AMBASSADOR'S MEETING WITH MOH VM ON PEPFAR

UNCLAS SECTION 01 OF 04 HANOI 002398

SIPDIS

STATE FOR G; CA/OCS/ACS/EAP; EAP/EX; EAP/BCLTV; EAP/EP; INR;
OES/STC (MGOLDBERG); OES/IHA (DSINGER AND NCOMELLA)
BANGKOK FOR RMO, CDC, USAID/RDM/A (MFRIEDMAN)
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (LSTERN)
USAID FOQANE AND GH (DCAROLL, SCLEMENTS AND PCHAPLIN)
STATE ALSO PASS HHS/OGHA (EELVANDER)


E.O. 12958: N/A
TAGS: AMED AMGT CASC EAGR PINR SOCI PGOV TBIO VM HIV AIDS
SUBJECT: AMBASSADOR'S MEETING WITH MOH VM ON PEPFAR


1. SUMMARY/COMMENT: The Ambassador met September 9 with Vice
Minister of Health Nguyen Thi Xuyen to discuss the progress
of the President's Emergency Plan for AIDS Relief (PEPFAR)
in Vietnam, the activities leading to the development of the
06 Country Operational Plan (COP),the development of a plan
of action to guide the relationship between the USG PEPFAR
Team and Vietnamese Ministry of Health (MOH) and concerns
about the supply and cost of branded antiretroviral drugs.
They agreed that since June, 2004 when Vietnam became the
fifteen focus country, substantial progress has been made in
establishing and refocusing programs to meet the PEPFAR
country goals. The VM acknowledged the need to continue
programs started in the 05 COP but also noted that the
program must meet the action plans outlined in Vietnam's
National Strategy to Control HIV/AIDS. The VM asked for
support of seven priority areas in the 06 COP which would
support and strengthen MOH's HIV/AIDS infrastructure.


2. The Ambassador emphasized that the expenditures on ARV's
will limit the possibility of expanding existing programs.
He suggested that Vietnam has three possible options to
increase access to ARV's: 1) leveraging funds from donors to
purchase ARVs; 2) by working with STADA, the Vietnam-based
pharmaceutical company that manufactures ARVs to obtain FDA
approval for ARVs produced in Vietnam; and, 3) permitting
the importation of FDA-approved generics into Vietnam. MOH
representatives of the Drug Administration, Therapy
Department, the Vietnam Administration of HIV/AIDS Control
(VAAC) and International Cooperation, as well as the
Embassy's Health Attache also attended the meeting.


3. This 75-minute meeting was frank and constructive. We
laid down clear markers about what PEPFAR can do and what is
cannot do (i.e., purchase cars). The two sides agreed that
since June, 2004 when Vietnam became the fifteen focus
country, substantial progress has been made in establishing
and refocusing programs to meet the PEPFAR country goals.
Lastly, and perhaps most importantly, we focused high-level
attention on the critical ARV issues and explored several
solutions that would help us overcome PEPFAR's budget
shortfalls. In the weeks ahead, we will continue to press
hard for movement on the use of generics in Vietnam. END
SUMMARY/COMMENT.


4. The Ambassador met with Vice Minister of Health Nguyen
Thi Xuyen to discuss the progress of the President's
Emergency Plan for AIDS Relief (PEPFAR) in Vietnam, the
activities leading to the development of the 06 Country
Operational Plan (COP),the development of a plan of action
to guide the relationship between the USG PEPFAR Team and
Vietnamese Ministry of Health (MOH) of the Socialist
Republic of Vietnam and concerns about the supply and cost
of branded antiretroviral drugs. [NOTE: VM Xuyen has
responsibility for PEPFAR within the MOH. END NOTE.]


5. VM Xuyen opened the meeting by thanking the United States
for naming Vietnam as the fifteen focus country and
described Vietnam's system for HIV/AIDS control at the
national, provincial and district levels. The National
Steering Committee for the Control of HIV/AIDS, Prostitution
and Drug Abuse is chaired by Deputy Prime Minister Pham Gia
Khiem and Minister of Health Tran Thi Trung Chien is the
permanent co-chair. People's AIDS Committees direct
activities at the provincial and district level. With
respect to PEPFAR, the MOH has been delegated the
responsibility to collaborate with the USG team. In
response, the MOH organized an Interministerial Coordinating
Committee, which is supported by a Technical Committee and
Secretariat composed of only MOH staff. To facilitate a

SIPDIS
coordinated response to the epidemic, the MOH had recently
reorganized their HIV/AIDS program under a new department,
the Vietnam Administration of HIV/AIDS Control (VAAC).


6. VM Xuyen then outlined a number of key issues and
challenges. The MOH and USG PEPFAR team have been working
together on the framework for cooperation which is important
to complete and must be submitted to the Government for
approval. The Technical Working Group is assigned to work
with the USG Team to finalize the document. While
acknowledging the need to continue programs started in 2005,
she stressed that the PEPFAR program must contribute to the
action plans outlined in Vietnam's National Strategy to
Control HIV/AIDS as well as the requirements of the Office
of the Global AIDS Coordinator (OGAC). Further, given the
number of donors in Vietnam, the MOH recognizes need to
balance resources and avoid duplication of effort. The VM
asked that the U.S. side consider additional support in the
06 COP for infrastructure development at the national,
provincial and district levels to improve care, treatment
and diagnosis as well as to expand ARV acquisition and
distribution and the transfer of technology from the United
States to Vietnam for the production of ARV's to improve
pharmaceutical manufacturing.


7. VM Xuyen stressed that coordination and supervision of
PEPFAR activities both by MOH and the USG team should be
improved through submission of annual reports and periodic
site visits of partner activities as well as evaluation of
the success of the programs. The Ambassador indicated that
the USG team was agreeable to providing the MOH annual
reports and noted that March 2006 marked the end of the 05
COP activities and suggested that a program review at that
time would be useful.


8. The VM asked for support of seven priorities in the 06
COP which would support MOH's HIV/AIDS infrastructure, in
particular the establishment of the VAAC. Dr. Nguyen Thanh
Long, Deputy Director of VAAC noted that the MOH Technical
Working Group meets with the USG PEPFAR team regularly to
evaluate 05 activities and to plan for 06. He requested
support for: 1) the VAAC through the purchase of medical
equipment, supplies, training including creation of a
National Training Center, and for the PEPFAR Coordinating
Committee and Technical Committee, particularly for site
visits and program evaluation activities; 2) the Provincial
HIV/AIDS offices in the form of facilities, lab equipment,
vehicles and improving lab capacity; 3) the districts in
severely affected areas by HIV/AIDS; 4) the expansion of
access to ARV's to 20 provinces (currently USG plans to
supply ARV's to six focus provinces); 5) the coordination of
the distribution of ARV's from different donors, including
the MOH; 6) the integration of HIV/TB programs, which are
currently not well integrated; and, 7) the development of
policies for improving the technologies of companies in
Vietnam which are producing ARV's. The Ambassador said he
appreciates the need to expand care and treatment facilities
and human capacity, but explained that PEPFAR is a target-
driven program focusing on care, treatment and prevention.
Not reaching the targets could jeopardize future funding.
Many of the items included in the MOH list are being
supported in part by the current program, and that the USG
was happy to coordinate ARV distribution and would consider
supporting the HIV/AIDS National Training Center. Support
for buildings, vehicles, computers and other items would not
be available through PEPFAR, however for these needs. He
suggested that the MOH look to other donors such as the
World Bank.


9. The Ambassador complimented the Vice Minister on her good
understanding of the PEPFAR program and noted that they both
shared the same vision for the program. He also has
observed a great improvement in the dialogue between the USG
PEPFAR team and the MOH. He then described next steps for
the collaboration including the development of an Action
Plan, which establishes the working relationship between the
MOH and the USG PEPFAR Team. He noted the importance of
keeping the language simple and avoiding duplication of
language in the Bilateral Agreement on Economic and
Technical Assistance signed during Prime Minister Phan Van
Khai's trip to the United States in June 2005.


10. The Ambassador emphasized the importance of coordination
at all levels to enhance the prevention and control of
HIV/AIDS. Noting that the interministerial Coordinating
Committee was key to bringing into the dialogue all
government entities, he volunteered to meet with the
Coordinating Committee and brief them on PEPFAR. He noted
that he meets regularly with other donors to discuss how to
enhance donor coordination, and that the recent addition of
the U.S. Embassy to the Country Coordinating Mechanism of
Vietnam's Global Fund Program to Prevent AIDS, Malaria and
Tuberculosis also provides another avenue to improve
coordination.


11. With respect to planning for 2006, the Ambassador
emphasized that the continuation of successful, existing
programs is vital and reported that although Vietnam PEPFAR
will receive USD 6,000,000 over last year's budget, there is
a critical need to ramp up access of ARV's to people living
with HIV/AIDS. However, due to the worldwide shortage of
branded ARV's, the USG must purchase 18 months of ARV's from
2006 funds to ensure coverage through the period. Unless we
find ways to reduce the cost of these essential drugs, the
expenditures on ARV's will block any possibility of
expanding existing programs. Vietnam PEPFAR Program sees
three possible options to increase access to ARV's: 1)
leveraging funds from other donors to purchase ARVs; 2)
working with STADA, the Vietnam-based pharmaceutical company
that manufactures ARVs to obtain FDA approval for ARVs
produced in Vietnam; and, 3) permitting the importation of
FDA-approved generics into Vietnam.


12. The MOH would welcome the Embassy's assistance in
speeding up FDA approval of ARVs produced in Vietnam, VM
Xuyen stressed. She assigned the Drug Administration to work
with STADA and the USG PEPFAR team to apply for FDA
approval. Mr. Truong Quoc Coung, Director of MOH Drug
Administrations, noted that drugs produced in Vietnam would
be 300-400 percent cheaper than branded ARVs.


13. VM Xuyen suggested that the United States consider a
fourth approach for expanding ARV provision in Vietnam:
having the MOH to purchase STADA ARVs that would then be
distributed and administered through existing USG PEPFAR
programs.


14. The Ambassador responded that the Embassy would explore
this idea and pledged to push hard to help STADA complete
the FDA approval process. He also asked the Vice Minister
for written confirmation of MOH's position on the
importation of generic drugs already approved by the FDA.


15. The VM and Ambassador agreed that the November 2006
visit to Vietnam by President Bush would be an opportunity
to showcase the collaborative efforts of the two countries
on HIV/AIDS and illustrate the success of the PEPFAR
program.


16. The Ambassador told the VM that he was always available
to talk with her or her staff about PEPFAR and that he
looked forward to having the Action Plan agreed upon and the
06 COP finalized as soon as possible.


17. Comment: The MOH continues to wrestle with how to
organize its response to the HIV/AIDS threat. At present,
VM Xuyen is one of three Vice Ministers responsible for one
aspect of the work or another. (The other two are VM Tran
Chi Liem, in charge of the USG-funded, Life Gap program,
which predates PEPFAR, and VM Trinh Quan Huan, who handles
overall HIV/AIDS policy and oversees other donor programs
dealing with the epidemic.) While this complicates our
work, the USG PEPFAR team, assisted by the Ambassador, will
overcome this handicap.


18. Comment (continued). This 75-minute meeting was frank
and constructive. We laid down clear markers about what
PEPFAR can do and what is cannot do (i.e., purchase cars).
The two sides agreed that since June, 2004 when Vietnam
became the fifteen focus country, substantial progress has
been made in establishing and refocusing programs to meet
the PEPFAR country goals. Lastly, and perhaps most
importantly, we focused high-level attention on the critical
ARV issues and explored several solutions that would help us
overcome PEPFAR's budget shortfalls. In the weeks ahead, we
will continue to press hard for movement on the use of
generics in Vietnam.

MARINE