AVIAN FLU UPDATE

UNCLAS SECTION 01 OF 05 MANILA 005458 SIPDIS STATE FOR OES/IHA FOR JKAUFMANN, DSINGER AND RDALEY STATE FOR INR/EAP FOR JSTROTZ STATE PASS USDA/FAS/ICD FOR ROSENBLUM STATE PASS USDA/FAS/DL&P FOR MAGINNIS STATE PASS USDA/FAS/ITP/AA FOR ALEXANDER STATE PASS USDA/FAS/FAA FOR HAGER STATE PASS USDA/APHIS/IS FOR HOFFMAN STATE PASS USDA/APHIS/VS FOR DUVERNOY STATE PASS USDA/ARS/SEPRL FOR SUAREZ 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: TBIO SENV ECON EAGR EAID PREL RP SUBJECT: AVIAN FLU UPDATE REF: A) STATE 209622 B) MANILA 5393 C) MANILA 5291 D) MANILA 5059 E) MANILA 4278 ¶1. This cable responds to questions in Ref A. Post previously reported on avian influenza preparedness (ref E),the GRP's limited surveillance capacity (ref D),the appointment of an Anti-Avian Flu Czar (ref C) and rising public concern in the Philippines over Avian Flu (ref B). -------------- SUMMARY -------------- ¶2. The GRP has made progress in Avian Flu preparedness, but resource constraints continue to prevent implementation. Although the Philippines remains free of the H5N1 Highly Pathogenic Avian Influenza (HPAI) virus, the country is vulnerable during the October-February migratory bird season. President Arroyo recently took several steps to raise public awareness and focus GRP resources on prevention and containment of HPAI in poultry. Arroyo highlighted these efforts at the November 18-19 APEC Summit and encouraged regional collaboration. The Bureau of Animal Industry (BAI) has solicited U.S. support to improve its poultry surveillance. USAID is helping the Department of Health to prevent possible human HPAI cases. The GRP has limited resources to respond to a large HPAI outbreak. The GRP relies on poultry farmers for HPAI surveillance, but has not established an adequate indemnity fund to encourage their cooperation. END SUMMARY -------------- PREPAREDNESS PLANNING -------------- ¶3. The GRP has an Avian Flu preparedness plan available at: www.doh.gov.ph/avian. The Department of Agriculture website (www.da.gov.ph/BirdFlu) also has information on Avian Flu preparedness including procedures for prevention and containment of HPAI in poultry. As reported in ref E, the Departments of Agriculture and Health have divided responsibilities for four stages:(1) preventing entry of the HPAI into the Philippines; (2) containing HPAI outbreaks in poultry; (3) preventing animal to human transmission of HPAI; and (4) preventing human-to-human transmission of HPAI. The GRP's capacity to effectively implement the plan is limited by budget constraints, ill-equipped diagnostic laboratories, and lack of indemnity funds for farmers. ¶4. Although the GRP has taken steps to procure limited stockpiles of materials and establish regional teams to prevent and contain HPAI outbreaks in poultry. The capacity of regional response teams could quickly be stretched in the event of a significant HPAI outbreak. -------------- TRANSPARENCY -------------- ¶5. The GRP has publicly affirmed its commitment to transparency and Post expects the Departments of Agriculture and Health to adhere to this commitment in reporting any confirmed HPAI cases among birds or people. Given the free flow of information and the widespread use of text messaging in the Philippines (noted in ref B),it is also unlikely that any significant HPAI outbreak would go unnoticed. GRP must overcome economic disincentives to encourage cooperation of poultry farmers in reporting and isolating potential AI cases. ¶6. The GRP is likely to delay any announcement of possible HPAI cases in poultry until the completion of confirmatory tests by the regional reference lab in Geelong, Australia. The Bureau of Animal Industry (BAI) estimates that these tests currently can take one week to complete, but BAI is upgrading its testing capacity (as reported in ref D),to allow more rapid identification of the H5N1 virus. The July 2005 Calumpit incident, where the human reference lab leaked incomplete information about a suspected HPAI case (later considered negative for HPAI) has led the government to more carefully manage information about potential AI cases. Only the BAI Director has the authority to announce a confirmed HPAI case in poultry. ¶7. Improved diagnostic capability, including quality control procedures, can also encourage prompt and accurate reporting of HPAI cases in animals and people. Indemnity funds could encourage cooperation from farmers in reporting potential HPAI cases and containing outbreaks. International cooperation to alleviate potential economic costs of an HPAI outbreak can also encourage further transparency. -------------- LEADERSHIP -------------- ¶8. President Arroyo has taken a leadership role in focusing GRP resources on AI preparedness. Per ref C, Arroyo appointed Agriculture Secretary Panganiban as Anti- Avian Flu Czar, leading the National Avian Influenza Task Force (NAITF) to concentrate on stages 1 and 2: prevention and containment of Avian Flu in poultry. Health Secretary Duque manages HPAI prevention and preparedness for human health. Arroyo also proposed to allocate 2.5 billion pesos ($50 million) for stages 1 and 2 in the 2006 National Budget currently under consideration by Congress. Arroyo's proposal would source these funds from savings in debt service but some legislators have suggested using U.S. PL-480 food aid funds for this purpose. ¶9. At the operational level, Dr. Davinio Catbagan, Director of the BAI, manages AI prevention and preparedness for poultry, while Dr. Luningning Villa, Program Manager for Emerging Infectious Diseases, serves as the point person for AI preparedness in the DOH. -------------- LEGAL ISSUES -------------- ¶10. The GRP has not reviewed national laws for compatibility with HPAI preparedness, but it does not anticipate legal obstacles to surveillance and control of HPAI outbreaks. The NAITF was authorized by Executive Order 280 to supervise HPAI preparedness. Based on its experience during the SARS crisis, the GRP can invoke the Sanitation Code and the Local Government Code to support containment and quarantine measures. The Quarantine Act of 2004 (Republic Act 9271) has strengthened the DOH's authority to impose quarantines and expanded its scope to cover public health emergencies of international concern. -------------- INTERNATIONAL COLLABORATION -------------- ¶11. The GRP is working with several international organizations on AI preparedness, notably the World Health Organization (WHO),the United Nations Food and Agriculture Organization, the International Organization for Animal Health, the Asian Development Bank and the World Bank. The Philippines has joined the International Partnership on Avian and Pandemic Influenza (IPAPI). At the November 18-19 APEC summit, President Arroyo reaffirmed GRP support for regional programs to prevent and control HPAI. ¶12. The GRP has solicited support from USDA to upgrade its surveillance capacity and from USAID to support preparedness for human HPAI cases. Although the GRP is trying to allocate sufficient funds for HPAI preparedness, it may solicit further bilateral or multilateral assistance, particularly if the approval and execution of the 2006 national budget is delayed. -------------- VACCINES -------------- ¶13. GRP currently has no program or plans to administer flu vaccines, so it does not procure these vaccines for government use. The private health sector does provide vaccines for its patients and some practitioners report that demand is increasing but the current supply is adequate for the private sector. ¶14. The DOH does not have any capacity to produce flu vaccines for humans or poultry, but it produces three other human vaccines. DOH estimates that the production facility would require additional modules and at least one year for conversion to flu vaccine production in an emergency. -------------- PUBLIC AWARENESS -------------- ¶15. Public awareness of Avian Flu has increased since the GRP launched an information campaign in November and the Philippine media has increased coverage of Avian Flu. The information campaign has sent eight teams to train local AI task forces in 37 provinces to diagnose and respond to potential HPAI cases. President Arroyo named Secretary Cerge Remonde, Head of the Government Mass SIPDIS Media Group, to assist the NAITF in developing public information campaigns on Avian Flu and enlisted the support of U.S. firm McCann-Erickson to assist in the campaign. The DOH has prepared information materials covering prevention of Avian Flu and has been working with the mass media. It is difficult to determine the geographic coverage and effectiveness of these measures to date. -------------- SURVEILLANCE/DETECTION CAPACITY -------------- ¶16. Per ref D, the GRP is upgrading the Philippine Animal Health Center (PAHC),its animal reference lab, to establish a specialized AI diagnosis facility capable of identifying the H5N1 virus. The PAHC currently conducts screening tests and can isolate the virus, but must send samples to Geelong, Australia to identify specific virus types. This process can take up to one week. The BAI conducts limited random surveillance of poultry in 20 critical areas where poultry are vulnerable to infection from migratory birds. BAI also relies on regional veterinarians to report potential AI outbreaks based on high mortality rates in poultry and clinical symptoms consistent with AI. ¶17. The Research Institute for Tropical Medicine (RITM) has the capacity to isolate viruses and identify virus types. The DOH has a surveillance system, through its National Epidemiology Center to monitor human cases of pneumonia or deaths related to poultry disease/deaths in the 20 identified critical areas. ¶18. The GRP has solicited USDA support to train technical staff and equip its new Avian Flu reference laboratory for prompt diagnosis of HPAI virus types. Indemnification funds will also be critical to encourage the cooperation of poultry farmers in identifying possible HPAI outbreaks. The GRP may solicit further assistance in procuring personal protective equipment (PPEs),anti-virals and other supplies for AI response teams. -------------- ANTI-VIRALS AND PPEs -------------- ¶19. The DOH currently has no stockpile of Tamiflu but expects 100,000 capsules to arrive by February 2006. Through the WHO, the DOH made arrangement for the supply of Tamiflu (worth $31,000). It also sent a Letter of Intent to Roche Pharmaceuticals for the procurement of an additional 8.5 million pesos ($154,000). The Philippine International Trading Corporation has reached an agreement with a local company, United Laboratories (Unilab),for the manufacture of Tamiflu in the Philippines in an emergency situation. ¶20. USDA contributed 100 sets of PPEs to equip BAI teams and laboratory workers to contain an AI outbreak in poultry. The DOH has retained PPEs from the SARS epidemic for health care providers at regional hospitals. -------------- RAPID RESPONSE CAPACITY -------------- ¶21. The GRP has developed the capacity to respond to limited HPAI outbreaks, but this capacity would likely be overwhelmed if an HPAI outbreak occurs in a major poultry producing area near metro-Manila. The BAI has produced guidelines for culling of birds and containment measures (www.da.gov.ph/BirdFlu/ProtectionProgram/manu al). -------------- QUARANTINE CAPACITY -------------- ¶22. The GRP is willing to impose quarantines and social distancing measures as needed, but its capacity could be quickly overwhelmed if a human pandemic occurs. The DOH has limited capacity to isolate human HPAI cases. The Research Institute for Tropical Medicine (RITM) has been designated as the National Referral Hospital for bird flu cases. RITM will use the negative pressure rooms used during the SARS outbreak in 2004. Moreover, a portion of the Lung Center of the Philippines, a sub-national referral hospital, has been designated for tent hospitals should a pandemic occurs. Ten other DOH hospitals have the capacity to admit Avian flu cases (with PPEs and isolation facilities). The DOH plans to establish isolation facilities in all 16-17 regions. For limited human HPAI cases, the GRP could draw on its experience during the SARS epidemic to enforce a quarantine. -------------- COMMENT -------------- ¶23. The GRP recently raised the profile of its Avian Flu preparedness programs and it is making progress in providing training and supplies to regional teams. Although President Arroyo has proposed a ten-fold increase in funding for Avian Flu preparedness, this funding may be delayed if the Congress fails to approve the 2006 budget. In the short term, the GRP will continue to need assistance in improving surveillance capacity, stockpiling Tamiflu and PPEs, training regional response teams and establishing an indemnity fund to encourage cooperation from farmers. JONES