AVIAN INFLUENZA TEAM VISITS VIETNAM TO DETERMINE

UNCLAS SECTION 01 OF 04 HANOI 001916

SIPDIS

STATE FOR FOR CA/OCS/ACS/EAP; EAP/EX; EAP/BCLTV;
STATE FOR OES/STC (M.GOLDBERG); OES/IHA (D.SINGER AND
N.COMELLA)
BANGKOK FOR RMO, CDC, USAID/RDM/A (MFRIEDMAN)
STATE PASS HHS, HHS/OFFICE OF GLOBAL HEALTH AFFAIRS
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USAID FOR ANE AND GH (DCAROLL, SCLEMENTS AND PCHAPLIN)

E.O. 12958: N/A
TAGS: AMED AMGT CASC EAGR TBIO VM AFLU
SUBJECT: AVIAN INFLUENZA TEAM VISITS VIETNAM TO DETERMINE
POTENTIAL AREAS FOR USG FUNDING


1. Summary: A ten member U.S. Government Interagency
Assessment Team visited Vietnam on July 18-19 to determine
key priorities and appropriate responses; find potential
partners; and, develop the next steps to implement U.S.
assistance for the prevention and containment of H5N1 Avian
Influenza (AI) in both humans and animals. The AI team met
with Vietnamese government (GVN) officials, international
organizations, non-governmental organizations and foreign
embassy officials to determine which activities should be
funded by a $25 million appropriation from Congress for
addressing AI in Asia. Interlocutors suggested that
additional funding should be used to provide immediate
assistance to the GVN to craft quickly a pandemic
preparedness plan; increase the capacity of the national lab
system to do broader and more complex surveillance; improve
communication; and help maintain the quality control in the
upcoming GVN's poultry vaccination program. The Minister of
Agriculture and Rural Development requested that the United
States send a special AI advisor to Vietnam to provide
technical assistance to the GVN. Mission Vietnam strongly
endorses this request and hopes that the USG will promptly
identify an AI specialist to visit Vietnam in the near
future to help the Vietnamese complete and internalize their
own AI plan. End Summary.


2. A ten member U.S. Government Interagency Assessment Team
visited Vietnam on July 18-19 to determine key priorities
and appropriate responses; find potential partners and
develop the next steps to implement U.S. assistance for the
prevention and containment of H5N1 Avian Influenza (AI) in
both humans and animals. The USG AI Team was led by Dr.
Dennis Carroll of the U.S. Agency For International
Development (USAID) and also included representatives from
U.S. Department of Agriculture (USDA) and the U.S.
Department of Health and Human Services (HHS). During its
two day visit to Hanoi, the AI Team met with representatives
from the Ministry of Health (MOH),Ministry of Agriculture
and Rural Development (MARD),MARD's Department of Animal
Health (DAH),National Institute of Hygiene and Epidemiology
(NIHE),World Health Organization (WHO),Food and
Agriculture Organization (FAO),European Union (EU),Japan
International Cooperation Agency (JICA),Vietnam Poultry
Producers Association, CARE and Agronomes and Veterinaires
Sans Frontieres (VSF). Econoff was the notetaker for these
meetings.


3. All parties agreed that AI is an integrated human and
animal health issue and that both aspects need to be
addressed immediately. While each of those two sectors has
a different focus on the areas that needed to be addressed,
there appears to be a consensus that Vietnam needs to
increase the breath and quality of surveillance, improve its
communication strategy in the countryside, and carefully
maintain the quality of the planned poultry vaccination
program. Most importantly, there remains the urgent need to
prepare a countrywide pandemic preparedness plan, given the
consequences that a pandemic could have for Vietnam in terms
of overall growth, tourism and foreign investments. The AI
Team was encouraged by the leadership of MARD Minister Cao
Duc Phat as he works across ministries to forge a
coordinated plan and put it into place. Having a well-
crafted plan in place and made public as soon as possible
and certainly no later than the end of September, would be
both prudent and send a strong signal to the international
community that Vietnam had taken the right preventive
measures. During the meeting with Minister Phat, he asked
whether the USDA could arrange for a senior expert to
quickly come out and assist the GVN in the preparation of
such a plan. In a separate meeting, the WHO also requested
that international donors send health experts to work in
country to help the GVN with its short- to medium-term
efforts against AI.


4. According to DAH, Vietnam has approximately 250 million
poultry, including 20 to 60 million ducks and geese.
Vietnam possesses the second largest number of ducks in the
world after China and the AI virus is currently endemic in
the poultry and water fowl population, DAH officials noted.
Commercialized large-scale production of poultry is Vietnam
is approximately 30 percent while 20 million farmers have
fewer than 10 chickens each. Most Vietnamese villagers on
the local level make no effort to separate animals, and it
is common practice to mix different animals together. With
20 million "backyard" farms, it is very common in Vietnam to
have pigs, ducks, chickens and humans in close proximity.
Most farmers grow poultry for their own consumption and it
is difficult, according to the DAH, to "change old ways" and
separate chickens from other animals in the countryside.
DAH admits that disease surveillance is a weakness and that
animal husbandry needs to be restructured, but this will be
a multiyear effort. Long-term efforts to stem the spread of
AI include: barring live poultry in cities; constructing
centralized slaughterhouses; educating farmers and
consumers; and vaccinating all poultry.

Surveillance
--------------


5. DAH recognizes that surveillance is an important tool
that needs better coordination among all government
ministries and other organizations to identify AI in
Vietnam. Coordination between both animal and human health
authorities on a district and communal level is weak and
needs to be addressed. Human capacity is another issue that
is lacking and both the NIHE and MOH agree that surveillance
should be the number one priority in the fight against AI.
In order to identify AI patterns and a potential outbreak,
NIHE needs reliable surveillance data to identify AI and
labs that have higher capabilities.


6. In certain instances, NGOs who specialize in working on
the local level are more easily able to determine the AI
situation on the local and communal level and could play a
potentially important role in AI surveillance. Both CARE
and VSF indicated that they have existing programs on the
local levels in some parts of the country and could benefit
from additional funding for AI surveillance. The GVN is
trying to expand its local surveillance capacity, but it
obviously lacks the financial resources to do so. According
to MOH, it has already drafted an AI Action Plan that
includes improving surveillance, but it lacks the financial
resources to carry out any action plan.


7. To improve its surveillance capacity in the laboratories,
MOH's medium priorities include improving its lab network
because AI samples that need complicated analysis now must
be shipped overseas for testing. The AI team agreed with
MOH that Vietnam needs Bio-Security Level 3 (BSL3) Labs,
which would greatly assist their efforts in identifying AI.
The construction of five BSL3 labs for MOH with JICA funding
is already in progress, the AI team learned. WHO
Representative Dr. Hans Troedsson urged that the provision
of any lab equipment or commodities be accompanied by
training assistance so that the equipment would be used
effectively.

Communication
--------------


8. The lack of communication among government ministries and
with the general population was a recurrent concern
throughout the AI Team's visit. A broad public awareness
campaign to change farmer behavior and educate the general
population on the potential dangers of AI is urgently needed
as well. FAO stressed that the commune level has the power
to influence local farmer animal husbandry techniques and
provide basic information about AI and its effects. FAO
suggested that any assistance in this area be coordinated in
some way at the commune level.


9. The EU and WHO also stressed that the local population,
health workers and hospitals have very little, if any,
information about AI. This needs to be addressed by the GVN
and international community. The WHO stressed that the
GVN's two most important ministries responsible for the
fight against AI, MARD and MOH, should better coordinate
their AI strategies and programs in order to be effective.

Poultry Vaccinations
--------------


10. The MARD and DAH outlined the GVN's pilot poultry
vaccination project set to begin this August in Tien Giang
and Nam Dinh provinces. The purpose of this campaign is to
curb avian influenza at its source and will target both
commercial and private poultry farms. This is in
preparation for a nation-wide program to begin in October.
To prepare for the program, the GVN has purchased 20 million
doses of vaccine (18 million from the Harbin China Institute
and 2 million from a Dutch company, Intervet). The cost of
the Chinese vaccine is approximately 200 VND/dose and the
Dutch vaccine costs 750 VND/dose (USD $0.012 and $0.047,
respectively).

WHO and Other Areas for Consideration
--------------


11. In addition to increasing surveillance, improving
communications and having a poultry inoculation plan, the
WHO underscored the urgency for Vietnam to develop a quality
AI National Preparedness Plan. It is apparent that such a
plan would have to be in place no later than the end of
September in case these are a resurgence of AI cases when
the cool season begins in October. According to WHO
Representative Dr. Hans Troedsson, there are nine key areas
where action must be taken and donor support would be
welcome. They are:

--Preparedness Planning Preparations;
--Rapid Response Team Development to quash or contain
quickly any outbreak;
--Development of an Effective Communication Strategy;
--Improved Surveillance Capacity Developed Jointly for Human
and Animal Health;
--Strengthened Lab Capacity;
--Improved AI Lab Sampling Capability;
--Addressing the Legal and Policy Requirements Inherent in
Any Preparedness Plan;
--Additional and Better Drugs and Equipment; and
--Improved AI Case Management.



12. The visit ended with a briefing for the Ambassador and
interested members of the Country Team. The AI team noted
that they would be prepared to share with us a more detailed
breakdown of the resources that would be committed to
Vietnam by August 2.


13. Comment: It is clear that the next 90 days is the
period when Vietnam will make basic policy decisions on how
it will address the threat of Avian Influenza both generally
and in response to a potential outbreak. As reported many
times, one of the first prerequisites is that Vietnam has a
strong pandemic preparedness plan in place prior to the
onset of the flu season in October. Fortunately, that task
has now been entrusted with the Minister of Agriculture and
Rural Development, one of the more able ministers in the
government. We have met with the Minister twice in the last
ten days. Each time he has said that he would be open to
technical assistance for plan preparation or more generally
determining the basic responses that need to be taken in the
agricultural sector to deal with the threat. We believe
that the United States should take advantage of this
opportunity. The USDA representative on the team said she
would look for expertise that might be available from her
organization. It would be helpful for our colleagues in
Washington to discuss with other U.S. centers of excellence
covering pandemic preparedness and response for someone who
could come out quickly. There maybe expertise in the
Federal Emergency Management Agency (FEMA),HHS, CDC, NIH or
state agencies that could have useful experience to offer
the Vietnamese. Promptly bringing a person or team with the
experience and diplomatic tact for a month or so to act as
an advisor would be relevant to Vietnam, take advantage of
this unique time and help the Vietnamese to complete and
internalize their own plan. End of comment.

MARINE