AVIAN INFLUENZA - LIMITED SURVEILLANCE AND

UNCLAS SECTION 01 OF 04 MANILA 005059 SIPDIS SENSITIVE STATE FOR OES/IHA FOR JKAUFMANN STATE FOR INR/EAP FOR JSTROTZ STATE PASS USDA/FAS/DL&P FOR WETZEL & MAGINNIS STATE PASS USDA/FAS/ITP/AAD FOR GRUNENFELDER & ALEXANDER STATE PASS USDA/FAS/FAA FOR YOUNG STATE PASS USDA/APHIS/IS FOR SHEESLEY STATE PASS USAID FOR DCARROLL AND ACLEMENTS BANGKOK FOR REO JAMES WALLER CIA FOR NATIONAL INTELLIGENCE COUNCIL NIO/EA E.O. 12958: N/A TAGS: ECON PINR SOCI EAGR SENV TBIO TSPL RP SUBJECT: AVIAN INFLUENZA - LIMITED SURVEILLANCE AND DIAGNOSTIC CAPABILITIES REF: A) STATE 151549 B) MANILA 2053 C) MANILA 3883 D) MANILA 4278 E) STATE 183776 -------------- SUMMARY -------------- ¶1. (U) This is the third of a series of reports on the Philippines' preparedness to avert a highly pathogenic avian influenza (HPAI) outbreak (Refs C and D). This report focuses on stages 1 and 2 of the Philippines' Avian Influenza Protection Program: HPAI prevention and the establishment of control measures for an outbreak in domestic poultry. Future reporting will cover human health preparedness for HPAI outbreaks, including the mission's action plan. ¶2. (SBU) The implementation of the Department of Agriculture's (DA) HPAI surveillance and response plan continues to be constrained by inadequate resources. Although the GRP has yet to detect evidence of the HPAI H5N1 virus, its surveillance system is limited. The country remains vulnerable, especially through smuggling of poultry and visits of migratory birds from HPAI- affected countries. Clinical testing for HPAI suffers from inadequate laboratory facilities. In addition to random surveillance of priority areas, DA relies on poultry farmers to report suspected cases of HPAI. Grassroots education and more aggressive public information campaigns are needed. The lack of an indemnity fund discourages the prompt reporting of potential cases and would impede efforts to contain an outbreak. -------------- LIMITED SURVEILLANCE SYSTEM -------------- ¶3. (U) The GRP has designated 20 areas as priorities for surveillance. DA conducts semi-annual collection and testing of 180 random samples from poultry flocks in each area (3600 samples every six months). These sites were chosen because of their significant poultry populations and their proximity to migratory bird sanctuaries. The DA has formed 10-person interagency teams consisting of regional office staff, Department of Environment and Natural Resources and local government unit representatives, and local police in 11 of the 15 regions around the country. The GRP is procuring a limited quantity of personal protective equipment (PPE) and Tamiflu vaccines for the teams. ¶4. (SBU) The DA estimates that the surveillance program, based on random sampling methods, provides 95% confidence of detecting exposure to AI assuming an infection rate of 20% (the level of surveillance recommended by the World Organization for Animal Health for countries where HPAI has not been detected). However, Bureau of Animal Industry (BAI) officials said that the actual sample sizes were smaller than planned because of budget constraints and the lack of cooperation among poultry raisers. ¶5. (U) Since random surveillance has a limited probability of detecting smaller and isolated outbreaks, the DA relies on poultry farmers and provincial veterinarians to identify suspected cases from clinical signs and high mortality rates. The DA is conducting public information campaigns to increase awareness and encourage early detection of potential cases. BAI plans two training sessions in November on diagnosis of HPAI. -------------- INADEQUATE DIAGNOSTIC CAPABILITIES -------------- ¶6. (U) APHIS Area Director, Ag Attache and Econoffs met with Philippine Animal Health Center (PAHC) Director Magdalena Cruz, D.V.M. to review their testing capabilities. PAHC, the national reference laboratory for AI surveillance in poultry, able to conduct several screening tests (ELISA, Agar Gel Immunodiffusion and HA tests) and isolate the virus, but it lacks the equipment needed to specifically identify the H5N1 virus. When PAHC detects evidence of antigens for H5 or H7 viruses, it can isolate the virus and forward samples to the Australian Animal Health Laboratory (AAHL) in Geelong, Australia, for more sensitive and confirmatory tests. ¶7. (U) PAHC has built a new specialized AI laboratory within its facility that is expected to be operational in November. PAHC also plans to procure a polymerase chain reaction (PCR) machine to enable it to quickly identify the H5N1 virus (and other virus types). The DA has 15 regional labs around the country, but only four labs are equipped to perform ELISA tests and none are currently testing for HPAI. The USDA's Animal and Plant Health Inspection Service (APHIS) Area Director is working with PAHC to specify training requirements and identify potential sources of technical assistance. APHIS underscored the immediate need to train PAHC staff to operate the new laboratory. They also would require training in applied methods for PCR-related research. PAHC also prepared an $840,000 proposal for which it is seeking funding to further upgrade and acquire supplies for its facilities. ¶8. (U) The GRP will implement quarantine and control measures for poultry under two scenarios: (1) if the PAHC or the Australian reference laboratory isolates an HPAI virus or (2) if at least 50% of samples test positive in rapid tests for Influenza A with increasing mortality and no evidence of other diseases. The identification of a suspected case would trigger a 3-kilometer radius quarantine around the potential outbreak while a confirmed case would expand the quarantine area to a 7- kilometer radius and trigger the culling of all poultry within these areas. Vaccination of poultry is planned only if DA detects related outbreaks in an expanding geographic area and vaccination is deemed to be more economical than culling. In this scenario, all poultry would be vaccinated within a 50-kilometer radius of each outbreak. -------------- INDEMNITY FUND NEEDED -------------- ¶9. (U) As the GRP improves its response capacity, lack of an indemnity fund may limit the GRP's ability to detect, contain and eradicate any HPAI outbreaks. The DA estimated that losses could exceed 312 million pesos (about $5.6 million) if an HPAI outbreak occurs in a major poultry-producing region such as Minalin, Pampanga (based on an estimated poultry population of 4 million within a 3 km radius and a price of 78 pesos per bird). Wider outbreaks could incur much higher costs - USDA/FAS estimated the Philippines' total chicken production reached 136 million in 2004. In the absence of indemnity, there remains a significant risk that HPAI- infected birds could be killed and sold for human consumption by farmers seeking to recover their investments. If an outbreak occurs in an intensive poultry-producing area, the GRP may need to quickly ramp up its capacity to quarantine and cull the affected poultry population. At present, the GRP does not appear to have the capacity for a rapid, effective response. -------------- BUDGET CONSTRAINTS -------------- ¶10. (U) All aspects of AI preparedness are constrained by limited financial resources. Since President Arroyo issued Executive Order 280 in February 2004 promising to use 250 million pesos in discretionary lottery funds for AI preparedness, only 40 million pesos have been allocated to the DA. After initially allocating 20 million pesos ($360,000) to the DA, the GRP recently added a supplementary allocation of 20 million from lottery funds. DA has estimated budget requirements of 175 million pesos ($3.2 million) for surveillance and preparedness for HPAI in poultry. The bulk of this is for poultry vaccines (42 million pesos),an indemnity fund (50 million pesos),upgrading labs (32 million pesos) and culling operations (27 million pesos). With the 2006 budget still under consideration by Congress, funding levels for 2006 have not been set. -------------- Comments -------------- ¶11. (SBU) Given the Philippines' close proximity to HPAI- affected countries, the GRP's most pressing priority is to strengthen its capacity to detect and contain potential HPAI outbreaks in poultry. The GRP's preparedness plan looks good on paper and is consistent with international guidelines, but resource constraints have prevented the GRP from fully implementing the plan. With a limited surveillance program, grassroots education and a more aggressive public information campaign along with an adequate indemnity fund are important to ensure that potential HPAI cases are detected and investigated. Prompt reporting is possible in the principal poultry- producing provinces in central Luzon, but less certain in more remote rural areas, particularly in Mindanao. In the absence of an indemnity fund, economic incentives and community pressures could deter self-reporting of possible cases.