UNCLAS SECTION 01 OF 02 KINGSTON 002643

SIPDIS

DEPARTMENT FOR WHA/CAR (BENT)

E.O. 12958: N/A
TAGS: TBIO SENV ECON EAGR EAID PREL JM
SUBJECT: RESPONSE TO INFORMATION REQUEST: AVIAN AND PANDEMIC
INFLUENZA

REF: A) STATE 209622

B) KINGSTON 2306


1. (U) This cable responds to information requested by
Department (Ref A). It is a joint State-USAID message.
Answers are updated from information provided by post (Ref
B).


2. (U) Responses are keyed to Ref A.

A) PREPAREDNESS/COMMUNICATION

-- The Government of Jamaica (GOJ) has a draft entitled:
"Influenza Pandemic Preparedness Plan" that, to date, has
not been finalized. The primary areas that still need to be
addressed involve budget assistance and persons/agencies of
final responsibility. The draft plan covers five topics:
Planning and Coordination; Human and Animal Surveillance;
Prevention and Containment; Health System Response; and,
Communications. Post will forward a hard copy of the draft
plan at the Department's request. Electronic copies are not
currently available.

-- GOJ is typically very open on many issues. However, the
GOJ's openness and transparency may depend on the
circumstances of an initial outbreak. If, as is likely, the
first signs of an infection occur in a rural area, fears of
an adverse effect on the tourism industry may prompt an
effort by authorities to manage the problem quietly. On a
positive note, the GOJ has shown itself proactive in the
airing of a public education campaign in the print media
about the disease and its dangers.

-- An Avian Influenza (AI) human pandemic is not currently
high among government priorities. Once the disease is more
prevalent in the Western Hemisphere, or if the GOJ comes to
understand that the tourism industry could be affected, it
will gain traction. The GOJ simply has greater priorities
such as high levels of violent crime, upcoming general
elections, and few resources to allocate. Given these
constraints, the GOJ would be obliged to spend funds now -
funds they do not possess - to guard against an issue, the
risk of which is still perceived as minimal. The key
figures for USG officials to engage are Dr. Headley Edwards,

Director of Veterinary Services at the Ministry of
Agriculture, and Dr. Elizabeth Ward at the Ministry of
Health. These officials in themselves indicate the priority
that the GOJ places on AI. While both are respected
professionals, neither is at the level of decision-making
that would enable swift and decisive action.

-- While Post knows of no systematic review of national laws
to ensure consistency with international health regulations,
GOJ follows Pan American Health Organization (PAHO)
guidelines, who in turn follow WHO guidelines. Although
there are no legal or regulatory barriers to Avian Influenza
detection, reporting, containment and response, GOJ has
indicated that the monitoring capacity of the Ministry of
Agriculture laboratories would be insufficient to handle a
pandemic-level outbreak.

-- As reported in Ref B, GOJ has been somewhat proactive in
reaching out to the international community. The GOJ has
been working with PAHO on the issue, and has good relations
with CDC and with the Caribbean Regional Epidemiological
Center (CAREC). GOJ has asked what the USG can contribute
on any level, be it materiel, vaccine or funding. USAID
communication with the rest of the international donor
community has revealed little outreach. While GOJ is likely
to be receptive to any approach that involves financial aid,
interlocutors reiterated their concern that Jamaica (and
other small Caribbean nations) may become a low priority
concern in the event of a pandemic. Financial assistance
would be welcomed by the GOJ in return for their efforts to
combat the spread of the disease.

-- Jamaica does not currently implement a national flu
vaccine program, as it does with other diseases such as
polio and MMR. GOJ gave no indication as to whether they
would be receptive to doing so, but the policy is under
review. Jamaica neither develops trivalent flu vaccine for
human influenza, nor for poultry influenza, nor is Jamaica
developing an H5N1 vaccine. All vaccines are imported from
abroad, although statistics on how much and from which
countries have not been obtained.

-- Although there has been a public campaign, it has been a
muted one only seen in the print media. Particularly in
rural areas, radio is the main source of news and
information for the populace, and Post is unaware of any
outreach through this medium. While there are public sector
health clinics where citizens can obtain information about
the disease, a greater public outreach campaign is required.
The Rural Agriculture Development Agency (RADA) is making
some effort, but often it is reactive. In addition, RADA is
sharply hindered by a lack of resources.

B) SURVEILLANCE/DETECTION

-- In general, the medical and agricultural sectors are
capable of identifying a new strain of influenza among
people or animals. However, Jamaica has limited capacity
for testing. USAID's HIV/AIDS outreach has exposed critical
gaps in this arena, most notably in rural areas. All
capable testing centers are in the capital, Kingston, at GOJ
and academic laboratories. Given that the rural areas are
the most likely to see the first outbreak, there may be a
significant delay in detection. The GOJ can send samples to
CAREC and/or to the United States for further testing and
confirmation, but CAREC is already overstretched, and would
lack the ability to perform effectively in the event of a
Caribbean pandemic. Embassy contacts expressed a desire to
obtain more equipment for testing, more reagent, more test
kits and more lab technicians.

-- The most critical gaps that remain to be addressed are
front-end: clinical surveillance and detection. Jamaica
must strengthen its public laboratory capacity. To do this,
equipment, supplies and personnel are all needed. This
capacity-building would allow for faster, more efficient
testing with a view to containment once diagnosed.
Following identification of an outbreak, GOJ lacks a
coherent, written strategy for overall management of a
pandemic. Jamaica must also develop a national
communication strategy, as well as guidance on intervention:
practical assistance on school closures, isolation, internal
travel, and port-of-entry monitoring.

C) RESPONSE/CONTAINMENT

-- GOJ has no stockpile of medications, and orders have not
yet been placed. GOJ sources told emboffs that since they
lack treatment protocols, they are reluctant to order drugs.
Before the GOJ has established what drugs it requires, in
what quantities, and at what doses, it cannot spare the
financial resources to order them. Post will continue to
engage the GOJ this issue, by encouraging interaction with
PAHO and WHO to establish such protocols.

-- The country has no stockpile of pre-positioned personal
protective gear.

-- As discussed above, GOJ currently lacks a specific
strategy for rapid response. No written guidelines are in
place for culling and vaccination of birds, disinfection of
facilities, and movement restrictions.

-- GOJ certainly possesses the political will to impose
quarantine and social distancing measures. The question of
capability is more hypothetical, but post believes that the
use of the disciplined and well respected Jamaica Defense
Force (JDF) would be likely to probable, as in the event of
a pandemic outbreak, the Jamaica Constabulary Force (JCF,
the police) would lack the credibility and professionalism
to complete the task.

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Comment
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4. (U) Given the large number of U.S. tourists that frequent
Jamaica, poor preparedness and limited detection and
management capabilities could quickly have an impact on the
United States and the spread of AI among U.S. citizens. At
the same time, however, restrictions on travel to Jamaica
would have a devastating effect on Jamaica's economic
situation. Post will continue to encourage the GOJ to raise
awareness of the disease among the population, especially in
rural areas, and to place management of a potential pandemic
at a higher priority level in the national agenda. The
GOJ's limited financial resources and currently perceived
low risk may preclude this at present.

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End Comment
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5. (U) Post will continue to follow this issue and will
update accordingly.

TIGHE