AVIAN INFLUENZA - NETHERLANDS TRIPWIRES AND

UNCLAS SECTION 01 OF 04 THE HAGUE 003394 SIPDIS E.O. 12958: N/A TAGS: AMGT ASEC CASC AMED KFLO NL AMER SUBJECT: AVIAN INFLUENZA - NETHERLANDS TRIPWIRES AND CONTINGENCY PLANNING REFS: A) STATE 219189 B) THE HAGUE 3202 C) THE HAGUE 3033 D) THE HAGUE 2634 E) THE HAGUE 2361 SUMMMARY -------------- ¶1. This message responds to the tasking in ref A to develop mission-specific tripwires and responses regarding avian influenza. We believe that the Netherlands is relatively well prepared to respond to such an epidemic, and that our most probable response to a significant outbreak of human H5N1 influenza would be to remain in country and operate the mission with essential personnel only, rather than to attempt a large-scale drawdown. In certain cases, however, medevacs and individual departures from post may be necessary. END SUMMMARY. Avian Influenza and The Netherlands -------------- ¶2. Although the Netherlands is well removed from the current concentration of human H5N1 avian influenza (AI) cases in Southeast Asia, Dutch authorities are highly cognizant of the dangers of the disease's spread and are relatively well advanced in their contingency planning. The Netherlands was in fact the site of one of the more recent AI incidents in Europe, a 2003 outbreak of the H7N7 virus among domestic poultry, which resulted in 83 people, most of whom were associated with the poultry industry, coming down with the flu or flu-like symptoms. One person, a veterinarian, died from the disease. Some 30 million birds, out of a total domestic poultry population of 100 million, were culled, with a direct cost to the Dutch poultry industry, the EU's second-largest exporter, of an estimated USD 175 million (155 million euro). ¶3. Post reported in detail on the state of Dutch preparedness for an H5N1 outbreak in ref B. To summarize, the Ministry of the Interior, which chairs the inter- ministerial National Operational Coordination Center, has overall responsibility for crisis management. The Ministries of Agriculture and Health are the key agencies responsible for preventing and coping with a possible AI outbreak among animals and people, respectively. Local governments are responsible for, and are in the process of developing, their own operational response plans. The Dutch AI contingency plan is divided into four separate phases, each with its own set of actions to be taken. The four phases are: 1) No AI in the Netherlands 2) Some AI infection among birds or other animals 3) Animal-to-human AI transmission begins 4) Human-to-human AI transmission is widespread (pandemic) Dutch officials caution that the four phases are not necessarily sequential, in that human AI infection could originate from persons outside the Netherlands, without Dutch poultry or other animals ever contracting the disease. ¶4. The Agriculture Ministry is responsible for monitoring, testing, and protecting Dutch poultry. In August, following the confirmation of an AI infection in Russia, the Ministry ordered that all poultry in the Netherlands (approximately 100 million birds) be kept indoors to protect against the spread of contamination from possibly H5N1-infected migratory birds. That order was subsequently rescinded but re-imposed on October 31, after confirmed H5N1 infections were reported among birds in southeast Europe. The confinement order will expire December 31 but is likely to be re-imposed for the spring bird migratory season. Other precautionary measures include: -- an EU-wide ban on the importation of poultry from countries with confirmed cases of H5N1 infections -- border checks on birds and animals brought into the Netherlands from neighboring countries -- a ban on the import of tropical or exotic birds for exhibitions or shows or as pets -- safety protocols for poultry workers or others likely to be exposed to the disease (masks, protective equipment, flu vaccinations, and so forth) -- a requirement that poultry farmers keep their birds separate from other birds, with more stringent precautions required in designated high-risk zones (close to watering holes or other likely areas of concentration for migratory birds) -- reporting requirements for poultry farmers if their birds show signs of disease (reduced egg production, reduced food and water consumption, higher death rates, etc.) -- mandatory reporting of suspected AI infection in poultry -- vaccination of exotic birds in zoos Dutch authorities will continue to closely monitor the domestic poultry population and will move aggressively to limit the spread of H5N1 infection, should it occur in the Netherlands, and to limit the chances of bird-to-human infection. ¶5. As reported in ref B, the Health Ministry has ordered five million doses of anti-viral medicines -- mostly Tamiflu but also Relenza, should the H5N1 virus show resistance to Tamiflu -- and expects to have 2.5 million doses on hand by end-December. (The Netherlands has a population of just over 16 million.) The Ministry also administers some 3.5 million vaccinations against seasonal flu each year, focused in particular among high-risk groups; it is aware that these may provide only limited protection against the H5N1 virus. Should the H5N1 virus take hold in the Netherlands or neighboring countries, the Ministry would step up its administration of both vaccines and anti-viral medicines. Both vaccinations and anti-viral treatments, as well as hospital admissions of the seriously ill, would be prioritized, with those in high-risk groups (the elderly, small children, and others in poor health) having first access. The Dutch health authorities' contingency plan would be administered by the National Coordinator for Infectious Disease Control (www.infectiezieken.info/index.php3). ¶6. Should human-to-human transmission become widespread, Dutch authorities would progressively ramp up their response. Dutch officials have told us that they will treat all those who contract the disease or are exposed to those who have -- including foreigners both resident or temporarily in the Netherlands -- but that they do not expect to treat all 16 million people in the country, relying on confinement and travel restrictions to contain the disease in isolated pockets. ¶7. As part of their effort to cope with the AI threat, the Dutch have participated actively in international efforts to assist countries already affected and in EU planning and crisis management efforts to cope with the disease should it spread to Europe. The Dutch have joined the International Partnership on Avian and Pandemic Influenza (IPAPI) and have also been active in WHO, FAO, and other international efforts to fight the disease and its spread. Mission AI Preparedness - Current Actions -------------- ¶8. As part of its contingency planning, post has taken or is in the process of taking the following actions: -- Ordered supplies of personal protective equipment (PPE) for mission caregivers. No PPE had previously been stockpiled. -- Confirmed that the mission's allocation of Department- supplied Tamiflu could be expected in March. -- Checked with local pharmacies as to their supplies of Tamiflu, with the result that supplies are available but limited. -- Scheduled a town hall briefing for mission personnel to be conducted by London-based RMO during the second week of January. -- Drawn up a list of essential personnel, and back-ups, to staff the mission should we decide to move to reduced- staffing. -- Developed a list of suggested food and simple medical supplies (thermometers, anti-fever medication, etc.) for mission personnel to stock should post move to a 'shelter in place' mode. This list will be distributed in early 2006. -- Highlighted links to the Department's and Centers for Disease Control's public AI information sites on the Embassy's internet home page. -- Included information on avian influenza in the Consul General's monthly newsletter to the local Amcit community (8000 recipients); MED's AI flyer is also being distributed to passport applicants and other American consular clients. -- Met with responsible Dutch officials in the ministries of agriculture, health, and defense. -- Consulted with DOD officers responsible for AI preparations for U.S. forces stationed in the Netherlands. -- Set up an avian influenza task force under the chairmanship of the economic counselor and including representatives from MED, GSO, DAO, ODC, PA, CONS, FCS, FAS, and RSO. Assignments of particular responsibilities to implement the responses outlined under the tripwires below will be completed in early 2006. ¶9. Should human H5N1 influenza become widespread in Western Europe, restrictions on international travel may make staff evacuations difficult. In addition, potential safe havens, such as the U.S., may also suffer from widespread H5N1 infection. As a result, post's initial response will be for AI-afflicted staff and their families to seek medical care locally and for uninfected personnel to restrict their movements but remain within the Netherlands. ¶10. Given that post's own medical resources are limited -- a small office with one part-time nurse at the embassy, and nothing at ConGen Amsterdam -- mission personnel and their families will need to rely on the Dutch medical system for care as the first line of defense in the case of an AI outbreak. However, Dutch medical care, while technically excellent, is rationed more tightly than is usually the case in the U.S. system; access to care tends to be more cost- constrained than demand-driven. As a result, post personnel and their families may not be able to obtain the care they believe they need, and some medevacs -- if feasible -- may be required. Our planning assumption, however, is that such medevacs or other drawdowns will be the exception rather than the rule. Mission AI Preparedness - Tripwires and Reponses -------------- --- ¶11. Post-specific tripwires and responses are detailed below. The two American officers responsible for inputting and maintaining the tripwires on the Tripwires Reporting and Integrated Planning System are RSO Roberto Bernardo and Economic Counselor Richard Huff (Post AI task force coordinator). Tripwire One: Confirmed case of bird or animal H5N1 influenza in the Netherlands (corresponds to the Dutch Phase 2 above). a) Convene EAC to confirm tripwire has been crossed and decide on next steps. b) Inform Amcit community, including DOD personnel and families, via warden network and embassy website as to extent of disease's spread, possible travel restrictions, and recommended precautionary measures. c) Update public travel guidance for the Netherlands as necessary. d) Consider vaccinating all mission staff who have not already received it with seasonal flu vaccine. e) Consult with Dutch authorities as to appropriate next steps. Tripwire Two: Confirmed case of human H5N1 influenza in the Netherlands or nearby countries (Germany, Belgium, Luxembourg, France, the UK) a) Convene EAC to confirm tripwire has been crossed. b) Update mission personnel; urge those who have not yet stockpiled food, water, and medical supplies to do so. c) Request delivery of Department-supplied Tamiflu, if not already received. d) Consider mandatory sick leave for mission staff with flu symptoms. e) Inform Amcit community, including DOD personnel and families, via warden network and embassy website as to extent of disease's spread, possible travel restrictions, and recommended precautionary measures. f) Update public travel guidance for the Netherlands. g) Implement 100% staff vaccination for seasonal flu vaccine. h) Consult with EUCOM on measures to protect DOD personnel and families at U.S. Army base at Schinnen. i) Consult with Dutch authorities as to appropriate next steps. Tripwire Three: A spike in the number and/or broadening geographic spread of animal-to-human H5N1 cases or confirmed but isolated cases of human-to-human transmission in the Netherlands or a neighboring country. a) Convene EAC to confirm tripwire has been crossed. b) Provide briefings for mission personnel and dependents; ensure that all have stockpiled essential supplies. c) Confirm that mission has sufficient reserves of water, fuel, and other essential supplies. d) Request delivery of Department-supplied Tamiflu, if not already received. e) Restrict official and unofficial by mission personnel travel to poultry farms or other areas in which the disease has become common. f) Require mandatory sick leave for mission staff with flu symptoms; administer Tamiflu as appropriate, in accordance with MED guidance. g) Consider voluntary departure from post for individual staff who wish to leave, as travel conditions permit. h) Consider restricting public access to mission buildings. i) Consider reducing consular services to public, in consultation with the Department. j) Update Amcit community, including DOD personnel and families, via warden network and embassy website as to extent of disease's spread, possible travel restrictions, and recommended precautionary measures. k) Ensure that duty officers are properly briefed to respond to after-hours public inquiries. l) In coordination with the Department, update travel guidance for the Netherlands as necessary. m) Consider restricting non-essential official travel to the Netherlands. n) Report to Washington on extent of disease and mission and Dutch responses. o) Coordinate with EUCOM on its responses to the disease's spread for U.S. military personnel in the Netherlands. p) Maintain daily liaison with Dutch authorities as to appropriate next steps. Tripwire Four: Sustained human-to-human transmission anywhere in the Netherlands or in neighboring countries. a) Convene EAC to confirm tripwire has been crossed; hold regular EAC meetings as necessary to decide on next steps. b) Provide regular briefings and electronic updates for mission personnel and dependents. c) Restrict non-disease-related official and unofficial travel by mission personnel within the Netherlands. d) Cancel non-disease-related official travel to the Netherlands. e) Require mandatory sick leave for mission staff with flu symptoms; administer Tamiflu as needed, in accordance with MED guidance. f) Implement use of protective equipment (gloves, masks, etc.) according to MED guidance. g) Consider medevacs for mission staff who cannot obtain needed treatment from Dutch sources. h) Consider requesting authorized departure from post, if feasible and appropriate. i) Shift to reduced-staffing, with only essential personnel on duty. j) Advise families to keep their children home from school. k) In consultation with Department, limit consular services to emergencies only. l) Ban public access to mission buildings. m) Update Amcit community, including DOD personnel and families, via warden network and embassy website as to extent of disease's spread, travel restrictions, and recommended precautionary measures. n) Consider establishing a special task force to answer public inquiries. o) Ensure that duty officers are properly briefed to respond to after-hours public inquiries. p) In coordination with the Department, update travel and press guidance and for the Netherlands as necessary. q) Divide MSG detachment into separate and independent teams to decrease the risk of infection in the entire unit. r) Report to Washington on spread of disease and mission and Dutch responses. s) Coordinate with EUCOM on its responses to the disease's spread for U.S. military personnel in the Netherlands. t) Maintain daily liaison with Dutch authorities as to appropriate next steps. ¶12. Post's principal point of contact for AI contingency planning is Economic Counselor and AI task force coordinator Richard Huff (31-70-310-2270; huffrx@state.gov). BLAKEMAN