Russia's Chief Medical Officer Wants to Expand Cooperation

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KCRM, RS

SUBJECT: Russia's Chief Medical Officer Wants to Expand Cooperation

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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.

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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

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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.

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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

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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

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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