AVIAN INFLUENZA IN AZERBAIJAN: NEED FOR MORE

C O N F I D E N T I A L SECTION 01 OF 02 BAKU 000377 SIPDIS SIPDIS DEPT FOR EUR/CARC AND EUR/PGI, ALSO OES DEPT PLEASE PASS USAID FOR GLOBAL HEALTH MURRAY TROSTLE ANKARA FOR AGRICULTURAL COUNSELOR ROME FOR FAO REPRESENTATIVE GENEVA FOR HEALTH ATTACHE TBILISI FOR USAID E.O. 12958: DECL: 03/07/2016 TAGS: ECON EAID PGOV PREL EAGR KFLU CASC AJ SUBJECT: AVIAN INFLUENZA IN AZERBAIJAN: NEED FOR MORE INTERNATIONAL EXPERTS ON THE GROUND REF: A. BAKU 356 ¶B. BAKU 329 AND PREVIOUS Classified By: AMBASSADOR RENO L. HARNISH III; REASONS 1.4 (B,D) ¶1. (C) SUMMARY AND ACTION REQUEST: Despite significant and prolonged intervention by Post, the GOAJ continues to react poorly to the threat of avian influenza. The GOAJ's extremely poor veterinary response appears to have largely destroyed the commercial poultry industry, in addition to an unknown number of domestic birds. Post is also aware of as many as 14 suspicious human illness cases within the past week, including three deaths, but lacks information necessary for a diagnosis. Post believes that the visits of several assessment teams, including a very effective USG team, over the past two months have left a clear picture of the GOAJ's policy and laboratory capabilities. However, based on our experience and the present situation, Post has little confidence in the GOAJ's ability to engage in the basic, field-level operations needed to manage this crisis. What has been successful to date has been direct involvement by visiting experts and U.S. Embassy staff to encourage positive action, and to gain knowledge at the source. Post requests Department's immediate engagement with FAO, WHO, and other international donors aimed in the first instance at getting WHO and FAO to establish a robust and permanent presence on the ground, as well as supporting the fielding of multiple teams of experts to Azerbaijan for field-level work. We also welcome, and strongly encourage, continued technical-level visits by American experts on both the veterinary and human health aspects of this issue. In our view, only field teams and hands-on support and guidance will provide the information needed to ensure an appropriate response. END SUMMARY AND ACTION REQUEST. Transparency Appalling -------------- ¶2. (C) Since October 2005, Post has repeatedly engaged the GOAJ, at every level from laboratory technicians to President Aliyev, seeking rapid action on avian influenza. Instead, we have found the going very slow. Only through direct and forceful intervention by Post were we able to send avian samples to the internationally recognized laboratory at Weybridge, UK, on February 6. When the GOAJ would not contact the lab directly, Post was forced to act as intermediary, delivering word to the GOAJ that H5N1 was confirmed in Azerbaijan. Rather than act prudentially, as many other countries have done, the GOAJ has done practically nothing to contain the spread of the virus. In fact, the GOAJ's ineptitude has almost certainly allowed the virus to spread to many regions in the country and into the commercial poultry industry. Even now, the vet authorities often misinform the public. ¶3. (C) The past week has seen human health issues move to the fore. As we have pressed our case at increasingly senior levels of government, all of whom have assured us the GOAJ is taking active measures, local press reported suspicious human illnesses, raising the possibility of human H5N1 infection. In total, Post has now counted as many as 14 separate cases of suspicious respiratory illness in which patients have been hospitalized. All the cases are from the same village in rural Azerbaijan; all are relatives. Three of these 14 patients have died. As reported to Embassy medical personnel, who examined two of the patients at the hospital March 6, symptoms in all cases are at least partially consistent with avian influenza. Only analysis of samples by an internationally-recognized reference laboratory, such as at Mill Hill in the UK, will give a clear answer. Rather than a focused message to the public, the press is now awash in contradictory reports, nearly all of which cite Health Ministry officials. A USAID prepared public service announcement, which was distributed to Azerbaijani television stations, is the most widely disseminated accurate public information on AI currently available. We have also distributed thousands of pamphlets in Azerbaijani about AI through the Ministry of Education, and directly to farmers BAKU 00000377 002 OF 002 and other groups. GOAJ Field Efforts Lacking -------------- ¶4. (C) In both the veterinary and human health areas, the GOAJ's attempts at surveillance and monitoring have been sorely lacking. For example, the GOAJ still lacks any plans for active surveillance of poultry. Since the February 6 sample shipment facilitated by the Embassy, the Vet Service has sent samples to an OIE lab only once. This latest batch of 12 samples arrived in the UK on March 7. In the interim, well over 100,000 poultry died in various commercial operations. In human health, while the GOAJ has taken samples from the patients referenced above, it has yet to send samples for WHO lab testing. Instead, the GOAJ continues to trust in equipment and testing that the international community -- including USG experts -- has flagged repeatedly to the GOAJ as deficient for identifying H5N1. ¶5. (C) Through the efforts of Post's medical team, Post has more information on the suspect human cases than virtually any other group in Azerbaijan. Yet, based on the information we have, we cannot ascertain whether the suspect human cases are H5N1 avian influenza. As of March 9, the GOAJ has sent no samples to a WHO reference lab. Sadly, Post is once again in the position of refereeing the WHO's unprepared and ineffectual attempts to send samples. Given the GOAJ's lack of ability to carry out rigorous veterinary and epidemiological investigation in the field, only multiple teams of experts in both of these areas can give the international community the information we need to meet this challenge head-on. ACTION REQUEST: More International Experts on the Ground -------------- -------------- ¶6. (C) We expected that once avian influenza was identified in Azerbaijan, WHO and FAO would establish a significant presence on the ground and lead the international response. This has not happened. It is telling that even with hundreds of thousands of poultry dying and humans taking ill under suspicious circumstances, FAO has no permanent presence (expert or otherwise). WHO has no permanent country representative in Azerbaijan. We would appreciate Department's continued pressure on WHO and FAO to field robust permanent teams to Azerbaijan that can both act at the technical level as well as engage directly with the GOAJ at the senior level. ¶7. (C) Separately, what is needed now are international teams of veterinary and health professionals, from international organizations, the donor community, and the USG, to deploy to the regions operationally. These teams should assist the GOAJ in direct operational ways, such as sample collection and shipment, culling, or epidemiological research. We would welcome and strongly encourage continued technical-level visits by American experts on both the veterinary and human health aspects of the issue, and appreciate the support received to date. A strong international expert presence on the ground is the best contribution we can make to improving GOAJ management of the avian influenza problem here. HARNISH