H1N1: ESTONIAN VACCINATION PLAN REMAINS UNCERTAIN

UNCLAS SECTION 01 OF 02 TALLINN 000302 SENSITIVE SIPDIS CA/OCS FOR RICK DOWELL E.O. 12958: N/A TAGS: TBIO KFLU CASC AMED SOCI EN SUBJECT: H1N1: ESTONIAN VACCINATION PLAN REMAINS UNCERTAIN REF: REF A: 09 TALLINN 169; REF B: 09 SECSTATE 99088 1) (SBU) Summary. Despite otherwise solid pandemic planning, Estonian health authorities have not placed an advance order for H1N1 vaccine, and continue to work out the details on a national campaign to vaccinate high risk groups for the H1N1 influenza virus this fall. Preliminary plans propose a modest vaccination campaign covering 2 - 5% of the population, focusing on high-risk groups. However, authorities are scrambling to find sources of the vaccine, seeking assistance from the EU. Some believe that there will be no H1N1 vaccine available at all in Estonia this winter. Estonian health authorities also have determined not to increase the country's modest Tamiflu stockpile. Health authorities point to science as the basis for their pandemic planning decisions, rather than budget limitations. Post will continue to provide information to the private American citizen community on the current H1N1 situation in Estonia, allowing them to consider appropriate measures for their families. End Summary. General Planning -------------- 2) (U) The Estonian health authorities (Ministry of Social Affairs, Health Care Board and Health Protection Inspectorate) have taken a number of steps in recent years to prepare for a possible pandemic. For example, the government has purchased additional ventilators and expanded hospital's ICU capacity by one-third. In addition, the Health Protection Inspectorate has engaged in outreach on the pandemic, issuing guidelines to primary care providers and ambulance workers on appropriate steps to be taken for persons suspected of H1N1 infection. Guidelines have also been issued to schools, and informational posters have been displayed at ports of entry and places where large numbers of people congregate (such as local festivals). A crisis management team, comprised of representatives of various interested agencies, meets weekly. 3) (U) Recent legislation has granted greater powers to the Estonian Health Care Board that can be invoked in the event of a medical emergency, such as the ability to issue binding obligations on medical providers. Already, the Health Care Board has issued a guideline mandating that all hospitals treat H1N1 patients, if needed (although specific hospitals have been designated to treat such patients at this time). H1N1 Vaccine -------------- 4) (SBU) The Estonian government has not placed any advance order for H1N1 vaccine. Realizing that they are now at the back of the line to get vaccine, the Estonian government is working with the EU on a "joint procurement process," and is maintaining contact with local representatives of vaccine manufacturers. One officer of the Health Inspectorate speculated that some vaccine might become available as countries move from a two-dose to a one-dose strategy for adults, freeing up supply. When asked, health authorities are reluctant to comment on the role of resources (in a time of cascading budget cuts across all agencies of the Estonian government). Conoff separately spoke with a prominent private doctor in Tallinn who said that she expects no H1N1 vaccine to be available in Estonia this winter on the private market as manufacturers are fulfilling only orders from governments and health organizations. 5) (SBU) Despite uncertainties on Estonia's ability to obtain vaccine, the health authorities continue to work on a vaccination campaign for the upcoming flu season which it hopes to be ready "on paper" by the end of October. Public health officials have "mapped" the financial resources needed to implement the program, but have not commented on the likelihood of resources becoming available. The proposed campaign would cover 2 - 5% of the population, focusing on key risk groups, such as health care workers, pregnant women and persons with chronic illnesses. Initially, authorities indicated that they would use the national health plan (Haigekassa) register to determine who would fall into these categories (e.g., pregnant women or those with chronic illnesses),but Conoff received assurances from the chairman of the Estonian Health Board that resident American citizens (and other foreigners) who are not covered under the Estonian national health plan, but who are members of these high-risk groups, would be eligible as well. Anti-Virals -------------- TALLINN 00000302 002 OF 002 6) (SBU) Earlier in the year, Estonian health authorizes established a stockpile of 3,000 courses of Tamiflu, enough to treat less than 0.3% of the population. Despite working under an ECDC-approved "worst-case" scenario under which the 25% of the country would be infected during an 8-week wave, with 5,000 "severe" cases, the authorities have determined not to increase the size of the stockpile at this time. Again, authorities indicate that the size of the stockpile is not determined by resources, but rather by experts estimating expected demand for anti-virals. In addition to the government reserve, Tamiflu remains widely available on the public market in Estonia. Post regularly uses a local internet site (www.raviminfo.ee) to track the number of pharmacies offering Tamiflu, in order to gauge changes in demand. The Current H1N1 Situation -------------- 7) (U) There have been 68 confirmed cases of H1N1 infection in Estonia, including some American citizens (see Ref A) and one member of the Embassy community. All have showed mild symptoms and quickly recovered. Only a small number of patients have been hospitalized, solely for isolation purposes. Health authorities have confirmed that currently there is no sustained human-to-human transmission of the H1N1 virus in Estonia, and so are applying a containment strategy. Should sustained human-to-human transmission occur, authorities will switch to a mitigation strategy, in accordance with guidelines from the European Center for Disease Control and Prevention (ECDC). Health authorities have promised transparency should this change occur. (One of Post EAP's pandemic influenza tripwires is triggered upon the commencement of sustained human-to-human transmission in Estonia.) Communicating with the American Community -------------- -------------- 8) (U) The Embassy maintains CA-approved language on its website regarding general pandemic preparedness, accompanied by information specific to Estonia, such as links to the Estonian Health Inspection Protectorate's website and links to local pharmacy information. In the event that Estonia successfully launches an H1N1 vaccination program for high-risk groups, Post will reach out to the American community to ensure that American citizens not enrolled in the national health plan will be able to request the vaccine. In addition, Post will ensure transparency with respect to internal actions and recommendations made pursuant to Department guidance on pandemic preparedness (Ref B). Comment -------------- 9) (SBU) Estonian health authorities continue to go through the motions to move forward with pandemic influenza planning, refusing to acknowledge that a lack of resources has limited their options. Taking advantage of complacency from the Estonian public due to the mild nature of the H1N1 pandemic so far, health authorities appear to be crossing their fingers that the country will avoid a severe wave of H1N1 infections during the fall/winter flu season. Perhaps conscious of criticism aimed at other EU countries that have dedicated significant resources to obtain large quantities of vaccine and anti-virals, Estonian health authorities' approach may look wise in retrospect if the pandemic's worst-case scenarios do not materialize and other countries appear to have overreacted. 10) (U) Meanwhile, Embassy continues to move forward with its own pandemic influenza planning for the Mission community. Post formed a Pandemic Influenza Working Group in April 2009, which provided recommendations to the EAC for revisions to the EAP's pandemic influenza tripwires and required actions. In addition, at the request of the Working Group, Post has inventoried anti-virals and personal protective equipment (PPE),while distributing additional hand disinfectant throughout the chancery. Post's own procedures were tested when a Mission employee became symptomatic with H1N1 influenza shortly after returning from the UK. Working with Embassy nurse and the Estonian hospital designated to perform H1N1 testing, the employee and his family (including children who attend the International School of Estonia) were isolated and he quickly recovered. Post has shared information with the International School of Estonia about pandemic planning. Post anticipates the receipt of H1N1 vaccine from MED in order to implement its own vaccination program this fall. End Comment. DECKER