Identifier
Created
Classification
Origin
05YEREVAN2053
2005-11-23 07:19:00
CONFIDENTIAL
Embassy Yerevan
Cable title:  

ARMENIA: RESPONSE TO AVIAN AND PANDEMIC INFLUENZA

Tags:  TBIO SENV ECON EAGR EAID PREL AMED AM WHO 
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C O N F I D E N T I A L SECTION 01 OF 05 YEREVAN 002053 

SIPDIS

E.O. 12958: DECL: 11/18/2015
TAGS: TBIO SENV ECON EAGR EAID PREL AMED AM WHO
SUBJECT: ARMENIA: RESPONSE TO AVIAN AND PANDEMIC INFLUENZA
REQUEST FOR INFORMATION

REF: A) STATE 206992 B) YEREVAN 1562 C) YEREVAN 1730

Classified By: Amb. John Evans for reasons 1.4 (b,d).

-------
SUMMARY
-------

C O N F I D E N T I A L SECTION 01 OF 05 YEREVAN 002053

SIPDIS

E.O. 12958: DECL: 11/18/2015
TAGS: TBIO SENV ECON EAGR EAID PREL AMED AM WHO
SUBJECT: ARMENIA: RESPONSE TO AVIAN AND PANDEMIC INFLUENZA
REQUEST FOR INFORMATION

REF: A) STATE 206992 B) YEREVAN 1562 C) YEREVAN 1730

Classified By: Amb. John Evans for reasons 1.4 (b,d).

--------------
SUMMARY
--------------


1. (SBU) Armenia is ill-prepared to respond to an avian
influenza (AI) outbreak in either the animal or the human
population. There is no active surveillance system in place
and the GOAM currently lacks basic diagnostic capacity to
evaluate any potential AI outbreak. There is, however, some
scientific equipment and expertise available that could be
adapted to respond to the AI threat. The GOAM recognizes the
nature of the AI threat, is likely to cooperate with the
international community and is open to both bilateral and
multilateral assistance. This cable presents a brief summary
of the poultry sector in Armenia in paragraph 2 and responds
to ref A questions in paragraph 3. End Summary.

--------------
BACKGROUND
--------------


2. (SBU) From November 12 to 19, at the GOAM's request, USAID
sponsored poultry expert Dr. Elizabeth Krushinskie to assess
preparedness to combat AI in the agricultural sector. The
Food and Agriculture Organization (FAO) considers Armenia to
be a high-risk country for AI because of bird migratory
patterns. According to Krushinskie, Armenia's vulnerability
is limited because there are few live bird markets in Armenia
and the domestic poultry industry is relatively small.
Commercial poultry farmers in Armenia raise chickens in
enclosures so they do not come into contact with wild birds.
Backyard chicken farmers often allow their birds to roam
outdoors but generally do not allow chickens, pigs and other
livestock to enter their homes. The Minister of Agriculture
told us that 75 percent of domestic poultry in Armenia,
approximately seven to eight million birds, is raised for
personal consumption on backyard farms. The remaining 25

percent is raised on one of six commercial poultry farms.
The Ministry estimates that 50 percent of chicken consumed in
Armenia is imported, primarily from the U.S. and South
America. In response to the AI threat, the Ministry has
banned poultry imports from Russia, Turkey, Romania, Iran and
Southeast Asia. The Ministry of Environment has banned wild
bird hunting, but local hunters routinely violate the ban.
Post's point of contact on avian flu is Economic Affairs
Officer Elizabeth Pelletreau who can be reached at
PelletreauEX@state.gov or via telephone at (347-10) 467-000
ext. 4402.


3. (C) Post's responses to the questions in ref A follow:

--------------
PREPAREDNESS/COMMUNICATION
--------------


Q. 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?


A. The Armenian Ministry of Health has taken the lead on
drafting a National Preparedness Plan, with other Ministries,
including the Ministry of Agriculture, tasked to draft
annexes for their specific area. In October, a
representative from the Ministry of Health traveled to
Copenhagen to review the Preparedness Plan with a group of
World Health Organization (WHO) experts. The plan provides a
progressive response depending on the nature of the threat
and includes provisions for the ban of poultry sales, mass
exterminations of birds in infected areas, limits on travel
and tourism, stockpiling of antiviral medication and banning
of public events. The plan does not discuss compensation for
farmers if there is a need to cull local flocks. The
Ministry of Agriculture is developing a specific agricultural
plan with the FAO, but this plan is significantly less well
developed than the Ministry of Health's plan. The greatest
constraint on implementation of the National Preparedness
Plan, which the Ministry of Health expects will be approved
in the near future, will likely be a lack of financial
resources. Per ref A, copies of both plans have been sent
via unclassified e-mail to Armenia Desk Officer Kami Witmer,
OES Senior Health Advisor Dr. Daniel Singer, Policy Advisor
Rebecca Daley and INR Senior Analyst Raymond Lester.


Q. 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?


A. The GOAM will likely cooperate with the WHO and World
Organization for Animal Health (OIE) in the event of an
outbreak among either humans or animals. Diagnostic capacity
in Armenia, however, remains extremely limited. The Armenian
press has repeatedly quoted representatives from the
Ministries of Health and Agriculture reassuring the general
public that there is no avian flu in Armenia, but no active
surveillance or diagnostic testing is being done to support
that claim. The GOAM has a passive surveillance system
whereby farmers and hunters are encouraged to report dead
birds. When dead birds are found, the GOAM collects live
birds from the same area for observation assuming that if the
disease has spread, the birds under observation will also
die. The GOAM does not have the capacity to test for H5N1
and rural inspectors would need training on how to collect
and transport samples before any active surveillance system
is put in place. International assistance to develop an
active surveillance system and diagnostic capacity would
allow the GOAM to collect reliable data to share with the
international community. Should there be an avian flu
outbreak, there will also be a need to convince the GOAM to
allocate funding to support culling and compensation efforts.


Q. 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 for USG
officials to engage on this issue?


A. The Ministries of Agriculture and Health place a high
priority on preparing for an AI outbreak. It is not clear
whether the Ministry of Finance is willing, or able, to
provide the necessary financial resources to ensure an
appropriate response. The following Ministries sit on an
inter-ministerial AI task force: Agriculture, Health,
Environment, Foreign Affairs, Territorial Administration and
the Department for Emergency Situations. The head of the
task force, and key "go-to" person, is Deputy Minister of
Agriculture Levon Rukhkian. Former Chief of Public Health
and Sanitation at the Ministry of Health, Prof. Vladimir
Davidyants has been our key contact for AI and human health
issues. As of November 21, Davidyants was reassigned to the
National Institute of Health. His replacement, Artyom
Vanyan, will likely become our new key contact within the
Ministry of Health.


Q. 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?


A. To the best of our knowledge, there has been no such
review. According to a representative from the Ministry of
Health, many of Armenia's health laws are out-of-date and the
Ministry has drafted a new consolidated public health law
which it hopes will be adopted in the next six to eight
months.


Q. Is the host country already working with international
organization or other countries on the avian flu issue? Are
government leaders likely to ask for assistance from the U.S.
or other countries? Would government leaders be receptive to
messages from U.S. leaders through a bilateral approach, at a
multilateral forum such as the UN (WHO, FAO, etc.) or through
bilateral contacts by a third country? What would the
country want from the U.S. in return for its efforts?


A. The Ministry of Health is collaborating with the WHO on a
National Preparedness Plan. Prior to the WHO review, the
Ministry of Health also requested that the USG provide a
Centers for Disease Control (CDC) expert to review the plan
(refs B and C). The Ministry of Agriculture is working with
the FAO. Due to funding constraints, however, FAO
programming on this issue has been, and is likely to be,
extremely limited. According to the FAO country
representative, the FAO has allocated USD 400,000 to support
avian flu preparedness for 13 countries in the region. The
European Commission (EC) is supporting a food safety project
at the Ministry of Agriculture and the project coordinator
says that the EC might be able to reallocate funding to
combat AI as well.

At the Ministry of Agriculture's request, USAID sponsored
poultry expert Dr. Elizabeth Krushinskie to assess
preparedness within the agricultural sector. She traveled in
Armenia from November 12-19. The Ministry of Agriculture was
extremely cooperative and facilitated Krushinskie's visits to
local poultry farms, regional veterinary centers and two
national labs. The GOAM is likely to want both technical and
financial assistance from the USG to implement Krushinskie's
recommendations. The Ministry of Agriculture has requested
bilateral support for laboratory equipment from the U.S. and
Germany and appears to be open to working on both a bilateral
and multilateral basis.


Q. Does the country currently administer annual flu shots?
If not, might it consider doing so? What is the production
capability for human influenza vaccines in country?


A. The GOAM does not regularly administer annual human flu
shots and it is difficult and costly to obtain annual flu
vaccines on the local market. There is no local vaccine
production in Armenia and all vaccines are imported either
from Europe or Russia. In response to the avian flu threat,
the GOAM has ordered 55,000 doses of vaccine from the German
pharmaceutical company Solvay and expects delivery on
December 15. The GOAM plans to provide these vaccines to
people who work in poultry farms and to villages which are on
bird migration routes. According to representative from the
Ministry of Health Prof. Vladimir Davidyants, there is a
shortage of this year's flu vaccine on the international
market. Davidyants told us the GOAM would be willing to
purchase and distribute additional human flu vaccines if
necessary. He explained that there is a network of
polyclinics throughout the country and said that distribution
would be simple if vaccines were available. The Embassy
Health Unit conducted an informal survey assessing
availability of annual human flu vaccines in Yerevan and
discovered that the annual flu vaccine was not available in a
number of hospitals and when the vaccine was available it was
often prohibitively expensive costing more than an average
month's wages for a single shot.


Q. Does the country produce the 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?


A. Armenia does not produce and is not developing a poultry
vaccine. Foot-and-mouth vaccine is produced locally and
Armenia has equipment and technical experts who would likely
be capable of producing vaccine if needed. We have no
information about a liability shield for foreign
makers/donors of vaccines, but according to representatives
from UNICEF and USAID, there has never been a lawsuit against
an international aid agency concerning vaccines.


Q. 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?


A. The general public is highly aware of AI, but poorly
informed. Basic food safety standards are low and public
consumption of poultry has decreased by 25 percent or more
over the past few months. The GOAM has distributed 5,000
posters, based on information provided by USDA, detailing
ways to limit the spread of AI. The impact of this campaign,
however, remains unclear. Local television stations have
aired shows about AI on at least two occasions, but the
thrust of this programming and the public announcements made
by the Ministries of Health and Agriculture has been to
reassure the public that there is no avian flu in Armenia.
Candid and accurate television programming and a public
information campaign including newspapers and posters would
be two ways to educate the Armenia public about AI and
general food safety. It would also be helpful to teach
regional representatives from the Ministry of Agriculture how
to conduct local-level training for farmers on food safety,
AI and proper slaughter and dressing techniques.

--------------
SURVEILLANCE/DETECTION
--------------


Q. How capable are the medical and agriculture sector of
detecting a new strain of influenza among people or animal
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/U.S. reference laboratory?

A. Armenia has no capability to detect new strains of
influenza among either people or animals. The GOAM has an
ELIZA testing unit, but when USAID-sponsored poultry expert
Krushinskie visited the lab where it is located, the unit was
not attached to a computer, lacked appropriate lenses for
testing and the lab staff had not been properly trained on
how to use the equipment. The GOAM also has a Polymerize
Chain Reaction (PRC) unit, but Krushinskie said the unit was
old and could not be used to test for AI. The Veterinary
Animal Breeding Research Center, according to Krushinskie,
might be able to test for avian flu using agar gel
immunodiffusion (AGID) testing. According to Krushinskie the
scientists at the center are well trained and well versed
with AGID and virus isolation techniques. Furthermore, the
scientists at this lab are producing vaccine for
foot-and-mouth disease and have some equipment which could be
used for AI diagnostic testing. Armenia particularly needs
increased diagnostic capacity because exotic Newcastle
disease is endemic and the GOAM has no way to distinguish
bird deaths caused by exotic Newcastle from bird deaths
caused by avian flu. The GOAM does not currently send
samples abroad. Deputy Minister of Agriculture Rukhkian told
us the GOAM would be willing to send samples to the Vladimir
Laboratory south of Moscow or to the Weybridge Laboratory in
the U.K., but they are not currently in contact with either
lab and it is not clear that they have the capacity to safely
collect or transport samples.


Q. 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 U.S. or international organizations?


A. USAID-suported poultry expert Krushinskie recommends the
following immediate, stop-gap measures to improve
surveillance and detection capability. Armenia needs:
protective clothing for poultry farm inspectors; training and
supplies for sample collection and shipment, including cold
shipment, to international laboratories; field screening
rapid antigen detection kits; reagents, disposable supplies
and training to enhance in-country AGID testing capacity;
data base management supplies and training so that samples
are tracked and that inspectors can identify where positive
samples were collected; and funding to support a public
awareness campaign focused on food safety, ways to limit the
spread of avian flu and proper techniques for killing and
dressing wild birds and chickens in a backyard setting. In
addition to these immediate measures, Krushinskie is drafting
a report based on her November 12-19 rapid assessment
detailing how best to improve preparedness within the
agricultural sector. We expect to receive Krushinskie's
report by the end of November and will share it with
Washington as soon as it is available.

--------------
RESPONSE/CONTAINMENT
--------------


Q. 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?


A. The GOAM has sufficient Tamiflu at the Yerevan Infectious
Disease Hospital to treat twenty people. The Tamiflu was
donated by members of the Argentinean-Armenia Diaspora. It
is not clear if the GOAM plans to purchase additional stocks.
According to the Ministry of Health, there are no other
stockpiles of Tamiflu or antivirals in Armenia. Tamiflu is
not available on the local market.


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


A. The Ministry of Agriculture has no protective gear in
stock and agricultural inspectors do not wear protective
clothing when visiting area farms. Visiting poultry expert
Krushinskie donated 14 coveralls with boots to USDA for its
use when visiting farms. According to the Armenian Ministry
of Health, health care workers have standard protective masks
and gowns which they used during regular annual flu
outbreaks, but they do not have special protective gear for
any potential avian flu outbreak.

Q. 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?


A. The rapid response capacity is minimal. There are no
specific guidelines for culling and vaccinating birds,
disinfecting facilities or limiting animal movement. The
National Preparedness Plan does discuss culling as an option
but does not provide any detail about how it will be done and
does not make any provision for compensating affected
farmers. There is also a lack of basic supplies, such as
protective equipment, plastic bags and duct tape in rural
areas.


Q. 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?


A. The Ministry of Health has the authority to close public
facilities in the event of an outbreak. In 1992 the Ministry
of Health delayed the opening of public schools for two weeks
in order to limit the spread of annual human influenza and in
1998 the Department of Emergencies and police jointly
quarantined the village of Zartok in response to a cholera
outbreak. The National Preparedness Plan also includes
provisions for banning public events and disinfecting the
public transportation system.

--------------
COMMENT
--------------


4. (C) There is no effective AI surveillance system in
Armenia and the GOAM currently lacks the capacity to
accurately diagnose potential AI cases. Armenia needs
immediate assistance to increase surveillance and diagnostic
capacity and to provide flu vaccines for at-risk populations.
Should there be an outbreak, Armenia will likely need
international assistance to isolate the disease, cull flocks
and compensate farmers. Despite a serious lack of financial
resources, Armenia does have basic laboratory equipment and a
group of scientists with technical expertise who could be
trained to diagnose AI cases. The GOAM is also a willing
partner and is likely to cooperate with the international
community in responding to this threat.
EVANS