COSTA RICA AND AVIAN AND PANDEMIC INFLUENZA

1. The responses below key off reftel.

A) 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 GOCR is finalizing a preparedness plan establishing a
Core Commission on avian flu seating key ministries and
agencies like the Ministry of Agriculture, Ministry of
Health, and the Costa Rican Fund for Social Security (Caja
Costarricense de Seguridad Social -CCSS), which administers
the country's public health care system. The plan also
establishes a Communications Council that would manage
outreach and education activities. The plan is modeled along
the recommendations that emerged from the Pan American Health
Organization/World Health Organization. The private sector
has not yet been consulted or incorporated into the plan. A
copy of the plan will be forwarded when it is issued.

Capacity for implementing the strategy is low. Much will
rely on the good will and common sense of the Costa Rican
public to follow what will essentially be voluntary measures.
The view among doctors is that emphasis of any effort should
be on education before an outbreak as an epidemic would
quickly overwhelm the health system.

-- 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?

We expect the GOCR to be truthful in reporting the scope of
the disease in animals or humans. Costa Rica's Ministry of
Agriculture and Livestock has good avian disease surveillance
capabilities and a longstanding cooperative relationship with
USDA's Animal & Plant Health Inspection Service. Difficulty
in diagnosing the disease in humans and slow processing time
of tests rather than a lack of truthfulness would be the more
likely cause of a delay in reporting the scope of the disease
in CR, should it be introduced. Timely reporting could be
bolstered by contributing to an adequate supply of
fast-reading tests that would permit a quicker diagnosis.

-- 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?

The Ministry of Health moved quickly to organize its approach
and develop possible strategies (The Ministry of Agriculture
already had an AI surveillance program in place). Avian flu
and its implications for Costa Rica have received
considerable public relations play. However, avian flu
preparation is likely to take a back seat to pressing issues
like burgeoning dengue numbers, malaria, TB, and deficient
infrastructure. Key go-to people include the Minister of
Health; Ministry of Health avian flu coordinator Dr. Salas;
and senior officials at the CCSS.

-- 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?

Answer is not known.

-- 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?

GOCR is working with the Pan American Health
Organization/World Health Organization. GOCR is likely to
seek U.S. assistance if an outbreak occurs. From technical
staff to the Minister of Health, the Ministry of Health has
comfortable contacts with their U.S. counterparts. GOCR
would be open to whatever approach is likely to deliver
assistance and cooperation soonest in the case of an
emergency. In the preparedness phase, GOCR is likely to look
to the U.S. for expertise and assistance in planning and in
underwriting development of stockpiles. In case of an
impending pandemic scenario, GOCR is likely to seek access
and financing for vaccines and medicines. Depending on the
scale of the outbreak, GOCR might request supplies needed to
establish makeshift isolation wards or financial assistance
to underwrite certain deferred infrastructure improvements.

-- 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?

Costa Rica administers annual flu shots to its most
vulnerable population --children, the elderly, those with
Cardiopulmonary Disease, or cardiopathology. Costa Rica does
not produce vaccines. An H5N1 vaccine is not in development.
Post does not know whether there is a liability shield for
donors or foreign manufacturers.

--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?

Recent press coverage focused on the risks of avian flu. The
population is aware of the risk, but are likely not familiar
with measures they can take to mitigate the threat. Most of
the population can be reached through newspapers, TV and
radio. The CCSS, system of hospitals and health care
centers is within reach of most of the population. Of
particular concern are the aboriginal peoples of remote
southern Costa Rica, who are the hardest for the government
to reach and whose subsistence farming occurs near wilderness
areas that may host migratory birds.

B) SURVEILLANCE/DETECTION

-- 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 WHO, AND IF NOT
WHERE ARE THEY SENT? DOES THE COUNTRY SEND SAMPLES TO A
WHO/EU/US REFERENCE LABORATORY?

We expect that detection capacity by the Health Ministry is
good and that Agriculture's capacity is better. However, the
lack of quick flu tests indicates that Costa Rican tests may
take a week or more to establish presence of the disease in
humans - a delay inconsistent with the nature of a pandemic
emergency. Influenza viruses are sent to CDC/Atlanta for
subtyping.

-- 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 US OR INTERNATIONAL ORGANIZATIONS?

Key gaps include shortage of fast flu tests for the number
required in case of a pandemic; limited ability to isolate
sick patients - and inadequate infrastructure for handling
suspicious cases- waiting rooms are not separated between the
infectious and non-infectious and many sick individuals using
public transport to get to hospitals.

GOCR could use equipment and supplies to quickly distinguish
among types of flu.

C) 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?

NO. GOCR is considering an order for sufficient vaccines for
50 percent of their population. The GOCR has not decided
whether to put itself on the waiting list for Tamiflu orders.

--DOES THE COUNTRY HAVE A STOCKPILE OF PRE-POSITIONED
PERSONAL PROTECTIVE GEAR?

GOCR only has on hand a stockpile of personal gear to meet
normal needs. Sometimes major public Hospitals have
shortages for normal needs due to distribution problems.

--WHAT IS THE RAPID RESPONSE CAPACITY FOR ANIMAL AND HUMAN
OUTBREAKS? ARE GUIDELINES IN PLACE FOR THE CULLING AND
VACCINATION OF BIRDS, DISINFECTING OF FACILITIES, AND
LIMITATIONS ON ANIMAL MOVEMENT?

Good. GOCR has worked with APHIS on tracking diseases among
domesticated poultry and other animals.
-- 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?

GOCR can persuade organizers to cancel many public events.
However, its capacity for enforcing restraints on private
behavior is limited. With no military, civil security forces
will bear the burden of persuading citizens to respect
government recommendations.



2. COMMENT: Costa Rica's underfunded, deteriorating health
care system is unlikely to be able to handle a full-scale
epidemic. Should the first line of defense, isolation of the
earliest cases, fail to contain the outbreak, the health care
system will have to resort to home quarantine, rely on the
"Honor System" for restraining public activities, and trust
that the common sense of the citizenry will respect
precautionary measures. In this case, as one doctor put it
to the Embassy nurse, "Cada uno a su santo" - Each to his
saint. End comment.
LANGDALE