REVISION OF VIETNAM'S AVIAN INFLUENZA ACTION PLAN

UNCLAS SECTION 01 OF 03 HANOI 001727 SIPDIS SENSITIVE SIPDIS STATE FOR EAP/MLS, OES/IHA STATE PASS TO HHS/OGHA (STIEGER/VALDEZ/BELL/HICKEY) CDC FOR OGHA (BLOUT/MCCALL) AND DIV-FLU (COX/MOHEN) DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (STERN) HHS PASS TO FIC/NIH (GLASS) USDA PASS TO APHIS, FAS (OSTA AND OCRA),FSIS BANGKOK FOR RMO, CDC (MALISON),USAID (MACARTHUR/BRADY) BEIJING FOR HHS HEALTH ATTACHE (ROSS) PHNOM PENH FOR CDC INFLUENZA COORDINATOR(BRADY) ROME FOR FAO VIENTIANE FOR CDC INFLUENZA COORDINATOR (CORWIN) E.O. 12958: N/A TAGS: TBIO AMED EAGR CASC KFLU VM SUBJECT: REVISION OF VIETNAM'S AVIAN INFLUENZA ACTION PLAN REF A: HANOI 1551, REF B: HANOI 687 HANOI 00001727 001.2 OF 003 ¶1. (U) Summary: The Ministry of Health (MOH) recently organized a workshop to discuss revisions of the Government of Vietnam (GVN) action plan on the prevention and control of human influenza. Under the cooperative agreement between U.S. Centers for Disease Control (CDC) of the Department of Health and Human Services (DHHS) and MOH, CDC supported the workshop, which focused on means to better coordinate and communicate between the animal and human health sectors and to more effectively use available resources. The GVN intends to take the recommendations from this workshop and from additional CDC supported gatherings as one set of inputs into the GVN process to revise the plan under the National Steering Committee on Avian Influenza (NSCAI). CDC and DHHS welcomed the opportunity to provide input and suggested that the GVN maintain a robust and open process to strengthen the plan and increase donor support. A successful amended action plan should more strongly emphasize monitoring and evaluation and better focus training for health care providers. End Summary. Vietnam Action Plan -------------- ¶2. (U) Three documents set forth GVN planning on avian influenza and pandemic preparedness. In November 2005, in response to global and national outbreaks of avian influenza, Vietnam developed a "National Plan of Action on Human Influenza Pandemic Prevention and Control in Vietnam," which only pertains to the human sector. Essential elements of this national action plan are contained in two widely distributed documents, both of which address both the human and animal sectors: Vietnam's Integrated National Plan for Avian Influenza Control and Human Pandemic Influenza Preparedness and Response, 2006-2008 (also known as the "Red Book") and the Vietnam Integrated National Operational Programme for Avian and Human Influenza (OPI),2006-2010 (known as the "Green Book") (See Ref B for additional details). The national action plan, together with the Red Book and the Green Book, contributed to the successful control of outbreaks of avian influenza and resultant isolated cases of human infection. However, after two years of implementation, the GVN and its donor partners have discovered gaps in coverage. Both agree that the national action plan needs modification to better address ongoing challenges and to recognize that Vietnam's response to avian influenza has switched from basic crisis management to a new stage, i.e., emergency preparedness. Ministry of Health Avian Influenza Workshop -------------- ¶3. (U) On September 11, 2007 in Ho Chi Minh City, the MOH's Vietnam Administration of Preventive Medicine (VAPM) organized a workshop to revise the national action plan to prevent and control human influenza. CDC supported the workshop, which included participants from MOH, regional institutes of hygiene and epidemiology, central hospitals, 20 southern provincial health services and preventive medicine centers, university and research institutes. Pursuant to a cooperative agreement with the MOH to assist GVN efforts to amend its national action plan, CDC will fund additional GVN-led workshops, including one in Hanoi on October 5 to obtain input from a wider selection of interested parties. GVN Strategy to Revise the National Action Plan -------------- -- ¶4. (SBU) MOH/VAPM convened this workgroup as part of the GVN process to revise the national action plan, pursuant to the Partnership Framework for Avian and Human Influenza (PAHI),the non-binding partnership between the GVN, donors and NGOs signed in HANOI 00001727 002.2 OF 003 November 2006 and which provides the overall framework for donor coordination to support the GVN's Avian Influenza efforts. An earlier September meeting, hosted by the Ministry of Agriculture and Rural Development (MARD) and the U.N. Food and Agricultural Organization, also provided comments on how to best update the national action plan (Ref A). According to PAHI staffers and the CDC Influenza Coordinator, this process will include additional workshops to collect information and solicit opinions from other stakeholders, experts, and consultants. These workshops are principally supported by CDC's cooperative agreement with VAPM, "Surveillance and Response to Avian and Pandemic Influenza in Vietnam." ¶5. (SBU) Following the end of this workshop, participants continue to work on VAPM draft changes and workshop suggestions, which will then circulate within MOH for comments. The GVN will use input from these workshops (along with information from GVN agencies, field interviews and consultants) in its internal deliberations on how best to modify the national action plan. Specifically, working level officials from the MARD and MOH will analyze workshop suggestions (and follow on comments),synthesize them, and then plug in selected and vetted ideas from these meetings into deliberations by the NSCAI, chaired by MARD Minister Cao Duc Phat. ¶6. (SBU) Once a subcommittee of NSCAI has compiled a draft amended plan, the document will be circulated to relevant GVN agencies for official comment, but will not include comments from donors and other interested parties. The Minister of Health needs to sign off on the final revisions before implementation. The GVN expects to produce a final version of the new, amended plan in 2008, which will then be released to bilateral and international partners. Gaps in the Action Plan -------------- ¶7. (SBU) Workshop participants noted gaps in coverage that prevented fully effective action and emphasized the need to modify the plan to reflect the current situation. Contributors specifically highlighted the need to improve coordination between the health and agricultural sectors, the importance of providing updated knowledge about AI to health workers, more effective use of health care facilities and medications, greater attention to border and remote areas, and more timely provision of funds. HHS attendees commented that the draft reviewed at the workshop did not yet provide for sufficient monitoring and evaluation and did not adequately match proper training to specific groups of health care practitioners. Importantly, several participants urged the GVN to better explain to the general public and affected individuals the necessity of continued preparations and research even though a pandemic has not yet occurred. Suggested Modifications -------------- ¶8. (U) Led by VAPM, workshop participants agreed to several possible revisions to the national action plan, tied to a Vietnamese proposal to add an additional stage to the WHO system of pandemic stages in order to cover the possibility of human pandemic influenza first occurring in another country and the GVN's need to organize a response to prevent the spread of the pandemic into Vietnam. Participants supported proposed language focusing on animal to human transmission of pandemic influenza and the concurrent need to better link the human health and animal health sectors. All agreed to include language on linkages between the four cross cutting areas of preventive medicine, communication, treatment, and financial resources, along with the need to stress on-site containment and treatment and district-level taskforces. Other agreed to changes in HANOI 00001727 003.2 OF 003 the action plan include more investment for facilities, training, and communication materials for district hospitals and preventive medicine units. The draft amended action plan also highlights the importance of international partnership. ¶9. (SBU) Comment: While there will be no formal "review period" for international comment, USG agencies at post have helped drive this revision process from before "day one." We are confident that, while a GVN product, it will reflect our concerns and result in a stronger plan. The "emergency preparedness" phase of the AI response is more complicated in some ways than the initial "crisis response" phase. By better coordinating the human and animal health sides of the issue, and by focusing greater attention on building long-term capacity in both, the new plan should help Vietnam build a sustainable capacity across critical areas, which will add strength to the national response, while enhancing the system's ability to respond flexibly to new situations. We will continue to help direct and closely monitor this process. MICHALAK