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

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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
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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