance strategy was implemented in March
1997 and consists of taking samples/specimens from patients
who appear to have influenza-like symptoms within the first
three days of possible infection. Six regions are the focus
of this active surveillance: Baranquilla, Bogota, Huila,
Manizales, San Jose del Guaviare and Valle. Samples are sent
to one of five laboratories in the National Laboratory
Network that are able to perform influenza fluorescence
diagnoses as well as subtyping. Samples are also sent to the
CDC in Atlanta for confirmation.

On the animal health side, ICA has been engaging in both
active and passive surveillance of poultry for the last three
years. Passive surveillance involves routine, random testing
of asymptomatic birds. Active surveillance involves the
examination of dead or symptomatic birds. The October 2005
H9N2 outbreak in Tolima Department was discovered through
ICA,s passive surveillance. According to APHIS, however,
ICA needs to further develop and refine its laboratory
techniques, but lacks the funding to do so. FENAVI, the
national federation of chicken producers, funds nearly all
laboratory work. (APHIS representatives are aware that
FENAVI paid for a Mexican avian influenza expert to spend a
month in Colombia assessing ICA's laboratory facilities and
techniques. The expert is currently in Colombia finishing
this assessment.)

Despite this comparatively extensive experience in monitoring
disease outbreaks in both humans and animals, the GOC is
limited by the lack of a local laboratory that is capable of
subtyping avian influenza viruses. The only lab in the
hemisphere capable of subtyping avian influenza is the NVSL
in Ames, Iowa. The Colombians were able to determine that
the virus found in Tolima Department was H9, but specimens
had to be sent to Ames to determine the N2 subtype. In
addition, the testing that is completed in Colombia requires
reagents that must be imported from the United States.


10. (SBU) 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?

It is critical that the GOC transform the September 2005 Plan
from a "to do" list to a detailed -- and implemented -- plan
of action. The Plan does not provide any details as to how
the GOC would deal with a disease outbreak. Further, the
Plan needs to better articulate the roles of responsibilities
of the various involved Ministries.

In the GOC,s assessment, one of the most critical gaps is
the lack of local/regional laboratories capable of subtyping
avian influenza. (Comment. The GOC's interest in a lab with
this capability is as much for economic as for scientific
reasons. If such a lab had existed in Colombia at the time
of the Tolima outbreak, the GOC may have been able to
determine that the Tolima virus had a low pathogenicity more
quickly, preventing the exclusion of Colombian chicken from
the regional market. End Comment.) In addition, the GOC is
concerned about the lack of appropriately trained medical and
animal health professionals. According to representatives
from ICA, there is only one animal health specialist in the
country who has received the most up-to-date training on
avian flu detection. (His training in the U.S. was funded by
APHIS.)

In addition, Ministry of Social Protection representatives
told Poloff and USAID officers that they were particularly
concerned about the lack of public information about avian
and other flu. The September 2005 Plan calls for the
establishment of a communications network to disseminate
information about avian and other pandemic influenza, but the
GOC currently does not have an information dissemination
system.

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RESPONSE/CONTAINMENT
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11. (SBU) 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?

The September 2005 Plan calls for vaccinating at-risk
populations. The Plan also calls for the development of a
policy for the use of antiviral medications during a pandemic
and ensuring a supply and proper distribution of antiviral
medications. To date, however, the GOC has no stockpile of
medications and has not placed an ordered for any
medications.


12. (SBU) DOES THE COUNTRY HAVE A STOCKPILE OF PRE-POSITIONED
PERSONAL PROTECTIVE GEAR?

At present, there is no stockpile of pre-positioned personal
protective gear. The September 2005 Plan does not address
the issue of a supply stockpile.


13. (SBU) 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?

The Embassy's medical unit assessment is that the GOC lacks
the capacity to respond rapidly to any human outbreaks.
There are insufficient stocks of medication and supplies, as
well as hospital beds, to deal with a pandemic in Colombia.

There are no guidelines currently in place for the culling
and vaccination of birds, disinfection of facilities or
limitations on animal movement. According to APHIS, the
birds in Tolima Department that have H9N2 have not yet been
culled because the various Ministries cannot agree as to
where and how to carry this out. Moreover, there are no
guidelines -- and insufficient funds -- for compensating the
owners of culled birds. The cost of culling the birds in
Tolima, most of which are breeder chickens, is estimated at
USD 5 million. The owners have resisted culling because the
GOC has no funds with which to indemnify them.


14. (SBU) 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?

The GOC is willing to impose quarantines and other measures.
The September 2005 Plan calls for the design and development
of public health measures to control the transmission of
avian and other pandemic influenzas. These measures may
include social isolation, quarantine, the closing of
establishments and the prohibition of mass meetings. To date,
however, there has been no further explication of how these
measures would be implemented.
DRUCKER