HEALTH AUTHORITIES MAINTAIN AH1N1 CONTAINMENT

C O N F I D E N T I A L SECTION 01 OF 02 RANGOON 000549

SIPDIS

STATE FOR EAP/MLS, G/AIAG;
PACOM FOR FPA;
USDA FOR FAS/PECAD, FAS/CNMP, FAS/AAD, APHIS;
BANGKOK FOR USAID:JMACARTHUR, APHIS:RTANAKA, REO:HHOWARD

E.O. 12958: DECL: 08/14/2017
TAGS: EAGR EAID AMED PGOV PREL CASC TBIO KFLU BM
SUBJECT: HEALTH AUTHORITIES MAINTAIN AH1N1 CONTAINMENT
STRATEGY

REF: RANGOON 00487

RANGOON 00000549 001.2 OF 002


Classified By: Econoff Marc Porter for Reasons 1.4 (b, d)

Summary
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1. (C) Burmese health authorities continue to rely on a
containment strategy to handle the A/H1N1 pandemic. While
WHO's worldwide guidance recommends a focus on mitigation, a
Burma-based WHO epidemiologist said Burma's containment
policy is not medically contraindicated and stems from fear
of acute cases, the desire for security engendered by the
SARS experience, and inertia among health authorities. WHO
predicts the GOB's containment strategy will be abandoned
once acute cases overwhelm limited local resources. End
summary.

GOB Emphasizing Containment Over Mitigation
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2. (C) Econoff met August 20 with Dr. Silvia Garelli, WHO
epidemiologist, to discuss the GOB's current approach to
A/H1N1. Dr. Garelli said countries choose between
containment (isolation and quarantine) and mitigation
(treatment) when facing a communicable disease outbreak.
While most countries currently acknowledge the spread of
A/H1N1 to be beyond the capacity of containment measures and
are focusing on mitigation, the GOB's Ministry of Health
(MOH) is still pursuing a containment strategy. Burmese
health authorities continue to monitor incoming travelers for
signs of infection and quarantine confirmed cases in Rangoon
hospitals for 10 days. Individuals that have been in close
contact (less than one meter) with confirmed cases are
restricted to their homes and monitored daily for the same
period of time.


3. (C) Dr. Garelli said WHO advised the Ministry of Health
(MOH) on July 16 to shift focus toward mitigation. She
noted, however, that there is nothing inherently wrong with a
continued containment strategy; quarantine, though less
effective in the long run, is an accepted response to
communicable disease. Dr. Garelli characterized WHO's advice
as an attempt to persuade MOH to face the reality of a
disease likely to spread rather than a critique of its
quarantine system.

Fear, Past Experience, and Bureaucracy Reinforce Containment
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4. (C) According to Garelli, the GOB would face difficulty
in implementing a mitigation strategy involving advanced
treatment of serious cases because of the lack of advanced
medical care here. Dr. Garelli suggested the GOB's
recognition of these shortcomings and fear of an
uncontrollable outbreak are prompting the continued reliance
on containment. Dr. Garelli said Burma's SARS experience --
in which Burma imposed strict containment measures and
recorded no SARS cases -- may also reinforce the containment
focus by creating an illusion of protection. Dr. Garelli
said MOH does not act independently and any change in its
policy must be approved by other ministries and the country's
senior leadership -- creating bureaucratic impediments to
policy changes.

Change in Response Will be Forced on Health Authorities
-------------- --------------


5. (C) Dr. Garelli predicted the GOB will eventually

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abandon containment due to medical realities. Once A/H1N1
spreads widely, even the small number of acute cases normally
associated with the disease will swamp the local health
system. Burmese hospitals will not have the capacity to both
treat seriously ill patients and isolate mild cases.


6. (U) To date, MOH has reported 23 confirmed cases of
A/H1N1, and no resulting fatalities in Burma. An American
citizen -- a student attending a Rangoon international school
who recently returned from vacation abroad -- is among the
latest confirmed cases.
VAJDA