VIETNAM - AVIAN INFLUENZA TRIPWIRES

UNCLAS SECTION 01 OF 04 HANOI 000875

SIPDIS

STATE FOR USAID

SENSITIVE BUT UNCLASSIFIED

FOR CA/OCS/ACS/EAP; EAP/EX; EAP/BCLTV; OES/STC (M.GOLDBERG);
OES/IHA (D.SINGER AND N.COMELLA)
BANGKOK FOR RMO, CDC, USAID/RDM/A (MFRIEDMAN)
ROME FOR U.S. MISSION (FODAG)
STATE PASS HHS
USDA FOR FAS/PASS TO APHIS
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP FOR LEW STERN
USAID FOR ANE AND GH (DCAROLL, SCLEMENTS AND PCHAPLIN)

E.O. 12958: N/A
TAGS: AMED AMGT CASC EAGR TBIO VM AFLU
SUBJECT: VIETNAM - AVIAN INFLUENZA TRIPWIRES

REF: A) Hanoi 846, B) Hanoi 467


1. (U) Summary: The representatives of the World Health
Organization and the Food and Agriculture Organization have
provided an Avian Influenza update to major donor missions
in Hanoi. They also revisited an outstanding GVN-WHO-FAO
request for donor assistance for an "Avian Influenza
Technical Support Unit." Such a unit would give the GVN
much needed capacity to combat the present AI epidemic and
to be in a position to possibly contain a pandemic, when and
if clusters of human-to-human transmission of the H5N1 virus
begin to appear. Specific needs are outlined below. We
recommend that U.S. agencies consider support for this
Technical Support unit in their deliberations on AI. End
Summary.

CURRENT SITUATION
--------------


2. (U) On April 7, 2005 the United Nations Development
Program (UNDP) resident coordinator convened a meeting of
major donors for briefings on the status of Avian Influenza
(AI) in Vietnam by the local representatives of the World
Health Organization (WHO) and the Food and Agriculture
Organization (FAO). The DCM and USAID chief attended. WHO
representative Hans Troedsson summarized the current health
situation in Vietnam. AI currently does not represent an
imminent human health crisis here; however, it has the
potential to become one on short notice. The virus remains
deeply entrenched in Vietnam's poultry and eradicating it
will require a long-term, concentrated effort. Lack of
action could lead to a major health crisis if human-to-human
transmission breaks out.


3. (SBU) Troedsson noted several recent changes in the
pattern of AI that deserve attention. Up to March 2005, the
pattern was similar to the outbreak of 2003-04. In that
cycle, the outbreak peaked at the beginning of March and
then stopped in April. This year cases are continuing well
into April. Moreover, some cases are less severe and some
individuals have tested positive, but show no symptoms. He
noted that the H5N1 virus is infecting more older persons.
While more analysis needs to be done, this indicates at
least a possibility that the virus may be changing.
According to Troedsson, if such a change resulted in a virus
that is transmitted human-to-human and at the same time is
less virulent, that is having a mortality rate lower than
the current 70%, this could in fact result in a much greater
risk of a pandemic. Rapid spread is difficult in cases of
very high lethality because most of those infected die or
are hospitalized before they can spread the virus very
widely, he noted. However, it is not known if recent are
cases of poultry-human or human-human transmission. Both
are possibilities to be considered, since those infected had
been in contact with both infected poultry and infected
people.

GOVERNMENT RESPONSE
--------------


4. (SBU) WHO and FAO representatives agreed that the GVN
should continue to give the issue the highest priority,
despite possible negative consequences such as harm to the
tourist industry. The severity of the problem and potential
risk is understood at the highest levels of government, but
some at lower levels do not seem to have the same sense of
urgency. Troedsson asked that embassies and other donors
highlight their continuing concern in their interactions
with the GVN. More importantly, he made a made a plea for
increased assistance to the GVN (see below).


5. (SBU) Recent interactions between the WHO and the
Ministry of Health (MOH) reflect increasing awareness by the
Ministry of the seriousness of the threat of AI. A month
ago the Minister believed that the problem was under
control. Now MOH clearly indicates that they need and would
welcome assistance. In addition, the Ministry has been more
forthcoming in providing confidential, informal reports to
WHO before each case has been officially confirmed. (Note:
Timely informal reports of suspected AI cases are necessary
for WHO to maintain an up to date risk assessment for both
Vietnam and WHO's international responsibilities.)

COORDINATION
--------------


6. (U) A number of donor countries have begun to provide
assistance. The Canadians will provide a mobile laboratory
for testing. The World Bank has been providing assistance
under an Avian Influenza Emergency Recovery Project (AIERP)
jointly funded with FAO. Laboratories participating in the
WHO's international warning network in Japan and the Unites
States (Centers for Disease Control and Prevention (CDC) in
Atlanta) are assisting in genetic sequencing of the virus,
necessary to analyze any mutation of the virus and for
vaccine development. CDC is also planning to provide
assistance to strengthen laboratory capacity and support
development of Vietnam's National Influenza Center.
OFDA/USAID will pre-position contamination suits for use
should there be a pandemic.


7. (U) While these are welcome steps, FAO Representative
Anton Rychener and WHO representative Troedsson stressed
that the GVN, the WHO, and FAO would like future assistance
to be provided under a master coordination plan as
recommended in the Second FAO/OIE Regional Meeting on Avian
Influenza Control in Asia held in Ho Chi Minh City February
23-25. They also feel strongly that assistance be
coordinated with, or channeled through, an Avian Influenza
Technical Support Unit (TSU).

TECHNICAL SUPPORT UNIT
--------------


8. (U) UNDP hosted a special meeting of the "Monthly Donor
Group Forum" on February 21 with the participation of the
GVN, the WHO, and FAO to introduce the concept of the TSU
and to ask for donor assistance (Ref B). Under the
proposal, the National Committee for Avian Influenza
Control, reporting to the Prime Minister, would have overall
oversight of the TSU. However, a special TSU oversight
committee would consist of the Vice-Ministers of the
Ministry of Agriculture and Rural Development (MARD) and the
MOH and the Representatives of WHO and FAO. Long-term
technical assistance personnel would staff the TSU, along
with GVN counterparts, and assist the various MARD and MOH
departments involved. The GVN would contribute heavily in
land and local costs to construct bio-secure labs and
breeding farms. While the current measures proposed in the
plan are largely short term, development of a longer term
"Emergency Contingency Plan" is now underway. The current
plan prepared by FAO is driven by the following principles:

--Prevent human H5N1 infection and reduce the risk of a
global Highly Pathogenic Avian Influenza (HPAI) pandemic.
--Improve active disease search, surveillance and early
detection for both humans and poultry.
--Consider poultry vaccine use either in field trials or
nationwide.
--Improve disease control by preventing the cycling of H5N1
virus between waterfowl and chickens and reducing H5N1 virus
reservoirs.
--Provide livelihood support and long term poultry sector
restructuring.
--Develop better tools to understand and control H5N1
infection, including diagnostic methods, vaccines,
disinfectants and antiviral agents.

WHAT DONOR ASSISTANCE CAN DO
--------------


9. (U) The creation of the TSU would result in better
coordination of assistance and avoid overlap. More
importantly, it would give the GVN an urgently needed
capability to implement preventive measures and prepare for
a possible pandemic. WHO and FAO urged that donors treat
this as an emergency rather than a request for traditional
development assistance. They distributed copies of a
revised version of the February 21 proposal for the TSU,
dated April 7, 2005. The proposal outlines a comprehensive
approach to immediate assistance needs. It will be revised
and expanded so that donor's can see where assistance is
most needed. Copies are being emailed as scanned
attachments to EAP/BCLTV, USAID, CDC, and HHS).
Additionally, WHO and FAO promised to work with the UNDP to
create a trust fund that would give donors the option of
either contributing specific inputs of technical assistance
or commodities as detailed in the plan or providing direct
funding into the trust fund, which the TSU then in turn can
allocate. Both WHO and FAO emphasized that the immediate
priority is funding to staff and make the TSU operational.

REQUIREMENTS
--------------


10. (U) Of the USD 14.7 million called for in the April 7
version of the plan, 8.8 million is requested to help
strengthen and expand Vietnam's agricultural surveillance
system and laboratory testing capacity.


11. (U) Other needs include construction and outfitting of
two Level 3 Biological Safety Laboratories (BSL3) for MOH.
The Government of Vietnam currently does not operate a BSL3
laboratory, although the private Welcome Trust has such a
laboratory in HCMC. Such laboratories conduct genetic
sequencing necessary for vaccine development and can carry
out more sensitive and sophisticated tests for infection
than those currently conducted in Vietnam. Donor
contributions would also be used to relocate poultry
breeding farms to areas that can be made "bio secure."
Finally, approximately 14 person years of technical
assistance is required for the TSU, in areas such as farmer
compensation, poultry industry economics, laboratory
technicians, surveillance system specialists, vaccination
specialists and a disease search specialist.

COMMENT
--------------


12. (U) We are impressed by both the professionalism and
commitment of the WHO and FAO staff in addressing the AI
issue and share with them and the other donors at the
meeting the view that assistance will be more useful if done
in the context of an overarching framework shaped by experts
on the ground. This constitutes good management, as it
avoids overtaxing the absorptive capacity of the GVN which
otherwise would have to deal with multiple donors. We hope
that U.S. agencies will factor this heavily into any
programs under consideration and consult with our country
team resources in USAID, HHS, USDA and DoS prior to
finalizing additional and welcome resources to this effort.
MARINE