1. (U) Summary: Djibouti has very little
capacity to handle avian and pandemic
influenza. Responses below are keyed to
questions in reftel. End Summary.



2. (U) Preparedness/Communication:

-- Djibouti does not have a plan/strategy
for preventing avian flu from becoming a
pandemic and containing a pandemic once it
occurs. It does not have sufficient
capability to implement such a plan.
Djibouti has not yet produced a plan, but
has been talking about writing one.

-- Djibouti will report a case, if they are
aware of it, however, since they have no
surveillance system for even basic diseases
among humans or animals, it is more likely
than not that they will not know. We do not
believe any incentives are needed for
transparency should the Government of
Djibouti discover a case.

-- Preparing for an avian flu pandemic does
not rank very high among government
priorities. We are not certain there is a
certain person or action that could
influence Djibouti to give the issue higher
priority. The Minister of Health is the
primary point of contact to engage on this
issue.

-- Post has no knowledge that Djibouti has
or has not reviewed its national laws to
ensure they are consistent with
international health regulations and do not
pose barriers to avian flu detection,
reporting, containment, or response.

-- Djibouti is currently working with
international organizations to a small
degree on the avian flu issue. Post is
certain Djibouti will seek assistance from
the US or other countries should the need
arise. Post believes government leaders
would be receptive to messages through all
channels. Djibouti would want money and
technical assistance in return for its
efforts on the avian flu. It is important to
note that Djibouti has asked chicken
importers to stop importing from Asia due to
the recent developments on Avian Flu.

-- Djibouti does not currently administer
annual flu shots, but may consider doing so
if it were funded by outside sources. The
Government does not have a budget to cover
such an expense. Djibouti has no production
capability for human influenza vaccines.
Djibouti does not produce influenza vaccine
for poultry , nor H5N1 vaccines, and does
not have a poultry industry. Licensing and
liability shields issues are not applicable
in this case.

-- The population of Djibouti is not very
well informed about the avian flu threat.
However, since there is no poultry industry
or lacustrine environment, the threat is
relatively low compared to other African
countries. Radio and community announcement
systems are available for providing
additional information to the population,
particularly in rural areas. Radio is fairly
effective for spreading messages throughout
the country.



3. (U) Surveillance/Detection

-- Medical and agricultural sectors are not
at all capable of detecting a new strain of
influenza among people or animals. All
diagnosis would have to be made outside the
country as there is no capacity to do so in
country. Samples would have to be shipped to
another country. Influenza viruses cannot be
subtyped in the country. In past polio
cases, samples were sent to a WHO reference
laboratory.

-- Djibouti has no effective systems in
place for any disease surveillance, not even
the most basic and common, such as polio,
diarrhea, malaria, etc. The greatest need in
this area is assisting the government in
building from the ground up an entire
disease surveillance system for all
diseases, not just Avian Flu.



4. (U) Response/Containment
-- Djibouti does not have a stockpile of
medications, particularly of antivirals. To
date, nothing has been ordered, but some
discussion on whether to order some has
occurred.

-- Djibouti does not have a stockpile of
pre-positioned personal protective gear for
humans working with poultry, nor for health
care personnel working with sick people.

-- There is little to no rapid response
capacity for animal and human outbreaks.
There are guidelines in place for the
culling and vaccination of birds,
disinfection of facilities, and limitations
of animal movement.

-- Djibouti is willing, but not very
capable, of imposing quarantines and social
distancing measures. This is due to
extremely porous borders and mass transit
being the only means of earning a small
daily income for a large portion of the
population. Schools could be closed if
necessary. Post believees Djibouti's
military would enforce quarantines if called
upon. However, Post does not know what the
general policy is and there is no strategy
currently in place for such an event. Post
has been told a strategy is being formed.