AVIAN FLU PANDEMIC PREPAREDNESS: GAPS IN PLANNING

UNCLAS SECTION 01 OF 05 MANILA 004278 SIPDIS STATE FOR EB/TPP/ABT FOR SPIRNAK AND GOETHERT STATE FOR OES/IHA FOR JKAUFMANN STATE FOR INR/EAP FOR JSTROTZ STATE PASS USDA/FAS/ITP FOR SIMMONS, RICHEY, AND CLARKSON ICD FOR PETLOCK STATE PASS USAID FOR JLEWIS DEPT OF INTERIOR FOR OSM RMCNEER BANGKOK FOR REO JAMES WALLER CIA FOR NATIONAL INTELIGENCE COUNCIL NIO/EA E.O. 12958: N/A TAGS: ECON PINR SOCI EAGR SENV TBIO TSPL RP SUBJECT: AVIAN FLU PANDEMIC PREPAREDNESS: GAPS IN PLANNING VS. CAPACITY REF: A) STATE 151549 B) STATE 153802 C) MANILA 3883 D) MANILA 2053 E) 04 MANILA 622 Sensitive But Unclassified - Protect Accordingly -------------- Summary -------------- ¶1. (SBU) Summary: Although there have been no reported cases of avian influenza (H5N1) in the Philippines, the GRP's capacity to respond to a potential outbreak is limited by lack of resources in many areas. The GRP lacks funds for materials such as protective gear and stockpiles of Tamiflu. Key activities such as surveillance in rural areas, public health information campaigns, and other programs remain under funded. No funds are available for indemnity payments to compensate farmers. Countermeasures at international ports of entry remain ineffective. A newly formed embassy task force will host a second roundtable discussion on AI with senior GRP officials and experts on September 16 (ref C) for the purpose of identifying and possibly filling gaps between planning and capacity. End Summary. -------------- AI is a High GRP Priority . . . -------------- ¶2. (SBU) Responding to the potential treat of avian influenza is a high priority for the GRP. The issue is receiving attention at the cabinet level and the secretaries of the Department of Agriculture (DA) and the SIPDIS Department of Health (DOH) are directly engaged on AI planning and countermeasures. Both of these lead agencies for AI have demonstrated their seriousness of purpose by having developed comprehensive plans for prevention and response. In view of this level of attention, probably only the president herself could raise the issue to a higher priority. ¶3. (U) The GRP's crisis manager for avian influenza is DOH Secretary Francisco Duque, M.D. (ref B). Luningning ¶E. Villa, M.D., Program Manager for Emerging Infectious Diseases, serves as DOH's point of contact. DA Secretary Domingo Panganiban serves as co-crisis manager. Chief Veterinary Officer Davinio Catbagan, D.V.M., serves as DA's principal point of contact. Samuel Animas, D.V.M., National Coordinator for Avian Influenza Protection, also serves as a point of contact at DA. Professional staff at DA and DOH include competent and experienced scientists and experts, some of whom were trained overseas. -------------- . . . GRP Has a Strategy . . . -------------- ¶4. (U) AgCounselor met September 9 with Philippine Chief Veterinary Officer, Davinio Catbagan, D.V.M., Bureau of Animal Industry, Department of Agriculture (DA/BAI) to discuss the GRP's four-staged response to avian influenza (AI): (1) prevent the introduction of AI into the Philippines from affected countries; (2) establish counter-measures for an outbreak among domestic bird flocks; (3) prevent transmission of AI from birds to humans, and (4) prevent human-to-human transmission. The DA is responsible for stages (1) and (2) while DOH is responsible for stages (3) and (4). -------------- . . . But Lacks Resources -------------- ¶5. (SBU) Serious constraints remain with respect to funding, training of officials, laboratory infrastructure, and scope of monitoring potential AI threats, especially in rural areas. The lack of an indemnity fund could be a major problem here (and in other developing countries) as cooperation diminishes when producers they see their livelihoods threatened by government regulators. Other weak links include lack of effective countermeasures at ports of entry, inadequate stockpiles of Tamiflu, and the absence of a public health education campaign. ¶6. (SBU) BAI's budget for AI-related activities is 20 million pesos ($360,000),but DA's experts estimate that about twice that amount would be required to effectively prepare for an outbreak. DA also expends significant resources on controlling other diseases such as foot-and- mouth disease. Funding for various activities to increase the efficiency of BAI's overall operations is "slow in coming", Chief Veterinary Officer Catbagan lamented. Resources also are needed to purchase protective gear for inspectors and technicians. Meanwhile, BAI is improving its information gathering, analysis, and dissemination functions to ensure that decision makers can respond quickly. BAI's field offices are supposed to report to headquarters three times weekly, but the system still contains flaws and appears to be a work in progress. ¶7. (U) A recent improvement includes the GRP's upgraded Animal Health Center laboratory where samples can now be evaluated domestically. Fourteen regional laboratories feed samples and data to the central lab in Manila. Previously, samples were sent to Australia to the Regional Reference Laboratory, Office International des Epizooties. -------------- Progress at DOH on Prevention and Control -------------- ¶8. (U) USAID/PHN Chief and RMO met September 7 with Department of Health (DOH) officials Dr. Luningning E. Villa, Program Manager for Emerging Infectious Diseases, and Dr. Vito "Jojo" G. Roque, Jr., Surveillance Unit Head, National Epidemiology Centre. The National Centre for Disease Prevention and Control leads DOH's initiatives in partnership with the National Epidemiology Centre and the Research Institute of Tropical Medicine. This partnership worked effectively during the SARS pandemic of 2003. DOH's strategy focuses on prevention, surveillance, and containment of suspected cases. ¶9. (U) The DOH has undertaken the following measures: -- Developed surveillance systems for which the quality of data is verified with methods similar to those used in responding to SARS; -- Designed prototypes of public health education and information materials; -- Made plans to stockpile Tamiflu; -- Conducted trainings for service providers, public health administrators, and program managers at regional levels; -- Set up Barangay emergency response teams with the Department of Local Government (DILG) through an official circular on preparedness for the local governments; -- Designated regional hospitals as referral centers for quarantine of infected human cases. -------------- -------------- DOH Needs Tamiflu, Rural Surveillance, and Flyers -------------- -------------- ¶10. (SBU) Critical gaps include the lack of funds for: -- Mass production of public health education and information materials; -- Procurement and stockpiling of Tamiflu; -- Effective operation of sentinel surveillance systems, especially in remote rural areas. DOH has requested funds for these activities from the Department of Budget and Finance. -------------- Surveillance of Human Subjects in Bulacan -------------- ¶11. (SBU) DOH's plans include conducting surveillance of human subjects in areas where migratory birds pass such as Bulacan, where an undefined, low-pathogenic strain of H5N was detected. DOH will sponsor a meeting at Subic Bay September 21 - 23, to train 70 epidemiologists and regional coordinators on surveillance, prevention, and emergency response. The DOH also will improve capacities for containment and case management at referral hospitals including San Lazaro, the Lung Centre, Davao Medical Centre, Vincente Sotto, and the Research Institute for Tropical Medicine. -------------- Special Challenges in Mindanao -------------- ¶12. (SBU) From October to February, 100 species of wild birds will cross the 7000 islands of the Philippines on their annual migratory routes. DA has identified 20 critical areas where BAI's regional offices are redoubling their efforts to monitor developments. Some of these areas are in conflict-affected regions of Mindanao where BAI's officers face greater challenges. For example, due to the absence of indemnity funds to compensate producers, when duck raisers see BAI's officers coming "they grab their flocks and head in the opposite direction", Chief Veterinary Officer Catbagan warned. ¶13. (U) About 17% of the country's poultry are produced in Pampanga Province in Central Luzon, Region III. Many producers in Pampanga raise ducks for "Balut," exotic duck eggs. They transport ducks to other provinces or regions to feed on snails and residual grain in newly harvested rice paddies. This integrated pest management practice works well for rice producers and duck raisers alike, but travel and exposure increase the potential for ducks to become vectors for the spread of AI. DA is drafting new regulations to limit or prohibit such movement of ducks within the country, although implementation will be difficult without effective monitoring. Region III, which comprises seven provinces, produces 43% of the country's chicken and 40% of all duck products. -------------- Embassy Task Force -------------- ¶14. (U) The Embassy's Task Force on Avian Influenza held its first meeting September 2, chaired by USAID/Manila. Membership includes RMO and representatives of FAS, APHIS, Peace Corps, Econ, Pol, ACS, and JUSMAG. The group convenes monthly to exchange information, refine preparedness planning at post, and liaise with public officials, scientists, donors, and international agencies to monitor developments. The task force will hold post's second roundtable discussion with senior officials and experts from DOH, DA, and the private sector on September 16 at the American Chamber of Commerce to explore ways to fill gaps between planning and capacity. -------------- Comment -------------- ¶15. (SBU) In the event of an outbreak, presidential leadership would probably become a key factor in imposing quarantines, social distancing measures, and other emergency steps. In large and densely populated cities such as Manila, crowded buses and other mass transit facilities would pose challenges for AI control, though schools and public facilities could quickly be ordered closed. Although the GRP could try to keep the lid on news coverage of an outbreak, this type of development would probably quickly receive TV and press coverage in the open media environment of the Philippines. In July 2005, for example, we observed widespread media coverage of suspected AI cases in the Philippines soon after the government learned of them. (These suspected cases later proved negative for AI.) ¶16. (SBU) The Armed Forces of the Philippines (AFP) have on occasion been called on to assist with natural disasters such as floods and landslides. The AFP never has responded to an epidemic, but probably would be capable of doing so, especially if urged through USG political and military channels. Further encouragement could be provided by possible offers of medical assistance and training by experts in disease research and quarantine procedures through U.S. military resources such as the Army Medical Component-Armed Forces Research Institute of Medical Sciences (USAMC-AFRIMS) in Bangkok. JOHNSON