UNCLAS SECTION 01 OF 02 LILONGWE 000316

CDC ALANTA
MILLENNIUM CHALLENGE CORPORATION WASHINGTON DC

SIPDIS

LONDON FOR AF WATCHER PETER LORD

E.O. 12958: N/A
TAGS: KFLU TBIO AEMR CASC KSAF KPAO MI
SUBJECT: MALAWI SWINE FLU RESPONSE: GOOD PLANNING BUT STILL
VULNERABLE


1. Summary: While experience with SARS and preparations for
Avian Influenza (AI) have benefited Malawi by raising
awareness and facilitating relatively advanced planning, the
GOM would face serious challenges in managing an actual H1N1
swine flu outbreak. Limited human capacity and scarce
financial resources present the greatest constraints. End
summary.

Good Planning Puts Malawi Ahead of the Curve
--------------


2. Soon after the H1N1 swine flu outbreak in Mexico, Malawi's
health services began developing a national response. Malawi
had experience in 2003 in mobilizing surveillance in response
to the SARS outbreak and has been able to apply some of that
experience in developing a pandemic response. Work since
2005 on AI has also made national health officials aware of
the implications of pandemic influenza, provided familiarity
with WHO phases, and has led to the development of a basic
planning / response framework and establishment of a standing
committee.


3. On May 5, the GOM convened a meeting of health sector
stakeholders from government and the donor community to work
on a swine flu action plan. With a draft plan and an
associated budget in hand, officials held a follow-up meeting
on May 15 and initiated individual task groups covering
Surveillance, Communications, Diagnosis and Treatment.

** Surveillance planning addressed airport and land border
crossings, including an assessment of quarantine facilities
at the airports and development of standard criteria and case
definitions to support immigration controls.

** Communications work included development of a strategy for
disseminating information in both English and Chichewa
through print and broadcast media. The Communications task
force has put out press releases and fact sheets for health
workers.

** Addressing diagnosis, the GOM activated the national
reference laboratory in Lilongwe for proper sample
collection, and it plans to activate a previously used
courier service to transport samples. The government also
intends to secure the services of two WHO-approved
collaborating laboratories in Kenya and South Africa to
receive and test samples for H1N1. The two laboratories have
since obtained primers from CDC-Atlanta and are now ready to
test samples.

** Hospital sites in Blantyre, Mzuzu and Lilongwe are
designated for managing H1N1 cases, including forward
deployment of sample materials and Tamiflu. Standard
operating procedures, based on AI procedures, have been
developed with the assistance of CDC and WHO. WHO has
brought in 19,096 doses of Tamiflu and the GOM has completed
an expedited registry of the drug, making it legally
available for use in Malawi.

Capacity Limitations Expose Continuing Vulnerability
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4. Despite commendable planning, Malawi's overall
preparedness for a major swine flu outbreak remains suspect.
Lack of resources, both in human capacity and funding,
presents the greatest challenge. Although planning has
been good for surveillance and management at the initial
stages, there is no national response plan should Malawi be
subject to a full blown pandemic. The inability of the
health sector to cope adequately with a cholera outbreak
earlier this year also raises concern. Finally, a high
incidence of HIV/AIDS, poor nutrition, and inadequate health
coverage, particularly in rural areas are examples of factors
that could make a pandemic flu outbreak in Malawi devastating.


5. Inadequate numbers of Personal Protection Equipment is of
particular concern. The MOH has made a specific request to
the USG for 1,000 PPEs.

Comment
--------------


6. Malawi's response to the outbreak of swine flu in Mexico
was gratifyingly swift. It's development of communication
materials, plans for surveillance, testing and treatment, and
structures to channel assistance represent a significant

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accomplishment. Nevertheless, capacity constraints continue
to make Malawi vulnerable to a serious outbreak in the
country or the region. Malawi must make continued efforts to
strengthen its health care system at all levels before it can
be fully prepared to face an outbreak.
BODDE