Russia's Chief Medical Officer Wants to Expand Cooperation

UNCLAS SECTION 01 OF 06 MOSCOW 003072 SENSITIVE SIPDIS DEPT FOR EUR/RUS, EUR/PGI, OES/PCI, OES/IHB OES/FO FOR CARTER-FOSTER USAID FOR GH, E&E HHS FOR OGHA HHS PLEASE PASS TO NIH AND FDA STATE PLEASE PASS TO NAS USDA FOR FAS/OSTA FOR MACKE E.O. 12958: N/A TAGS: TBIO PREL EAID SOCI KHIV TSPL ETRD EAGR ECON PARM KCRM, RS SUBJECT: Russia's Chief Medical Officer Wants to Expand Cooperation MOSCOW 00003072 001.2 OF 006 SENSITIVE BUT UNCLASSIFIED -- PLEASE PROTECT ACCORDINGLY. ¶1. (SBU) SUMMARY: On December 15, Ambassador Beyrle met with Dr. Gennadiy Onishchenko, Russia's Chief Medical Officer and Director of the Russian Federal Service for Supervision in the Sphere of Consumer Protection and Human Well-Being (Rospotrebnadzor). The almost 90-minute meeting was cordial and positive, with expressions of praise by Onishchenko for U.S. assistance, the activities of the Centers for Disease Control (CDC),the National Institutes of Health (NIH),and the U.S. Agency for International Development (USAID). Onishchenko several times expressed interest in expanded cooperation. Although he categorically opposed Department of Defense access to Virology and Biotechnology Center "Vector," he was open to working with civilian agencies, particularly on Vector's application to the World Health Organization to become a regional influenza collaborating center. He agreed to study the scientific materials presented on the use of chlorine in poultry processing and said that if U.S. representatives come to discuss the issue, we could reach a "mutually acceptable" solution. End Summary. HIV/AIDS: PRAISES NIH/OAR, CDC, USAID; LET'S DISCUSS METHADONE -------------- ¶2. (SBU) Onishchenko opened the meeting by thanking Ambassador Beyrle at length for U.S. government work in co-organizing the October 2009 U.S.-Russia Workshop on HIV Prevention Science, convened in connection with the Third Eastern Europe-Central Asia AIDS Conference. Emphasizing the "extreme importance" of the conference for Russia, he said that U.S. assistance in setting the agenda and selecting scientists helped make it so successful. Working together so closely on preparations for the three regional conferences held since the 2006 St. Petersburg G-8 summit has helped Russia advance its HIV programs, which now provide ARVs to over 60,000 people. He intends to send "thank you" letters to Dr. Whitescarver, Director of the Office of AIDS Research at NIH, and to the Ambassador. He commented that in particular, scientists were very positive about the conference, adding that after such a long period of relatively weak scientific contact, it was good to have such a large number of Russian and U.S. scientists working together. (Note: The U.S. delegation included over 150 scientists. End note.) Onishchenko then recalled the regular and effective bilateral interaction in the Health Committee under the Gore-Chernomyrdin Commission, which gave many new ideas for fruitful cooperation. Reflecting on the several years during the Bush administration when U.S.-Russia health contacts were more distant, Onishchenko said that he took heart in the fact that relations are now being restored and we can now enjoy more frequent and regular contact under the new Health Working Group under the Bilateral Presidential Commission. ¶3. (SBU) Agreeing that it is useful to have structures for cooperation, Ambassador Beyrle highlighted the "great promise" of the Health Working Group because of the many concrete results of our health cooperation. Explaining that he sees our HIV/AIDS cooperation as a model, Ambassador Beyrle said he hoped we could expand HIV/AIDS cooperation, particularly programs for the most vulnerable. He noted that in addition to new cooperation with NIH on AIDS prevention science research, USAID is expecting continued funding and a new HIV prevention project, which was developed in collaboration with Rospotrebnadzor. Once USAID has completed the necessary bureaucratic formalities, it will contact Rospotrebnadzor to establish routine working arrangements to advance cooperation. MOSCOW 00003072 002.2 OF 006 CDC's HIV surveillance is also very important. Onishchenko called U.S. experience on HIV/AIDS "extremely interesting" for Russia, and stated that cooperation with USAID and CDC should "absolutely" continue. ¶4. (SBU) Thanking the Ambassador for personally attending the Regional Conference and making one of the speeches at the opening plenary, Onishchenko turned to the topic of the use of methadone in medication-assisted therapy for injecting drug users as a means of preventing the spread of AIDS. (Note: This topic was one of the more heated issues discussed at the conference.) Onishchenko reiterated his often-stated conviction that using methadone as treatment is tantamount to legalizing of addictive narcotics. Russia does not support this approach and has "its own methods" for treatment of drug dependency. Onishchenko declared that he often uses the argument that there must still be concern in the United States because the federal government has not approved methadone's use, only some states. (Note: The federal government has had guidelines for several decades on methadone's use as treatment. Onishchenko could be confused because Medicaid funding for methadone is on a state-by-state basis, with some states including payment for methadone and others not. We will try to clarify this with Onishchenko when the opportunity arises. End note.) However, he stated that methadone should be an acceptable subject in a discussion of international best practices. He then said that he would welcome data about the results of methadone's use and would welcome the opportunity to engage with the international experts. The Ambassador said we would be pleased to get Onishchenko more information on the results of methadone. (Note: To follow up on this, USAID will work with the Substance Abuse and Mental Health Services Administration at HHS to collect the data. End note.) ¶5. (SBU) Onishchenko was also positive about needle exchange programs, saying that they were proving effective. He strongly endorsed civil society involvement in battling AIDS, saying that while civil society is not well developed in Russia, its engagement is "absolutely essential." Peer counseling is useful. Recalling the "ABC" policies (Abstinence, Being faithful and Condom use as appropriate) of the Bush Administration in AIDS prevention, he said that such a policy has an important role to play -- with children in school, for example. However, for AIDS-infected adults, something more is needed to address both the medical and psychological aspects of HIV, particularly within the drug user population. Stigma and discrimination are major problems and could be an area of joint work with the United States, which has a lot of experience in addressing this issue. Noting the effectiveness of celebrities such as Anna Kournikova in reducing stigma, the Ambassador called her visit an example of a useful communication channel. Onishchenko noted that even in the area of stigma, Russia is making progress. Russians are starting to adopt HIV-positive children, which was unheard-of only several years ago. INFLUENZA: THANKS FOR HELP ON H1N1; WANT CLOSER COOPERATION -------------- ¶6. (SBU) Continuing his praise of U.S. cooperation, Onishchenko said U.S. help was much appreciated during H1N1 influenza outbreak in April 2009. He particularly appreciated that CDC expeditiously provided strains of the virus for study in Russian labs, and later the vaccine strains that Russia used to develop its four vaccines. He stressed that it was particularly productive and encouraging to be able to cooperate with the native Russian-speaking experts at MOSCOW 00003072 003.2 OF 006 CDC; this helped get past roadblocks such as the usual "ritual dances of diplomats" and political rhetoric to achieve practical successes. ¶7. (SBU) Onishchenko urged that the U.S. and Russia need to cooperate more closely on influenza. He asked for U.S. support for Russia's plan to make the Virology and Biotechnology Center "Vector" near Novosibirsk the fifth WHO Regional Collaborating Center (CC) for influenza. (Note: After the CCs in the U.S. (CDC, Atlanta), UK, Japan, and Australia. End note.) He said that Vector is now well-equipped and he could "guarantee" professionalism and skills of scientists working there. Sooner or later, he said, a major pandemic will appear, and we need to be prepared. This is particularly troublesome in the post-Soviet space, where Russia and Kazakhstan share a long and porous border. He noted that he particularly regrets the lack of Russian-U.S. activities in the CIS to prevent infectious diseases. China could also be a source for the spread of many infectious diseases. Emphasizing that pandemic preparedness would be a good area for bilateral cooperation, he recalled the discussion he had on this topic with Senator Lugar, whom he called a straightforward, solid professional. (Note: During Russia's G-8 Presidency in 2006, Onishchenko proposed that Vector become a full-scope WHO CC on Influenza. Although Russia applied for this status soon thereafter, WHO only awarded Vector the status of an H5N1 (avian influenza) CC in June 2009. WHO regional influenza CCs are expected to share flu strains and provide access to visiting foreign scientists. However, we have heard that Vector is still not very active in sharing strains. Vector regularly denies access to U.S. officials and we understand that Vector also denied access to visitors from China and Kazakhstan who came on a recent H5N1-related visit. The only visit Vector allowed recently was from the WHO smallpox team. In addition to Vector's lack of openness, there are remaining questions about its expertise in epidemiology. As a virology/molecular biology research institution, Vector has had limited experience with human influenza. Vector reports to Rospotrebnadzor, unlike Russia's two premier influenza institutes, the Influenza Institute in St. Petersburg and the Ivanovskiy Institute of Virology in Moscow, both of which are WHO influenza CCs for Russia and report to the Russian Academy of Medical Sciences. Both of these institutes have decades of experience in influenza surveillance and both have made it clear to professional counterparts their negative view of Onischenko's desire to turn Vector into the regional WHO influenza CC. End note.) CONCLUDE A COOPERATION AGREEMENT WITH CDC -------------- ¶8. (SBU) Returning to the subject of cooperation with CDC, Ambassador Beyrle recalled that during Onishchenko's June 2008 visit to CDC in Atlanta, both sides discussed creating a bilateral working group on infectious diseases. The Ambassador relayed that CDC is interested in continuing those discussions and asked what Onishchenko's highest priorities are for cooperation. Commented on how "strange" it is that a professional institution like CDC is led by political appointees, Onishchenko recalled that after his visit for meetings with CDC's previous leadership, he received the U.S. side's suggestions to the Rospotrebnadzor-produced draft cooperation agreement. But then the U.S. elections came, and the draft "expired" with the coming of CDC's new leadership. He said it would be "appropriate" to renew those talks and conclude an agreement to exchange specialists, share knowledge, and hold conferences. Ambassador Beyrle said that we could invite CDC to send experts to Moscow in early 2010 to resume those talks. MOSCOW 00003072 004.2 OF 006 ¶9. (SBU) Note: We do not recall any actual draft agreement. However, Onishchenko's exchange of letters with then CDC Director Dr.Gerberding outline the following areas of interest: actions to advance the Declaration on Cooperation in Infectious Diseases Prevention, adopted at the G-8 summit in St. Petersburg in 2006; measures to prevent the spread of avian influenza and collaboration in the framework of activities of the WHO influenza collaborating centers; timely response to emergency situations with sanitary epidemiological implications, including training programs for experts working in this area; improving epidemiological surveillance, prevention and control of HIV while taking into account the prospects of development of an HIV vaccine; implementing International Health Regulations and exchange of best practices; implementation of WHO resolutions on smallpox in preparation for the World Health Assembly in 2010; and tuberculosis prevention and control. Each time the Ambassador tried to propose a CDC visit or ask about priorities for cooperation with CDC, Onishchenko returned to the topic of an agreement. To move forward, it may be helpful for CDC to develop a very simple letter of intent that CDC intends to develop a joint working group with Rospotrebandzor (and possibly Ministry of Health and Social Development). We would share this with Rospotrebnadzor (and possibly MOHSD) prior to the visit, noting that CDC plans to explore specific areas for collaboration during the visit. End note. SMALLPOX AND ANTHRAX COOPERATION; U.S. POSITION ON BWC? -------------- -------------- ¶10. (SBU) Onishchenko reflected that the United States and Russia share the burden and joint responsibility for working with WHO to safeguard our repositories of smallpox. U.S.-Russian cooperation on smallpox research in the wake of 9/11 had been critical in stemming the fear of terrorism at that time. He remembered the visit of Glenn Schweitzer and David Franz of the National Academy of Sciences in March 2009 and their dialog on anthrax. Their tremendous experience and authority allowed them to have a frank discussion with him on the need for joint work, "since working alone, you can fall into the void." They were persuasive that the risk of the "human factor" in securing biomaterials cannot ever be discounted. For this reason, Onishchenko agreed that continuing cooperation on counterterrorism would also be "appropriate." We could, for example, work together under the Convention on Biological Weapons. He was interested in the position of the new U.S. administration on biological weapons convention that is "rotting" in Geneva, which he noted, unlike other conventions on WMD, does not have an enforcement mechanism. (Note: Post has seen Under-Secretary Tauscher's remarks that the Obama administration will not seek to revive negotiations on a verification protocol to the BWC because a legally binding protocol would not achieve meaningful verification or greater security since it is extraordinarily difficult to verify compliance. However, we would appreciate Department's guidance on if/how it would like us to respond to Onishchenko on this topic. End note.) SMOKING PREVENTION: VERY INTERESTED IN U.S. EXPERIENCE -------------- -------------- ¶11. (SBU) The Ambassador noted that when he had discussed the Health Working Group with Deputy Minister of Health and Social Development Skvortsova the previous day, Skvortsova had said she was open to the input of various health agencies and institutes. He expressed hope that Rospotrebnadzor would be an active participant, noting that the current interest matrix included few Rospotrebnadzor MOSCOW 00003072 005.2 OF 006 activities. Onishchenko responded that he would be most interested in U.S. legislation and actions to prevent smoking. He commented that Americans were lucky when the Clinton Administration took office and the "current Secretary of State" took up the cause of battling smoking. The U.S. won its fight against the "fat cats." However, he said, "Russia was not so lucky, because the four biggest U.S. tobacco companies moved into our market and became an enormous force." Now, he said, 400 billion cigarettes are produced every year in Russia even though not a single tobacco plant is grown in Russia. He admired the U.S. and Canadian practice in reducing demand for tobacco products by raising prices through excise taxes. However, he said, the tobacco lobby is very strong in Russia, and these policies are very difficult to pass, as was witnessed by the adoption of tobacco technical regulations, which, according to Onishchenko, are too mild. (Note: There is draft legislation currently circulating in Russia to support anti-smoking measures and consider taxation. End note.) When the Ambassador told a personal story that proved how effective anti-smoking education was in schools, Onishchenko expressed strong interest in the U.S. experience in smoking prevention, including such programs for school children. CHLORINE AND CHICKEN; COOPERATION ON FOOD SAFETY -------------- --- ¶12. (SBU) The Ambassador raised the issue of Russian regulations that threaten to cut off hundreds of millions of dollars in poultry and pork trade between the U.S. and Russia by strictly limiting the amount of chlorine that can be used in poultry processing and insisting on zero tolerance for antibiotics. While our veterinarians continue discussing the science, the Ambassador argued, we should hold off on these bans. Recalling discussions with U.S. experts in November 2008 on moisture content, Onishchenko stated that he had said at that time he was willing to negotiate and had agreed to that the two sides would work over the next year on a step-by-step basis to address the concerns, but the process had stopped. Onishchenko claimed that since 1994, the vast majority of Russian poultry processors have abandoned the use of chlorine and switched over to cold airdrying and vinegar as an antibacterial agent. This, he said, is a more modern, safer, and more effective method. He had met two weeks earlier with a representative from the European Commission, which is also not using chlorine. ¶13. (SBU) The Minister Counselor for Agricultural Affairs emphasized that chlorine processing is effective, and several scientific studies have shown that it has no harmful health effects. He noted that representatives from U.S. industry had travelled to Russia in February/March 2009, but acknowledged that their discussions were focused primarily on moisture content, not chlorine. He explained that two U.S. universities had completed studies on chlorine use in poultry processing in 2009 that concluded that it is safe. It is also cost effective. Onishchenko said he and his experts would examine the scientific studies. He suggested that U.S. poultry producers should come directly to Rospotrebnadzor to discuss the issue. He also asked (perhaps rhetorically) "Why don't you allow your companies to transfer to the newer technology?" Finally he said, "Drag them [the people who understand the science] here by the scruffs of their necks. We'll talk and come to a mutually agreeable solution." When the Ambassador added the Ministry of Health and Social Development (MOHSD) was willing to participate in discussions in the Agriculture Working Group of the Bilateral Presidential Commission on this topic and asked if Rospotrebnadzor would be as well, Onishchenko answered without MOSCOW 00003072 006.2 OF 006 hesitation, "Absolutely. We must cooperate on food safety." NO DOD ACCESS TO VECTOR LAB, EXCEPT TO COMPLETE AUDIT -------------- -------------- ¶14. (SBU) Turning to the issue of access to Vector, the Ambassador said that Onishchenko had written to the International Science and Technology Center that its assistance is no longer required on smallpox projects at Vector. U.S. government inspectors have been repeatedly denied access to Vector to verify the work performed under a $3 million bio-security upgrade project begun in 2006, as required under the project agreement. Onishchenko said that civilian cooperation is perfectly acceptable, as in the case of the two-year project being carried out now under the auspices of the World Health Organization (WHO). (Note: As far as we know, there is no current U.S.-Russian smallpox work. End note) Civilians are more transparent and open, he said. However, as he told the Ambassador's predecessors, if the request is from the Department of Defense, he will never accept it, even if it is from "over the shoulder" of a civilian organization. If access is necessary to complete an audit to fulfill reporting requirements, it can be arranged. DTRA should simply re-submit their access request, and it will be re-examined. (Note: DTRO-M will draft such a request. End note.) ¶15. (SBU) Comment: Most Russians know Onishchenko from his hundreds of press conferences and ceaseless travel all over Russia. Although most respect him for his dedication, hard work, and knowledge, his reputation with the broader public has been tainted by his central role in decisions to ban foreign food products for alleged safety reasons, when the bans were clearly motivated by political concerns. Onishchenko does not have warm relations with MOHSD, to which he is technically subordinate. He is in the midst of a political battle with the MOHSD that may result in a reduced role for Rospotrebnadzor in the area of HIV/AIDS programs and greater role for the MOHSD. Rospotrebnadzor may have already lost about 240 million rubles (apx $8 million) to the MOSHD for HIV/AIDs prevention work in 2010. In the past few months, he has made far fewer public statements on H1N1, with Deputy Minister Skvortsova taking the media spotlight. This was the warmest meeting with Onishchenko that we can remember in the past few years. Despite his political battles with MOHSD, Onishchenko still is very influential and a valuable partner. It is well worth following up on the many openings he provided during this meeting, particularly since many are high priorities for the Health Working Group. BEYRLE