H1N1 Vaccine development in Thailand

UNCLAS SECTION 01 OF 02 BANGKOK 001966

SIPDIS
SENSITIVE

DEPARTMENT FOR OES/IHB:JJONES,CPATTERSON; EAP FOR DHANNEMAN
DEPT FOR USAID/GBH
USDA FOR FAS AND APHIS
HHS FOR CDC
USCINCPACLO FOR AFRIMS

E.O. 12958: N/A
TAGS: KFLU AEMR ASEC CASC TBIO KSAF KPAO PREL PINR AMGT
MG, ECON, EAID, WHO, EAGR, ETRD, TH
SUBJECT: H1N1 Vaccine development in Thailand

REF: BANGKOK 01359

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SENSITIVE BUT UNCLASSIFIED


1. (SBU) SUMMARY: Thailand's Government Pharmaceutical Organization
(GPO) is moving ahead with its program to produce H1N1 vaccines
later this year. H1N1 continues to make headline news with the
country's first prenatal infection, 81 deaths, over 10,000 cases and
as many as 500,000 suspected cases. The Ministry of Public Health
(MoPH) has stopped updating H1N1 case data on a daily basis. The
MoPH is distributing Tamiflu without charge to reach more of those
in need, but many private clinics are not joining in the effort.
The U.S. agencies CDC and AFRIMS co-hosted with the MoPH a
conference on Zoonotic and Vector-Borne Diseases. END SUMMARY.

THAILAND VACCINE PRODUCTION
--------------

2. (SBU) Thailand is moving ahead with H1N1 nasal vaccine production
plans, which could place it as one of the first nations to produce
an H1N1 vaccine. The World Health Organization (WHO) granted a
sublicense agreement to Thailand's GPO to access Russian technology
and use seed virus to produce live attenuated influenza vaccine.
Thailand plans to start a phase I-II vaccine trial in early
September. The two-part trial will take an estimated 90 days to
complete. The first part will assess the safety-tolerability and
optimal immune response of the newly manufactured PLAIV candidate
strain. The second part will use the suitable dose obtained from
part A and study the safety and efficacy of the vaccine. In
December GPO plans to submit the vaccine to FDA for final approval
after which vaccinations will begin. (Reftel)


3. (SBU) There is also a separate initiative from the WHO/GPO live
attenuated influenza virus (LAIV) project in which Thailand's
biotechnology agency BIOTEC is supporting Dr. Prasert Urworakul of
Siriraj Hospital to prepare pandemic influenza vaccine seeds as part
of Thailand's self reliance objective. They have succeeded in
producing seed viruses but have not yet tested for safety or
efficacy. (Note: the WHO/GPO LAIV project uses seed strains from
Russia that have already been well tested. End Note.)

H1N1 MAKES HEADLINE NEWS
--------------

4. (U) H1N1 news continues to make headlines. Press news about the
decline in tourism has been widely reported and one of the concerns
sited is the outbreak of H1N1. The increased risk to pregnant women
made front page news in Thailand recently when the country's first
confirmed case of pre-natal H1N1 infection was announced. The baby
fully recovered but the mother died. Details about the case were
sent to the WHO for further examination. In an effort to avoid
public frenzy the MoPH, which publicizes the number of confirmed
cases, has announced it will only release information on confirmed
cases once a week instead of daily. To date there have been 10,045
confirmed infections and 81 deaths, although MoPH estimates that
over 500,000 may have contracted H1N1 in Thailand. (Note:
Thailand's reported data indicate a disease spread greater than in
neighboring countries, but it is not clear whether that results from
a larger epidemic, or from a more well-developed reporting system.)



5. (U) MoPH officials have announced that the rate of transmission
is declining though they note that the data is showing more cases in
rural areas and fewer in Bangkok. Over 60 percent of deaths have
been from patients that suffered from underlying issues such as
heart, liver and lung diseases; many of the people who have died
were also late in seeking medical treatment. Health volunteers are
visiting households across the country to educate families about the
disease and ways to protect themselves from being infected.


6. (U) The MoPH is providing state and private clinics with free
anti-viral Oseltamivir phosphate (the generic form of Tamiflu) to
give to flu patients. The Government Pharmaceutical Organization
(GPO),which manufactures Tamiflu, has enough to treat 10 percent of
the population. GPO is currently producing 20 million tablets and
will import raw materials to produce 40 million more. The GPO

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produces Tamiflu at a cost of approximately $0.75 per tablet. The
MoPH hopes that the free distribution of antiviral drug will prevent
delayed treatment of patients with severe flu cases. Clinics will
receive 50 tablets of Tamiflu, enough to treat five people. Only
doctors at clinics will be allowed to prescribe the antiviral drug
and all patients treated with Tamiflu must be closely monitored.
The Ministry of Public Health has so far found that few clinics
nationwide have agreed to participate in this free distribution
because they do not want to shoulder the burden of monitoring. In
particular, specialized clinics providing medical care for pregnancy
and chronic diseases are not participating in this project for fear
that their patients, who are in high-risk categories, may contract
the virus from flu patients who would come to the clinic for the
free antiviral drugs.

U.S. AND THAI ZOONOTIC AND VECTOR-BORNE DISEASES
-------------- ---

7. (SBU) The Armed Forces Research Institute of Medical Sciences
(AFRIMS) and U.S. Centers for Disease Control and Prevention (CDC)
held the first scientific conference on "Zoonotic and Vector-Borne
Diseases" on June 25-56, 2009 in Bangkok, Thailand. Ambassador John
presided over the opening ceremony. Partnering for this seminal
event on Zoonotic and Vector-Borne Diseases were Major General
Krisada, Director General, AFRIMS; COL James W. Boles, Commander
US-AFRIMS; Dr. Michael Malison, Director, Thailand MOPH - U.S. CDC
Collaboration (TUC) and US CDC Regional Office in Thailand; and Dr.
Susan Maloney, Director International Emerging Infections Program
(IEIP) and Global Disease Detection (GDD) Center, TUC, US CDC
Regional Office.


8. (SBU) Initial reviews of the conference were positive.
Approximately 170 public health scientists from Thailand and the
Asia-Pacific region joined this inaugural scientific conference to
share scientific information on emerging and reemerging infectious
diseases which currently pose public health threats to the region.
In addition to updating their knowledge on regionally important
diseases such as dengue, influenza, malaria, and chikungunya,
participants also learned about national and regional partners and
activities, and discussed ways to foster research collaborations and
programmatic networking.


9. (U) AFRIMS in Bangkok is producing a bimonthly report on
influenza surveillance. It contains summarized influenza testing
results from samples collected in the region. The information is
sent to stakeholders within South and Southeast Asia region that
work on influenza in order to highlight global influenza activity.

PRESS BRIEFING ON H1N1
--------------

10. (SBU) On July 22 the Ministry of Public Health held a Press
Briefing on H1N1 status update. Dr. Michael Malison, the Director of
TUC and the CDC Regional Office in Thailand, updated the media on
current H1N1 status in the United States. Dr. Malison also took the
opportunity to commend the Ministry of Public Health on their
efforts to contain the outbreak, reduce transmission and minimize
mortality in high risk groups. Thailand has proven itself as a
leader on H1N1 vaccine development. Experts agreed that Thailand
will become a regional vaccine production center in the near future.



11. (U) POC is regional/bilateral ESTH officer Hal Howard,
howardhh@state.gov.

COMMENT:
--------------

12. (SBU) While Thailand is expected to become an important regional
vaccine production center in the future, Post believes that the
timeline Thailand's health officials are asserting is overly
ambitious.

JOHN