Visit of HHS Secretary to Guangzhou Highlights Infectious

UNCLAS SECTION 01 OF 04 GUANGZHOU 032406

SIPDIS

PACOM FOR FPA
STATE FOR EAP/CM, EB, AND OES
HHS FOR MCKEOWN, STEIGER, AND BHAT, OGHA
CDC FOR BLOUNT, COGH
BANGKOK FOR ESTH AND CDC

SENSITIVE
SIPDIS

E.O. 12958: N/A
TAGS: TBIO SOCI ECON ELAB PGOV SCUL SENV CH
SUBJECT: Visit of HHS Secretary to Guangzhou Highlights Infectious
Diseases and Preparedness

REF: A) Guangzhou 17685; B) Guangzhou 6174


1. (SBU) SUMMARY. U.S. Health and Human Services (HHS) Secretary
Michael O. Leavitt and his delegation met with doctors, hospital and
orphanage administrators, students, and businesspersons to discuss
infectious diseases and health-care issues during a December 11-12,
2006 visit to Guangzhou. Highlights of his visit included a
conversation with an unusually lively and forthright group of
students at Zhongshan Medical School; a meeting with a medical
worker at a hospital who had contracted and recovered from Severe
Acute Respiratory Syndrome (SARS); a review of cooperative projects
between HHS, the World Health Organization (WHO) and Guangzhou City
authorities; and a walk through a wet market to observe health
measures taken by Guangdong municipal authorities to prevent an
outbreak of avian influenza. Local media provided extensive
coverage of the visit; local and Provincial Chinese officials with
whom the Secretary met were overwhelmingly positive in their
feedback. END SUMMARY.


2. (U) During a December 11-12, 2006, visit to Guangzhou, HHS
Secretary Michael O. Leavitt visited the Guangzhou Children's

SIPDIS
Welfare Institute, the Number 3 Teaching Hospital, the Number 8
People's Hospital, the Guangdong Provincial Center for disease
Control (GDCDC),a city "wet market" (live-animal market),and the
Guangdong Vice Governor in charge of health issues. The Secretary's
delegation of 15 persons included HHS Chief of Staff Richard
McKeown; HHS Assistant Secretary for Public Affairs Suzy DeFrancis;
HHS Assistant Secretary for Health ADM John Agwunobi; and HHS
Special Assistant for International Affairs William Steiger.
Chinese Vice Minister of Health Chen Ziaohong and Dr. Ren Minghui,
Deputy Director of the Department of International Cooperation in
the Chinese Ministry of Health, also accompanied the Secretary.

AmCham Breakfast: Preparing for an Epidemic
--------------


3. (SBU) During a December 11 breakfast sponsored by the American
Chamber of Commerce (AmCham) of South China, Dr. Zhong Nanshan,
Chair of the China Medical Association and President of the
Guangzhou Respiratory Diseases Research Institute, presented an
overview of China's experience to date with the H5N1 strain of
highly pathogenic avian influenza. According to Dr. Zhong, China
has had 21 human cases of H5N1, 14 of which were fatal. The
majority of victims contracted the disease through contact with sick
or dead poultry, including at open-air markets. Eight cases,
however, showed no sign of such contact, and transmission could have
occurred through contact with wild birds.


4. (SBU) Dr. Zhong, known as the "SARS hero" because of his
leadership during the SARS outbreak in 2002 and 2003, highlighted
the importance of transparency and rapid response in treating AI
cases. In a June 2006 case in Shenzhen, doctors cured an H5N1
victim who was succumbing to multiple organ failure by performing a
tracheotomy and administering convalescent serum collected from
another patient who had contracted the H5N1 virus and survived.
[Note: ADM Agwunobi and the HHS medical professionals regard this
technique as particularly risky and unproven. End Note]. Dr. Zhong
expressed confidence in a new human H5N1 vaccine - currently in the
experimental phase - that he and Chinese colleagues are developing.
The event also featured Dr. Tang Xiaoping, President and
Chief-Physician of Guangzhou Number 8 People's Hospital, who said
the nature of infectious diseases makes containment impossible in
today's global world. Cooperation between countries, especially the
United States and China, is essential to prevent the next pandemic.


More Than an Orphanage
--------------


5. (SBU) During a visit to the Guangzhou Children's Welfare
Institute, which currently houses 700 children and supervises an
additional 600 in family-based foster care, the Secretary had an
opportunity to observe and interact with children between the ages
of one and three. The Institute employs 380 medical personnel,
including surgeons, who are especially skilled in care for those who
come to the orphanage with disabilities. The facility also provides
education - from pre-school to occupational training - so the
children can become independent adults. The facility assists adult
children in finding work, though those who are disabled can stay to
live on-site.


GUANGZHOU 00032406 002 OF 004



6. (SBU) Zhang Mengchuan, director of the orphanage, said that 80
percent of the 40 children adopted by international families each
year are from the United States. Zhang praised the coordination of
the U.S. and Chinese Governments in processing adoptions. [Note:
Consulate Guangzhou operates the only immigrant visa unit among the
China posts, and will process approximately 7,000 adoptions in 2006.
End Note] He explained the China Center for Adoption Affairs (CCAA)
in Beijing makes matches based on the prospective adoptive parents'
requests for age and special needs, as well as according to the
availability of children for adoption throughout China.

An Open Discussion with Medical Students
--------------


7. (U) On the afternoon of December 11, 2006, the Secretary
participated in a lively, forthright give-and-take conducted in
English, marked with good-natured asides, with students from the
Number 3 Teaching Hospital of Zhong Shan University. During the
discussion, the Secretary said he was looking forward to discussing
with his Chinese counterparts strategies to combat infectious
diseases, deliver health care to rural patients, promote scientific
cooperation, and finance medical care on a sustainable basis.
Students asked questions about pandemic preparedness, protections
for rights of Americans with disabilities, the role of Traditional
Chinese Medicine (TCM),health-insurance and the challenge of the
uninsured in the United States, and the Secretary's background and
own role in health policy. The Secretary emphasized HHS's role in
promoting international cooperation on controlling infectious
diseases through bilateral cooperation with China and multilateral
efforts under the auspices of the WHO. [Comment: The questions from
the students and subsequent discussions were remarkably lively and
open. Students had done their homework on the Secretary's
background and current policies at HHS and spoke good English with
confidence. One girl, who said polio had crippled her as a child,
wanted more information on the HHS Office of Disabilities and
whether the U.S. Government had plans to help with the
rehabilitation of the disabled in developing countries. A young man
told the Secretary he "had been praying for him and praying that
[he] would have a chance to ask a question." Other students did not
shy away from asking the Secretary about access to medical care by
the poor in the United States. End Comment.]

Guangzhou No. 8 Hospital: Lessons from SARS
--------------


8. (SBU) During a tour of the Guangzhou Number 8 People's Hospital
infectious-disease ward, Director Tang Xiaoping discussed the
hospital's experiences during the SARS crisis. He pointed out
improvements in the hospital since the outbreak, including
ventilation fans in the halls that blow the air out of the rooms to
the outside to decrease the likelihood of the infection's spreading
within the facility. During the SARS crisis, Tang said the
Provincial Government held regular briefings and also published
daily updates in the newspaper. He described how the hospital was
able to maintain sufficient staffing levels during the crisis, for
example, through the use of monetary rewards. He emphasized that
high morale was the key to ensuring medical workers performed their
responsibilities under very stressful conditions. The Secretary
also had an opportunity for a memorable exchange with one medical
worker who contracted and recovered from the SARS virus. After the
tour of the hospital, Secretary Leavitt and his delegation had a
roundtable exchange with Dr. Tang, Vice Minister Chen and hospital
staff. In a rare display of emotion, Vice Minister Chen teared up
during a discussion of the courage of Chinese health-care workers
during the SARS outbreak; he said his own daughter was a nurse who
was the age of many of the nurses who had battled and contracted the
disease in Guangzhou.


9. (SBU) The Number 8 Hospital's Red Ribbon AIDS research center has
40 beds, and is partially staffed by volunteers. Tang noted China
has encouraged more HIV/AIDS testing recently; this naturally has
led to a large increase in the reporting of new cases.
Nevertheless, he said, the fatality rate among new HIV/AIDS patients
is decreasing because of the use of anti-retroviral drugs.
Guangdong has three levels of hospitals for infectious diseases, as
well as teams of experts who can travel to other hospitals to assist
staff.

Visit to a Wet Market
--------------


GUANGZHOU 00032406 003 OF 004



10. (SBU) On December 12, 2006, the Secretary visited Dajiangyuan
Wet Market. The indoor market, a favorite of Guangzhou locals, has
stalls that sell fresh produce as well as live fish and chickens.
The poultry workers were suitably dressed in white smocks, wore
plastic gloves and covered their mouths with masks (though in most
wet markets, workers do not use gloves). Signs posted on the walls
of the market warned of the dangers of avian flu, and described how
to identify sick poultry, cautioned against handling dead birds, and
told how to report suspicious bird deaths to authorities. The signs
cautioned against keeping poultry and pigs in the same area, warned
against letting poultry roam free, and ordered that all poultry be
vaccinated against avian flu. The delegation also noticed signs
hung in a nearby neighborhood that displayed prevention messages
about the dangers of HIV/AIDS sexually transmitted diseases.

Meeting with Guangdong Vice Governor
--------------


11. (SBU) Following his visit to the market, the Secretary met with
Guangdong Vice Governor Lei Yulan, who is responsible for
public-health issues in the Province. In her remarks, Lei noted
that Guangdong's dramatic rise in living standards has mirrored an
expansion of social programs, including those that cover public
health, and discussed initiatives that assist rural populations,
fund research and development (R&D),build community clinics in
urban areas, and train world-class physicians. Madame Lei said that
since the SARS outbreak, the Provincial Government had invested over
RMB 10 billion (USD 1.25 billion) to enhance its capabilities to
deal with public-health emergencies such as highly pathogenic avian
influenza and dengue fever. Lei said Guangdong has increased its
R&D capabilities through cooperation with U.S. entities:
-- A joint USD 300,000 HIV/AIDS project with HHS to monitor and
assist in the early prevention of HIV, part of the Global AIDS
Program activities in China under the President's Emergency Plan for
AIDS Relief;
-- A separate joint project between Guangdong Province and the U.S.
National Cancer Institute, part of the National Institutes of Health
at HHS and the University of California Berkeley, with an investment
of USD 110,000; and
-- A joint project between Guangzhou's Zhong Shan University and the
University of Pennsylvania on the development of vaccines against
emerging epidemics; such as novel strains of influenza and dengue
fever.

Guangdong CDC: SARS, Influenza, and HIV/AIDS
-------------- --------------


12. (SBU) During the Secretary's meeting with the Guangdong Center
for Disease Control (GDCDC),Dr. Lin Jinyan, Deputy Director of
GDCDC, discussed Guangdong's experience in dealing with SARS, the
H5N1 strain of avian influenza, and HIV/AIDS. Guangzhou and other
Pearl River Delta cities accounted for 97 percent of all SARS cases
in Guangdong. Lin said Provincial officials contained SARS through
a combination of early detection, rapid reporting, isolation of sick
patients, along with a policy of local quarantine and rapid
treatment. When asked how GDCDC would respond differently if a SARS
outbreak were to occur again, Lin said GDCDC would improve case
management, public education, the identification of sources of
infection, and the prevention of infection among hospital staff.
[Comment: Dr. Lin and Provincial officials did not acknowledge that
obfuscation by Provincial and national authorities allowed the SARS
virus to spread to Guangdong around the world. End Comment.]


13. (SBU) Guangdong has seen two human cases of H5N1 avian flu this
year. The first was a salesman from a food company in Guangzhou who
died on March 2, 2006 (ref B),the second was a truck driver in
Shenzhen who died on August 2, 2006 (ref A). The suspected source
of the first case was a wet market, but the source of the second
case is still unknown. Lin described control and prevention
measures against avian influenza in animals, such as surveillance,
case quarantine and treatment, the timely exclusion of non-cases,
and epidemiologic investigations. Ke Changwen, Director of GDCDC's
Institute of Microbiology, said gene-sequencing tests have shown
there have been no significant developments in the disease's
human-to-human transmission capability. Ke added the GDCDC is
currently conducting a project with the WHO on animal-to-human
transmission.


14. (SBU) According to official statistics, Guangdong province has
17,855 reported HIV/AIDS cases, the fifth-highest number in China.
The five largest cities of the Pearl River Delta account for over 75

GUANGZHOU 00032406 004 OF 004


percent of these cases. To combat HIV/AIDS, GDCDC continues to
promote awareness through public campaigns, and provides
comprehensive treatment, intervention, and care to prevent secondary
infections. GDCDC also sponsors intervention programs, such as
syringe exchanges and condom promotion.


15. (SBU) Dr. Yang Xingfen said the WHO and the Chinese Ministry of
Health launched a training center for the surveillance and detection
of emerging diseases in Guangdong in June 2006. The goal is to
improve surveillance capacity, improve animal-husbandry techniques,
research animal-to-human interaction in the transmission of highly
pathogenic influenza, establish a training base for neighboring
Southeast Asian countries, and provide greater information sharing
with the WHO Secretariat and its partners.


16. (SBU) When asked about the role of GDCDC in responding to an
outbreak emergency, Dr. Lin Jinyan said that after receiving local
case reports the GDCDC arranges "initial diagnosis-and-exclusion"
activities. The local CDC will go to the site for sampling, and
begin an epidemiological study. GDCDC decides whether to include
national or more advanced experts, who will coordinate control
measures. Lin noted that GDCDC announced the two human cases of
H5N1 influenza to the media before testing was completed, the first
time this had been done and a sign of improved transparency.

Press Coverage: Extensive and Positive
--------------


17. (SBU) Local media outlets were present at every part of the
Secretary's visit (except for the AmCham event),and coverage was

SIPDIS
overwhelmingly positive. Newspapers made special mention of the
Secretary's session with medical students, and his visit to the wet

SIPDIS
market. In addition, the China Daily, which has national
distribution, conducted an interview with the Secretary during the
visit. The article quoted the Secretary on health-care issues and
U.S.-China collaboration, and mentioned the Secretary's trip in
Chengdu on December 9-10, 2006.


18. (U) The HHS delegation has cleared this cable.

GOLDBERG