SPECIAL REPRESENTATIVE IN BANGKOK - THAILAND'S CONTAINMENT

UNCLAS SECTION 01 OF 08 BANGKOK 002856

SIPDIS

DEPARTMENT FOR G/AIAG/JLANGE AND RFENDRICK
DEPARTMENT FOR EAP/MLS
DEPARTMENT FOR OES/STC/MGOLDBERG AND PBATES
DEPARTMENT FOR OES/PCI/ASTEWART
DEPARTMENT FOR OES/IHA/DSINGER AND NCOMELLA
DEPARTMENT PASS TO USAID/ANE/CLEMENTS AND GH/CARROLL
DEPARTMENT PASS CDC FOR COGH SDOWELL AND NCID/IB AMOEN
DEPARTMENT PASS HHS/OGHA/WSTEIGER AND MSTLOUIS
USDA FOR OSEC AND APHIS
USDA FOR FAS/DLP/HWETZEL AND FAS/ICD/LAIDIG
USDA/FAS FOR FAA/YOUNG, MOLSTAD, ICD/PETTRIE, ROSENBLUM
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP FOR LEW STERN
PARIS FOR FAS/AG MINISTER COUNSELOR/OIE
ROME FOR FAO
KATHMANDU FOR REO KOCH

E.O. 12958: N/A
TAGS: TBIO KFLU SOCI PGOV EAID EAGR KPAO XE
SUBJECT: SPECIAL REPRESENTATIVE IN BANGKOK - THAILAND'S CONTAINMENT
OF AVIAN INFLUENZA


1. Summary: Thailand experienced 22 cases of human H5N1 avian
influenza in 2004 and 2005, 14 of which were fatal. It has also
reported more than 1000 separate outbreaks of avian influenza in
poultry, most of them occurring in 2004. Since November 2005,
however, Thailand has not detected a single human or animal H5N1
infection. During his visit to Bangkok on May 2, Special
Representative on Avian and Pandemic Influenza Lange heard Thai
officials credit high-level political commitment and a highly
integrated village network of health and surveillance volunteer
workers for the success of their efforts at containing avian
influenza. The Thai officials were quick to point out, however,
that they remain "vulnerable" and that their goal cannot be to
eradicate the virus, but to contain it. End summary.

High-Level Political Commitment
--------------

2. In separate meetings with Thai Ministry of Agriculture and
Cooperatives Department of Livestock Development (DLD) Deputy
Director General Dr. Chaweewan Leowijuk and with Ministry of Public
Health (MOPH) Vice-Minister Dr. Wachara Phanchet, Ambassador Lange
inquired what they attribute to the absence of reported avian
influenza outbreaks in Thailand over the past several months. The
Vice-Minister and Deputy Director General both placed "high-level
political commitment" at the top of the list. After the first
outbreaks occurred in early 2004, they said, Prime Minister Thaksin
put the fight against avian influenza at the top of the political
agenda. He created a horizontally integrated National Committee on
Avian Influenza Response with representatives from 14 ministries
chaired by the Deputy Prime Minister that continues to meet once a
week to plan, prepare, and promulgate strategies and courses of
action to contain avian influenza in the country. The Committee has
compiled a "Strategic Plan for Avian Influenza Control," as well as
a "Strategic Plan for Pandemic Preparedness," they said.

From National Committee to Village Health Volunteers
-------------- --------------

3. The MOPH Vice-Minister and LDL Deputy Director General also
emphasized that "vertical integration" from the national center to
the provinces, district, and community level is also essential to
successfully carry out the Committee's strategies and activities on
the ground in the countryside. More than 1000 MOPH Surveillance and
Rapid Response Teams have been trained in the past year and operate
at the district level. They make daily reports of their
surveillance findings. Separate DLD teams would be the first on the
scene to implement culling and other control measures if an outbreak
is detected.


4. In addition, Vice-Minister Wachara said that between 800,000 and
900,000 "village health volunteers" perform daily visits to local
households throughout Thailand. They not only look for sick or dead
birds and severe respiratory illness in humans, but distribute news
and information on avian influenza and other health issues. MOPH
Vice-Minister Wachara said that the system of village health workers
in Thailand has developed over a 30-year history, long before the
threat of avian influenza emerged. They have been involved over the
years in campaigns, he said, to correct cleft palates, to battle
dengue fever, and to fight HIV/AIDS, and will continue to be useful
even if the H5N1 virus one day disappears. He said the key to the
success of Thailand's village health volunteer program is that
volunteers are recruited from their own locality and not sent in
from the outside. He said it might be difficult for other countries
to duplicate such a system, and certainly not within a short
timeframe. He added that the village health volunteers gain
prestige and receive recognition (March 20 is Village Health Worker
Day in Thailand),but receive no remuneration for their services.


Culling, Sampling, and Testing
--------------

5. In response to Ambassador Lange's questions about poultry
culling as an avian influenza control measure and about sampling of
birds as possible carriers of the virus, Deputy Director General
Chaweewan said that during the first round of outbreaks in poultry
in early 2004, which she described as "very devastating," the DLD
culled all birds within a 5-kilometer radius of an affected farm or
household. During the next two rounds of poultry outbreaks
(September-October 2004 and September-November 2005) the DLD cull
only those birds in an infected flock. In addition, the DLD
disinfects affected areas, collects samples for testing from birds
within a one-kilometer radius and restricts the movement of birds
within a 10-kilometer radius of an affected farm or household. She
said that current policy is to compensate farmers 75 percent of the
market price per culled bird - sufficient, she said, to secure
farmers' cooperation in reporting outbreaks.


6. Deputy Director Chaweewan said the DLD performs "X-ray
surveillance operations" in February and July, in which surveillance
teams perform close inspections of poultry-raising farms and
households. During this past February the DLD collected 60,000
samples for testing in addition to more than 200 samples collected
in wet markets during Chinese New Year - all of them, she said,
tested negative for H5N1. In response to a question, Dr. Chaweewan
said the samples collected are swabs for PCR testing (which detects
viral nucleic acid, indicating the actual presence of the virus).
The DLD has not yet implemented sampling of blood specimens for
serological antibody-testing (testing for previous exposure to the
virus).


7. (Note: Antibody-testing would provide a picture of the general
prevalence of the H5N1 virus in various species of poultry and other
birds. However, it is much more expensive to perform and requires a
biosafety level 3 laboratory to conduct the micro-neutralization
test. In addition, when the DLD performs antigen-testing, tests are
performed on pooled material from batches of swabs. Although
separate testing on each individual sample would provide better
scientific data, it would be time- and cost-prohibitive. Post
wishes to point out that DLD is not performing scientific research,
however, but instead is screening samples as part of public health
surveillance. End note.)

Improved Infrastructure
--------------

8. Vice-Minister Wachara told Ambassador Lange that Thailand has
significantly improved its own human health infrastructure and
capacity since the emergence of avian influenza. At the beginning
of 2004, Thailand had only one laboratory capable of testing samples
for H5N1 virus; now the Thai National Institute of Health has 14
regional medical science centers, all of which are being trained in
H5 diagnosis. The Ministry has worked to better prepare hospitals
in infection control. Even the smallest district hospital now has at
least one isolation room, he asserted. He also said that risk
communication, public awareness and education about avian influenza
have been a priority.


9. The MOPH Vice-Minister acknowledged shortfalls in pandemic
preparedness. Thailand has stockpiled 1.5 million capsules of
Tamiflu, enough for 150,000 treatment courses. Vice-Minister
Wachara said this would be enough only to contain a single
human-to-human outbreak and only if it was detected early enough.
He said Thailand would like to begin local production of Tamiflu,
but may not have the capacity or resources to do so. He added that
MOPH procured API (active pharmaceutical ingredient) from India and
is testing it now to see if they can buy in bulk and then package in
Thailand. Likewise, Thailand wants to develop a human H5N1 vaccine,
but realizes that it would not be able to do so on its own. He said
he is proposing to other countries in the region the idea of
regional collaboration on producing Tamiflu for a regional
stockpile, as well as regional collaboration on human vaccine
development.

Regional Activities
--------------

10. Both Vice-Minister Wachara and Deputy Director General
Chaweewan described activities they are undertaking to combat avian
influenza from a regional perspective. Thailand's Northeast
Veterinary Research and Diagnostic Centre and National Institute of
Animal Health have accepted and performed tests on poultry samples
from Laos and Burma. Deputy Director Chaweewan said the DLD sent
veterinary laboratory experts to Vietnam in 2004 and on several
occasions to Cambodia carry out training and help establish lab
procedures for avian influenza testing. The DLD also recently
donated laboratory reagents and supplies and sent an animal
virologist to Burma for a 2-week TDY to conduct laboratory
training.


11. Vice-Minister Wachara listed several training activities the
MOPH has conducted, many of them in conjunction with the U.S. CDC
and WHO, at which invitees from other countries in the region
participated, including training in H5N1-related epidemiology at the
Field Epidemiology Training Center, laboratory diagnostics,
surveillance and control measures, and risk communication. He
expressed special appreciation of the Thailand MOPH-U.S. CDC
Collaboration (TUC),and particularly for TUC's International
Emerging Infectious Disease Program, in developing Thailand's
capacity to contain avian influenza and become a regional center of
H5N1 expertise. He noted that Thailand has a self-interest in
building the health capacity of its neighbors. "As long as avian
influenza is present in countries around us," he said, "we feel
vulnerable."


12. Comment: Thailand has made great progress in developing
procedures and strategies to deal with the threat of avian
influenza. Not all of Thailand's methods, however, can be adapted
to other countries. Nor is there any guarantee, for all of
Thailand's preparedness, that it can avoid future H5N1 poultry
outbreaks or human infections. But there are lessons that can be
learned from Thailand's experience. At the end of his meeting with
Ambassador Lange, Deputy Director General Chaweewan summed it up
best by declaring, "We cannot control avian influenza, but we can
contain it."
BOYCE