UNCLAS SECTION 01 OF 03 DUBLIN 001434

SIPDIS

E.O. 12958: N/A
TAGS: TBIO SENV ECON EAGR EAID PREL EI
SUBJECT: IRELAND INFORMATION ON AVIAN AND PANDEMIC INFLUENZA

REF: SECSTATE 209622


1. On November 21, Emboffs reviewed reftel with Brian
Mullen, Principal Officer for Community Health in the
Department of Health and Children and also the GOI
point-of-contact on avian flu issues. The following
information, drawn principally from our discussion with
Mullen, is keyed to reftel's questions.

Preparedness/Communication
--------------


2. The GOI is drafting Ireland's national avian flu
preparedness plan and aims to publish the document in late
December/early January, said Mullen. The plan will draw from
the GOI's 2002 Influenza Pandemic Report and the 2004 Public
Health Emergency Plan, which are not publicly available. The
plan also incorporates input from the WHO. The Health
Service Executive (HSE), a government body that manages
Ireland's health care system, is the plan's lead drafter and
is finalizing an implementation strategy covering over 100
health system actions that would be required in the event of
a pandemic outbreak.

3A. Mullen said that preparedness for an avian flu pandemic
ranks among the government's highest priorities, a view
echoed by Deputy Prime Minister and Minister of Health and
Children Mary Harney and Minister of Agriculture and Food
Mary Coughlan in regular public remarks on the pandemic
threat. As evidence of GOI attention to the issue, Minister
Coughlan introduced legal measures on October 27 to: ban the
collection of poultry and captive birds for poultry markets,
shows, exhibitions, and cultural events (consistent with the
EU Commission Decision of October 21); require reporting and
record-keeping on unusual or unexplained patterns of bird
mortality at commercial premises; and, register with the
Department of Agriculture and Food all poultry flock-owners
and owners of premises where captive birds are kept for sale
or sporting purposes.

3B. The GOI "go-to" person for USG officials is Department
of Health and Children Secretary General Michael Scanlon
(353-1-635-4154). Scanlon chairs the Public Health Emergency

Group, the locus of GOI decision-making on avian flu that is
comprised predominantly of Health, Agriculture, and HSE
officials, including, notably, Gavin Maguire, HSE Head of
Emergency Planning. The Group is advised by the Influenza
Pandemic Expert Group, a committee of academics and doctors
with expertise in influenza science. The Public Health
Emergency Group, moreover, meets regularly with an
inter-agency standing committee with responsibility for avian
flu-related actions that fall under the members' respective
Departments. For example, the representative for the
Department of Communications, Marine, and Natural Resources
coordinates public outreach on the GOI's avian flu measures.
Lastly, the Public Health Emergency Group works with (though
is separate from) the Irish Department of Defense-chaired
National Emergency Planning Task Force, which has
responsibility for GOI response to disasters in general.



4. Mullen said that Irish laws were consistent with
international health regulations and were guided by the best
available medical/veterinary advice at both the national and
EU levels. He added that laws governing the detection,
reporting, containment, and response to avian influenza were
being reviewed in conjunction with the drafting of the
national preparedness plan.


5. The GOI works regularly with the WHO, EU, and other
organizations to monitor international developments
concerning avian flu, said Mullen. Ireland, for example,
participated in the October 24-26 Copenhagen avian flu
conference hosted jointly by the EU Commission and WHO, and
also in the WHO/FAO/World Bank Geneva conference on November
7-9. Mullen commented that Ireland currently did not see a
need for U.S. assistance, but would be receptive to bilateral
approaches from USG officials.


6. Ireland currently administers an annual flu shot, giving
approximately 550,000 doses of a trivalent vaccine to 12-15
percent of the population, namely, high-risk individuals such
as the elderly and those with vulnerable immune systems.
Ireland obtains the vaccine through tenders at the EU level,
usually from multiple manufacturers. Ireland does not
produce any vaccines of its own. In addition, the country
does not produce, nor is developing, an influenza vaccine for
poultry. Mullen noted that while there is no liability
shield in Ireland for foreign makers of the vaccine, the
possibility of enacting such a shield is an issue under
examination for the national preparedness plan.


7. The Irish populace is generally well-informed about the
pandemic threat, having access to regular print, radio, and
television reporting on the subject. The website of the
Health Protection Surveillance Center (an HSE office at
www.hspc.ie) provides the most comprehensive information on
avian flu. Websites for the Department of Health and
Children and the Department of Agriculture and Food also have
avian flu pages, though the Health Department's information
is only current as of January 2004. Mullen said that a
public information campaign would feature in the national
preparedness plan and would rely on all available media
outlets. In a November 8 discussion with visiting U.S.
Deputy Secretary of Health and Human Services Alex Azar,
Deputy Prime Minister Harney noted challenges in providing
information on the pandemic threat without adding to public
anxiety (septel).

Surveillance/Detection
--------------


8. Laboratories attached to the Department of Agriculture
and Food and the Department of Health and Children are fully
capable of identifying on short notice new strains of
influenza in animals and humans, respectively, according to
Mullen. Ireland is also able to sub-type influenza viruses
and therefore does not usually send samples to WHO/EU/U.S.
reference laboratories, although Irish officials would do so
if requested by such laboratories.

9A. Mullen identified the health sector's surge capacity as
the most significant concern in Ireland's efforts to
formulate a national preparedness plan. He also mentioned
that the GOI was attempting to calculate the likely
economic/social losses that would accompany an expected
30-percent attack rate on the national labor force in the
event of a pandemic outbreak. A specific concern related to
this expected attack rate would be the health sector's
ability to function without 30 percent of its labor force.

9B. Comment: Post wishes to highlight that Ireland's health
sector has not kept pace with the country's rapid economic
rise. Ireland's "mixed" health care system features public
and private hospitals and entitles persons over 70 or who
fall within the poorest one-third of the population to free
health services and medicine. The system, however, has
several high-profile deficiencies, including, most visibly,
long waiting times in hospital facilities, a problem that
would be exacerbated by a pandemic outbreak. A shortage of
hospital beds (3 per 1,000 population, versus the EU average
of 4.4) has contributed to this problem. The Irish health
system also has a perceived inequity issue, insofar as
persons with private insurance (roughly 52 percent of the
population) enjoy speedier access to care and have incentives
to maximize treatments in subsidized public facilities.
Public hospitals often ring-fence up to 20 percent of beds
for private use, even when uninsured patients on waiting
lists have greater medical need -- again, a problem that
would affect surge capacity in a pandemic scenario. Lastly,
the health system suffers from administrative confusion,
which centers on the fact that the Department of Health and
Children has responsibility for overall health care policy
and implementation, though the HSE controls the government's
euro 10 billion health care budget (roughly 20 percent of
total government spending).

Response/Containment
--------------


10. Between now and early 2006, Ireland is expecting the
arrival of one million doses of tamiflu, which would cover 20
percent of the population (of four million) at a cost of euro
15 million. Mullen expects 600,000 of those doses to arrive
the week of November 28 and 400,000 to follow in early
January. There are no plans to purchase more tamiflu beyond
these anticipated shipments. The GOI is also considering
purchasing other anti-viral medications, though, similarly,
there are no specific plans at the moment.


11. Mullen said that there was not enough personal
protective gear in the current stockpile, and the national
preparedness plan would outline the quantities needed. In
terms of essential protective gear, Mullen said the GOI was
focusing almost exclusively on face masks.


12. Rapid response guidelines in the national preparedness
plan would encompass movement restrictions on animals, the
culling of birds, and the availability of anti-viral
treatments for persons handling potentially infected animals,
according to Mullen. As noted in para 3A, the Department of
Agriculture and Food recently unveiled legal measures
requiring the registration of all flock-owners and premises
that keep or sell captive birds, so that the GOI might be
able to localize a possible outbreak.

13. Mullen observed that the GOI was willing to enact
quarantines creating social distancing, such as closing
schools and restricting public gatherings. Police
enforcement of quarantines is incorporated into the national
preparedness plan, but Mullen does not anticipate any
military involvement, except as an exceptional measure.
KENNY