RESPONSE TO INFORMATION REQUEST: AVIAN AND PANDEMIC

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