VISIT OF UNDER SECRETARY DOBRIANSKY - STAKEHOLDER

UNCLAS GENEVA 000525 SIPDIS SENSITIVE SIPDIS DEPT FOR G, OES, IO/T HHS FOR OGHA USAID FOR KENT HILL/ELLYN OGDEN E.O. 12958: N/A TAGS: TBIO WHO SUBJECT: VISIT OF UNDER SECRETARY DOBRIANSKY - STAKEHOLDER CONSULTATION ON POLIO ERADICATION ¶1. Summary. Under Secretary for Democracy and Global Affairs Paula J. Dobriansky visited Geneva February 28 as head of the U.S. delegation to the World Health Organization (WHO) Consultation on Polio Eradication, resulting in continued global commitment to eradication and establishment of milestones for donors and affected nations alike. The Under Secretary also met with the WHO Director-General and delegations from the four polio-endemic countries - Nigeria, India, Afghanistan and Pakistan - urging head of state engagement on polio and addressing other critical roadblocks to eradication. End Summary. Stakeholder Consultation on Polio Eradication -------------- ¶2. WHO Director-General Margaret Chan convened the Urgent Stakeholder Consultation on Polio Eradication to address the waning donor support and skepticism regarding the feasibility of eradication. Participants included representatives from the spearheading partners of the Global Polio Eradication Initiative (GPEI) - Rotary International, the U.S. Centers for Disease Control and Prevention of the Department of Health and Human Services (HHS/CDC),UNICEF and WHO - representatives from the offices of the Presidents and ministries of health of the endemic countries, major donors, political organizations and independent technical experts. ¶3. Under Secretary Dobriansky led the U.S. delegation, which included Dr. Julie Gerberding, Director of HHS/CDC; Dr. Kent Hill, USAID Assistant Administrator for Global Health; Dr. Steve Cochi of HHS/CDC and Chair of the WHO Advisory Committee on Polio Eradication; Dr. Denise Johnson of HHS/CDC's Polio Eradication Branch; Ellyn Ogden, USAID's Worldwide Polio Eradication Coordinator; Jeff DeLaurentis, Executive Assistant to the Under Secretary; and David Hohman, Mission Health Attache. ¶4. Under Secretary Dobriansky addressed the consultation on "Eradication vs. Control: comparing the costs and polio case numbers." Strongly reaffirming the global goal of polio eradication as a top foreign policy objective and one of the highest international public health priorities for the United States, the Under Secretary stressed the benefits derived from the initiative: the development of health infrastructure around the world, including networks of trained field staff, enhanced laboratory capacity, and access to a range of immunizations; progress in media management, social mapping, community outreach, religious and social leader involvement, and social mobilization; serving as bridges to tranquillity during times of conflict; and serving as a model for public-private partnerships. ¶5. The consultation reaffirmed the commitment to polio eradication and agreed to raise within 12 months - and then sustain for as long as needed - the levels of vaccination coverage and child immunity in the areas with endemic polio to levels that stopped the disease altogether in the polio-free parts of these countries. Ten other countries are currently fighting the tail-end of outbreaks caused by importations of poliovirus. ¶6. The consultation outlined specific milestones in two areas where improvements would raise the coverage and immunity levels. The first is to ensure that vaccine reaches children by improving the quality of polio vaccination campaigns, strengthening health infrastructure, addressing security challenges, and by enhancing acceptance of vaccination through tailored social mobilization and community engagement strategies. ¶7. The consultation also agreed there was a collective responsibility to mobilize the resources needed to complete polio eradication, in particular by filling the funding gap of $575 million for 2007-2008. Of that amount, $60 million is needed by April. India announced in New Delhi, on the day of the consultation, a commitment of approximately $293 million for 2007-2008. Other endemic countries outlined specific steps to provide domestic resources. Members of the international donor community also reaffirmed their continued commitment to provide resources. The U.N. Foundation said it would host a funding meeting with members of the Organization of the Islamic Conference (OIC),and invited the Director-General to attend, which she agreed to do. In his closing remarks, Bruce Aylward, Director of WHO's Polio Eradication Initiative, reiterated the importance of "making the case" for finishing polio eradication at upcoming meetings, such as the G8 Development Ministers' meeting March 26-27, the OECD-DAC high-level meeting April 3-4, and the World Bank/IMF spring meetings April 14-15. Meeting with WHO Director-General Margaret Chan -------------- -- ¶8. Thanking the Director-General (DG) for convening the polio consultation, the Under Secretary mentioned her personal engagement in the eradication initiative, noting in particular her work with the U.N. Foundation and Rotary International. The DG responded by recalling the late Director-General J.W. Lee's pledge to eradicate polio and her desire to fulfill his commitment. Chan said her objective at this meeting was to get all the issues on the table, to focus on the reality of the situation, have a frank and transparent exchange of views and to take advantage of a window of opportunity to get the job done. She had, for example, met with the Minister of Health of Pakistan to stress Pakistan's responsibility for the situation on its border with Afghanistan and the movement of people across that border, stressing her willingness to meet with President Karzai and the Prime Minister to reinforce this point. The DG stressed the importance of good governance in eradication efforts, the need to monitor the use of resources, and suggested the possibility of an independent evaluation of the eradication program. ¶9. Under Secretary Dobriansky assured the DG of strong U.S. support for a final push for eradication, and said she would reinforce the DG's message to Pakistan in her meetings with the Pakistan and Afghanistan delegations later in the day. Turning to resource needs, the Under Secretary noted the U.S. contribution of $132 million last year and her efforts to press for increased contributions from other donors, including Kuwait. The Under Secretary suggested the possibility of a donors' meeting later in the year, noting the desirability of a Muslim country, perhaps Kuwait or Saudi Arabia, acting as host. ¶10. Turning to the subject of avian influenza, the DG said she was working with the Minister of Health of Indonesia for the immediate resumption of sharing of virus strains for risk assessment purposes. They are also discussing convening a meeting in Jakarta, possibly at the end of March, to focus on sample sharing and access to vaccines. Noting the meeting would focus on WHO's Western Pacific and South East Asia regions, the DG confirmed the U.S. would be included. ¶11. Noting the H5N1 virus is well-entrenched in countries, the DG emphasized the need to work with FAO and OIE on agriculture and animal issues related to influenza. These issues include the culture of maintaining backyard stocks of chickens, animal vaccination, compensation for owners of culled stocks, and possible regulation of trade in poultry. ¶12. In closing, the Under Secretary informed the DG about plans for the next meeting of the International Partnership on Avian and Pandemic Influenza (IPAPI),to be held in India in December. Meeting with Nigerian Delegation -------------- ¶13. The Under Secretary met with Mrs. Amina Ibrahim, Senior Special Assistant to the President of Nigeria for Millennium Development Goals (MDGs); Dr. E. Abebe, Interim Coordinator of the National Program on Immunization; and representatives of the States of Kano and Katsina. ¶14. Noting the challenge of eradicating polio in Nigeria, especially in the north, the Under Secretary asked how the United States could be helpful. Abebe expressed appreciation for U.S. contributions to the Nigerian Immunization Service and identified several priorities: stepping up social mobilization, especially to disabuse rumors and engage traditional rulers to support acceptance of vaccination; to increase support for vaccines for routine immunizations; and to strengthen surveillance capacity, especially for State epidemiologists. The Kano representative emphasized supporting community groups and teachers at Koranic schools. The Katsina representative stressed working with Muslim women's organizations. ¶15. Responding to the Under Secretary's call for engaging religious leaders, Abebe said Nigeria had looked at the Egyptian experience in using religious leaders to support immunization programs and would build on that model. Ibrahim stressed that funding had to be predictable and flexible and pledges had to be fulfilled. The Under Secretary agreed, noting funds from the private sector were usually more flexible. Meeting with Indian Delegation -------------- ¶16. The Under Secretary met with Mr. N. Dayal, Union Secretary of Health and Family Welfare, and Mr. R. SIPDIS Gopalakrishnan, Joint Secretary, Prime Minister's Office. Recalling her visit to India and her meeting with Foreign Secretary Menon, the Under Secretary underscored the U.S. SIPDIS desire to have a strong partnership with India on polio eradication, particularly to work together on the challenges in Uttar Pradesh. Noting that polio doesn't preclude cooperation on other health issues, the Under Secretary thanked Dayal for India's hosting the next IPAPI meeting in the fall. ¶17. Dayal thanked the Under Secretary for strong U.S.-India health cooperation, noting particularly collaboration with HHS's CDC and National Institutes of Health and the active role played by Dr. Altaf Lal, the HHS Health Attache. Dayal said this cooperation had helped India maintain strong surveillance for avian influenza throughout the country, which had been free of the virus since last August. He said India maintained an adequate stock of Tamiflu for cullers of poultry stock, although Tamiflu was not available for retail sales. He noted that the Indian generic manufacturer, Ranbaxy, could produce Tamiflu. ¶18. Turning to polio, Dayal noted the increase in cases in 2006 (672) compared to 2005 (66),but said the immunization rounds conducted at the end of last year and the beginning of this year gave him confidence that the cases would be reduced. He observed that the National Rural Health Mission program would receive additional funds to address polio eradication and the Associated Social Health Activists program was recruiting women at the village level to integrate polio eradication in child health programs. Meeting with Delegation of Afghanistan -------------- ¶19. The Under Secretary met with Dr. N. Mojadidi, Advisor to the President of Afghanistan on Health and Education, and Dr. ¶F. Kakar, Deputy Minister of Public Health. The Under Secretary, noting the strong cooperation in health between SIPDIS Afghanistan and the United States, expressed the desire for continued partnership on polio eradication, especially along the border with Pakistan. ¶20. Mojadidi, noting he had worked in WHO for thirteen years and had also served as Minister of Health, identified two key issues he wished to discuss "off the record." He described the first as political - the need for the United States to pressure Afghanistan's "neighbors" not to interfere in its problems, citing particularly the holding of days of tranquillity. The second issue was financial, he said, signaling that President Karzai would write to donors seeking financial support, but that polio was just one of many key priorities. These included security issues, such as protecting hospitals and clinics, social mobilization, and infrastructure, such as schools and roads. The Under Secretary responded by emphasizing President Bush's SIPDIS encouragement of a broader dialog between Afghanistan and Pakistan, and noted the U.S. resources available for reconstruction. ¶21. Kakar said the goodwill of the United States for Afghanistan was not translated into health assistance, and that HHS should be more involved with Afghanistan in projects related to maternal and child health, nutrition, and support for Afghanistan's new Public Health Institute, which is modeled on CDC. The Under Secretary assured Kakar she would raise this matter with HHS Secretary Leavitt. Meeting with Delegation of Pakistan -------------- ¶22. The Under Secretary met with M. Nasir Khan, Federal Minister of Health, and Dr. R. A. Hafiz, National Programme Manager for Immunizations of the Ministry of Health. In response to the Under Secretary's question on holding immunization days, the Minister said Pakistan was administering vaccines all the time, particularly at border points. Saying immunization activities were coordinated with Afghanistan, the Minister said the NATO command did not approve tranquillity days, an issue he intended to raise with the American Ambassador. He said he had also asked the DG to raise this issue with NATO. ¶23. Turning to the topic of U.S. assistance, the Minister said that the bulk of USAID funds were channeled through NGOs, and that USAID should give more consideration to government priorities and programs, a subject he has discussed with the USAID Mission. Saying the government is both transparent and accountable, he recalled former HHS Secretary Thompson's view that the health sector could be SIPDIS used to improve communications between Pakistan and the United States. The Minister said CDC had been very helpful with the National Institute of Health of Pakistan, modeled on CDC, particularly in strengthening surveillance and routine immunizations. He regretted, however, that support from HHS to build a hospital to treat land mine victims had not been forthcoming. The Under Secretary said she would raise these concerns with HHS Secretary Leavitt. Press Conference -------------- ¶24. The Under Secretary, joined by Dr. Kent Hill, met with journalists to discuss her participation in the polio consultation. The well-attended event included representatives from Reuters, Associated Press, Agence France Presse, Kuwait News Service, and Voice of America. After an opening statement, the Under Secretary and Dr. Hill responded to questions covering what was new coming out of the consultation, eradication vs. control, adoption of milestones and benchmarks, resource issues, including the role of the OIC, cease fires for immunization days in conflict zones and the role of NATO, claims that the vaccine causes infertility, and engaging community and religious leaders. ¶25. Under Secretary Dobriansky cleared this cable. TICHENOR