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
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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.

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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.

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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

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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

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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

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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