THAILAND HOSTS USG CUTTING EDGE DISEASE PROGRAMS

UNCLAS SECTION 01 OF 04 BANGKOK 000611 SIPDIS DEPARTMENT FOR OES/IHB:JJONES,LMILLER DEPT FOR USAID/GBH USDA FOR FAS AND APHIS HHS FOR CDC USCINCPACLO FOR AFRIMS/WALTER REED ARMY INST. OF RESEARCH E.O. 12958: N/A TAGS: TBIO WHO KPAO KFLU KHIV ECON EAID TH SUBJECT: THAILAND HOSTS USG CUTTING EDGE DISEASE PROGRAMS REF: State 2172 BANGKOK 00000611 001.2 OF 004 ¶1. SUMMARY: With over one-fifth of Mission Bangkok's staff of roughly 2000 working on health issues, the Embassy hosts one of the USG's largest efforts to fight the world's most dangerous diseases: malaria, TB, dengue, HIV/AIDS and avian/pandemic influenza. USAID, HHS/CDC, USDA/APHIS and the Armed Forces Research Institute of Medical Sciences (AFRIMS) collaborate with each other and Thai counterparts, and are platforms for assistance and partnership throughout the region. A number of important breakthroughs, such as in the prevention of HIV/AIDS transmission from mothers to children, were developed here. The agencies supplement their Southeast Asia focus with collaboration in Central and South Asia as well as the Pacific Islands. SE Asia is a critical locale as the birthplace of avian influenza and the most drug-resistant malaria strains; our health agencies with Thai and ASEAN counterparts do everthing from assuring the health of U.S.-bound Burmese refugees to developing malaria treatments and testing of HIV vaccines. ¶2. Thailand and Mission Bangkok collaborate to make a regional health hub of excellence, relying on extensive Embassy management support, excellent infrastructure, good air connections and pro-U.S. attitudes. The relative sophistication of the Thai scientific and medical community makes collaboration as useful to USG research as it is to the Thais themselves. Thailand is emerging as a donor and science collaborator to help other countries as far away as Africa. AFRIMS, CDC, USDA and USAID programs reach a wide range of people, from the military to migrants, refugees and farmers. END SUMMARY. THE THREAT FROM EAST ASIA -------------- ¶3. Many of the infectious diseases that pose critical threats to the U.S. and world have important connections to Southeast Asia. As the birthplace of avian influenza (AI),and bearing the brunt of the outbreaks along with China, SE Asia is the logical focus for research in prevention and treatment. SE Asia has been the locus for emerging strains of drug-resistant malaria pathogens. Multiple-drug resistant strains of tuberculosis (TB) have also emerged here. Other prevalent diseases include HIV/AIDS, hepatitis, diarrheal and respiratory diseases, dengue fever, hand, foot and mouth disease, and Japanese encephalitis. Climate change is also expected to have a particularly harmful effect on the people and ecosystems of SE Asia, coupled with significant mega-urbanization. Research and program development are vital to this region to ensure its economic health as rising temperatures, sea levels, precipitation and drought combine to increase the threats, especially from vector-borne diseases. Thailand is one of the most developed and stable nations in the midst of this infectious disease panorama. WHY BANGKOK IS THE HUB -------------- ¶4. With around one-fifth of the employees at the fourth-largest U.S. mission working on infectious disease and health issues, Bangkok is one of the USG's largest centers to fight the world's most dangerous global health threats. The well-developed embassy management platform, coupled with the excellent infrastructure, air travel infrastructure and connections, and a generally pro-U.S. attitude among the Thai government and populace make Bangkok the ideal USG health hub for Asia. These same advantages make Bangkok the premier conference site in Southeast Asia, possibly in all of East Asia. ¶5. In the past six months there have been major international conferences here on dengue, HIV/AIDS, and other diseases, and Thailand's transportation nexus enables agencies such as USAID to hold NGO and national partner conferences with dozens of institutional participants and representatives of 15 nations. Bangkok is also home to a large number of conferences on topics related to public health such as climate change, air pollution and mega-urbanization; the availability of Bangkok-based USG personnel to participate in these conferences helps both those disciplines and USG/global health partnerships (Reftel). (Note: The airport closures last year certainly affected the conference industry in Thailand, but it has now largely recovered. End Note.) Having agencies grouped here has also facilitated coordination and enhanced cross-agency collaboration on a number of different fronts THAILAND: THE IDEAL U.S. PARTNER BANGKOK 00000611 002.2 OF 004 -------------- ¶6. The relative sophistication of the Thai scientific and medical community makes the primary collaboration with the Thais as useful to USG research as to the Thais. With three kinds of partners, our health agencies cover a range of sophisticated actors in Thailand: NGOs (USAID),the Royal Thai Army Medical Department (AFRIMS); the Ministry of Agriculture (USAID and APHRIMS) and the Ministry of Public Health (CDC). ¶7. Aided considerably by our partnership, Thailand is emerging as a donor and science collaborator in its own right, helping other countries with their health problems. The Royal Thai Government's development agency, TICA, has programs in 27 nations, for example: TICA sends primary health care trainers to Timor Leste and has recently started a multifaceted cooperation project in public health for Pacific Island countries. TICA conducts far flung programs for malaria and HIV/AIDS (Mozambique),and medicine (Cuba). TICA has recently proposed an AI training program, to share its successes in prevention and control with members of the Bay of Bengal Initiative for Multi-Sectoral Technical and Economic Cooperation public health (BIMSEC) and the Organization of Islamic Conference (Thailand is an observer),both of which also cooperate with Thailand on other public health topics. The Thai International Postgraduate Programme reaches over 50 countries with annual training and degree programs; Thailand offers scholarships in public health in cooperation with other donors such as JICA and UN agencies. THE USG RESPONSE: RESEARCH, COLLABORATION AND SUCCESS -------------- -------------- ¶8. The three main health agencies - USAID/RDMA, HHS/Centers for Disease Control (CDC) and the Armed Forces Research Institute of Medical Sciences (AFRIMS) -- collaborate with Thai counterparts as well as operate regional platforms for assistance and partnership. While Southeast Asia is a focal region, the three agencies support other USG programs in Central and South Asia as well as the Pacific Islands. Activities run the gamut of research, treatment, capacity building and cover other diverse subjects such as health screening for U.S.-bound Burmese refugees (CDC); multi-country malaria containment programs and validation of a new TB test (USAID) to the testing of HIV vaccines (AFRIMS). USDA's food safety and animal health programs also contribute to Mission Bangkok's human health efforts. ¶9. The reach of these agencies from India to China and the Pacific Islands gives our agencies in Thailand a unique middle ground between the two Asian nations with the largest health problems and vulnerable populations, as well as important health infrastructures with which to partner. Bangkok-based USG agencies also partner with those UN agencies that use Bangkok as their Asia hub. For example, CDC's Global AIDS Program developed new technical support programs in Laos and Papua New Guinea, working in close partnership with AFRIMS, USAID, and WHO. A short synopsis of a few of the programs follows. USAID -------------- ¶10. USAID's Regional Development Mission - Asia (RDMA) supports with direct and indirect funding over 50 NGOs, other USG agencies, and both national and multinational institutions. RDMA manages health programs for infectious disease and chronic health problems in eleven countries from India to China; some programs are regional, some are bilateral and some are advisory to USAID missions in Asian countries such as Vietnam. RDMA focuses on HIV/AIDS, malaria, TB, dengue and Avian Influenza in the Greater Mekong Subregion. The Asian Collaborative Training Network for Malaria brings together National Malaria Control Programs from 11 malaria-endemic countries in Southeast Asia for staff training and enhancement of a regional information network. RDMA's new Asian Network of Excellence in Quality Assurance of Medicines (ANEQAM) led the effort to identify problematic pharmaceuticals, using Thailand and the Philippines as its centers of excellence and partnering with the WHO and the United States Pharmacopeia, the official standards-setting authority for all medicines sold in the U.S. that also has a regional office in Bangkok. ¶11. The USAID Avian Influenza program develops prevention and control (for bird and human health) in the Mekong Region, China, Bangladesh, India and Nepal. HIV/AIDS prevention and care programs BANGKOK 00000611 003.2 OF 004 target Laos and Thailand. USAID supports key treatment facilities such as the Mercy Center, visited by President Bush in 2008, for education and home-based care to AIDS victims in low-income communities. RDMA has played a key role in the USG health and other responses to Cyclone Nargis as well as the health problems among Burmese refugees, where there is a danger that AI and other diseases could take root. The TB program among that group resulted in a new Multi-resistant TB diagnostic test. HHS/CENTERS FOR DISEASE CONTROL -------------- ¶12. In the past ten years, the CDC Office in Thailand has nearly doubled in size to almost 200 employees; currently almost all of CDC's direct-hire staff have regional responsibilities. CDC assures the quality of health screening for all U.S. -bound refugees and immigrants from the region. CDC conducts collaborative research with the Thai Ministry Public Health (MoPH) in areas like evaluating the efficacy of pre-exposure prophylaxis with anti-retroviral therapy to prevent HIV/AIDS in high risk groups such as IV drug users. With assistance from CDC, Thailand has become a model partner demonstrating the success and expandability of multiple HIV programmatic interventions in the quality of HIV care and prevention of prenatal HIV transmission, for example; the first successful drug therapy to prevent mothers from passing the HIV virus to their offspring was developed in a CDC program in Thailand. CDC has documented the risks of mortality among HIV-infected TB patients in Thailand and demonstrated the benefits of early antiretroviral therapy. ¶13. CDC's support for the Thai Field Epidemiology Training Program recently helped launch an electronic journal for regional outbreaks and helped sponsor "TIGER," a regional collaboration of Mekong Basin countries aimed at strengthening the detection and control outbreaks. CDC has also been heavily involved in helping Thailand develop a pandemic and all-hazards preparedness plan, and in strengthening surveillance and diagnostic capacity for severe respiratory illnesses. These successes have helped Thailand help other nations. For example, CDC's Global AIDS Program, working with AFRIMS, USAID and WHO developed new technical support programs in Laos and Papua New Guinea, to complement the already existing USAID HIV programs in those two countries. ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES -------------- -------------- 14. Over 50 years ago the U.S. Army identified the Royal Thai Army Medical Department (RTAMD) as the ideal medical collaborator in the region and Thailand the ideal site for its research. What is now the Armed Forces Research Institute of Medical Sciences - U.S. Army Medical Component (AFRIMS-USAMC) works in militarily-relevant infectious disease research, including conducting disease surveillance, and evaluating and testing new drugs, vaccines, and diagnostic procedures. AFRIMS now has around 470 employees and contractors. Beyond its in-house research on diseases of military importance to directly benefit U.S. servicemen, AFRIMS conducts collaborative research with Thai and international partners on HIV/AIDS, malaria, dengue, Japanese encephalitis, scrub typhus and other rickettsioses, diarrheal and respiratory diseases, and HIV/AIDS. Partner nations include Cambodia, Bhutan, Nepal, Philippines and Vietnam. AFRIMS has had a renowned HIV research program but its most striking achievement is its HIV vaccine development program, started in 1991. AFRIMS is currently testing a new HIV vaccine in a Phase III efficacy trial. AFRIMS-USAMC assists the RTAMD with health surveillance in several Thai border regions and for the large number of UN peacekeeping forces that Thailand provides around the world. USDA -------------- ¶15. The United States Department of Agriculture (USDA) contributes to human health in several ways, with the Foreign Agriculture Service (FAS) and Animal and Plant Health Inspection Service (APHIS) regional offices in Bangkok working in food safety. APHIS veterinarians also play a key role building capacity to combat Avian Influenza (AI),as nearly all human AI cases have been attributed to direct contact with infected birds. APHIS Bangkok oversees offices in Burma, Cambodia, Indonesia, and Laos, and has supported activities in other nations such as Vietnam and the Philippines. APHIS collaborates with the other USG agencies, the various host governments, and international organizations to provide prevention BANGKOK 00000611 004.2 OF 004 and control activities. Programs include: developing regulatory frameworks; field investigation; outbreak response; wildlife surveillance; epidemiology research; laboratory diagnosis; vaccination; compensation for producers; managing live bird markets; and information management. As these capacity building activities apply to general animal health programs, the APHIS promotion of international standards for animal health activities have led to sustained improvement in general animal health, food security and economic infrastructure in addition to an important public health service. COMMENT -------------- ¶16. The number of health professionals at Mission Bangkok is no surprise when one considers the near-ideal environment Thailand provides. Thailand is a solid ally with the infrastructure, capacity and attitude to make USG collaboration a plus for both countries, and a tremendous asset globally in the effort to fight infectious disease. At the same time, Mission Bangkok's infectious disease collaboration is one of the best agents for creating a positive impression of the United States in this region of the world. JOHN