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