RESPONSE TO DEPARTMENT TASKER ABOUT AVIAN

UNCLAS SECTION 01 OF 03 KUWAIT 004824

SIPDIS

STATE FOR OES/PCI, OES/IHA
HHS FOR OGHA STEIGER/BHAT
CDC FOR BLOUNT/JANI/LEDUC/NCOX/ARTHUR
GENEVA FOR WHO
USDA PASS FSIS AND APHIS

E.O. 12958: N/A
TAGS: TBIO SENV ECON EAGR EAID PREL XX KU
SUBJECT: RESPONSE TO DEPARTMENT TASKER ABOUT AVIAN
INFLUENZA INFORMATION IN KUWAIT

REF: A. REF A: STATE 206992

B. REF B: KUWAIT 4516

C. REF C: KUWAIT 4673

D. REF D: KUWAIT 4755


1. (U) This message is Post's response to the questions
contained in Reftel A regarding the GOK's efforts to control
Avian Influenza (AI),and its capability to respond to an AI
epidemic. Questions are answered in the order provided in
reftel.

--------------
ANSWERS TO QUESTIONS
--------------


2. (U) Answers.

A) PREPAREDNESS/COMMUNICATION

-- The GOK has formed a committee of representatives from the
Department of Public Health (DPH),Public Authority for
Agricultural Affairs and Fish Resources (PAAAFR),the
Infectious Disease Hospital, and the Ambulance Service to
develop a comprehensive plan to prevent and/or manage an AI
pandemic in Kuwait (Ref B). The plan involves regular
inspections by trained teams from the Animal Resources arm of
the PAAAFR which take samples from farms, bird markets, and
locations where migratory birds gather (Ref C). The GOK has
also banned the import of all live birds and poultry products
from affected countries. The PAAAFR has established a
hotline for those encountering dead birds, to which the
PAAAFR responds by sending a team to collect the carcasses.
So far, Post has observed that this preventative inspection
plan seems to work, evidenced by regular reports of farm and
market inspections, and reports of samples taken at migratory
bird areas (Ref D). Additionally, Post has witnessed quick
responses by bird collection teams when calling to report
dead birds found on the Embassy compound.

-- The GOK would likely be forthcoming in reporting any cases
of AI among people. Kuwait's vibrant press and outspoken
MPs, who are often critical of the government, mean that the
GOK would have great difficulty concealing any outbreak.
Another factor influencing transparency is that, because
Kuwait is the first GCC nation to have an AI incident (Ref
D),other GCC countries are watching the situation closely
and would not hesitate to raise alarms at any hint of a
cover-up. As we have seen in recent media reports, the
PAAAFR has been open about infected birds found during
inspections, and there is little reason to think that this
openness would diminish.

-- Preparations for AI appear to be high on the GOK's
priority list. Post has been told by both DPH and PAAAFR
officials that the PM is very concerned about the issue. The
aforementioned planning committee, the GOK's order of 10
million tablets of Tamiflu (enough to treat 1 million
patients),and the relatively quick forming of PAAAFR
inspection teams attest to the attention that AI is getting
at decision-making levels (see Reftels B and C for more
details). Nominally, the "go-to" person in the GOK is
Minister of Health (MOH) Sheikh Ahmed Al-Abdullah who heads
the coordination committee, but Post's experience has been
that Al-Abdullah's deputy, Assistant Undersecretary Ali
Al-Seef, as well as Drs. Rashed Al-Owaish and Mussab Al-Saleh
(Ref B) are the prime movers. On the PAAAFR side, Sheikh
Fahd Salem Al-Alki Al-Sabah, the PAAAFR Director, is in
charge, but his deputy Dr. Mohammad Al-Muhanna, who is in
charge of all animal health inspections, has been the most
informed contact (Ref C).

-- Post has no indication that any Kuwaiti laws will be
impediments to AI detection, reporting, containment, or
response.

-- GOK officials at the MOH and PAAAFR have been in regular
contact with the WHO and have repeatedly stated that they are
following WHO planning and response guidelines. In addition
to the GOK's willingness to provide information at Post's
request, Post understands that the GOK has also been
providing information to the British Embassy and other EU
nations. DPH officials have previously inquired about USG
assistance in obtaining anti-viral drugs (see Ref B, para 6
for discussion of GOK concerns about the availability of
Tamiflu). Notwithstanding current GOK assertions that the
public health infrastructure can handle an outbreak, it is
Post's assessment that the GOK indeed would ask for foreign
assistance. Given GOK receptiveness and openness with Post's
inquiries, multilateral approaches would not likely add much
value.

-- Kuwaiti hospitals currently administer annual flu shots,
but Kuwait does not produce any influenza vaccines and has no
capacity to develop an H5N1 vaccine. Similarly, all vaccines
for birds are imported.

-- Because AI features prominently on the front pages of
local newspapers every day, most of the population is likely
aware of the issue. However, DPH officials have expressed
concern that the public may disregard or downplay the threat
of AI because of previous public health threats (most notably
SARS and bio-warfare concerns prior to the 2003 Iraq
invasion) that were ultimately non-events (Ref B). There is
a certain risk of ill-informed third-country nationals (TCNs)
working, and usually living, at Kuwaiti poultry farms not
being fully aware of the threat, but the frequent appearance
of PAAAFR inspection teams at such sites seems to mitigate
that risk.

B) SURVEILLANCE/DETECTION

-- The PAAAFR has its own laboratory to test samples taken
from farms, markets, and migratory birds (Ref C). Hospitals
also have in-house labs that can test for influenza A viruses
(of which H5N1 is one) which would therefore give a positive
result for AI. The PAAAFR and Kuwaiti hospitals have limited
ability to sub-type viruses, with the capability to test with
methods appropriate for some, but not all, types of birds.
(NOTE: A PAAAFR laboratory scientist has just completed a
USDA training course in Athens, GA focusing on H5N1
identification and diagnosis. He is due to return to Kuwait
on November 19) The GOK has a long-standing relationship
with the reference lab Veterinary Laboratories Agency in
Weybridge, UK, to which samples are sent for verification.

-- The most pressing gaps in Kuwait's ability to respond to
an outbreak are the lack of anti-viral stockpiles and a
shortage of isolation/ICU capacity. According to DPH
statistics, there are approximately 600 ICU beds in Kuwait,
with roughly half in government hospitals and half in private
hospitals (NOTE: this total includes Cardiac Care Units
(CCU),which constitute about 75% of the total ICU beds; CCUs
can be effectively used as isolation beds in an AI outbreak.
These numbers are DPH estimates of Kuwait's hospital
capacity, but the DPH does not have exact figures; however,
Post believes these estimates to be reasonably accurate).
Given the DPH's estimate of 9,000-12,000 hospitalizations
(Ref B),this indicates a serious lack of ICU capacity.
Additionaly, there are only 4 negative-flow rooms in Kuwait.


C) REPONSE/CONTAINMENT

-- Although the Kuwaiti public health sector has adequate
stocks of most medications, there is no stockpile of
anti-viral drugs, particularly of Tamiflu or Relenza. The
GOK has ordered 10 million tablets (enough to treat 800,000
patients) of Tamiflu which are due to arrive no earlier than
June 2006, and according to hospital contacts, perhaps as
late as September 2007. Hospital contacts have said that,
because of this delay, the GOK has placed an order for
generic Tamiflu from Taiwan, which is due to arrive early in

2006. DPH officials have said that they propose to order the
more widely-available drug Relenza, but no order has been
placed yet (see Ref B for details).

-- Kuwait has adequate supplies of Personal Protective
Equipment (PPE).

-- According to the plans in progress described by DPH and
PAAAFR officials, especially on the animal side, GOK rapid
response capacity appears to be adequate. PAAAFR teams are
already regularly disinfecting facilities and monitoring
birds, and officials have repeatedly said that infected birds
will be quickly culled. Although the Council of Ministers
has not decided on a specific amount, the GOK plans to
include compensation to bird owners should a cull be
necessary. Regarding the GOK's capacity to handle an
outbreak among humans, Post has concerns about the capacity
of Kuwaiti hospitals to handle a surge of patients, but fewer
concerns about the level of care available to those for whom
there are beds.

-- Post believes that the GOK is both capable and willing to
impose quarantines and social distancing measures. Any
quarantine would not be enforced by the military, but would
instead be enforced by the Ministry of the Interior (MOI)
which oversees police forces.
TUELLER