US embassy cable - 05HANOI875

UNCLAS SECTION 01 OF 04 HANOI 000875 
 
SIPDIS 
 
STATE FOR USAID 
 
SENSITIVE BUT UNCLASSIFIED 
 
FOR CA/OCS/ACS/EAP; EAP/EX; EAP/BCLTV; OES/STC (M.GOLDBERG); 
OES/IHA (D.SINGER AND N.COMELLA) 
BANGKOK FOR RMO, CDC, USAID/RDM/A (MFRIEDMAN) 
ROME FOR U.S. MISSION (FODAG) 
STATE PASS HHS 
USDA FOR FAS/PASS TO APHIS 
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP FOR LEW STERN 
USAID FOR ANE AND GH (DCAROLL, SCLEMENTS AND PCHAPLIN) 
 
E.O. 12958: N/A 
TAGS: AMED, AMGT, CASC, EAGR, TBIO, VM, AFLU 
SUBJECT: VIETNAM - AVIAN INFLUENZA TRIPWIRES 
 
REF:  A) Hanoi 846, B) Hanoi 467 
 
1. (U) Summary:  The representatives of the World Health 
Organization and the Food and Agriculture Organization have 
provided an Avian Influenza update to major donor missions 
in Hanoi.  They also revisited an outstanding GVN-WHO-FAO 
request for donor assistance for an "Avian Influenza 
Technical Support Unit."  Such a unit would give the GVN 
much needed capacity to combat the present AI epidemic and 
to be in a position to possibly contain a pandemic, when and 
if clusters of human-to-human transmission of the H5N1 virus 
begin to appear.  Specific needs are outlined below.  We 
recommend that U.S. agencies consider support for this 
Technical Support unit in their deliberations on AI.  End 
Summary. 
 
CURRENT SITUATION 
----------------- 
 
2. (U) On April 7, 2005 the United Nations Development 
Program (UNDP) resident coordinator convened a meeting of 
major donors for briefings on the status of Avian Influenza 
(AI) in Vietnam by the local representatives of the World 
Health Organization (WHO) and the Food and Agriculture 
Organization (FAO).  The DCM and USAID chief attended.  WHO 
representative Hans Troedsson summarized the current health 
situation in Vietnam.  AI currently does not represent an 
imminent human health crisis here; however, it has the 
potential to become one on short notice.  The virus remains 
deeply entrenched in Vietnam's poultry and eradicating it 
will require a long-term, concentrated effort.  Lack of 
action could lead to a major health crisis if human-to-human 
transmission breaks out. 
 
3. (SBU) Troedsson noted several recent changes in the 
pattern of AI that deserve attention.  Up to March 2005, the 
pattern was similar to the outbreak of 2003-04.  In that 
cycle, the outbreak peaked at the beginning of March and 
then stopped in April. This year cases are continuing well 
into April.  Moreover, some cases are less severe and some 
individuals have tested positive, but show no symptoms.  He 
noted that the H5N1 virus is infecting more older persons. 
While more analysis needs to be done, this indicates at 
least a possibility that the virus may be changing. 
According to Troedsson, if such a change resulted in a virus 
that is transmitted human-to-human and at the same time is 
less virulent, that is having a mortality rate lower than 
the current 70%, this could in fact result in a much greater 
risk of a pandemic.  Rapid spread is difficult in cases of 
very high lethality because most of those infected die or 
are hospitalized before they can spread the virus very 
widely, he noted.   However, it is not known if recent are 
cases of poultry-human or human-human transmission.  Both 
are possibilities to be considered, since those infected had 
been in contact with both infected poultry and infected 
people. 
 
GOVERNMENT RESPONSE 
------------------- 
 
4. (SBU) WHO and FAO representatives agreed that the GVN 
should continue to give the issue the highest priority, 
despite possible negative consequences such as harm to the 
tourist industry.  The severity of the problem and potential 
risk is understood at the highest levels of government, but 
some at lower levels do not seem to have the same sense of 
urgency.  Troedsson asked that embassies and other donors 
highlight their continuing concern in their interactions 
with the GVN.  More importantly, he made a made a plea for 
increased assistance to the GVN (see below). 
 
5. (SBU) Recent interactions between the WHO and the 
Ministry of Health (MOH) reflect increasing awareness by the 
Ministry of the seriousness of the threat of AI.  A month 
ago the Minister believed that the problem was under 
control.  Now MOH clearly indicates that they need and would 
welcome assistance.  In addition, the Ministry has been more 
forthcoming in providing confidential, informal reports to 
WHO before each case has been officially confirmed.  (Note: 
Timely informal reports of suspected AI cases are necessary 
for WHO to maintain an up to date risk assessment for both 
Vietnam and WHO's international responsibilities.) 
 
COORDINATION 
------------ 
 
6. (U) A number of donor countries have begun to provide 
assistance.  The Canadians will provide a mobile laboratory 
for testing.  The World Bank has been providing assistance 
under an Avian Influenza Emergency Recovery Project (AIERP) 
jointly funded with FAO.   Laboratories participating in the 
WHO's international warning network in Japan and the Unites 
States (Centers for Disease Control and Prevention (CDC) in 
Atlanta) are assisting in genetic sequencing of the virus, 
necessary to analyze any mutation of the virus and for 
vaccine development.  CDC is also planning to provide 
assistance to strengthen laboratory capacity and support 
development of Vietnam's National Influenza Center. 
OFDA/USAID will pre-position contamination suits for use 
should there be a pandemic. 
 
7. (U) While these are welcome steps, FAO Representative 
Anton Rychener and WHO representative Troedsson stressed 
that the GVN, the WHO, and FAO would like future assistance 
to be provided under a master coordination plan as 
recommended in the Second FAO/OIE Regional Meeting on Avian 
Influenza Control in Asia held in Ho Chi Minh City February 
23-25.  They also feel strongly that assistance be 
coordinated with, or channeled through, an Avian Influenza 
Technical Support Unit (TSU). 
 
TECHNICAL SUPPORT UNIT 
---------------------- 
 
8. (U) UNDP hosted a special meeting of the "Monthly Donor 
Group Forum" on February 21 with the participation of the 
GVN, the WHO, and FAO to introduce the concept of the TSU 
and to ask for donor assistance (Ref B).  Under the 
proposal, the National Committee for Avian Influenza 
Control, reporting to the Prime Minister, would have overall 
oversight of the TSU.  However, a special TSU oversight 
committee would consist of the Vice-Ministers of the 
Ministry of Agriculture and Rural Development (MARD) and the 
MOH and the Representatives of WHO and FAO.  Long-term 
technical assistance personnel would staff the TSU, along 
with GVN counterparts, and assist the various MARD and MOH 
departments involved.  The GVN would contribute heavily in 
land and local costs to construct bio-secure labs and 
breeding farms.  While the current measures proposed in the 
plan are largely short term, development of a longer term 
"Emergency Contingency Plan" is now underway.  The current 
plan prepared by FAO is driven by the following principles: 
 
--Prevent human H5N1 infection and reduce the risk of a 
global Highly Pathogenic Avian Influenza (HPAI) pandemic. 
--Improve active disease search, surveillance and early 
detection for both humans and poultry. 
--Consider poultry vaccine use either in field trials or 
nationwide. 
--Improve disease control by preventing the cycling of H5N1 
virus between waterfowl and chickens and reducing H5N1 virus 
reservoirs. 
--Provide livelihood support and long term poultry sector 
restructuring. 
--Develop better tools to understand and control H5N1 
infection, including diagnostic methods, vaccines, 
disinfectants and antiviral agents. 
 
WHAT DONOR ASSISTANCE CAN DO 
---------------------------- 
 
9. (U) The creation of the TSU would result in better 
coordination of assistance and avoid overlap.  More 
importantly, it would give the GVN an urgently needed 
capability to implement preventive measures and prepare for 
a possible pandemic.  WHO and FAO urged that donors treat 
this as an emergency rather than a request for traditional 
development assistance.  They distributed copies of a 
revised version of the February 21 proposal for the TSU, 
dated April 7, 2005.  The proposal outlines a comprehensive 
approach to immediate assistance needs.  It will be revised 
and expanded so that donor's can see where assistance is 
most needed.  Copies are being emailed as scanned 
attachments to EAP/BCLTV, USAID, CDC, and HHS). 
Additionally, WHO and FAO promised to work with the UNDP to 
create a trust fund that would give donors the option of 
either contributing specific inputs of technical assistance 
or commodities as detailed in the plan or providing direct 
funding into the trust fund, which the TSU then in turn can 
allocate.  Both WHO and FAO emphasized that the immediate 
priority is funding to staff and make the TSU operational. 
 
REQUIREMENTS 
------------ 
 
10. (U) Of the USD 14.7 million called for in the April 7 
version of the plan, 8.8 million is requested to help 
strengthen and expand Vietnam's agricultural surveillance 
system and laboratory testing capacity. 
 
11. (U) Other needs include construction and outfitting of 
two Level 3 Biological Safety Laboratories (BSL3) for MOH. 
The Government of Vietnam currently does not operate a BSL3 
laboratory, although the private Welcome Trust has such a 
laboratory in HCMC. Such laboratories conduct genetic 
sequencing necessary for vaccine development and can carry 
out more sensitive and sophisticated tests for infection 
than those currently conducted in Vietnam.  Donor 
contributions would also be used to relocate poultry 
breeding farms to areas that can be made "bio secure." 
Finally, approximately 14 person years of technical 
assistance is required for the TSU, in areas such as farmer 
compensation, poultry industry economics, laboratory 
technicians, surveillance system specialists, vaccination 
specialists and a disease search specialist. 
 
COMMENT 
------- 
 
12. (U) We are impressed by both the professionalism and 
commitment of the WHO and FAO staff in addressing the AI 
issue and share with them and the other donors at the 
meeting the view that assistance will be more useful if done 
in the context of an overarching framework shaped by experts 
on the ground.  This constitutes good management, as it 
avoids overtaxing the absorptive capacity of the GVN which 
otherwise would have to deal with multiple donors.  We hope 
that U.S. agencies will factor this heavily into any 
programs under consideration and consult with our country 
team resources in USAID, HHS, USDA and DoS prior to 
finalizing additional and welcome resources to this effort. 
MARINE