INFLUENZA PANDEMIC SIMULATION EXERCISE

UNCLAS SECTION 01 OF 02 JAKARTA 000877 SIPDIS SIPDIS SENSITIVE DEPT FOR EAP/MTS, G/AIAG, L/DL, EAP/EX, AND OES/IHA USAID FOR ANE/CLEMENTS AND GH/CARROLL DEPT ALSO PASS TO HHS/WSTEIGER/ABHAT/MSTLOUIS AND HHS/NIH GENEVA FOR WHO/HOHMAN USDA/FAS/OSTA BRANT, ROSENBLUM USDA/APHIS ANNELLI E.O. 12958: N/A TAGS: TBIO EAGR KFLU AMGT PGOV ID SUBJECT: INFLUENZA PANDEMIC SIMULATION EXERCISE ¶1. (SBU) Summary. The Indonesian Ministry of Health (MOH) hosted a three-day pandemic avian influenza simulation exercise in Jembrana Regency, Bali during 25-27 April 2008. The exercise focused on early detection and rapid containment of an epicenter outbreak of Avian Influenza virus with capacity for human-to-human transmission. More than 1,000 participants from various Indonesian government agencies, district as well as local volunteers participated in the event. Simulation activities testing operational plans to contain the outbreak occurred at multiple sites including Dangin Tukaday village, local health centers, and health care facilities. In addition, players simulated activities at Bali's international airport to prevent international spread of disease. End Summary. -------------- MULTISECTORAL EXERCISE -------------- ¶1. (SBU) Led by the Ministry of Health, the simulation activity culminated six months of inter-sectoral planning with representatives from the Ministries of Transportation, Agriculture, People's Welfare, Education, Defense, Police, Port authorities, KOMNAS (National AI Committee),UN organizations, CDC, and other partners. Working groups developed operational plans to contain an outbreak based on Ministry of Health guidelines for epicenter containment. CDC and WHO provided technical support and funding including $500,000 for operational costs provided by CDC and approximately $86,000 for training provided by the government of Japan through WHO. ¶3. (U) Planning for the exercise began in October 2007 and included formation of working groups to develop operational plans for epicenter containment in keys areas including: incident command and control, surveillance, risk communication, quarantine, port control, non-pharmaceutical interventions, medical treatment, mass prophylaxis, and logistics/essential services. The working groups tested these plans in desk-top exercises before the simulation activity. Based on these exercises, teams finalized the plans and developed training materials to orient provincial and district level staff on epicenter containment. -------------- HIGH LEVEL GOVERNMENT INVOLVEMENT -------------- ¶4. (SBU) Several key government officials attended the event including Bayu Krisnamurthi, Head of KOMNAS; Dr. Nyoman Kandun, DG of the Indonesian CDC; Dr. Imansyah, the Surgeon General of the Navy; and Dr. I. Gede Winsasa, Jembrana District Governor. (Note: Winsana is running for Governor of Bali and is known as an advocate for the poor.) During the welcome ceremony, Dr. Nyoman Kandun, the Director General (DG) of Indonesian Centers for Disease Control (CDC),read Minister Supari's welcome speech that included reference to virus sample sharing and Material Transfer Agreement (MTA). -------------- OUTBREAK SKENARIO -------------- ¶5. (U) The outbreak scenario involved human to human transmission of avian influenza in Dangin Tukaday village as well as human to human transmission in Tabanan hospital. Containment guidelines included quarantining of the village; providing hospital staff with mass anti-viral prophylaxis; and providing essential services to the affected populations. Dr. Winasa, as the local level incident commander, played a key role in organizing efforts. There was wide scale involvement of local government officials and community-based organizations in the simulated response. ¶6. (U) The village at the epicenter (Dangin Tukaday) was the site of actual AI fatalities in 2007. Residents of the affected village and the outlining community participated with enthusiasm in the exercise. Three hospitals also participated in the exercise and implemented full measures of epicenter containment. -------------- OBSERVERS VISIT THE FIELD -------------- JAKARTA 00000877 002 OF 002 ¶7. (U) Over 50 international visitors observed the exercise. Key activities included setting up the incident command and control centers and management of patients with avian flu. Visitors also observed surveillance teams deployed to the epicenter, provision of mass antiviral prophylaxis, triage and referral of affected patients, infection control procedures, quarantine of the community and affected households, implementation of non-pharmaceutical interventions such as closing of schools, and culling of poultry. ¶8. (U) Police used wire barricades to block access to the village and implemented decontamination procedures for persons and vehicles going in and out of the containment zone. The government communicated with the public using posters, flyers, person to person outreach, and a patrolling can equipped with a loudspeaker. Workers used personal protective equipment in the containment zone. ¶9. (SBU) Health educators and communication experts staffed a media center using SMS/call/website lines. On day two, Minister Supari announced an epicenter outbreak in Jembrana in a mock press conference. ¶10. (U) On day three of the exercise, activities moved to Bali's international airport. Passengers entering the terminal completed a health questionnaire and passed through a thermal scanner to screen for possible AI. Suspect cases taken to a mobile clinic and monitored. -------------- MEDIA COVERAGE -------------- ¶11. (U) More than 30 local and international news organizations, representing TV, print, radio reported on the simulation exercise. UNICEF will be releasing a video/DVD of the simulation. -------------- LESSONS LEARNED -------------- ¶12. (U) International observers provided technical recommendations to WHO and MOH to help further refine protocols and operational plans. Lessons learned from the exercise are being summarized in a final report that will be shared with the international community. A USAID contractor is assisting the MOH to develop revised epicenter containment guidelines and operational plans (in Bahasa and English) to be shared with the international community. ¶13. (SBU) International observer list: --WHO (Indonesia, SEARO, WPRO, Geneva) --US, CDC (Jakarta, Atlanta) --USAID (Jakarta) --AusAID --Embassy of Japan/JICA --Embassy of Nigeria --Embassy of New Zealand --Embassy of Canada --Government of Laos --Ministry of Health, Egypt HUME