YEMEN INFORMATION ON AVIAN AND PANDEMIC INFLUENZA

C O N F I D E N T I A L SECTION 01 OF 03 SANAA 003290

SIPDIS

PASS TO OES SENIOR HEALTH ADVISOR DR. DANIEL SINGER, POLICY
ADVISOR REBECCA S. DALEY, INR SENIOR ANALYST RAYMOND LESTER

E.O. 12958: DECL: 11/23/2015
TAGS: TBIO SENV ECON EAGR EAID PREL YM ENVIRONMENT
SUBJECT: YEMEN INFORMATION ON AVIAN AND PANDEMIC INFLUENZA

REF: SECSTATE 206992

Classified By: DCM NABEEL KHOURY FOR REASONS 1.4(B) AND (C)


1. (U) Summary: This cable describes
ROYG preparations and capabilities in the event of an avian
influenza pandemic; responses are keyed to reftel questions.
End Summary.


2. Preparedness/Communication

-- 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.

The Yemeni Government does have a preparedness strategy
approved by parliament. The government is currently not
capable of fully implementing the policy, but is slowly
moving toward a greater level of capability in
identifying a threat. Due to poor medical facilities and
lack of resources, both monetary and technical, the ROYG is
unable to handle a pandemic.

-- 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?

The government will likely be truthful in reporting the
scope of the disease to the best of their capabilities.
The Yemeni Government has expressed a strong interest in
maintaining the utmost level of transparency in regard to
avian influenza.

-- Where does preparing for an avian flu human pandemic
rank among the 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?

Preparing for a pandemic is high on the list of government
priorities. The primary offices are the Ministry of
Health and the Ministry of Agriculture, which are working in
concert on this issue. The government has also set up an
operations center disease surveillance unit. The main
contacts are Dr. Majid al-Gunaid, who is the Deputy Minister
of Public Health and Population, Yahia Al-Areshi with the
Ministry of Agriculture and Irrigation, and Mr. Nabil
Shaiban of the Ministry of Planning and International
Cooperation.

-- 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?

There are no Yemeni laws that pose barriers. As part of
their Plan of Action (POA),the government implemented two
new laws aimed at addressing the prevention of disease from
the animal source
and at preventing the spread of the flu.

-- 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 US or other countries? Would government leaders be
receptive to messages from US 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 US in
return for its efforts?

The Yemeni Government has already worked closely with WHO
to develop the current POA. FAO and the Animal Health
Organization have also assisted the government. The
government is seeking to coordinate with members of the Gulf
Cooperation
Council, as well.
The government has sought additional technical and monetary
assistance directly from USAID and is likely to seek
assistance from other countries.

-- 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?
Yemen does not currently administer annual flu shots and is
not likely to consider doing so in the future. The
government does not spend large amounts of money on health
and curative medicine is of a greater priority than
preventative medicine. Yemen currently does not produce
any vaccines and has no production capabilities for either
human or poultry influenza vaccinations. Post is unaware
of any liability shield or prospects of one being enacted.

-- 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?

The general population has limited information about the
threat. Part of the POA addresses raising awareness among
veterinarians, technical staff and poultry breeders. There
is an initiative to inform farmers and fisherman along the
main migratory bird route. So far, however, the
information has been limited to instructions to bring dead
birds to a local laboratory. There is currently no larger
initiative to educate the public on ways to protect
themselves in the event of a pandemic or ways to prevent
the spread of the disease if an outbreak occurs. This is
particularly true of rural areas where poultry to human
contact is prevalent. The Yemeni public has gained its
information about AI through local and international media
outlets.


3. Surveillance/Detection

-- How capable are the medical and agricultural 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 who,
and if not where are they sent? Does the country send
samples to a WHO/EU/US reference laboratory?

The Ministry of Agriculture has procured test kits, but
post has no information that they are currently being
used. Yemen uses the NAMRU 3 regional lab out of
Alexandria, Egypt. Yemen has very primitive scientific and
health capabilities. The POA seeks to increase the
capabilities of the Central Public Health Laboratory.

-- What are 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 US or international organizations?

In general, Yemen is a very poor country with a failing
health care system. Even absent a pandemic, the Yemeni
Government will be hard pressed to deal with many issues
such as financing, technological necessities and access to
affected areas. Public education needs to be increased,
particularly in rural areas where much of the poultry food
is raised. In the event cases are found in the poultry
food population, it is very likely that affected farmers
will underreport, and likely actively fight
against government actions or restrictions, especially if
large scale culling is deemed necessary.


4. Response/Containment

-- 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?

The country currently has enough Tamiflu on stock for 2000
people. The Ministry of Health estimates a need for enough
to cover 20 percent of the population (approximately 5-6
million people).

-- Does the country have a stockpile of pre-positioned
personal protective gear?

Yemen has a very limited protective gear stockpile. The
POA calls for an increase in stockpiles and the WHO has
expressed intentions to assist the Ministry of Health in
acquiring more.

-- 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 movement?

Although the government expresses a high level of confidence
in
its ability to rapidly respond to an outbreak, absent a
stronger central government and a comprehensive plan to
compensate affected farmers, the government is likely to
face tough resistance from affected farmers. No current
guidelines exist for any rapid response reaction.

-- How willing and capable is the government of imposing
quarantines and social distancing measures (closing public
schools, public gatherings, mass transit)? Would its
military enforce quarantines?

The government is willing to impose quarantines. The POA
includes
the outfitting of a national fever hospital and local fever
hospitals in each of the governorates. The military would
attempt to enforce quarantines, but given the weak central
government, resistance to large-scale quarantine is almost
assured outside of the large cities.


5. Given Yemen's location on a major migratory bird route,
the large number of poultry food farms, and the high
incidence of human to poultry contact, an outbreak of
avian influenza, even if restricted to animals, would have
serious ramifications on the Yemeni economy. While the
government
has prepared a Plan of Action, absent an influx of
funding or technical assistance, Yemen will be ill-equipped
to deal with even a small-scale pandemic. The government is
actively seeking assistance bilaterally, multilaterally and
through international organizations, and post recommends that
it be accorded due support.
Krajeski