HHS SECRETARY LEAVITT'S MEETING WITH THE VIETNAMESE

UNCLAS SECTION 01 OF 09 HANOI 002824 SIPDIS SENSITIVE BUT UNCLASSIFIED - DO NOT POST ON THE INTERNET STATE FOR G; CA/OCS/ACS/EAP; EAP/EX; EAP/MLS; EAP/EP; INR; OES/STC (PBATES); OES/IHA (DSINGER AND NCOMELLA) BANGKOK FOR RMO, HHS/CDC, USAID/RDM/A (MFRIEDMAN) USDA FOR FAS/PASS TO APHIS DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (LSTERN) USAID FOR ANE AND GH (DCARROLL, SCLEMENTS AND PCHAPLIN) HOMELAND SECURITY COUNCIL FOR RVENKAYYA NSC FOR FSHIRZAD, JMELINE STATE PASS USTR (ELENA BRYAN) STATE ALSO PASS HHS/OGHA (EELVANDER) USMISSION GENEVA FOR HEALTH ATTACHE ROME FOR FAO E.O. 12958: N/A TAGS: AMED AMGT CASC EAGR PINR SOCI PGOV TBIO VM AFLU HIV AIDS SUBJECT: HHS SECRETARY LEAVITT'S MEETING WITH THE VIETNAMESE MINISTER OF HEALTH ¶1. (SBU) Summary: U.S. Secretary of Health and Human Services (HHS) Michael Leavitt met with Vietnamese Minister of Health (MOH) Tran Thi Chung Chien on October 14 at the Ministry to discuss avian influenza (AI) issues and ways to improve U.S.-Vietnam cooperation to combat AI more effectively. After a brief MOH presentation to provide data on the AI and HIV/AIDS situation in Vietnam, Minister Chien and HHS Secretary Leavitt identified Vietnam's top health needs and priorities. They also discussed new programs, cooperation and funding the United States will provide to assist those needs. After the meeting, the two officials signed a "Letter of Intent on Cooperation between the Vietnamese Ministry of Health and the Department of Health and Human Services of the United States of America" (see text, para. 22) to express their mutual commitment to improving cooperation on all health issues of concern. End Summary. OPENING REMARKS: LET US BE FRANK -------------- ¶2. (SBU) On October 14, U.S. HHS Secretary Michael Leavitt met with Vietnamese MOH Minister Tran Thi Chung Chien at the Ministry for 80 minutes, the first of a series of meetings with Vietnamese officials that day and the following day on improving U.S.-Vietnam health cooperation. A full list of participants follows in paragraphs 23, 24 and 25. Minister Chien began the meeting by emphasizing how important U.S.- Vietnam cooperation on emerging health issues like avian influenza (AI) and HIV/AIDS is to Vietnam and to its ability to control and prevent the spread of these diseases. She said she wanted to conduct the meeting in an "open atmosphere," with frank exchanges and discussion for the benefit of future U.S.-Vietnam health cooperation efforts. ¶3. (SBU) The Secretary replied that this visit is a reflection of the strong relationship the United States and Vietnam have built in recent years. He thanked Minister Chien for her welcome, and also for the support of the Government of Vietnam (GVN) and the Vietnamese people for American victims of Hurricane Katrina and Hurricane Rita. The Secretary described this generosity as "warming to our spirits," and noted that Vietnam's contribution had also assisted in aiding the many Vietnamese-Americans in Louisiana affected by the storms. He expressed his condolences for the human and economic losses Vietnam had suffered from AI, and noted that "no nation on earth can avoid" this disease if it establishes the ability to move efficiently from human to human. The Secretary emphasized that if AI mutates to enable sustained human-to-human transmission, it has the potential to kill millions of people and alter the customs, prosperity, and way of life of billions of people all over the world. Thus, he welcomed Minister Chien's interest in speaking candidly about the reality of and solutions for combating AI. AI: THE NUMBERS -------------- ¶4. (SBU) Following the Secretary's remarks, Vice Minister of Health Trinh Quan Huan provided a PowerPoint presentation on the AI and HIV/AIDS situations in Hanoi. He described the history of the H5N1 AI strain in Vietnam as follows: -The first outbreak had a four-month duration, from December 2003-April 2004, across 13 provinces, with a total of 23 human cases and 16 human deaths. In all, 57 of the 64 Vietnamese provinces reported AI outbreaks in poultry. -The second outbreak had a two-month duration from July 2004- August 2004, spread across three provinces, where there were four human cases and four human deaths. In all, 17 of the 64 provinces in the country reported AI outbreaks in poultry. -The third outbreak had a seven-month duration from January 2005-July 2005, spread across 25 provinces, with 64 human cases and 21 human deaths. In all, 36 of the 64 Vietnamese provinces reported AI outbreaks in poultry. ¶5. (SBU) Huan emphasized that all human AI cases had previously been in contact with poultry, and that these human AI cases only occurred in provinces that had also had AI outbreaks in poultry. He attributed this to the low levels of knowledge rural people have about AI and their poor awareness of appropriate control measures. There are, he stressed, no proven human-to-human cases of transmission in Vietnam. ¶6. (SBU) According to Huan, the GVN faces several challenges in combating AI, namely improving surveillance, establishing Bio-Safety Level 3 (BSL-3) laboratories at the National Institute of Hygiene and Epidemiology (NIHE) of the MOH in Hanoi and the Pasteur Institute in HCMC, increasing public awareness about AI and its methods of transmission, and training medical workers in proper containment and treatment procedures. HIV/AIDS: THE NUMBERS -------------- ¶7. (SBU) Huan then presented an overview of the HIV/AIDS situation in Vietnam. All 64 provinces, 90 percent of the districts and 50 percent of the communes in Vietnam have reported cases of HIV/AIDS, he said, but the prevalence rate varies by region. Quang Ninh Province, for example, has just fewer than 600 cases per 100,000 people, one of the highest rates. ¶8. (U) HIV/AIDS is predominantly present in drug users in Vietnam. According to MOH statistics, 54 percent of intravenous drug users in the country have HIV/AIDS, whereas less than three percent of prostitutes have the disease. This distribution, however, also varies by region, according to the Ministry, with a higher rate of HIV/AIDS infection among drug users in Hanoi and a higher rate of infection among prostitutes in HCMC. The Ministry estimates that eighty percent of all HIV/AIDS cases in Vietnam exist among 20-29-year-olds, which is also the most important age group for labor productivity. ¶9. (SBU) The Vice Minister emphasized that the projects and training the GVN will implement from 2005-2010 require large amounts of money, which the GVN and contributions from the British Government, the Global Fund, and other donors cannot completely cover. According to the MOH, the total 2005-2010 budget shortfall is USD 498,606,352 million. ¶10. (SBU) Finally, Huan reviewed the educational capacity of the GVN in health and pharmacology. There are 14 universities, four medical colleges, and 74 pharmacology schools in Vietnam, which annually produce approximately 3,000 postgraduate students, 6,200 medical college graduates, 18,800 college graduates, and 14,500 pharmacology school graduates. The GVN hopes to improve these graduation rates to meet its 2010 social development target of seven doctors and .5 pharmacologists per 100,000 people. Huan stated that the GVN would also like to expand cooperation and assistance to develop capabilities in molecular biology, information technology, genetics, immunology, bio-safety laboratories, biotechnology, vaccine research and transplant techniques. (Note: Huan did not distribute copies of his slides, and moved through them very quickly. The information above comes directly from his presentation. End Note.) MOH'S MAIN REQUESTS OF THE USG -------------- ¶11. (U) After Huan finished speaking, Minister Chien reviewed the progress the GVN has made in developing a National Plan for Emergency Preparedness, as well as training courses for health personnel. The MOH drafted the plan, she added, by using the lessons learned from the experience of combating Severe Acute Respiratory Syndrome (SARS). The plan also includes district- and commune-level support, as well as coordination with the army and the air force in case their assistance in transportation is needed. Media cooperation is another important aspect of the plan, since television and radio communication, especially with rural areas and in local languages, is important to increasing awareness and distributing critical information. The GVN has also taken into account the linguistic differences of some minority groups, and has prepared for translating messages into appropriate tongues. All Ministries and other elements of the GVN involved in this plan now meet twice a year to discuss and improve their response to national disasters and emergency situations. ¶12. (SBU) Madame Chien then listed the top priorities and concerns of the MOH, including areas in which the GVN would like to increase cooperation with and assistance from the United States. First, she encouraged more foreign direct investment (FDI) in the Vietnamese health sector for training, health care and high-technology development, especially FDI from U.S. pharmaceutical corporations. Second, developing an effective human vaccine against the H5N1 influenza virus is a top priority for the GVN. Third, the GVN wants its two main laboratory facilities - NIHE under the MOH and the Pasteur Institute - to have BSL-3 capabilities. The GVN also needs basic medical supplies and equipment to better respond to potential AI outbreaks. Minister Chien concluded by noting the GVN wants to become self-reliant in its ability to develop vaccines against influenza and other disease and conduct testing and clinical trials that are up to international standards. U.S. SUPPORT FOR MOH REQUESTS -------------- ¶13. (SBU) After thanking Minister Chien for the helpful presentation and her suggestions, the Secretary explained the details of ongoing and future U.S. assistance to Vietnam for combating AI and HIV/AIDS. The United States continues to value and encourage opportunities for Vietnamese and U.S. professionals in disease control to exchange ideas and visit testing facilities. Many of these exchanges have been going on for some time, and the United States will continue to expand this effort, he said. The Secretary asked several of his delegation members to explain these efforts in detail. SURVEILLANCE PROGRAMS -------------- ¶14. (SBU) Dr. Julie Gerberding, Director of the HHS Centers for Disease Control and Prevention (CDC),explained that the United States will commit USD 2.6 million out of Fiscal Year 2005 emergency supplemental funding to assist surveillance programs in four specific areas. First, it would fund prevention and education programs as well as training for epidemiologists and other scientists. Second, it would focus on detection, by helping rural people understand how to identify and report potential AI cases. Third, it would help the GVN develop rapid-response teams that could move quickly to assist people at the local level. Finally, it would also support vaccine and antiviral development. In addition to the USD 2.6 million from HHS/CDC, the U.S. Agency for International Development (USAID) will also provide USD 3.4 million out of Fiscal Year 2005 emergency supplemental funding to help combat AI by improving animal health efforts and communications between health and agricultural officials at the national and provincial levels. USAID HIV/AIDS PREVENTION PROGRAMS -------------- ¶15. (SBU) Dr. Kent Hill, Acting Assistant Administrator for Global Health at USAID, then described a second area of U.S. assistance funded by his agency. Noting that President Bush's designation of Vietnam as the fifteenth focus country in his Emergency Plan for AIDS Relief (PEPFAR) demonstrated the depth of U.S. commitment in this area, Hill said that in Fiscal Year 2005, USAID will provide a total of USD 16 million for HIV/AIDS programs in Vietnam and USD 20 million in 2006. (NOTE. As part of the President's Emergency Plan, HHS will also spend USD xxx in Fiscal Year 2005 for HIV/AIDS programs in Vietnam, which brings the total USG investment in Vietnam under the Emergency Plan in Fiscal Year 2005 to USD xxx.) USDA ASSISTANCE WITH POULTRY PROGRAMS -------------- ¶16. (SBU) Dr. James Butler, Under Secretary for Farm and Foreign Agricultural Services at the U.S. Department of Agriculture (USDA),said that USDA will also cooperate on and contribute to AI efforts by sending scientists to Vietnam to help with the diagnosis of AI in animals and providing equipment and resources to assist vaccination programs. Butler said USDA will continue to work closely with the Vietnamese Ministry of Agriculture and Rural Development (MARD) on these programs. U.S. EFFORTS IN VACCINE RESEARCH -------------- ¶17. (SBU) Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID) within the HHS National Institutes of Health, explained that the U.S. vaccine development efforts had found humans respond differently to the H5N1 virus than they do to regular, seasonal flu strains, and that clinical trials are very important in the development of an H5N1 human vaccine, its safety, and its appropriate dosage. He promised that HHS would continue to work closely with Vietnam in these efforts. THE INTERNATIONAL PARTNERSHIP -------------- ¶18. (SBU) Under Secretary of State for Global Affairs Paula Dobriansky welcomed Vietnam's participation in the International Partnership to Combat Avian Influenza, and noted that the Partnership is committed to surveillance, transparency and the sharing of information. She thanked the Minister for the GVN's participation in the Senior Officials' meeting held in Washington on October 6-7, and expressed appreciation for the Vietnamese delegation's endorsement of the core principles of the Partnership. She emphasized that AI is not just a health issue but also something that will have social, economic and security implications in Vietnam and around the world. THE IMPORTANCE OF TRANSPARENCY -------------- ¶19. (SBU) Secretary Leavitt emphasized that the most important aspect of U.S.-Vietnam cooperation on health issues is transparency. He appealed to the Minister that Vietnam must provide an absolute commitment to cooperation and transparency when the GVN discovers cases of H5N1. HHS/CDC Director Gerberding explained that when a case of H5N1 AI is discovered, the United States needs to know three things and know them quickly. First, the United States must know the "who, what, when, where and how" of each case. Second, we must understand the illness, the clinical conditions and treatment of each patient, and his or her response. Finally, without specific samples and information on the virus, we cannot make an appropriate vaccine. She urged the GVN to share as much of this information directly with the USG as soon as possible. ¶20. (SBU) To emphasize this point, the Secretary asked Dr. Margaret Chan, Assistant Director-General for Communicable Diseases at the World Health Organization (WHO),to address the delegations. Dr. Chan, who had commanded the response to SARS in Hong Kong while she was head of the Health Department there, shared that, in her experience, transparency and rapid response were the most important weapons against disease. She said the WHO Secretariat and its Regional Office in Manila would continue to assist Vietnam in fighting AI. ¶21. (U) Following the conversation, HHS Secretary Leavitt and Minister Chien then signed a Letter of Intent to pledge their mutual support to addressing health issues. (NOTE: Post and HHS intend to pursue negotiations to turn the Letter of Intent into a more binding Memorandum of Understanding underneath the U.S.-Vietnam Science and Technology Agreement. END NOTE.) ¶22. (U) Begin text of Letter of Intent: "Letter of Intent on Cooperation between the Ministry of Health of the Socialist Republic of Viet Nam and the Department of Health and Human Services of the United States of America" The Ministry of Health of the Socialist Republic of Viet Nam and the Department of Health and Human Services of the United States of America, hereinafter referred to as the "Participants": Guided by the willingness to develop fruitful cooperation between their respective countries in the field of health and medical sciences; Considering the importance of international cooperation to ensure an enhanced focus on influenza, emerging infectious diseases and other important public health issues; Noting the commitment both countries have to preparing for a pandemic of infectious diseases; Desiring to work in the spirit of transparency, mutual benefits and accurate and timely exchange of information; Intend to negotiate an Agreement to outline the forms of cooperation between the Participants. s. Negotiations under this letter of Intent are to commence upon signature by both Participants. Signed at Ha Noi, in duplicate, this fourteenth day of October, 2005, in the English and Vietnamese languages; all texts being equally authentic. End Text. PARTICIPANTS -------------- ¶23. (U) U.S. Participants: U.S. HHS Secretary Michael Leavitt Dr. Paula Dobriansky, Under Secretary of State for Global Affairs U.S. Ambassador Michael Marine Kerry Weems, HHS Deputy Chief of Staff Dr. Kent Hill, Acting Assistant Administrator for Global Health, USAID Dr. James Butler, Under Secretary for Farm and Foreign Agricultural Services, USDA Dr. Julie Gerberding, Director, HHS/CDC Dr. Anthony Fauci, Director, HHS/NIH/NIAID Suzy De Francis, Assistant Secretary for Public Affairs, HHS Dr. William Steiger, Special Assistant for International Affairs, HHS Dr. Vaughan Turekian, Special Assistant to Under Secretary Dobriansky Allyson Bell, Director of Scheduling and Advance, HHS HHS Hanoi Health Attach Marie Sweeney HHS/CDC Chief of Party Mitchell Wolfe USDA/FAS Hanoi Attach John Wade ¶24. (U) Vietnamese Participants: MOH Minister Tran Thi Trung Chien MOH Vice Minister Trinh Quan Huan MOH International Cooperation Department (ICD) Director Dr. Tran Trong Hai MOH Department of HIV/AIDS Control Director Nguyen Huy Nga MOH Department of Science and Training Director Truong Viet Dung MOH Department of Therapy Director Ly Ngoc Kinh MOH Drug Administration Director Cao Minh Quang National Institute of Hygiene and Epidemiology (NIHE) Director Nguyen Tran Hein Institute of Clinical Research of Tropical Diseases Director Nguyen Duc Hien Hanoi Medical University Director Nguyen Lan Viet Public Health University Director Le Vu Anh MOH ICD Officer Nguyen Thi Minh Ministry of Foreign Affairs (MOFA) America Department Director Nguyen Duc Hung Ministry of Agriculture and Rural Development (MARD) Deputy Director Hoang Van Nam Hanoi Health Department Deputy Director Pham The Tuan ¶25. (U) International Organization Participants: Dr. Margaret Chan, Assistant Director-General for Communicable Diseases, World Health Organization (WHO) Dr. He Changchui, Assistant Director-General, Food and Agriculture Organization (FAO) Dr. Alejandro Thiermann, Special Representative to the Director-General of the World Animal Health Organization (OIE) and Chairman of the OIE Terrestrial Animal Health Standards Commission WHO Country Representative Hans Troedsson FAO Country Representative Anton Rychener ¶26. (SBU) The Secretary's party has cleared this cable. BOARDMAN