SECRETARY CHERTOFF'S MEETING WITH HONG KONG

C O N F I D E N T I A L SECTION 01 OF 03 HONG KONG 001469

SIPDIS

SIPDIS

STATE FOR EAP, EAP/CM
NSC FOR WILDER
HHS FOR STEIGER/ELVANDER

E.O. 12958: DECL: 04/08/2031
TAGS: PREL PGOV ECON KFLU AMED TBIO HK CH
SUBJECT: SECRETARY CHERTOFF'S MEETING WITH HONG KONG
SECRETARY FOR HEALTH, WELFARE AND FOOD DR. YORK CHOW

SIPDIS

Classified By: Consul General James B. Cunningham. Reasons: 1.4 (b,d).

Summary
--------------


1. (C) On March 31, U.S. Department of Homeland Security
Secretary Michael Chertoff met with Hong Kong Secretary for

SIPDIS
Health, Welfare and Food (SHWF) Dr. York Chow. They
discussed Hong Kong's preparations for a possible Avian
Influenza (AI) pandemic, AI-related border issues,
international cooperation on AI, and the need for governments
to remain transparent with AI information. Chow briefed
Secretary Chertoff on the Hong Kong Government's (HKG) past

SIPDIS
experience with AI as well as recent steps it has taken to
deal with the resurgence of AI. Chow did not think an AI
outbreak would originate in Hong Kong but was worried about
AI entering from other places, especially from mainland
China. On AI-related border issues, Chow said that
temperature screening was a "symbolic" measure to reassure
the public; he expected the first notice of a human AI case
in Hong Kong would come from a hospital. Hong Kong regularly
sends its public health officials to countries and
territories needing assistance with AI efforts and brought up
the need to provide more aid to areas that lacked basic
medical and scientific infrastructure. Chow agreed with
Secretary Chertoff on the need for governments to remain

SIPDIS
transparent about new AI developments and acknowledged that
mainland China needed a greater degree of transparency on
public health information. End summary.

Overview of AI Preparedness in Hong Kong
--------------


2. (C) On March 31, Homeland Security Secretary Michael
Chertoff met with Hong Kong's Secretary for Health, Welfare
and Food (SHWF),Dr. York Chow. Chow was accompanied by
Director of Health Dr. P.Y. Lam, Deputy Secretary for Food
and Environmental Hygiene Eddy Chan, and Assistant Secretary
for Health Howard Lee. The SHWF began his briefing by noting
that AI was first discovered in Hong Kong in 1997 at the
Queen Elizabeth Hospital while he was Chief Executive of the
hospital. He continued that AI is not a human virus yet but
resides mostly in reservoirs such as waterfowl, which is why
no duck or goose farms are permitted in Hong Kong, and no
imports of live ducks or geese are allowed. Chickens usually
have very visible outbreaks, but there is now evidence that
chickens can also carry the AI virus without showing symptoms
and thus act as reservoirs for the virus.


3. (C) There were two previous outbreaks in Hong Kong, in
1997 and in 2003. As a result, all chickens in Hong Kong,
whether locally raised or imported, are now vaccinated.
Until recently, 30,000 locally raised live chickens and
30,000 imported live chickens were put on sale in Hong Kong
every day, accounting for about 50% of the chicken consumed
in Hong Kong. As a result of this love for freshly
slaughtered chicken, Chow ruefully commented, the HKG's
proposal to set up a central slaughtering house was "driving
people to riot." The H2N2 poultry vaccine used by Hong Kong
poultry farms, and by farms in Guangdong Province exporting
to Hong Kong, seems to be effective. Although the Guangdong
Provincial Government has decreed that all chickens in the
province must be vaccinated, Chow doubted whether it was
possible to vaccinate all of the 1 billion estimated chickens
in Guangdong province. All of the chickens imported into
Hong Kong, however, should be fine.


4. (C) Secretary Chertoff said that compensation for major
chicken culls was an important issue and asked what Hong
Kong's policy was. Chow said that the HKG would compensate
poultry farmers $38 Hong Kong Dollars (approximately $5 USD)
per chicken but would only do so in the event of an actual AI
outbreak in poultry.

Preparations for Human AI Cases
--------------


HONG KONG 00001469 002 OF 003



5. (C) Chow said that a recent human AI case in Guangzhou had
led to a temporary ban on all live chicken imports from the
province. Backyard poultry farms have also been banned, so
the likelihood of an AI outbreak in Hong Kong poultry farms
is low. However, it would be impossible to prevent any human
AI cases from showing up in Hong Kong, especially when
dealing with people who have traveled to other countries.
The key, said Chow, is to catch the first case and lower the
chance of human-to-human transmission. After its experience
with SARS, Hong Kong has set up a network of 14 hospitals
that have 150 isolation rooms each, meaning that Hong Kong
has 2,100 isolation rooms ready to deal with a pandemic
disease outbreak at any time. As for other preparations,
Chow said that Hong Kong holds "visible" drills more than
once a year and is in the planning stages for a combined
drill with mainland China.


6. (C) Besides drills, Chow also said that the HKG was
conducting a wide ranging public information campaign on AI
emphasizing personal hygiene and teaching the difference
between AI and normal flu using radio, television, the
internet, signs, and even classroom outreaches. The outreach
efforts were timed to begin in October and November so that
Hong Kong residents would be ready for the flu season in Hong
Kong, which runs from January through March.

Antivirals and Vaccines
--------------


7. (C) Hong Kong has stocked enough Tamiflu to cover 20% of
its population. Chow warned, however, that the difficult
issue would be determining how the Tamiflu should be
distributed. Hong Kong will give first priority to actual AI
patients, second priority to anyone who has any contact with
an AI patient, and finally keep the rest of its Tamiflu in
reserve to give to people running essential services in the
event of a true pandemic situation. If Tamiflu is
distributed too broadly, there is a risk that the AI virus
will rapidly develop resistance to the antiviral medication.
Chow said that Hong Kong is also conducting research on
different antiviral medications but has not found anything as
effective as Tamiflu.


8. (C) Chow suspected that current vaccines being developed
around the world might not be effective against an actual AI
outbreak. HKG labs as well as labs in Hong Kong University
have received samples showing multiple genetic changes. The
H5N1 AI virus recently discovered in wild birds in Hong Kong,
for example, is considerably different from the H5N1 virus
isolated in 1997. Many of the human AI vaccines that have
been developed to this point are based upon old Vietnamese
samples and may not work against the currently circulating
forms of the H5N1 virus. In any case, he concluded, the time
gap that exists between the formulation of a vaccine and the
production of mass quantities of a vaccine is a major problem.


9. (C) Chow commented that Hong Kong is trying to attract
pharmaceutical companies to come to Hong Kong to do more
research, development, and production of innovative drugs.
Secretary Chertoff pointed out that liability protection

SIPDIS
would be a key issue, and Chow responded that although
insurance prices were high in Hong Kong he hoped the HKG
would be able to help pharmaceutical companies overcome
obstacles.

AI and Border Issues
--------------


10. (C) Secretary Chertoff asked Chow for his risk assessment
of the current AI situation in the region. Chow replied that
there are varying assessments on the actual threat posed by
AI. Some experts want more research funds and use scare
tactics to achieve their ends, whereas some experts are very
complacent. Hong Kong will prepare for a medium threat
scenario in which an AI outbreak occurs but is manageable.
If a true disaster strikes, said Chow, there won't be much
that the HKG can do in any case. The best thing to do is try

HONG KONG 00001469 003 OF 003


to prevent the pandemic from happening, an effort that may
largely depend upon carefully watching Hong Kong's borders.


11. (C) Chow pointed to Hong Kong's land border with mainland
China, through which over 300,000 people enter or exit Hong
Kong day, as the area of greatest risk. Although Hong Kong
has instituted temperature checking since the SARS epidemic,
against AI temperature screening is a largely symbolic
gesture. On the other hand, AI symptoms are so much more
severe than normal flu symptoms that AI patients will almost
certainly end up in one of Hong Kong's hospitals, where the
case will be detected and reported. Since it is not
realistic to expect that the first human AI case will be
caught at the border, Hong Kong must focus on tightening
border controls after the discovery of the first AI case
traveling into the territory.


12. (C) Director of Health Dr. P.Y. Lam said that when Hong
Kong first started temperature screening in 2003 during the
SARS epidemic, the main impetus behind the move was to screen
outgoing travelers to avoid "exporting" SARS cases out of
Hong Kong. Chow reassured the Secretary that even though
Hong Kong would strive not to "export" cases in the event of
an AI outbreak in Hong Kong, as long as the U.S. had set up
screening and quarantine facilities in U.S. ports of entry
the HKG would most likely allow U.S. citizens in Hong Kong to
return home.

International Cooperation on AI
--------------


13. (C) Secretary Chertoff said that since AI infected people
can be infectious for between 24-48 hours before showing
symptoms, the U.S. will put a great deal of emphasis on
screening travelers based on their travel history. Chow
agreed with the Secretary and said that the best way to react
to an actual AI outbreak that showed efficient human-to-human
transmission would be to encircle the affected area and
inject massive amounts of resources into the area. The
Secretary pointed out that this would only be effective if

SIPDIS
countries were both willing and able to identify such an
outbreak. Chow agreed and said that there is a great need to
assist countries that do not have any labs or any other means
to analyze an AI outbreak. In some countries hospitals will
be reluctant to report AI cases that show up in there
facilities out of fear that the report will drive away
"business" for several months -- a situation that would not
happen in Hong Kong with its publicly funded health care
system. Chow asserted that he constantly tries to send his
public health officials to other countries which need
technical assistance with AI issues.

The Need for Transparency
--------------


14. (C) Secretary Chertoff emphasized to the SHWF that
transparency and efficient communications were of the utmost
importance in preparing for AI. Chow agreed and noted that
the HKG had good communications with the Consulate, a point
that Consul General Cunningham concurred with. Chow
reassured the Secretary that he has told mainland Chinese
officials that the HKG will not "hide anything" that it hears
about. The HKG may wait "just a few hours" to let mainland
Chinese officials go public with its information first,
though. When asked by CG Cunningham whether the transparency
situation had improved, Chow said that the Central Government
was good but did not have complete control over local
situations. Shenzhen, Guangzhou, and Guangdong Province
overall are good, but other provinces are less dependable and
may be burdened by inferior capabilities. In any case, said
Chow, "we are telling mainland China that they need to be
more transparent."


15. (U) Secretary Chertoff's party has cleared this cable.
Cunningham