TUNISIAN HEALTH MINISTER: HIV/AIDS, AVIAN FLU, IPR

C O N F I D E N T I A L SECTION 01 OF 03 TUNIS 000212

SIPDIS

SIPDIS

NEA/MAG FOR HOPKINS AND HARRIS
EB/CBA (WINSTEAD)
STATE PASS USTR (BELL),USPTO (ADLIN)
USDOC FOR ITA/MAC/ONE (NATE MASON),ADVOCACY CTR (JAMES)
CASABLANCA FOR (FCS ORTIZ)
AMMAN FOR EST/SCI JOCK WHITTLESEY

E.O. 12958: DECL: 02/12/2017
TAGS: ETRD KFLU KHIV KIPR TS
SUBJECT: TUNISIAN HEALTH MINISTER: HIV/AIDS, AVIAN FLU, IPR
UNDER CONTROL

Classified By: Ambassador Robert F. Godec for reasons 1.4 (b) and (d)

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Summary
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1. (C) During Ambassador's courtesy call on Ridha Kechrid,
Minister of Public Health (MOH),topics ranging from avian
influenza and HIV/AIDS to Intellectual Property Rights (IPR)
were discussed. The discussion was amicable, with Kechrid
addressing each issue thoroughly and with seeming candor.
The Minister said that GOT has good programs in place to
manage and control avian influenza, HIV/AIDS, and malaria.
He would like to see more cooperation between the United
States and Tunisia, particularly in the area of scholarships
for Tunisians to study at US universities known for their
public health and hospital management programs. Ambassador
raised the issues of data exclusivity, reliance, and patent
linkage with the Minister. The Minister said that the GOT is
TRIPS compliant, that test data is protected as stated in
TRIPS article 39.3, and that its correlation system for
pharmaceuticals was terminated as of December 31, 2006.
Cooperative medical research projects were discussed and
Ambassador suggested that both governments seek ways to
increase cooperation in the area of public health. End
Summary.

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Public Health in Tunisia
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2. (SBU) Minister Kechrid opened the January 24 meeting by
singing the praises of health care in Tunisia. He said that
Tunisia's health system is mainly public but that the number
of private clinics and doctors has increased over the past
several years. Kechrid stated that Tunisia's specialized
health and curative medicine facilities are very well-known
and annually attract thousands of foreign clientele from
Europe and the Middle East. He said that health education is
excellent, including programs on HIV/AIDS prevention and on
food and family health issues. Kerchid said that the GOT's
vaccination program is effective and thus children's health
is much improved. He also said that the national mortality
rate is decreasing and joked that the quality and standards
for health care are so good that people refuse to die.
Kechrid acknowledged that by 2025-2030 Tunisia's aging
population will strain the health care system. Highlighting
that the cost of medicines and of medical technology is very
expensive, the Minister said that Tunisia was encouraging the
use of generic medications in order to reduce costs.

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HIV/AIDS
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3. (C) Stressing the importance of a strategy to fight
HIV/AIDS, Ambassador requested a brief overview of GOT's
HIV/AIDS prevention efforts. Kechrid said that Tunisia does
not have a big HIV/AIDS prevention program. He said that
only a small number of Tunisians have the virus; treatment is
free; students, whom GOT considers an "at-risk" population
are tested; and Tunisia provides excellent health education
on HIV/AIDS prevention. He added that that it is easy
educate the public about HIV/AIDS prevention but much more
difficult for the public to put that knowledge into practice.
The Minister said that GOT is encouraging health,
educational, and other professionals to spread the message.


4. (C) The Ambassador congratulated the Minister on the
GOT's successful proposal for a US $17 million grant from the
UN Global Fund for AIDS to put in place a program and policy
on the prevention of HIV/AIDS, malaria, and tuberculosis.
(Note: The Tunisian proposal for this grant states that from
1985 until March 2006 there have been 1327 reported cases of
HIV/AIDS, with 875 currently living, and approximately 70 new

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cases reported each year. End Note.) Kechrid said that
there is a bill before Parliament to authorize confidential
testing for HIV/AIDS and to cover diagnostic exams for
at-risk populations and medicine to fight the disease.
(Note: EUCOM has financed the construction of an anonymous
HIV/AIDS testing center in Sfax using EUCOM humanitarian
assistance funds. This center will be operated by a Tunisian
NGO. The GOT plans to put similar testing centers in other
places, if the Sfax operation is successful. End Note.)

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Avian Influenza
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5. (C) Kechrid said that avian influenza is also under
control in Tunisia, because the GOT had put in place several
levels of defense against transmission in 2005. He said the
defense mechanisms were:

-- Banning hunting in the wetlands since migratory birds
are the primary carriers of this virus;

-- Banning temporarily the import of all poultry products;

-- Banning live chickens inside farmers' homes to prevent
contact with infected domestic poultry.

Kechrid also said that in May 2006 a UN Food and Agriculture
Organization (FAO) mission had visited Tunisia for
consultations and had conducted avian influenza detection
activities at relevant sites. He said that this mission
confirmed that there was no avian influenza virus present in
Tunisia.

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Bilateral Cooperation
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6. (SBU) Ambassador asked the Minister for his suggestions
for areas on which the United States and Tunisia can
cooperate. Kechrid said that there are currently several
cooperative research efforts between the Pasteur Institute
and research laboratories in the United States. The areas of
cooperation are in the neurology, genetic and muscular malady
fields. In addition, there is an agreement in principle for
a US researcher to conduct studies on five diseases that are
unique to Tunisia (NFI). He said that the Pasteur Institute
also has a cooperative venture with Walter Reed Institute
working on the development of a malady bank. Kerchid added
that Tunisia also has agreements with Boston and John Hopkins
Universities and that about four or five students/year win
scholarships to pursue US degrees in the medical field.
Commenting that the United States has excellent schools with
specializations in public health and hospital management, the
Minister indicated that he would like to see cooperation to
train more Tunisians in these fields.

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IPR Protection
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7. (SBU) Kechrid said that GOT had terminated its
"correlation" system on December 31, 2006. Ambassador said
that the MOH's termination of its correlation system was a
welcome move forward in liberalizing the marketplace but that
US pharmaceutical companies had expressed concern over the
GOT's correlation of approximately 150 drugs several days
before its termination (septel). The Minister said that
there is an appeal process to contest any drugs added to the
correlation list after January 1, 2005 and that he is open to
discussing specific drugs with individual US pharmaceutical
companies. (Note: The relevant Circular No. 113, specifies a
deadline of May 2007 for the filing of an appeal. Post
relayed this information to relevant companies and advised
them to file appeals and to request a meeting with MOH as

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soon as possible. Pfizer has since succeeded in having its
affected drugs removed from the list. Post is currently
working with Eli Lilly with hopes of achieving a similar
outcome. End Note.) The Ambassador raised USG concerns over
data exclusivity and reliance, and encouraged the GOT to
initiate a patent linkage system. Kechrid said that GOT
respects the principal of data protection and data
exclusivity. He said that Circular No. 40 (dealing with data
exclusivity and data protection) coincides with TRIPS article
39.3 and that if a laboratory participates in a study, it
must sign a confidentiality agreement to protect data.


8. (SBU) Comment and Bio Note: Minister Kechrid was
loquacious and had a pleasant demeanor. He had a good
command of his highly technical ministry and appeared open to
a discussion on any health-related topic. Kechrid speaks
French and Arabic but conducted the meeting in French. He
was accompanied in the meeting by many staffers, several of
whom he invited to speak, creating an unusually inclusive
atmosphere for a GOT ministerial-level meeting. Kechrid is a
cardiologist and holds an MA in pharmacology. Prior to his
government administrative positions, he worked as a physician
in government-run hospitals in Tunis and taught pharmacology
at the University of Tunis Faculty of Medicine. End Note.
GODEC