AVIAN FLU PREPAREDNESS IN SRI LANKA

UNCLAS SECTION 01 OF 03 COLOMBO 001592

SIPDIS

SENSITIVE

STATE FOR OES/PCI, NEA/IPA AND NEA/RA
USDA FOR APHIS/US/NCIE
HHS FOR OGHA
CIA FOR NATIONAL INTELLIGENCE COUNCIL NIO/EA

E.O. 12958: N/A
TAGS: TBIO ECON PREL SOCI EAGR CE KSTH WHO
SUBJECT: AVIAN FLU PREPAREDNESS IN SRI LANKA

REF: STATE 153802


1. (SBU) Summary: EconOff met with the Chief Epidemiologist
for the Ministry of Health (MOH) as well as an officer working
in the Colombo office of the World Health Organization (WHO)
regarding reftel. Sri Lankan officials and academics are
watching for signs of avian flu and other illnesses with
epidemic or pandemic potential. However, with no sufficient
laboratories on the island, as well as communication and
language barriers, it is unclear whether detection would occur
rapidly. Following detection, the government is not ready for
a coordinated and fast response. No exercises are planned to
prepare for such incidents. End Summary.

FOCAL POINT: MOH,S EPIDEMIOLOGY UNIT


2. (SBU) EconOff met with Dr. Nihal Abeysinghe, Chief
Epidemiologist for the MOH, who identified his epidemiology
unit as the focal point when contagious epidemics take place
in Sri Lanka. However, this does not mean that the
epidemiology unit will have the authority that it may need
for fast and sufficient response. Per the WHO official, the
MOH controls around 98 percent of all medical services in Sri
Lanka, with the private sector only serving about 2 percent
in urban areas.

WATCHING FOR AVIAN FLU, BUT NOT EXPECTING ITS ARRIVAL


3. (SBU) Officials are watchful for the arrival of avian flu
or other such diseases. Per Abeysinghe, September is
traditionally the month migratory birds arrive in Sri Lanka.
Officials at the Veterinary Research Institute are monitoring
the situation, on the alert for any unusual bird deaths.


4. (SBU) Abeysinghe added that Sri Lanka seems to be almost
immune from some of the diseases that plague the region. He
noted that SARS did not affect Sri Lanka and that avian flu
"seems to have been spreading to Mongoloid countries," but
added that Sri Lanka still needs to be on the lookout for
signs of the disease. The WHO official noted that avian flu
is "currently no threat" to Sri Lanka

DETECTION: COMMUNICATION AND DIAGNOSTIC PROBLEMS


5. (SBU) According to the WHO official, if an epidemic would
begin in the urban center of Colombo, it is likely that
detection (not/not diagnosis) of a disease could take as few
as two or three days. But Colombo comprises only a small
portion of the country. If an epidemic grew in a
Sinhala-speaking rural area, the WHO official said that MOH
might not hear of a problem until 15 or 20 cases are
discovered. This was the case when a myocarditis epidemic
was not detected by the MOH until two weeks after it began.
The WHO office was then advised only after 70 cases had been
reported. (Note: The WHO official noted that the epidemic
occurred in the MOH Minister's part of the country, implying
that perhaps the WHO would have learned of the epidemic even
more slowly if it had occurred elsewhere. End Note.) The
WHO official noted that there were ultimately 200 true cases
with 400 people appearing to be affected; yet no cause could
be found and the epidemic subsided on its own.


6. (SBU) The WHO official identified the Northern and
Eastern Provinces occupied by the Liberation Tamil Tigers of
Eelam (LTTE) as especially problematic for detection due to
language barriers. These are Tamil-speaking areas and many
health officials do not speak Tamil. Per the WHO official,
Tamil-speaking medical officers allegedly prefer living in
Colombo. (Note: The security situation in those areas could
prevent fast response. End note.)


7. (SBU) Abeysinghe's office is in regular communication
with MOH's Medical Research Institute, which conducts
laboratory testing for various diseases. However, its
facilities are inadequate. Alternatively, Abeysinghe
contacts the CDC in Atlanta, the University of Hong Kong, and
laboratories in India, and has transmitted specimens to those
laboratories on various occasions. Abeysinghe noted that
transport of the viruses to these facilities is difficult.
He articulated a desire to see Sri Lankan labs obtain
adequate resources for timely diagnosis.


8. (SBU) Both Abeysinghe and the WHO official described Sri
Lanka's isolation facilities as inadequate and inadequately
maintained. Abeysinghe speculated that in the event of a
pandemic, perhaps a military hospital could assist, or the
government could order/persuade another hospital to care for
patients.

RESPONSE TO EPIDEMIC COULD BE SLOW AND UNCOORDINATED


9. (SBU) Both Abeysinghe and the WHO official said that a
lengthy response time may be required in the event of an
epidemic or pandemic. Abeysinghe first claimed that Sri
Lanka has experienced "enough reality" with its floods,
droughts, influenza, myocarditis, dengue and meningitis and
therefore doesn't need exercises in epidemic management. But
later, he acknowledged that the Government of Sri Lanka (GSL)
is not very good at coordinating activities. "There are many
stakeholders within the government," Abeysinghe said. "It
will take time to coordinate."


10. (SBU) Abeysinghe described a scenario in which a disease
would first be detected somewhere in Sri Lanka, followed by
diagnosis which might require transport of specimens to Hong
Kong, India or the US. Following diagnosis, he would need to
contact the Minister of Health who may then contact the
President to coordinate/mandate treatment, isolation,
quarantine and other services. (Note: This is credible
given Sri Lanka's heavily centralized structure. Immediately
after the Asia tsunami, it was the President's office that
coordinated the GSL response, with many basic decisions going
to the President for decision. End note.) Abeysinghe does
not know whether the military would ever be called to
quarantine an area. He described one epidemic in which many
people had fled from their homes to other parts of Sri Lanka
before the MOH even arrived on site.

PREVENTION: FUTURE EFFORTS


11. (SBU) On September 12, Sri Lanka's Advisory Committee on
Communicable Diseases will meet to discuss various matters.
Following the 12 September meeting, Abeysinghe plans to make
suggestions to the Health Education Bureau and the MOH press
office on how to utilize the media to educate the public on
prevention of flu. He said that the media does "a good job
in spreading information."


12. (SBU) Per the WHO official, the WHO's South East Asia
Regional Office is coordinating a Pandemic Preparedness Plan
and is pressing countries in the region to develop their own
national pandemic plans. Pandemic preparedness will be a
part of the WHO biennial (2006-07) budget. The MOH's
epidemiology unit is working with the WHO on this project, in
the hopes of what the WHO official called "harm reduction."
However, the WHO official noted that the WHO invested heavily
some time ago in an Emergency Action Plan in Sri Lanka. That
plan has never been implemented.


13. (SBU) COMMENT: Chief Epidemiologist Abeysinghe appears
to have experience in handling small epidemics in some parts
of Sri Lanka but his philosophy that Sri Lanka might be
"immune" is disturbing. While putting past work in a positive
light, he also appears to know his office's limits. Sri Lanka
seems unprepared for a pandemic, which could spread long
before it is even diagnosed in foreign laboratories. Upon
diagnosis, the MOH and other government agencies do not seem
ready to combat a pandemic in an efficient and coordinated
manner. Should a pandemic occur, assistance would most likely
be accepted from bilateral and multilateral entities.
LUNSTEAD