TAIWAN CDC DIRECTOR ON WHO, AVIAN FLU AND

C O N F I D E N T I A L SECTION 01 OF 02 TAIPEI 004903

SIPDIS

STATE PASS AIT/W, GENEVA FOR DAVID HOHMAN

E.O. 12958: DECL: 12/08/2006
TAGS: AMED CASC SENV TBIO PREL TW ESTH
SUBJECT: TAIWAN CDC DIRECTOR ON WHO, AVIAN FLU AND
PREPAREDNESS

REF: TAIPEI 4764

Classified By: Dir for reasons 1.4 (b and d)


1. (U) Summary: Steve Kuo, Director General of Taiwan,s
Center for Disease Control, met with AIT/T on December 1 and
discussed aspects of Taiwan,s participation in the WHO,
particularly those areas related to infectious disease
control, Taiwan,s plans to construct a level 4 research
laboratory, and efforts to stockpile Tamiflu. Kuo provided
AIT/T a tour of TCDC,s Command Center. End summary.


2. (U) AIT/T Econ Chief and new ESTH officer paid a courtesy
call on CDC Director General Steve Kuo at his office on 12/1.
Kuo spent over an hour with AIT/T.

WHO Participation
--------------


3. (C) We asked if he had any information on Taiwan,s plans
to respond to the letter from WHO outlining the guidelines
for Taiwan,s participation in the International Health
Regulations. Kuo said that Taiwan,s response to the letter
would be coordinated by the Ministry of Foreign Affairs. He
reiterated Taiwan,s policy that it needs to obtain some form
of membership in WHO and that it could not accept the title
of &Taiwan, China.8 However, as a practical matter, Kuo
said that Taiwan has agencies that could, and do, cooperate
with the WHO and confirmed that the WHO treats the TCDC as
the focal point in Taiwan for issues regarding infectious
diseases. As an example, Kuo said that he and two other
specialists from Taiwan attended the November WHO meeting in
Geneva discussing Avian Influenza issues.

PARTICIPATING IN GOARN
--------------


4. (U) Kuo said that Taiwan has been participating in a WHO
mechanism for some time. He cited GOARN (Global Outbreak and
Response Network),saying that Taiwan health institutions
have been active in GOARN for many years. Taiwan,s
participation, he said came about from work done with the
USCDC when it established its Field Epidemiology Training
Program in Taiwan in 1984. Kuo said activities under GOARN
are strictly technical sessions where Taiwan experts interact
with experts from other places. Kuo noted that in 2001,
Taiwan tried to set up a meeting in Taiwan of GOARN members,
but that the PRC had blocked Taiwan,s proposal.


5. (C) When Kuo visited Geneva in November he consulted with
some WHO officials. Kuo said that he discussed GOARN and
other mechanisms of cooperation with Michael Ryan Director,
WHO Office of Epidemic and Pandemic Response. Kuo said that
Ryan stuck strictly to technical issues and told Kuo that the
ground rules for Taiwan participation in WHO mechanisms and
events are that Taiwan is not to introduce any political
issues into the discussions.


LEVEL 4 LAB
--------------


6. (C) AIT/T noted that we have received information from
U.S. firms bidding on contracts to supply services for
Taiwan,s tender to build a level 4 ward. Kuo confirmed that
Taiwan is in the process of planning to build a level 4 lab,
describing it as one of the most sophisticated medical
isolation units in the world. Kuo said TCDC had run into
negotiation difficulties with Battelle Corporation of
Maryland over the bidding for construction of the project.
According to Kuo, TCDC originally had budgeted NT$ 8 billion
to build the lab and has divided the project into two phases:

Phase I. A NT$30 million tender to write the design
specifications and request for proposal for the project, but
specifically not to include the design of the facility.

Phase II. The remaining funds are for a separate tender for
the actual design, construction and equipping of the
facility.


7. (C) Kuo said that Battelle,s bid for phase I was NT$60
million and included design of the structure. Kuo said that
at twice the proposed budget, TCDC had no option but to
reject this bid. Kuo said he believes that Taiwan cannot
move forward on this project without a clear indication that
the USG approves of the project. Further, he believes that he
must have U.S. firms involved in the construction of the ward
to win USG approval. He said that he is prepared to cancel
the project if there is no U.S. participation and that he has
already started to draft such a recommendation for the
Minister of Health. Kuo explained that this project would
involve joint research programs with scientists from other
countries, particularly the U.S., and that it would be vital
to have a facility that meets the most stringent standards.
Just prior to meeting with AIT/T, Kuo said that he had
received a last minute e-mail from the Trade Representative
from the State of Maryland requesting further discussions
with Battelle. Kuo said that TCDC is considering its next
steps and TCDC confirmed on December 9 that it is still
discussing its options.

TAMIFLU & Avian Influenza
--------------


8. (U) Taiwan issued a compulsory license to produce Tamiflu
on 11/25 in spite of objections by Roche, the Swiss
pharmaceutical company (reftel). Under the terms of the
license, the Department of Health (DOH) must first exhaust
Roche-supplied Tamiflu before distributing locally produced
stock. Kuo said TCDC started in 2004 to procure sufficient
courses of Tamiflu from Roche to cover 10 percent of the
population. He could not guarantee that Taiwan would continue
buying from Roche if the needs went beyond 10 percent of the
population. He indicated that Taiwan thought it unlikely that
Roche would be able to meet all of Taiwan's needs. He added
that if a pandemic was evident then Taiwan drug companies
would be allowed to make Tamiflu under the terms of the
compulsory license. When asked about the 4-5 Taiwan firms
that allegedly can produce Tamiflu, Kuo was non-committal,
neither confirming the number nor providing names of the
firms.


9. (SBU) Kuo said that in the event of an avian influenza
pandemic, TCDC,s leadership role is likely to diminish
because Taiwan has established a formal plan to move decision
making up to the Executive Yuan and the President as any
pandemic increases in severity. But he believes that the
Taiwan citizenry is well informed about contagious disease
outbreaks because of the wide dissemination of information by
the authorities during and since the SARS outbreak. He also
felt that Taiwan was a leader in terms of preparedness
against communicable diseases, particularly regarding Avian
flu.

TCDC Command Center
--------------


10. At the end of the visit, Kuo provided a brief tour of the
Command Center. It is an impressive office with monitors
showing real-time images of incoming passengers being
screened for fevers and Chiang Kai-shek International
airport, data charts showing incidence of Avian Flu and other
communicable diseases in foreign countries and in Taiwan. The
office was well equipped with phones and computers and could
be quickly staffed in the event of an emergency. It was very
visiable display of preparation by Taiwan to combat not only
AI, but also other communicable diseases and threats to
public health. This is in stark contrast with the pre-SARS
era arrangements, before AIT and USCDC became heavily engaged
in helping Taiwan update its procedures and facilities.


PAAL