APEC OFFICIAL MICHALAK'S WHO MEETING ON AVIAN

UNCLAS SECTION 01 OF 03 HANOI 002709

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SUBJECT: APEC OFFICIAL MICHALAK'S WHO MEETING ON AVIAN
INFLUENZA

SENSITIVE BUT UNCLASSIFIED


1. (SBU) Summary: U.S. Senior Official for the Asia Pacific
Economic Cooperation (APEC) Michael Michalak met with Dr.
Hans Troedsson, World Health Organization (WHO)
Representative to Vietnam, on October 10 to discuss avian
influenza (AI) issues, including Vietnam's response plans,
current control efforts and future response capabilities.
Troedsson noted the Government of Vietnam (GVN) had made
significant progress on control measures, but not in
planning and response capabilities. He and Michalak
discussed potential solutions and mechanisms for improving
donor coordination to better assist the Vietnamese in
improving their capacity for rapid response to a potential
AI outbreak during the upcoming December flu season. End
Summary.

DECEMBER 2005: THE NEXT OUTBREAK IN VIETNAM?
--------------


2. (SBU) U.S. Senior Official for the Asia Pacific Economic
Cooperation (APEC) Michael Michalak met with Dr. Hans
Troedsson, World Health Organization (WHO) Representative to
Vietnam, on October 10 to discuss avian influenza (AI)
issues. Troedsson began by explaining that AI outbreaks in
Vietnam are seasonal: the first outbreak occurred from
December 2003 until March 2004. The second outbreak began
in December 2004 and ended in July 2005, though the July
case was not confirmed until August. No AI cases have been
found in Vietnam since then. Dr. Troedsson cautioned that
it was "very likely" a third outbreak will occur beginning
in December 2005.

GVN PLANNING, CONTROL, AND TRANSPARENCY: SLOW BUT IMPROVING
-------------- --------------


3. (SBU) Though he acknowledged progress has been very slow,
Troedsson's current evaluation of the GVN's AI preparedness
planning was guardedly positive. With WHO help, the GVN has
drafted a national preparedness plan that significantly
improves inter-ministerial coordination and lays out a
reasonable response to an AI outbreak. The GVN, he said, is
finally thinking of AI as an issue that can affect multiple
sectors, not just health. Troedsson also affirmed that the
GVN's control capabilities have greatly improved. The GVN
has been stockpiling Tamiflu, begun efforts to develop a
human vaccine, and is receiving advice and technical
assistance from teams of independent experts. Mass poultry
vaccinations conducted by GVN officials are decreasing the
virus load in the country.


4. (SBU) According to Troedsson, the GVN's level and quality
of cooperation with the WHO and other donors has also
dramatically improved. The GVN now shares samples with the
WHO as well as other information, such as suspected cases,
in a more timely manner. The Prime Minister and Deputy
Prime Minister, rather than lower-ranking officials at a
single ministry, are now involved in the decision-making on
AI response. Even the Ministry of Health (MOH),which has
been very unresponsive in its initial response to AI, is
improving its cooperation with the WHO and other bilateral
and multilateral agencies, he explained.

GVN TECHNICAL CAPACITY IS BETTER...
--------------


5. (SBU) Troedsson laid out in detail the two main
components of the GVN's AI efforts in the field. The first
is the sentinel program, where eight regional laboratories
around the country conduct blood tests on any Vietnamese
with flu-like symptoms and send those specimens for further
confirmation testing to the National Institute of Hygiene
and Epidemiology (NIHE) in Hanoi or the Pasteur Institute in
HCMC. Four of these sites are in the north and four in the
south. There are no sentinel sites in the Central region
because there have been no reported cases of AI from this
area. The second component is a surveillance program where
any health facility in the country that sees a suspicious
case will try to take samples and send them on for further
testing. Troedsson confirmed the GVN does have the
capability, despite some earlier problems, to identify both
the H5 and the N1 parts of the AI virus using the CDC
Atlanta's PCR Step One methodology. It also has adequate
laboratory and technical capacity to carry out the sentinel
and surveillance program testing. According to Troedsson,
there is now a "critical mass" of knowledge in these labs.

...BUT THERE ARE STILL NO MEANS FOR RAPID RESPONSE
-------------- --------------


6. (SBU) While response planning and coordination has
improved and the technical capacity for control and
detection of AI has become more sophisticated, Troedsson
acknowledged that the GVN still does not have the ability to
respond rapidly to a large outbreak, especially in more than
one area. In light of this, the WHO has been proposing that
the GVN and donors create and deploy expert teams stationed
in the provinces that can make a first assessment in the
field without having to ship or transport specimens for
testing in Hanoi. Questions remain about team composition
(domestic, international or mixed),but the purpose is
clear: these teams would quickly identify the virus and
initiate response plans immediately, hopefully containing
the spread of the virus. Troedsson warned that even with a
contained outbreak, the GVN will immediately encounter
capacity problems with inadequate numbers of beds, medical
personnel, Tamiflu and quarantine facilities. Thus, the
donors have to help the GVN expand this capacity now so that
health services, particularly at the provincial level, can
manage any future outbreak.

THE DONOR ROLE: MORE FOCUSED COORDINATION
--------------


7. (SBU) Troedsson emphasized that because flu season
usually begins in December and since Vietnam has only a few
trained, qualified epidemiologists, there is a limited
window for financial and technical assistance from donors to
really have an impact. To do so at all will require
significant donor coordination. In response to Michalak's
question about whether or not the donors needed a new donor
mechanism to administer aid and assistance in order to meet
this urgent need, Troedsson noted that in the short-term the
UN has taken on a coordinating role and is developing an
efficient funding mechanism and steering committee. As for
long-term coordination to combat AI, this is still an
evolving issue that requires more work and effort. He
emphasized that Vietnam needs it own coordinating body and
that since it cannot be immediately funded and created, the
UN Development Program (UNDP) office in Hanoi will continue
to be the focal point for donors right now.


8. (SBU) Looking ahead, Troedsson suggested that Vietnam
might need donor coordination at the country level and
possibly at the regional and international level as well.
Acknowledging that an international coordinating body risked
creating a global AI fund, which would not be the most
efficient means of responding, Troedsson stated he believed
long-term donor assistance for Vietnam needed to start at
the country level and build up from there.


9. (U) Mr. Michalak has cleared this cable.

MARINE