INTERAGENCY DELEGATION ENGAGES WITH EGYPTIAN

UNCLAS SECTION 01 OF 04 CAIRO 000620 SIPDIS SENSITIVE SIPDIS STATE FOR NEA/ELA, AND G/AIAG FOR LANGE AND WINN AMMAN FOR WHITTLESEY USAID FOR HILL, CLEMENTS, AND CARROLL HHS FOR BELL DHS FOR MCGINN USDA FOR ANNELLI DOD FOR MISHRIK E.O. 12958: N/A TAGS: KFLU KSTH TBIO ECON PREL WHO EG SUBJECT: INTERAGENCY DELEGATION ENGAGES WITH EGYPTIAN OFFICIALS ON AVIAN AND PANDEMIC INFLUENZA REF: STATE 22291 Sensitive but unclassified. Not for internet distribution. ¶1. (SBU) Summary. Special Representative on Avian and Pandemic Influenza John Lange and an interagency delegation of USG officials from DOS, USAID, HHS, USDA, DHS and DOD met with senior Egyptian government officials, toured laboratory facilities, and visited poultry farms from February 19-21. While Egypt is struggling to combat outbreaks of H5N1 in its backyard sector, a wide-ranging vaccination campaign in the commercial sector has controlled outbreaks on medium and large farms. The interagency team was impressed with the overall high level of transparency and organization GOE officials have shown in tackling this disease. The Embassy, in close consultation with Washington agencies, is working to identify specific areas for increased assistance to the GOE on both human and animal health activities. End Summary. ¶2. (U) During the December 2006 donors, conference in Bamako, Mali, participants recognized Egypt as a priority country of concern in 2007, in addition to Indonesia and Nigeria. The purpose of the interagency team,s visit was to assess Egypt's AI and pandemic flu preparedness, and to pinpoint areas for future assistance. Members of the Interagency Delegation included: Ambassador John Lange, DOS; Kent Hill, USAID Assistant Administrator for Global Health; Dr. David Bell, HHS; Dr. Joseph Annelli, USDA-APHIS; David Winn, DOS; Andrew Clements, USAID; Dr. Tom McGinn, DHS; Captain Nada Mishrik, DOD; Dennis Carroll, USAID. ¶3. (SBU) Since health officials first confirmed the H5N1 highly pathogenic virus in Egypt in February 2006, GOE officials confirmed 23 human cases, 13 resulting in fatalities, making it the most severely affected country outside of Asia. On February 27, Ministry of Health and Population (MOHP) officials confirmed the most recent case, a four-year-old girl in Daqahliya, 90 km north to Cairo. Two human cases in December 2006 showed a moderate resistance to the antiviral drug Tamiflu. MOHP plays a lead role in steering the Supreme Council on Combating Avian Influenza, a ;high-level inter-ministerial committee currently meeting on a weekly basis to discuss AI reaction and preparedness. While there is some confusion among donors and even GOE officials on the status of a cohesive, national strategy on AI and pandemic flu, it is clear that officials at the highest levels of government are making a serious effort to coordinate activities (ref A). -------------- MOHP LEADS COMMITMENT TO TRANSPARENCY -------------- ¶4. (SBU) On February 21, Minister of Health and Population (MOHP) Hatem El Gabaly met with the interagency team and Ambassador Ricciardone, outlining the ministry's program of active surveillance and risk communications. Undersecretary Dr. Nasr El Sayed presented specific details about their communication program and a detailed analysis of their surveillance techniques. According to the minister, maintaining a high level of transparency is an essential element of both their surveillance and communication strategy, though they continue to fight the public perception that they conceal true statistics. During the initial outbreak in 2006, MOHP established a 24-hour call center, and has received over 450,000 inquiries during the past year. MOHP also launched a communication plan, including television, radio, and press releases designed to "build and maintain public trust," a largely USAID-funded campaign. ¶5. (SBU) In addition to an organized communication plan, CAIRO 00000620 002 OF 004 MOHP officials have a system for case surveillance and specimen verification, accomplished partly via a partnership with NAMRU-3, a WHO collaborative center in the region. The MOHP Central Public Health Lab, which screens about 50 human samples per day, sends all positive cases to NAMRU-3 for confirmation and sequencing before passing on results to WHO and CDC. Dr. Hassan Al-Bushra from the WHO told the interagency team on February 19 that Egypt is "by far the most advanced country in the region" in terms of human surveillance and verification. Virus sequencing results generally appear in an on-line data base only three to four weeks after confirmation, fast even by international standards. ¶6. (SBU) Staff of the Abbassiya Chest Hospital, where 12 of the 23 human cases received treatment, also demonstrated transparency and organization during a February 20 visit. Hospital director Dr. Mahmoud Abdel Mageed presented an outline of several human cases, displaying x-rays and a detailed timetable summarizing the patients, conditions. Since October, 7, 2007, nine of the confirmed human cases succumbed to H5N1, and hospital officials openly discussed their concern for the increased speed in multi-systemic organ failure shown in recent patients. Though hospital staff is equipped to handle the current trickle of patients, it has limited isolation capacity and, like nearly all hospitals in the world, would be overwhelmed in the event of a pandemic outbreak. -------------- MOA STRUGGLES TO VACCINATE BACKYARD SECTOR -------------- ¶7. (SBU) While vaccination of the 420 million birds in the commercial sector has reached nearly 100%, the Ministry of Agriculture (MOA) continues to struggle with implementing a free vaccination campaign in the backyard poultry sector. GOE officials estimate that 5 million families raise backyard poultry, but only 30 million of the 200 million backyard birds have been vaccinated. The high mobility of people among Egypt's 5000 villages, most of which hug the Nile and form "one big village," is another challenge to disease containment. Citing the fact that 21 of the 23 human cases come from the backyard sector, Minister of Agriculture Amin Abaza told the team in a candid discussion on February 20 that, "the number one reason for vaccinating birds is to protect human health." ¶8. (SBU) Dr. Mona M. Aly, director of MOA,s Central Laboratory for Veterinary Quality and Control of Poultry Production, responsible for AI screening and surveillance in poultry, cited the need for increased lab capacity, during the February 20 visit. "We need at least two satellite labs to handle the sample screening." The lab, which screens samples from the commercial and backyard sector as well as migratory birds, has identified almost 300 positive sites in the backyard sector, and nearly 900 in the commercial sector since February 2006. She also stressed the need for enhanced technical training for laboratory assistants and MOA vets, who conduct sample collection and vaccinate all backyard birds. (Note: On commercial farms, workers vaccinate birds under the direction of MOA veterinarians. End note.). The GOE purchases most flu vaccinations from several companies including one in China, but on February 22, the Prime Minister announced a new LE 120 million allocation to produce and purchase vaccines locally. ¶9. (SBU) In addition to facing significant obstacles in mass vaccination in the backyard sector, the MOA is also hindered by lack of cooperation between MOA labs and the General Organization for Veterinary Services (GOVS). In CAIRO 00000620 003 OF 004 meetings with FAO and WHO on February 19 and 20, representatives from both organizations agreed that the Egyptian veterinary service needs to be bolstered and intra-ministerial cooperation enhanced. FAO is making attempts to rectify disparate GOVS and MOA plans for AI eradication. The MOA is proposing a reorganization of the GOVS to provide better support for the animal health sector. ¶10. (SBU) A February 21 visit to two commercial poultry farms and a hatchery in Gharbiya governorate, one of the most severely affected governorates, interagency team members saw evidence of the success of the wide-scale vaccination plan. Biosafety and biosecurity practices on the farms were limited, and several recent outbreaks in commercial farms illustrate the need for continued vigilance. Indefinite vaccination for the commercial sector, though, is not a major obstacle. Farm owner Ehab Ramone noted that although he suffered significant financial loss during the initial outbreaks, he has recovered his profits and the vaccine cost, about 1 LE/dose, was negligible. "The most pressing costs for us are the high cost of feed, imported from America," he noted. -------------- GOE OFFICIALS CONSIDER COMPENSATION REFORM -------------- ¶11. (SBU) The GOE is looking to revise its self-admittedly botched compensation scheme for backyard poultry farmers. Last year, the GOE spent over 120 million LE (USD 21 million) to compensate mostly commercial farmers. MOA and MFA officials cited wide abuse by unscrupulous farmers. When demand for poultry fell and prices plummeted, some farmers were reported to have purposefully infected their birds to get compensation from the government. A revised compensation plan, where the government would replace culled infected birds with vaccinated chicks, is under consideration. -------------- INTERNATIONAL ORGANIZATIONS OFFER SUPPORT -------------- ¶12. (SBU) WHO representatives stressed in a February 19 meeting that AI in humans is a "disease of behavior" and that because the deeply rooted cultural practice of living in close proximity to poultry will continue, an improved community awareness and communication campaign is the only solution to stopping the spread of H5N1 to humans. WHO deputy regional director Mohamed Abdi Jama warned of the sensitivities in developing nations surrounding expeditious access to vaccines in the event of a pandemic flu. In a February 20 meeting with FAO representatives from both Cairo and Rome, they presented a proposal to bolster the MOA's vaccination capabilities and to mend the division between the GOVS and the MOA's lab service. In a February 22 meeting with the Minister of Agriculture, he stated his support for their proposal. -------------- MINISTER OUTLINES SPECIFIC FUNDING PRIORITIES -------------- ¶13. (SBU) Stressing the need to stem the spread of H5N1 in Africa, as well as the cost-effectiveness of fighting it here instead of the Western Hemisphere, Minister El Gabaly outlined specific funding priorities for 2007: Animal Health: Total of USD 143 million Surveillance (USD 28.81 million) Vaccination and Vaccination Production (USD 46.82 million) CAIRO 00000620 004 OF 004 Compensation (USD 36.38 million) Poultry Farm Census (USD 15,000) Capacity Building for Veterinary Services (USD 18 million) Capacity Building for the Central Laboratory (USD 3 million) Awareness Campaigns (USD 8.8 million) Quarantine Measures (USD 1.55 million) Human Health: Total of USD 205 million Anti-Viral Drugs (USD 20.9 million) Personal Protective Equipment (USD 8.7 million) N95 Masks (USD 139.1 million) Disinfectants (USD 3.48 million) Ventilators for ICUs (USD 8.7 million) Strengthen Emergency Care Services (USD 8.7 million) Medications and Hospital Equipment (8.7 million USD) Two Additional Flu Labs (USD 5.2 million) Social Mobilization and Communication Activities (USD 1.7 million) ¶14. (SBU) On the animal health side, Minister El Gabaly asked for specific USG support on bolstering their capacity to develop vaccines, training for veterinarians, and assistance in creation of MOA satellite labs. On the human health side, he asked for technical expertise in making their pandemic plan operational, N95 masks, and assistance in human vaccine research and preparation. -------------- NEXT STEPS: DEFINING FUTURE ASSISTANCE -------------- ¶15. (SBU) Embassy Cairo is currently working in close conjunction with Washington agencies to expand upon its 2006 assistance on AI. In FY 2006, USAID directed 750,000 USD to the MOHP's AI surveillance and response activities, as well as its communication campaign. APHIS and USAID sent MOA vets to the US for training, and conducted a regional workshop on AI Veterinary Epidemiology. NAMRU estimates it spent USD 300,000 for testing and anti-body analysis. FY 2007 USAID assistance will include up to USD 4 million more for technical assistance in their massive vaccination and disease surveillance campaign for backyard poultry, and increased funding for MOHP communication efforts. RICCIARDONE