HONG KONG: H1N1 LESSONS LEARNED

UNCLAS SECTION 01 OF 02 HONG KONG 001066 SIPDIS STATE FOR EAP/CM, OES/IHB AMBASSADOR LOFTIS, CA; HHS PASS CDC, HHS FOR OGHA E.O. 12958: N/A TAGS: KFLU AEMR ASEC CASC KFLO TBIO KSAF KPAO PREL PINR, AMGT, HK SUBJECT: HONG KONG: H1N1 LESSONS LEARNED REF: A. STATE 54435 ¶B. HONG KONG 940 ¶1. Summary. The recent and ongoing H1N1 outbreak has loomed large on the consciousness of the Hong Kong Government (HKG) and its citizens. This issue was especially sensitive in Hong Kong, given the collective memory of the SARS outbreak in 2003. Our task became more difficult when public and media attention focused on the fact that most cases of H1N1 were imported from the United States and that the U.S. Government (USG) was not screening passengers departing from U.S. airports for H1N1. While the net result was a validation of our preparedness for a pandemic event, it is also apparent that Post and the USG need to address several important issues as this public health crisis continues and before the next one develops. On June 11 the HKG announced extensive school closures following confirmation of a cluster of H1N1 cases (Septel). End Summary. Post Management: A Valuable Test of Capabilities -------------- --- ¶2. Post was conducting regular Avian Influenza Working Group (AIWG) meetings long before the H1N1 crisis unfolded, and during the initial stages of the H1N1 outbreak the AIWG met in order to coordinate Post's response to events on the ground. Eventually, the AIWG expanded to include the entire Emergency Action Committee (EAC),bringing all of the members, expertise and capabilities together to address the current outbreak as it unfolded. As part of the ongoing AIWG meetings, Post regularly reviewed the tripwires for a pandemic outbreak, both for relevance and to ensure flexibility and responsiveness. This continuous review and refinement led to the establishment of robust yet flexible tripwires that have remained relevant and useful throughout the whole H1N1 outbreak. ¶3. Post was well prepared for prevention and/or treatment of an outbreak among the staff. The Health Unit stocked adequate personal protective equipment (masks, hand wash, etc. and maintained sufficient supplies of antiviral Tamiflu and Relenza to treat an outbreak among Consulate staff, to include Direct Hire Americans, Eligible Family Members (EFMs) and Locally Employed Staff (LES). Additionally, the Management Section had already established and successfully operated internal communications systems including phone trees, SMS messaging and AIWG work and personal email distribution lists, enabling Consulate leadership to communicate routine and emergency messages in response to changing conditions. ¶4. One issue we identified as an area for improvement was the need to designate a single point of contact for Consulate staff who may be sent into quarantine in the future. In response to this identified need, Post designated the duty officer as the point of contact for all personnel, in order to ensure a rapid response from Consulate leadership in the event of staff involvement in the quarantine. Consular Issues: Amcits ) Handle With Care -------------- ¶5. The HKG's quarantine program affected American citizens from the beginning and continues to impact Americans arriving in Hong Kong and transiting to other destination through Hong Kong. In total, the HKG ordered more than 30 Americans into quarantine, of whom six tested positive for the H1N1 virus. Additionally, dozens were and continue to be placed in medically supervised self-isolation and treatment and prevented from departing Hong Kong. The ACS Unit coordinated with the numerous HKG agencies involved to obtain assistance for the affected Americans for a variety of issues related to their involuntary quarantine or self-isolation. We continue to provide updates and information to affected individuals by telephone, as well as to the larger American community in Hong Kong via warden messages and the consulate website. Public Diplomacy: Responding to Hysteria -------------- ¶6. (SBU) As a result of statements by Hong Kong officials, the Hong Kong media and political groups accused the USG of ¬ doing enough8 to prevent the spread of H1N1. They were particularly critical that the USG was not screening departing passengers from U.S. airports for H1N1. In one unfortunate incident, Hong Kong's Secretary for Health went public with criticisms of the USG's response to the crisis HONG KONG 00001066 002 OF 002 before raising them directly with Post or Washington. Post tried to overcome this negative perception by developing talking points and messaging tailored to demonstrate the positive steps the U.S. federal, state and local governments were taking to prevent the outbreak from spreading. Privately, the Consul General pressed both the Secretary for Health and the Chief Executive on the matter, reiterating steps we were taking to halt the spread of H1N1 and its transmission outside of the United States. ¶7. Once the H1N1 outbreak spread to Hong Kong, the HKG and the public perceived it as an &American8 disease and, as such, we needed to address significant political and public relations issues. We would have benefited from a coordinated effort in Washington to counter this widespread public perception. A quick and coordinated interagency response would have done much to halt the steady stream of negative press and public sentiment surrounding the origins of H1N1 in North America and its spread via U.S. outbound travelers. Interactions with the Hong Kong Government: Hits and Misses -------------- -------------- ¶8. Post had developed an extensive network of contacts at the working level in the HKG who were accessible and able to provide a continuous stream of information about the situation during the outbreak. The statements and actions of policy-level actors in the HKG, however, were more difficult to predict and, without authoritative guidance from Washington, difficult to respond to. U.S. Secretary for Health and Human Services Kathleen Sebelius, meeting with Hong Kong Secretary for Health York Chow on the sidelines of the World Health Organization Assembly in Geneva was an invaluable reinforcement of Post's message about the sustained and positive response the USG was making to contain the spread of H1N1. However, while Secretary Chow went public with his account of the meeting within an hour or two, we have yet to receive any reports from within the USG on what they discussed. ¶9. The HKG asked Post for USG assistance on several occasions, including requests to screen passengers and provide informational and advisory signs at airports for outbound passengers. Post relayed the requests to Washington but did not receive a response. ¶10. The HKG response to the H1N1 outbreak evolved as their understanding grew and as they saw how difficult it was to contain the spread of the disease. As a result, the rhetoric coming both from the HKG and the media has calmed considerably. We continue to cooperate closely with both Hong Kong and Macau, and maintain an active and positive campaign to inform the media and the public about actions the USG is taking to combat H1N1. ¶11. The H1N1 outbreak has been less serious than initially feared and has served as a valuable opportunity for Post and the Hong Kong and Macau Governments to refine plans and procedures for dealing with pandemic outbreaks, as well as to identify areas for closer cooperation. This issue is far from over, however. The HKG announced the first confirmed local transmission of H1N1 in Hong Kong on June 10 (Septel), followed by confirmation on June 11 that 12 students were infected in a cluster of cases at the same school. In response the HKG announced a series of additional steps, including closure of all nurseries, kindergartens and primary schools for two weeks, in an effort to contain this community outbreak. In the face of this ongoing public health crisis, we will continue to build relationships and maintain close lines of communication with our partners in Hong Kong and Macau in order to increase our ability to respond to this and future outbreaks. DONOVAN