U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION (U. S.

UNCLAS SECTION 01 OF 03 BEIJING 002814 HHS PASS TO MONOHAN AND MILLER CDC ATLANTA FOR COGH, AND PASS TO BLOUNT, KELLY, DOWELL, COX, SIMONE AND PINNER AMEMBASSY GUATEMALA CITY FOR CDC AND PASS TO DANEL AND SCHOMOYER AMEMBASSY NAIROBI FOR CDC AND PASS TO DECOCK, WHEELER AND BREIMAN AMEMBASSY CAIRO FOR CDC AND PASS TO DUEGER AMEMBASSY BANGKOK FOR CDC AND PASS TO MALISON, CHONG AND MALONEY USOFFICE ALMATY FOR CDC AND PASS TO MORAN STATE FOR EAP/CM, OES/PCI, AND OES/IHB SENSITIVE SIPDIS TAGS: PREL SENV TBIO SOCI CH GT KE EG TH KZ SUBJECT: U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION (U. S. CDC) ENHANCES EMERGING INFECTIOUS DISEASE INVESTIGATION, RESPONSE AND CONTROL IN CHINA BEIJING 00002814 001.2 OF 003 ¶1. (SBU) Summary: In mid-September, a request for technical consultation by U.S. Centers for Disease Control and Prevention (U.S. CDC),and U.S. Department of Health and Human Services (U.S. HHS) experts working in China on 2009 pandemic influenza A (H1N1) was made by Dr. WANG Yu, Director of the Chinese Center for Disease Control and Prevention (China CDC). This request exemplifies the strong and trusted relationship between China and U.S. public health agencies at the critical beginning of an influenza season with heightened global concern. This cable outlines the public health capacities U.S. HHS/CDC has enhanced in China to help address current global health threats. In order to continue the successful partnership between U.S. and China's public health agencies, attendance at the next U.S. HHS and MoH Collaborative Committee Meeting of the China-US Collaborative Program on Emerging and Re-emerging Infectious Diseases (EID) currently proposed in early December 2009 (see paragraph 5) is crucial. ¶2. (SBU) On 22 September 2009, more than 20 U.S. Centers for Disease Control and Prevention (CDC),U.S. Department of Health and Human Services (U.S. HHS),and the Chinese Center for Disease Control and Prevention (China CDC) experts met with Dr. WANG and outlined a critical plan to address short-term emergent issues, such as methods to improve detection of 2009 pandemic influenza A (H1N1) cases in the upcoming months, and launching an agenda for neglected public health problems, including obesity and chronic disease. ¶3. (U) The Global Disease Detection (GDD) program, funded by Congress in 2004, works to protect the health of Americans and the global community from the spread of emerging infectious disease threats by collectively building a global network of public health assets in support of the World Health Organization's (WHO) International Health Regulations (IHR). The GDD program is working to close the critical gap between global public health capacity and the ability of many member states to meet their requirements as stated in the IHR. GDD unites the resources of the U.S. and its international partners to provide technical assistance, logistical support, and funding through regional networks and intergovernmental organizations. ¶4. (U) The GDD center in China is the U.S. CDC component of the China-U.S. Collaborative Program on Emerging and Re-emerging Infectious Diseases (EID),created under the terms of a comprehensive Memorandum of Understanding (MoU) between the U.S. HHS and the Chinese Ministry of Health (MoH) signed in 2005. EID includes coordinated U.S. programs from CDC, the National Institutes of Health, and the Food and Drug Administration. ¶5. (SBU) U.S. CDC experts in China represent a critical node of CDC's GDD network, and serve as the crucial pipeline between U.S. CDC and China CDC to rapidly share information and expertise to face key public health issues, such as the expected surge of 2009 pandemic influenza A (H1N1) cases this winter. According to the MoU, a Collaborative Committee Meeting of U.S. HHS and China CDC should meet annually to steer this cooperative team. The China side is headed by a representative of China Ministry of Health (China MoH) and the U.S. side is headed by an American based representative of HHS. The last meeting was on May 10, 2008 in Beijing and the U.S. side was led by Dr William Steiger, former Special Assistant to the Secretary for International Affairs. It is necessary to identify who will head the U.S side and convene the Collaborative Committee Meeting which is currently proposed for early December 2009, particularly in the midst of a worldwide pandemic. INFECTIOUS DISEASES ARE NO LONGER A LOCAL PROBLEM BEIJING 00002814 002.2 OF 003 ¶6. (U) With the advent and proliferation of worldwide air travel, infectious diseases can no longer be considered problems local to one area or country. One of the most prominent examples occurred in 2003, when Severe Acute Respiratory Syndrome, or SARS, spread quickly from southern China throughout China, Asia, Europe and North America. Another well known example is avian influenza A (H5N1), where infected migratory wild birds fly across multiple continents, and transmit avian influenza A (H5N1) to susceptible domestic birds, which have then infected humans in multiple countries. ¶7. (U) Similar to the multi-pronged approach to combat infectious public health threats in the U.S. such as 2009 pandemic influenza A (H1N1),GDD works directly with Chinese counterparts to confront disease in China on multiple fronts. Through its influenza supported work, GDD and U.S. CDC Influenza Division provide crucial technical assistance on influenza detection and control, and give critical support for the national influenza surveillance system. Because China CDC needs strong epidemiologic expertise, GDD helps build epidemiological capacity through the Field Epidemiology Training Program (FETP) which helps train future public health leaders in China. To detect new and emerging diseases such as SARS, GDD assists counterparts to build surveillance and laboratory capacity through the International Emerging Infections Program (IEIP) to monitor many organisms, including those that cause diarrhea and pneumonia. To support Chinese authorities to properly implement public health recommended education and behavior change, GDD provides health communications expertise through the Health Communications Program. Examples are implementing hand washing and cough etiquette guidance to the public and communicating evidence-based public health research findings to key decision makers responsible for determining health policy. GDD IN CHINA PRODUCES TANGIBLE RESULTS ¶8. (U) GDD has helped the China CDC build capacity. Since 2004, GDD's FETP has trained more than 100 new epidemiologists to investigate outbreaks and serve as public health leaders in China. GDD's IEIP has helped establish salmonella surveillance in eight provinces and trained provincial laboratory technicians on capacity building and quality management. GDD and the U.S. CDC's Influenza Program have worked with partners to create protocols for prevention, detection, preparation and control of pandemic influenza, and provided methods to determine drug resistance in circulating strains. ¶9. (U) GDD has participated in Chinese investigations of disease outbreaks and epidemiological research in China. Outbreak investigation is critical to detecting and controlling emerging and re-emerging diseases. GDD's FETP staff along with FETP trainees have helped investigate outbreaks of acute disease ranging from plague pneumonia transmitted from dogs in Qinghai province, to cholera in Hainan province. To begin to understand the extent of any disease or the impact of any intervention in China, epidemiological research must be done. Due to poor infection control practices in China, GDD's IEIP and the National Center for Tuberculosis Control and Prevention have sought to determine the number of healthcare workers infected with tuberculosis (TB) in highly drug-resistant TB areas. In addition, GDD's Influenza Program and Chinese experts have developed models that will be necessary to determine the true, and not just reported, number of deaths due to influenza during a pandemic. ¶10. (U) GDD's activities have resulted in crucial positive guideline and policy changes, which are critical to sustainably BEIJING 00002814 003.2 OF 003 prevent illness and control disease. GDD and the U.S. CDC's Influenza Division have developed clinical guidelines for treatment of avian influenza cases. GDD's IEIP, Influenza Division and Health Communications Program have helped develop a respiratory infection control curriculum, which has been adapted by the MoH. Recently, the MoH decided to disseminate this curriculum nationwide using its own funds and mechanisms. GDD's IEIP has helped shape national TB treatment guidelines, which have now been ratified and are being disseminated this year. EQUALLY IMPORTANT, GDD IN CHINA PRODUCES INTANGIBLE RESULTS ¶11. (U) Health diplomacy has been established. In addition to the high-level commitment between U.S. HHS and MoH, prior Collaborative Committee Meetings of U.S. HHS, U.S. CDC, MoH, and China CDC staffs have engendered cooperation on multiple projects. Day-to-day work and interactions between U.S. CDC and China CDC have created opportunities for dialogue about multiple other issues, including food safety and implementing WHO's International Health Regulations, which are pressing issues for China. ¶12. (U) Partners have been created. Multiple long-term high level exchanges of staff have occurred, including an eight-month exchange of key emerging infectious disease staff from China CDC to U.S. CDC, which helped not only to foster understanding between the two agencies, but also to advance China CDC appreciation of the need to use evidence to establish health policy and practices. Furthermore, multiple meetings of project collaborators each week promote rapid exchange of information and expertise. Epidemiological partnerships have also been created through co-authorship on scientific papers. ¶13. (U) Joint collaborations continue. Multiple joint trainings, workshops, and meetings have been convened, and U.S. CDC experts consult regularly on influenza, salmonella, pneumonia, and other public health issues.