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)

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Summary
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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.

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GOT Reasonably Prepared
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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.)

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Communication, or Lack Thereof
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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.

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No Longer an Animal Health Issue
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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.

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Comment
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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