AVIAN INFLUENZA: BUILDING ANIMAL SURVEILLANCE

UNCLAS SECTION 01 OF 02 DHAKA 000117 SIPDIS SIPDIS E.O. 12958: N/A TAGS: TBIO KFLU KSCA PREL EAID WHO WB BG SUBJECT: AVIAN INFLUENZA: BUILDING ANIMAL SURVEILLANCE CAPACITY DHAKA 00000117 001.2 OF 002 ¶1. SUMMARY. Avian Influenza (AI) surveillance efforts in Bangladesh are expanding to include animal surveillance, but much work is needed. USAID conducted a local "Train the Trainers" program for the use of USAID-supplied personal protective equipment, decontamination equipment and field testing kits for both human and animal response workers. The World Bank is offering to fund a new animal health project to increase animal surveillance capabilities and early detection of an AI event with a package of grants and loans. END SUMMARY. ¶2. USAID has identified Bangladesh as a high priority country at risk for an outbreak of the Highly Pathogenic Avian Influenza (H5N1) strain of AI because migratory wildfowl flight paths traverse Bangladesh and its proximity to countries with AI outbreaks. As a result, USAID and other international donors are pursuing several programs to improve human and animal surveillance capacity in Bangladesh. The international donor community is also working to strengthen animal surveillance in Bangladesh to provide more advanced warning of an AI outbreak. Animal Surveillance -------------- ¶3. During a December 2006 visit, USAID Veterinary Epidemiologist Dr. Zandra Holloway Andre reviewed both animal and human surveillance mechanisms in Bangladesh. Animal surveillance is by far the least developed of the two as the Ministry of Livestock and Fisheries is chronically under-funded, historically low on the GOB's priorities, and not considered a strong career path for GOB civil servants. Currently, the Ministry of Livestock and Fisheries has only two veterinarians authorized per upazilla (local government sub-unit between the district and village level). They operate without reliable field support and frequently supplement their government salary with a private practice. One indicator of the weakness in the animal health system is reports that little work is done at the eight veterinary labs across Bangladesh due to persistent shortages of equipment and supplies. USAID Provides Training, Technical Assistance -------------- ¶4. USAID is pre-positioning AI outbreak commodities such as personal protective equipment, decontamination kits, and field testing kits in Bangladesh. In December, USAID conducted a successful "Train the Trainers" workshop on the proper use of the equipment for local authorities from the Ministry of Health, the Ministry of Livestock and BRAC (a local NGO with substantial involvement in poultry production). The trainees included epidemiologists (Ministry of Health),laboratory heads (Ministry of Livestock),and field managers (BRAC). Additional follow-up is required to ensure that the primary trainers pass along their knowledge and conduct second level training within their organizations. In discussing the trainer role with the participants, they highlighted the need for simple, pictographic instructions, noting that many end users in the field will be non-English speaking and some may not even be literate in Bengali. ¶5. USAID is working with the UN Food and Agricultural Organization (FAO) to establish a basic epidemiology unit within the Bangladeshi Department of Livestock Services in the Ministry of Livestock and Fisheries. The inputs into this project include technical assistance from FAO experts, rapid test kits for the AI virus, reagents for lab testing, computers, GPS for field teams, and training. Currently, USAID has distributed 2,000 of the pre-positioned personal protective equipment kits (PPE units) to the Bangladesh Department of Fisheries and Livestock, with an additional 4,500 PPE units expected to be delivered in early 2007; these are the same units used in the train the trainer exercise. World Bank Offers Funding -------------- ¶6. The World Bank conducted an Appraisal Mission for Bangladesh Avian Influenza Programs in December, which DHAKA 00000117 002.2 OF 002 included a briefing for development partners. The World Bank is proposing to fund a new project to improve surveillance capacity and diagnostics, to conduct both poultry industry-focused and public education campaigns, and to undertake capacity building in general at all veterinary infrastructure levels. Donor funding of advanced veterinary laboratories, even up to a BioSafety Level 3 facility, is possible, although maintenance and operation costs are very high for a facility at that level. Funding for the $20 - $25 million project would consist of $3 million in grants, and $17-$22 million in concessionary loans. Human Surveillance -------------- ¶7. The Bangladesh medical system is stronger than the veterinary system and human surveillance is likewise considered to be stronger. Dr. Andre underscored the importance of accurate testing for human AI surveillance, based on her experiences in Sub-Saharan Africa where AI was often misdiagnosed as, or masked by, other more common local diseases such as malaria or pneumonia. In this respect, Bangladesh's testing capacity will soon be significantly enhanced when the International Center for Diarrheal Disease Research - Bangladesh (ICDDR-B) completes the US Department of Health and Human Services funded upgrade of its facilities to provide a BioSafety Level 3 lab. ¶8. The World Bank assessment team generally gave the Bangladesh National AI/Human Pandemic Preparation and Response Plan good marks as a document, with the caveat that whether or not it will be adequately funded and implemented remains to be seen. Concerning the existing human health programs, active since 1998 in Bangladesh and funded by a mixture of grant and credit funding, the team noted these programs are already prepared for sudden demand increases due to the periodic natural disasters in Bangladesh. The focus, therefore, will need to be on improving capacity to handle the specific needs of an AI/Human Pandemic event, such as isolation facilities and hospital surge capacity. Comment -------------- ¶9. The GOB has not strongly supported veterinary infrastructure in the past and this systemic deficit must be overcome before AI animal surveillance can be established and maintained at internationally recommended levels. International donors will need to convince the GOB that it should continue to invest in AI human and animal surveillance capacity, notwithstanding competition from other high-priority public health needs for scarce government resources. BUTENIS