BURMA: RESPONSES TO AVIAN AND PANDEMIC INFLUENZA

UNCLAS SECTION 01 OF 04 RANGOON 001323 SIPDIS STATE FOR EAP/MLS; PACOM FOR FPA; USDA FOR FAS, APHIS E.O. 12958: N/A TAGS: EAGR EAID PGOV PHUM PREL SENV SOCI TBIO BM SUBJECT: BURMA: RESPONSES TO AVIAN AND PANDEMIC INFLUENZA REF: A. STATE 209622 ¶B. RANGOON 1275 ¶C. RANGOON 1157 ¶D. RANGOON 1036 ¶1. Burma has made some strides in preparing for a potential avian influenza (AI) pandemic, but much more needs to be done. Our responses to questions in ref A follow: PREPAREDNESS /COMMUNICATION ¶2. Does the government have a preparedness plan/strategy for preventing avian flu from becoming a pandemic and containing a pandemic once it occurs? If the country has a strategy, how capable is it of implementing it? Please provide a copy of the plan or the Internet address for the plan. Response: The Ministry of Health established a task force to formulate a "Contingency Plan for Preventing and Controlling an Avian Influenza Epidemic in Myanmar" dated on December 31, ¶2004. The Plan of Action was published in January 2005. Since then a National Pandemic Plan has been prepared by various sub-committees and submitted to the National Health Committee. The National Health Committee endorsed both the National Influenza Pandemic Plan and the Plan of Action. The Government of Burma (GOB) subsequently formed a multi-sectoral National Steering Committee on Prevention, Management, and Control of Avian Influenza with six sub-committees. The capability of the GOB to implement their plan is doubtful. According to the Minister of Health, the GOB will attempt to fight AI to the best of its ability despite its "meager resources" (ref B). The Ministry of Health is cooperating closely with the WHO on AI issues, which gives hope that the GOB will receive at least some sound guidance. The sudden move of the government from Rangoon to a new administrative capital in Pyinmana comes at a season when Burma is most vulnerable to incoming migratory birds. The ongoing move could divert the attention of the Ministry of Health and other relevant ministries from AI outbreaks and reduce their ability to respond rapidly. Post has obtained a copy of the GOB plan and is translating it into English; we will forward it to OES and EAP upon completion. ¶3. How truthful will the government be in reporting the scope of any disease outbreak among people? Among animals? What incentives could be offered that would likely result in more transparency? Response: According to the Minister of Health, his ministry is committed to transparency and has shared details of several recent suspect outbreaks that it investigated and concluded they were caused by other infectious diseases, not AI. The FAO in Burma has informed us on several occasions that they are not aware of any outbreaks of AI among animals in Burma to date and report good cooperation from the Livestock and Fisheries Ministry. However, the culture discourages forwarding bad news, so individuals outside of the capital might decide to suppress reports of suspicious outbreaks. The Minister of Health has specifically asked us whether the United States could provide rapid laboratory test kits for use in suspected outbreaks of AI among humans (ref B). Since it is in our interests to contain an outbreak of AI wherever it occurs, it will be helpful to explore ways the U.S. or international agencies could meet this request. ¶4. Where does preparing for an avian flu human pandemic rank among government priorities? Who and what would most influence the country to give the issue a higher priority? Who is the key "go-to" person, office, or department (i.e. Minister for Health, Prime Minister, etc.) for USG officials to engage on this issue? Response: In recent weeks, the GOB appears to be paying more attention to AI issues and has disseminated more media reports to raise awareness among the public. However, relocating the capital and other command and control operations is the top priority now and could distract senior officials' attention away from AI. Burma's neighbors probably have the most influence in getting the GOB to give AI a higher priority, especially China and the ASEAN. The Minister of Health is the best person in the GOB to contact on AI issues. Absent reliable contacts with GOB officials, our key interlocutors on this issue remain the WHO and the FAO. ¶5. Have national laws been reviewed to ensure that they are consistent with the international health regulations and do not pose barriers to avian influenza detection, reporting, containment, or response? Response: We are not aware that any national laws have been reviewed in light of current AI threats. However, the GOB relies heavily on guidance from the WHO on AI issues and has incorporated WHO guidelines into their national plan for combating AI. ¶6. Is the host country already working with international organizations or other countries on the avian flu issue? Are government leaders likely to ask for assistance from the U.S. or other countries? Would government leaders be receptive to messages from U.S. leaders through a bilateral approach, at a multilateral forum such as the UN (WHO, FAO, etc.) or APEC, or through bilateral contacts by a third country? What would the country want from the U.S. in return for its efforts? Response: The GOB works closely with WHO, FAO, and regional countries on AI issues. The Prime Minister recently attended the Ayeyarwaddy-Chao Phraya-Mekong Economic Cooperation Strategy (ACMECS) summit in Bangkok. He stated on national television that the GOB will participate with regional countries to fight AI and other diseases. The Minister of Health has requested the international community, including the U.S., to assist his ministry with rapid laboratory test kits for suspected AI cases among humans. The GOB has received assistance from Japan for testing suspected AI outbreaks among animals. The Minister of Health said that if someone could help him with rapid laboratory test kits he would ask for nothing more (ref B). ¶7. Does the country currently administer annual flu shots? If not, might it consider doing so? What is the production capability (i.e. how many doses of the annual trivalent flu vaccine can the country make) for human influenza vaccines in the country? Does the country produce influenza vaccine for poultry and if so, how much? If the country is developing an H5N1 vaccine, where is it in production and testing? Any licensing issues? Is there a liability shield for foreign makers/donors of vaccines? If not, any prospects of one being enacted? Response: The government does not administer annual flu shots to the public or to its civil servants or military. Flu vaccine is only available at two private clinics in Rangoon in very limited amounts, for approximately US$ 25 per dose, which is equal to the average monthly salary of a Burmese civil servant. The country does not produce trivalent flu vaccine nor is it developing H5N1 vaccine. ¶8. How well informed is the population about the avian flu threat and about measures they should take to mitigate the threat? What mechanisms are available for providing additional information to the population, particularly in rural areas and how effective are these measures? Response: The population is not well informed about the threat of AI and what they can do to mitigate it. The GOB has been increasing its coverage recently about AI issues on its officially-controlled radio, television, and print media. Many people in Burma rely on foreign radio broadcasts (VOA, RFA, BBC, DVB) for their news. This avenue offers an excellent medium for increasing knowledge among rural populations about what they can do to mitigate the threat of AI. SURVEILLANCE / DETECTION ¶9. How capable are the medical and agriculture sectors of detecting a new strain of influenza among people or animals respectively? How long might it take for cases to be properly diagnosed, given other endemic diseases? Can influenza viruses be subtyped in the country, if so by whom, and if not, where are they sent? Does the country send samples to a WHO/EU/US reference laboratory? Response: The Livestock Breeding and Veterinary Department of the Ministry of Livestock and Fisheries has some rapid laboratory test kits for detecting new strains of influenza among animals. The Ministry of Health lacks this capability for humans, although it has assigned its Central Epidemiology Unit as the focal point for surveillance. The WHO has informed us that in-country laboratories do not meet international standards. Influenza viruses cannot be identified easily by subtype in the country, therefore specimens are normally sent to Bangkok for analysis. In a recent suspected outbreak of AI among humans, which turned out to be Influenza A, the Ministry of Health cooperated closely with the WHO, which transferred blood samples from the victims to Bangkok within 24 hours of the samples being collected. WHO is the primary reference laboratory for samples collected in Burma. ¶10. What are the critical gaps that need to be filled in order to enhance the country's disease detection and outbreak response capabilities? What is the country's greatest need in this area from the U.S. or international organizations? Response: -- The population, 75% of whom live in rural areas with minimal access to information, needs to be better informed about being alert to deaths among wild bird and domestic bird populations and how to report such deaths; -- The communication channels from grassroots areas to the central government need to be improved for rapid transmission of reports; -- The Ministry of Health needs rapid laboratory test kits to be able to quickly diagnose suspected cases among human populations; -- The country needs sufficient stockpiles of antiviral drugs to administer to populations that may live in the area of an outbreak. RESPONSE / CONTAINMENT ¶11. Does the country have a stockpile of medications, particularly of antivirals, and if so, how much? If some has been ordered, how much and when is it expected? Response: The Ministry of Health says it does not even have sufficient stockpiles of antiviral drugs to provide prophylaxis to its health personnel who are responsible to care for AI victims, but claims it is in the process of stockpiling 10,000 doses of Tamiflu. The WHO donated the Tamiflu they currently have. The GOB has appealed to other countries for donations of antivirals and believes that China will provide some once it has established its own production capacity. The GOB also counts on access to WHO's regional stockpile of antivirals in the event of an AI outbreak in Burma. ¶12. Does the country have a stockpile of pre-positioned personal protective gear? Response: The GOB has very limited stocks of personal protective gear for use by field investigation teams and health care providers in designated isolation wards and medical facilities only. ¶13. What is the rapid response capacity for animal and human outbreaks? Are guidelines in place for the culling and vaccination of birds, disinfection of facilities, and limitations on animal movements? Response: The Ministry of Health and the Ministry of Livestock and Fisheries have AI rapid response teams reportedly on standby to respond to new suspected outbreaks around the country (ref B). These teams were reportedly activated several times in recent weeks. Their investigations revealed other diseases, not AI. Rapid response teams have also been formed at the international airports in Rangoon and Mandalay to screen passengers and triage suspect cases. According to the Ministry of Health, personnel at border crossing points with China and Thailand are conducting ongoing surveillance. We are awaiting translation of the "Contingency Plan for Preventing and Controlling an Avian Influenza Epidemic in Myanmar" before we can comment on specific guidelines for culling, vaccinating, disinfecting and curtailing animal movements. We believe the GOB has established guidelines for three of the four areas, excluding vaccination of birds. ¶14. How willing and capable is the government of imposing quarantines and social distancing measures (closing schools, public gatherings, mass transit)? Would its military enforce quarantines? Response: The authoritarian, military-dominated regime is both willing and capable of imposing quarantines if it deems such measures expedient. Recent events have revealed the senior leadership to be unpredictable, yet able to suddenly uproot its civil service and move them 240 miles north of Rangoon. VILLAROSA