TFFLU01: TUNISIA'S READINESS FOR AN H1N1 OUTBREAK

C O N F I D E N T I A L TUNIS 000276 SIPDIS STATE FOR S/ES-O (CMS INFLUENZA TASK FORCE); EEB/IFD/OMA, EEB/EPPD, AND NEA/MAG (PATTERSON/HAYES) CASABLANCA FOR FCS (ORTIZ) RABAT FOR FAS (AHMED) AMMAN FOR ESTH HUB OFFICER LONDON AND PARIS FOR NEA WATCHER E.O. 12958: DECL: 05/05/2019 TAGS: KFLU AEMR ASEC CASC TBIO KSAF PREL AMGT TF FAO, TS SUBJECT: TFFLU01: TUNISIA'S READINESS FOR AN H1N1 OUTBREAK REF: STATE 45269 Classified By: Ambassador Robert F. Godec for reasons 1.4 (b) and (d) -------------- Summary -------------- ¶1. (SBU) H1N1 influenza has not yet arrived in Tunisia. According to the WHO, Tunisia is reasonably prepared for a pandemic, with 100,000 doses of Tamiflu already stockpiled and heightened screening measures in place at the Tunis-Carthage International Airport. Although the GOT's testing capability is limited, there is already a surveillance system in place for seasonal influenza. The GOT has not issued any travel advisories, and is unlikely to do so in the near future in order to protect the tourism industry. There has been some regional coordination among health ministers, and the GOT has been actively communicating across ministries, regional medical authorities, and the WHO. However, there has been a concerted downplay of the issue in public statements. Tunisia has also banned imports of pigs and pork products. End Summary. -------------- GOT Reasonably Prepared -------------- ¶2. (SBU) There are currently no reported cases of H1N1 influenza in Tunisia. On May 4, EconOff and MedOff met with the Director of the World HEALTH Organization in Tunisia, Dr. Ibrahim Abdelrahim, who has been in direct and frequent contact with the GOT. Abdelrahim noted the GOT was "reasonably prepared" for a pandemic. They have 100,000 doses of Tamiflu stockpiled and are in the process of acquiring 75,000 more. Media reported the government had requested over 350,000 additional doses. Tamiflu is imported solely by the Pharmacie Centrale (PC),the government's monopoly medication importer. The GOT will reportedly allow physicians to request it directly from the PC. ¶3. (SBU) Currently, the GOT has the ability to test for Influenza A, but not specifically for H1N1. They have a surveillance system in place for seasonal influenza, but testing and reporting have not been meticulous. According to the WHO, the GOT would welcome additional testing kits, as they don't have them currently. The GOT has not discussed their capacity for critical care. ¶4. (SBU) Authorities have heightened surveillance at the Tunis-Carthage International Airport. Officials are using one thermosensor camera to screen incoming passengers, but the GOT has provided no information on whether they are targeting specific flights or if they have threshold temperatures on which they will base action. The WHO reports the GOT is looking to buy eight additional thermosensor cameras for placement at air and sea ports. The press reported the government has taken precautionary measures at 39 frontier posts in order to cope with a possible H1N1 infiltration. ¶5. (SBU) The GOT has not issued any travel advisories, though according to the WHO, they have notified hotels and travel agencies to be on heightened alert. The GOT was in direct phone contact with a group of Tunisians who returned the week of April 26 from Mexico, although none had flu-like symptoms. In addition, the spouse of a Locally Employed Employee who had recently returned from Mexico received an unsolicited call from the Ministry of Public HEALTH asking about his well-being. (Comment: the GOT is highly unlikely to restrict any flights from countries with suspected or confirmed cases of H1N1 for fear this will hurt Tunisia's tourism industry. Those countries in Europe who current have confirmed cases - Spain and Italy - are some of the biggest sources of tourism in Tunisia. End comment.) -------------- Communication, or Lack Thereof -------------- ¶6. (SBU) Although the GOT has been holding regular meetings on the H1N1 issue, there has been a concerted effort to avoid public alarm and downplay the issue in the press. According to the WHO, the GOT had some readiness plans in place for Avian Flu two years ago, and is communicating actively across ministries, with the WHO, and with regional HEALTH authorities. However, the GOT has not been in direct contact with the Embassy. As reported by the press, the HEALTH Ministers of Libya, Algeria and Tunisia met on May 3 in Tripoli, and announced the formation of a joint commission on experts. The WHO believes the biggest challenge with the GOT is its unlikelihood to share information publicly, which could slow response time in the event of an outbreak. ONE bright note is the existence of a 2005 WHO regulation that allows the organization to make public HEALTH announcements, even if the host-country government is keeping silent. -------------- No Longer an Animal HEALTH Issue -------------- ¶7. (SBU) According to the WHO, Agriculture Minister Abdessalem Mansour declared in a GOT meeting that it was clear H1N1 was no longer an animal disease, rather a human-to-human disease. Despite this, the media reported Tunisia is banning imports of pigs and pork meat. Tunisia currently has at least two pig farms, neither of which has reported an outbreak or is expressing concern. -------------- Comment -------------- ¶8. (C) Overall, Tunisia appears reasonably prepared to deal with an H1N1 outbreak. Heightened surveillance, a relatively good HEALTH infrastructure, and some existing Tamiflu stockpiles would leave Tunisia capable of dealing with a full-scale outbreak in the first stages. However, the international economic crisis is starting to take a toll on Tunisia's tourism industry - a major source of revenue for the country - and the GOT is unlikely to take any measure that might further threaten this sector. Given the spread of this virus in key source countries for tourism in Tunisia, especially in Europe, it is likely H1N1 will arrive in Tunisia eventually. Unfortunately, it is also probable the GOT will be reluctant to admit there is a problem until that problem is visible. End Comment. Godec