H1N1 HIGHLIGHTS TAIWAN'S SHORTCOMINGS IN RISK

C O N F I D E N T I A L SECTION 01 OF 04 TAIPEI 001069

SIPDIS
SENSITIVE

STATE FOR OES/IHA, OES/IHB FOR AMB LOFTIS, HHS FOR MARK
ABDOO, CDC ATLANTA FOR CCID, BANGKOK FOR CDC MALISON,
USDA/FAS FOR OFSO/WAINIO OSTA/HAMILTON, OCRA/BEILLARD

E.O. 12958: DECL: 09/02/2019
TAGS: AEMR AMGT ASEC CASC KFLU KFLO TBIO XE TW
SUBJECT: H1N1 HIGHLIGHTS TAIWAN'S SHORTCOMINGS IN RISK
COMMUNICATION AS CASES AND ACRIMONY MOUNT

REF: TAIPEI 1010 AND PREVIOUS

TAIPEI 00001069 001.2 OF 004


Classified By: Economic Chief Hanscom Smith for reasons 1.4 (b) and (d)
.


1. (SBU) SUMMARY. H1N1 has caused five deaths in Taiwan,
and although the illness' trajectory is not atypical relative
to other areas with outbreaks, more severe cases and deaths
are expected in the coming months. Taiwan has placed an
order for Tamiflu and an H1N1 vaccine from Swiss sources, and
is working to ready a domestic vaccine for deployment by
mid-November. Tamiflu and vaccine stockpiles together are
expected to cover over 50 percent of the island's population.
Increased competency in risk communication and public
education would benefit Taiwan's efforts to combat H1N1, and
there may be bilateral training opportunities with the U.S.
available for Taiwan in these areas. AIT continues to
monitor H1N1 and notes there is at least one confirmed case
at the Taipei American School. An EAC is planned for
September 7 to review overall preparedness and tripwires.
END SUMMARY.

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SEVERE CASES INCREASE; DEATHS STILL AT 5
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2. (SBU) According to the latest official statistics, Taiwan
has had a total of 95 severe cases of H1N1 (now referred to
publicly as "hospitalized" cases),of which 49 have been
discharged, 41 are still in hospital, and 5 have died. The
Central Epidemic Command Center (CECC) recently announced
that a viral specimen collected from the fifth death case was
confirmed to have been Tamiflu-resistant. None of the other
45 Taiwan H1N1 cases analyzed thus far have shown
Tamiflu-resistance. According to the WHO, a total of 12
cases of Tamiflu-resistant H1N1 have been detected globally
(in Denmark, Japan, Canada, the U.S., China, Singapore, and
Hong Kong). Taiwan CDC still estimates that nearly 9 out of
every 10 flu cases in Taiwan are made up of the H1N1 strain,
and there are likely 14,000 new cases of H1N1 weekly on the
island.

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H1N1 TREND NORMAL TO DATE, BUT SPIKE EXPECTED
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3. (SBU) Contacts in the international health community,
including U.S. CDC in Bangkok, note that there are no
indications at present that the spread of H1N1 in Taiwan is
out of line with regional trends, or that H1N1 in Taiwan
currently presents medical concerns or challenges rising to
the level of an emergency. Taiwan's medical response to H1N1
thus far is generally characterized by international health
experts as reasonable, responsible, and transparent.


4. (SBU) Experts predict that over the coming months we will
see a growth in H1N1 infections, in severe H1N1 cases, and in
H1N1-related deaths in Taiwan. However, because Taiwan does
not keep good historic data on its seasonal flu trends, it is
difficult for epidemiologists to extrapolate how local
transmission of H1N1 will progress through the fall and

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winter months. Health professionals do expect that as
Taiwans return to the island during peak flu season from
travel, study, and residence overseas in places such as
Europe and the U.S., some of these travelers may bring H1N1
back to Taiwan with them, which will contribute to the growth
of cases on the island.

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TAMIFLU STOCKPILE GROWING AS VACCINE IS READIED
-------------- -


5. (SBU) Taiwan CDC (TCDC) announced on September 1 an
order to purchase 2.68 million doses of Tamiflu from Swiss
pharmaceutical company Roche. TCDC tells us that this
purchase will bring Taiwan's total anti-viral medicine
stockpile in line to treat 25 percent of the population (the
current stockpile will treat 13 percent of the population;
2.21 million people with Tamiflu and 969,000 with Relenza).
TCDC plans to at least temporarily stop purchasing Tamiflu
after the shipment arrives from Roche, as the Tamiflu
stockpile at that time, plus availability of an H1N1 vaccine,
is expected to be sufficient to meet demand. On September 1,
TCDC published Tamiflu guidelines and distributed to all
hospitals island-wide. Individuals who react positively to a
quick swab test will be given Tamiflu, as will individuals
with "dangerous" flu symptoms who react negatively to the
quick swab test. "Dangerous" symptoms are based on WHO
definitions such as difficulty breathing, chest pain, blood
in sputum, low blood pressure, and lowered level of
consciousness. The guidelines note that there is no concrete
evidence that Tamiflu can effectively prevent severe cases of
H1N1 or death resulting from H1N1. TCDC Deputy Director Ling
Ding tells us that his agency is concerned about Tamiflu
resistance, and does not want to "wasteful" with use of the
drug. Some foreign health experts have stated that the
authorities' move to issue a waiver of H1N1 lab testing for
individuals affected by Typhoon Morakot, so that they can
receive Tamiflu if doctors notice any flu-like symptoms, is
an apparent political move unsupported by medical science.


6. (SBU) Meanwhile, local bio-medical company Adimmune Corp
expects to begin human clinical trials of an H1N1 vaccine in
early-October, and have 10 million doses ready to deploy by
mid-November. TCDC announced plans on September 1 to
purchase 5 million doses of H1N1 vaccine from Swiss
pharmaceutical company Novartis. This purchase will allow
Taiwan authorities to begin inoculations by the end of
October. Moreover, whereas Adimmune's vaccine reportedly can
only be used on individuals over 6 months of age, the
Novartis vaccine is suitable for infants under 6 months of
age. It is expected that an individual will require two
doses of the H1N1 vaccine, which means that the combined
Swiss and Taiwan vaccine stockpile will be able to inoculate
one-third of the island's population. No guidelines for use
of the vaccine have been developed in Taiwan, but TCDC has
produced a 12 point priority list for inoculations. In
addition to typhoon victims, the top of the list includes
medical personnel, pregnant women, infants between six-months
and one-year of age, and individuals older than seven-years
who have severe diseases.


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TRAINING AS AN ANTIDOTE
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7. (C) H1N1 has provoked aggressive media attention and
criticism of the ruling authorities. As a novel flu
pandemic, increased public attention on H1N1 is not
unexpected. Moreover, memories of the 2003 SARS epidemic,
where Taiwan was a virtual ground-zero, are still fresh on
the island, and only add to the public's intense interest in
the present flu. Finally, in the wake of a widely-perceived
official mishandling of the response to Typhoon Morakot,
opposition media and politicians have actively accused the
ruling KMT party of further incompetence on addressing what
they refer to as a public health emergency. H1N1 has become
both a medical and political issue in Taiwan. The
authorities have responded with twice daily press briefings
in an attempt to "choke the media" with a glut of
information, according to a highly placed contact in the
public health field. Despite this, local media still print
factually incorrect information, with the China Post recently
referring to Tamiflu as a vaccine, in just one example. The
authorities' greatest deficiency in handling H1N1, according
to one source, is not in their medical response to H1N1, but
rather in their ability to deal constructively with the
media, and to launch an effective public education campaign
that accurately communicates risks. The reactive, damage
control-focused response taken by the authorities here has
not benefited the KMT, medical professionals overseeing the
response to H1N1, or the general public.


8. (C) A U.S. CDC Bangkok contact with extensive experience
in Taiwan notes that U.S. CDC is in close and regular contact
with Taiwan health authorities, and provides advice and
recommendations on issues such as H1N1. However, bilateral
cooperation is currently on an ad hoc basis, without a
regularized mechanism for information exchange or training.
While Taiwan does have good laboratory and analytical
capacity, and maintains access to WHO materials on pandemic
flu, we understand that Taiwan would benefit in this area
from increased cooperation and training with U.S. CDC and
HHS, particularly in the field of risk communication.
Effective training in this area could help to mitigate the
unhelpful public confusion and fear-mongering surrounding
outbreaks of novel diseases, as described in para 7. We also
understand that U.S. CDC does have the capacity to provide
risk communication training, and a detailed request from the
Taiwan side can get the ball rolling. AIT will encourage
contacts in Taiwan CDC and the Ministry of Health to explore
the possibility of new bilateral cooperation opportunities
with the U.S., and will offer to coordinate between relevant
U.S. and Taiwan agencies, as necessary.

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AIT MONITORS SITUATION AS SCHOOL YEAR BEGINS
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9. (SBU) The consular section has received virtually no
inquiries concerning H1N1 from the American citizen
community. Nonetheless, AIT parents with children at Taipei
American School (TAS) have observed heightened concern among

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the parent population at the school. Both TAS and Taipei
European School have instituted temperature screening
procedures. One student at TAS has been confirmed positive
for H1N1, and a second diagnosis in the same class would
result in temporary closure of the class (Taiwan's so-called
"3-2-5 Policy" states that a class will be closed for five
days if two students in the same class exhibit flu symptoms
within three days of each other). AIT has heard, but has not
confirmed, that there may be three or more additional H1N1
cases at TAS. Last week, TAS administrators determined that
the H1N1 situation was of sufficient seriousness that, as a
precaution, they decided to cancel the middle school camp
scheduled for the week of September 13. We anticipate that a
class closure at either of the schools would considerably
increase concern in the American community. Given the
widespread media attention, we have not yet felt that a
warden notice was necessary. As more schools re-open for the
school year, and as developments progress, we will continue
to monitor and evaluate what additional steps, including a
warden notice, might be warranted.


10. (SBU) AIT will hold an EAC this Friday, August 7, to
review overall preparedness and tripwires.
STANTON