A REVIEW OF VIETNAM'S AVIAN INFLUENZA POULTRY VACCINATION

UNCLAS SECTION 01 OF 04 HANOI 002041 SIPDIS SENSITIVE SIPDIS STATE FOR EAP/MLS, EAP/EP, INR, OES/STC, OES/IHA, MED STATE PASS TO USAID FOR ANE AND GH HHS/OSSI/DSI PASS TO OGHA (WSTIEGER/LVALDEZ/DMILLER/CHICKEY) AND FIC/NIH (RGLASS) CDC FOR OGHA (SBLOUT/KMCCALL) AND DIV-FLU (NCOX/AMOHEN) DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (STERN) USDA PASS TO APHIS, FAS (OSTA AND OCRA),FSIS BANGKOK FOR RMO, CDC (MALISON),USAID (CBOWES/JMACARTHUR/MBRADY), APHIS (NCARDENAS),REO(JWALLER) BEIJING FOR HHS HEALTH ATTACHE (BROSS) PHNOM PENH FOR CDC INFLUENZA COORDINATOR(WBRADY) ROME FOR FAO VIENTIANE FOR CDC INFLUENZA COORDINATOR (ACORWIN) E.O. 12958: N/A TAGS: TBIO AMED AMGT CASC EAGR PINR KFLU VM SUBJECT: A REVIEW OF VIETNAM'S AVIAN INFLUENZA POULTRY VACCINATION PROGRAM REF: A. 2005 HANOI 3055 B. 2005 HANOI 1791 HANOI 00002041 001.2 OF 004 ¶1. (SBU) Summary. Four years into its efforts to counter pandemic influenza, the Government of Vietnam (GVN) has placed ongoing emphasis on a vaccination program to limit the possible spread of avian influenza (AI) caused by the highly pathogenic influenza A H5N1 virus. The nationwide program focuses on high-risk poultry populations, especially hatchling ducks and chickens, primarily through a subsidized vaccine campaign. Despite the imperfect balance between effectiveness and cost of vaccinations, the GVN believes the program is an important short-term control measure that has reduced (but not eliminated) the threat to Vietnamese poultry and to the human population. End Summary. Role of Vaccination Program -------------- ¶2. (SBU) The GVN recognizes that AI has now become endemic in animals (i.e., enzootic) in Vietnam. Per Dr. Do Huu Dung, a veterinary epidemiologist at the Department of Animal Health (DAH) within the Ministry of Agriculture and Rural Development (MARD),the GVN focuses on identifying and mitigating the most risky points in the poultry market chain to protect animal health and prevent possible transmission to humans. To minimize the risk of a human epidemic (i.e., reduce the probability that the virus mutates into a form that is transmissible from humans to humans),the GVN aims to lower the viral load circulating among pultry and has selected an aggressive vaccination program as a contributory means to accomplish this goal. Dr. Hoang Van Nam, deputy Director of DAH,recently stated that the GVN will continue the animal vaccination program for the next five years, combined with other interventions including measures to improve backyard poultry raising techniques and better hygiene in poultry trade and slaughtering. The GVN views vaccination as a necessary short- to medium-term activity until it can implement longer-term measures, including strengthened surveillance and laboratory capacity, increased biosecurity, and more complete poultry industry restructuring to better monitor and reduce risk. Dung noted that while Vietnam's vaccination program is designed to prevent a widespread animal epidemic (i.e., epizootic),it cannot eliminate scattered outbreaks, particularly among flocks of unvaccinated and unregistered ducks far from commercial and urban centers. Current vaccines prevent disease and reduce spread, but may not curb shedding sufficiently to eliminate secondary AI infections among susceptible animals. Possible Impact of a Vaccination Program -------------- ¶3. (SBU) According to a presentation prepared by Dr. Nam, the GVN believes that the vaccination program has played an important role in limiting the spread of AI, though it acknowledges that it cannot separate out the effects of the vaccine program from other measures. .At the same time, a UN Food and Agricultural Organization (FAO)-led evaluation of the 2005 vaccination campaign found that 54 percent of poultry flocks were effectively protected at one to two months and 45 percent protected at three to four months post vaccination[0]. 2006 results showed 56 percent protection at one to HANOI 00002041 002.2 OF 004 two months and 33 percent protection at three to four months. Initial results from the first 2007 campaing show 60 percent at protection at one month. The absence of reports of disease in fully vaccinated poultry, supports, but does not prove, vaccine efficacy. The GVN maintains that vaccination has reduced the susceptibility of a substantial part of the poultry population. Constraints -------------- ¶4. (SBU) DAH acknowledged several short-term and long-term constraints on its vaccination program. The need to import vaccines from abroad puts Vietnam at a disadvantage. While prices have dropped over the past few years and remain low, Vietnam faces the risks of future price hikes. Once vaccines arrive in Vietnam, the GVN must satisfy several logistical requirements to get the vaccines to the field, including maintaining cold chains, training and paying vaccinators, shipping vaccines to isolated areas, and maintaining lab and field capacity to perform surveillance and monitor the effectiveness of the program. During periods without outbreaks, the DAH struggles to maintain farmer cooperation in the program, raising concerns about continued sustainability. Further threatening sustainability, the mass vaccination campaigns overtax the resoucres of local DAH staff. Finally, the GVN cannot ensure that free ranging ducks receive both vaccine doses needed for full protection, as they move within and among provinces throughout their lifetimes. If infected, these adult ducks can become a resevoir for the disease, spreading AI to new generations of farm raised poulty with which they come into contact. History of Vaccination Program -------------- ¶5. (SBU) Beginning in late 2003 and lasting until mid-2005, Vietnam's initial response focused on surveillance, rapid destruction of birds at infected farms and at-risk farms, rapid movement control and disinfection of infected premises, periodic bans on hatching of water fowls, closures of live bird markets in urban areas, and better communication (ref A). Though the bans and closures were not completely enforced, these efforts, combined with public education campaigns reduced consumer demand for poultry. In August 2005, Vietnam added vaccination as a supplementary measure as it could not contain outbreaks by other response measures such as culling and disinfection (ref B). Initially implemented in provinces covering most of the high risk populations of poultry, particularly villages at which human infections had occurred, the GVN used vaccines where it could not modify high-risk poultry rearing and consumption behaviors. Current Program -------------- ¶6. (SBU) Currently, the GVN implements three vaccine programs; campaign, commercial, and hatchling, each designed to help limit the spread of AI through the poultry population. Funding for the program, including strategy development and post-vaccination surveillance, comes from the government (estimated at USD 10 million HANOI 00002041 003.2 OF 004 per round),as well as USAID, World Bank, and the UN Joint Program. At this time, a state-owned company imports and distributes all vaccines. According to DAH, Vietnam has considered domestic production, but has hesitated to do so due to concerns about long-term sustainability. If global efforts succeeded in controlling AI, the GVN worries what it would do with this new and expensive vaccine production facility. As the GVN imports such large volumes, vaccine costs have moved steadily downward over time. The GVN now is considering importing vaccines in bulk and then bottling itself, which would limit concerns about shipment schedules and allow Vietnam to stockpile resources. Dung stated that Vietnam had not encountered any difficulties with counterfeit vaccines, though the FAO has recommended that it begin quality assurance on imported vaccines. Through the sharing of animal isolates, the Centers for Disease Control and Prevention and the Department of Agriculture) are providing technical assistance to help MARD with molecular sequencing and evaluation of current vaccines in animal models. National Vaccination Campaign -------------- ¶7. (SBU) The GVN subsidized AI animal vaccination mass campaigns take place twice per year (March/April and September/October/November) with supplemental vaccinations at other times. If farmers or commercial poultry raisers want to obtain vaccines outside the normal campaign cycle, they can do so, but need to pay for the vaccines. The program continues to grow rapidly and now focuses on 33 provinces in high risk areas (Red River and Mekong River deltas) with vaccination of all long-lived poultry and all poultry in villages. The program also vaccinates high risk poultry in other provinces, i.e. those in border, urban or previously infected areas. In 2005, some 166.3 million doses were given to chickens and 78.1 million doses to ducks, for 81 percent coverage. As the program expanded to two campaigns in 2006, the GVN provided 368 million doses to chickens and ducks combined, for 89 percent coverage. The first 2007 vaccination campaign started in mid-March and vaccinated 131.7 million birds by mid-May. The second campaign began in September and has provided over 124.29 million doses. ¶8. (SBU) Though FAO provides technical assistance to the annual GVN review of its vaccination strategy, the GVN determined that lack of social mobilization prevented it from implementing FAO's suggestion that it move to one mass vaccination campaign. Instead, on November 12, the MARD Minister approved the 2008 vaccination plan, which envisions two mass campaigns and supplemental vaccinations covering all chickens and ducks in 33 provinces. In other provinces, the GVN will make vaccination compulsory for all ducks, all commercial and semi-commercial chicken farms, and will recommend vaccinations for all backyard farms. Citing concerns regarding the sustainability of mass vaccination and reduced protection for poultry vaccinated at improper ages, FAO had recommended the GVN focus on age-appropriate vaccination available year round, with one mass campaign in November to provide protection through the high-risk winter/Tet season[0]. Under this plan, provinces would pay for a second round, if deemed necessary, with farmers increasingly bearing financial responsibility for additional vaccinations. HANOI 00002041 004.2 OF 004 ¶9. (SBU) For its nationwide campaign, the GVN imports the vaccine from China and in 2007 brought in 1.14 billion doses. According to Dung, the campaign utilizes H5N1 inactivated virus from Harbin Veterinary Research Institute sold commercially by Weike Biotechnology Development Company to vaccinate chickens and ducks at a cost of about 280 dong (approximately 0.017 USD) per dose. In the past, DAH used H5N2 vaccine for chickens and H5N1 vaccine for ducks. DAH recently also halted separate H5N9 (serum based) vaccines for Muscovy ducks (though it had already imported 19 million doses in 2007),as the bottles were too unwieldy and the vaccine provided too short an immunity duration. Chickens require one injection of the H5N1 inactivated virus. Ducks require two injections, 28 days apart. Chickens need to be over 8 days old, ducks over 14 days old. DAH would prefer vaccines for newly hatched ducks, but this is not yet available on the market. The campaign vaccine provides six month immunity in chickens, five months in ducks -- more than the normal life cycle for chickens and ducks raised for meat. DAH believes that based on empirical criteria, the Chinese vaccines produced "acceptable" levels of immunity one month post-vaccination. According to virus sequencing work, minor changes in the structure of avian influenza have not affected immunity. Commercial and Hatchling Vaccine -------------- ¶10. (SBU) The GVN provides an unsubsidized commercial vaccine, usually to large farms, of which it imported 105 million doses in ¶2007. The H5N2 vaccine, under the trade name Nobilis from the Intervet Company in the Netherlands, is used only for chickens at an estimated cost of 650 dong (approximately USD 0.04) per dose. For chicken hatchlings, the GVN imports H5N8 recombinant Trovax vaccine from Merial Company. Donor Analysis of Vietnamese Vaccination Program -------------- --- ¶11. (SBU) International experts generally approve of the Vietnamese vaccination program and note that Vietnam's over-all strategy to combat AI may have played a substantial role in the large decrease in animal and human AI cases over the past four years. Poultry vaccination not only helps prevent disease but also reduces the viral burden and the amount and duration of viral shed. Given Vietnam's limited biosafety capacity, the FAO believes Vietnam's focus on vaccinations to be technically appropriate, and public health practitioners have described it as a model for other developing countries to follow. At the same time, donors agree that additional studies must be performed to evaluate the program. To that end, USAID will fund an FAO study on the effectiveness of various vaccination strategies. Meaningful annual reviews designed to improve efficiency and develop sustainability are a crucial component of the program and USAID and FAO agree that the GVN needs to develop an eventual exit strategy. MICHALAK