Guangdong's AI Strategy: Expanding Vaccination and

UNCLAS SECTION 01 OF 03 GUANGZHOU 000047 SIPDIS SENSITIVE SIPDIS STATE FOR EAP/CM, CA/OCS/ACS/EAP, AIAG, OES/IHA, MED STATE PASS TO USAID FOR ANE AND GH CDC FOR OGHA AND DIV-FLU DEPARTMENT OF DEFENSE FOR OSD/ISA/AP HHS PASS TO FIC/NIH USDA PASS TO APHIS, FAS (OSTA AND OCRA),FSIS BANGKOK FOR RMO, CDC, USAID BEIJING FOR HHS HEALTH ATTACHE AND RMO PHNOM PENH FOR CDC INFLUENZA COORDINATOR VIENTIANE FOR CDC INFLUENZA COORDINATOR E.O. 12958: N/A TAGS: TBIO AMED AMGT CASC EAGR PINR KFLU CH SUBJECT: Guangdong's AI Strategy: Expanding Vaccination and Enhancing Surveillance REF: A. Guangzhou 1048; B. Guangzhou 1070; C. Guangzhou 1075; D. Guangzhou 1279; E. Beijing 7401; F. Beijing 7567; G. Guangzhou 0043 ¶1. (U) Summary: As part of its five-point AI prevention strategy (Ref G),Guangdong is implementing a compulsory vaccination program which aims for 100 percent coverage of domestic poultry. Significant resources and manpower have been invested in this prevention strategy and to strengthening the testing and surveillance regime, but challenges remain, given the remoteness of many rural farms, the inability of ducklings to develop antibodies if vaccinated too soon and the quality control necessary for ensuring that vaccines are used prior to their expiry date. End Summary. -------------- More than Just an Ounce of Prevention -------------- ¶2. (U) Following the 2004 H5N1 AI outbreaks, Guangdong implemented a compulsory vaccination program. This program, which calls for scheduled vaccinations, is more stringent than the national vaccination strategy which only requires emergency vaccinations in the event of an outbreak, as well as rapid culling. The program is headed by the provincial Veterinary Center for Epidemic Prevention and Control (VCEPC),a component of the Department of Agriculture. Under this vaccination program, all farm-raised poultry, including broilers and breeders, will receive at least one vaccination before being sold in the market. Breeders with a longer production cycle will receive two or possibly three vaccinations in order to maintain a healthy level of immunity. In 2006, Guangdong VCEPC administered 1.5 billion doses of H5N1 vaccines to a poultry population of 1.35 billion, and claimed that the province achieved a 100% vaccination rate, based on the dose-to-poultry population ratio. ¶3. (SBU) Thus far, Guangdong's provincial government has invested RMB 150 million (approx. USD 21.5 million) in its vaccination program, which is estimated to cost RMB 400-500 million (approx. USD 57-71 million) a year. According to YU Yedong, Director of the Guangdong VCEPC, the provincial, municipal and district governments pay for 80% of the total cost, with the remainder subsidized by the central government. In contrast to Guangdong, other provinces with more limited resources normally receive a larger central government subsidy. -------------- Vaccine Efficacy is the Key -------------- ¶4. (SBU) Under its current program, Guangdong province administers a recombinant inactivated H5N1 vaccine (extracted from chicken eggs) to farm-raised poultry. The current vaccine targets the H5N1 virus of the 1996 Guangdong strain. The same H5N1 vaccine is also widely used in other parts of China and purchased by Vietnamese authorities. YU told us the Guangdong vaccine has proven to be effective in protecting all poultry if given sufficient time to develop immune response. Thus far, there have been no indications that the H5N1 virus circulated in Guangdong has mutated in a way that would render the current vaccine ineffective. Previously, an H5N2 vaccine and a Newcastle Disease Virus-H5N1 (ND-H5N1) vaccine were used in Guangdong; however, YU revealed that these vaccines are now less effective and no longer used. -------------- --- Controlled Vaccine Manufacturing and Procurement -------------- --- ¶5. (U) Vaccines administered as part of the AI vaccination program adhere to stringent supply controls. For example, vaccines are only GUANGZHOU 00000047 002 OF 003 procured from seven Chinese Ministry of Agriculture-approved H5N1 vaccine manufacturers, two of which are located in Guangdong province. Guangdong Department of Agriculture uses vaccines from three of the seven approved locations, Harbin Veterinary Research Institute, Zhaoqing Dahuanong Biological Medicine Company, and Guangdong Yongshun Bio-pharm Company Ltd. This strategy safeguards against shortages and production or storage failure. ¶6. (U) Under Guangdong's AI vaccination program, the government pays for the procurement, storage, distribution, and administration of the vaccines. Veterinary vaccine supply stations, scattered throughout the province, maintain cold chain supplies. In constructing this distribution infrastructure, Guangdong provincial government invested RMB 20 million (USD 2.8 million),which included importing mobile storage units from the United States. In general, large poultry farms obtain their AI vaccines from these supply stations and employ their own veterinary technicians to administer the vaccines. In the countryside, government-trained grassroots workers administer vaccines for small-scale poultry farmers. Distributing and administering vaccines prior to their expiration date remains a constant challenge. ¶7. (U) AI vaccines are regulated under the national laws for "Management Methods in Business with Veterinary Bioproducts", "Animal Epidemic Prevention Law", and the "Regulations on Administration of Veterinary Drugs". AI vaccine production must comply with the requirements of the Good Manufacturing Practice (GMP) standards for animal vaccines, regulated by China Institute of Veterinary Drug Control (CIVDC) under the Ministry of Agriculture. Each production batch must meet the criteria established by CIVDC for H5N1 vaccine and pass inspection for safety and efficacy. The Guangdong Department of Agriculture and the Veterinary Drug Inspection Department of the Ministry of Agriculture (Beijing) station inspectors in vaccine factories to monitor the production and product release processes. -------------- --- Enhancing Veterinary Monitoring and Surveillance -------------- --- ¶8. (SBU) Approximately 20,000 certified animal disease prevention and treatment workers provide technical support and vaccinations in village areas. These grassroots workers, subsidized by the government, are trained by the provincial Department of Agriculture to administer vaccines and issue vaccination records. They also check vaccination records and monitor possible AI virus mutation precursors or outbreaks. In addition, technicians collect both routine and unscheduled samples of poultry serum and swabs for testing. The standard methods and reference reagents for performing the tests are provided by the National AI Reference Lab (Harbin Veterinary Research Institute). Yu Yedong, Director of the Guangdong VCEPC, told us that these reagent standards and test methods comply with guidelines set by the International Organization for Animal Health (OIE). As of November, authorities tested 108,000 poultry serum samples and 19,000 swab samples in 2007 alone. In addition, 13 batches of 'surprise' poultry checks have been conducted to ensure that poultry producers are in compliance with vaccination regulations and that vaccination records are accurate. -------------- Challenges - Vast Scale and Ducklings -------------- ¶9. (SBU) Guangdong has a large poultry industry and a high poultry-to-human density ratio of approximately 15:1. Of the 1.35 billion poultry produced in 2007, 30-35% of them were raised in rural and remote areas rather than on industrial poultry farms. GUANGZHOU 00000047 003 OF 003 These small-scale farms pose a significant challenge to achieving the "100% vaccination" goal. YU mentioned that an electronic information system similar to the framework of the U.S. National Animal Information System (NAIS) for animal premises registration, identification (including vaccination records),movement and disease tracing, is being considered for poultry. A similar pilot program was just recently initiated for large farm animals, including cattle, pigs, sheep, and goats; it is unclear when the pilot program might be expanded to poultry. ¶10. (U) Successful vaccination among ducks, the source of the September 2007 outbreak, remains a great concern (Ref A). In general, ducks are farm-raised for 40 days before being sold on the market. Sufficient protective antibodies can normally be attained 20 days after vaccination with the current H5N1 vaccine. Ducklings under 20 days of age do not respond with sufficient protective antibodies if given the vaccine too early. Thus, vaccination in ducks remains the weakest link in this program unless an improved vaccine that could mount a much more efficient immune response in ducks can be deployed. GOLDBERG