HHS SECRETARY LEAVITT'S MEETING WITH THE VIETNAMESE

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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