US embassy cable - 05HANOI1034

UNCLAS SECTION 01 OF 04 HANOI 001034 
 
SIPDIS 
 
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 
STATE PASS HHS FOR STEIGER 
USDA FOR FAS/PASS TO APHIS 
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP FOR LEW STERN 
DIRAFMIC FOR WENNER, MULLINS, WYMA 
USAID FOR GHB, ANE/DCAROLL, SCLEMENTS AND PCHAPLIN 
 
E.O. 12958: N/A 
TAGS: AMED, AMGT, CASC, EAGR, TBIO, VM, AFLU 
SUBJECT: VIETNAM  - AVIAN FLU: RECENT MEETINGS 
 
REF: Hanoi 875 and previous 
 
1.  (SBU) Summary:  This week new information emerged about 
Avian Influenza H5N1 (AI) in meetings with CDC Influenza 
Epidemiologist Keiji Fukuda, the Minister of Agriculture and 
Rural Development, and the Donor Group.  Experts now believe 
that the virus may be changing in the north of Vietnam, but 
do not yet have laboratory confirmation of this change.  The 
Government response and acknowledgement of the problem seems 
to have improved significantly.  The Vietnam Mission shares 
the view of WHO and FAO that the next six months will be 
critical to Vietnam's efforts to devise and implement an 
effective strategy to control AI in poultry and prevent a 
more serious outbreak in humans.  Post recommends that the 
USG speed up its consideration of a positive response to WHO 
and FAO's call for donor assistance.  End Summary. 
 
2.  New information emerged at three meetings this week in 
Hanoi on Avian Influenza (AI).  On April 25, the Ambassador, 
USAID Country Manager and Consul attended a meeting of the 
"donor group," hosted by the United Nations Development 
Program (UNDP) with briefings by World Health Organization 
(WHO) and United Nations Food and Agriculture Organization 
(FAO) officials.  The meeting focused on coordinating 
international assistance for AI response.  One of a team of 
influenza experts from Australia, New Zealand and the United 
States, Influenza Epidemiology Unit Leader at the U.S. 
Centers for Disease Control and Prevention (CDC), Dr. Keiji 
Fukuda briefed the DCM and Health Attache separately. 
Finally, on April 26, the DCM, Health Attache and 
Agricultural Attache met with the Minister of Agriculture 
and Rural Development (MARD). 
 
Vietnam's Response 
------------------ 
 
3. (SBU) An important development is that the Government, at 
every level, now openly acknowledges that AI is a major 
problem.  AI is now included in regular briefings to the 
Prime Minister, according to FAO.  There is still a tendency 
to focus on economic costs while downplaying the social 
health threat. But since Deputy Prime Minister (DPM) Nguyen 
Tan Dzung publicly estimated that AI has shaved a half point 
off this year's annual GDP growth rate, political attention 
to the issue has been more readily forthcoming and seems to 
be energizing discussions of response strategies.  While DPM 
Dzung has asserted publicly that the situation is contained, 
he had acknowledged privately to WHO and FAO representatives 
that that is not true.  Moreover, he and other senior 
officials appear to recognize the clear consequences of not 
taking action. 
 
4. (SBU) Minister of Agriculture and Rural Development 
(MARD) Cao Duc Phat called for urgent action and assistance 
in meetings with the DCM as well as with WHO and FAO 
officials.  To remove the threat of a human AI pandemic, 
Vietnam must change its poultry industry, improve veterinary 
services at the grassroots level and strengthen its capacity 
to remove the virus, he stressed.  The Ministry is 
implementing all three activities.  To do so, the Ministry 
must strengthen surveillance to know where the virus is and 
its characteristics.  Minister Phat requested international 
assistance to strengthen surveillance and diagnostic 
laboratory capability.  He asked for the immediate 
assistance of laboratory experts for virus isolation and 
characterization and for developing a suitable surveillance 
program. 
 
5.  (U) MARD has a plan to compensate farmers, which it 
calls a "farmer support plan."  The Government is 
uncomfortable with the term "compensation" because it 
implies 100 percent compensation.  The "farmer support plan" 
has recently been augmented to provide 50 percent 
reimbursement for poultry culled.  To be effective, FAO 
Country Representative Anton Rychner states that 
reimbursement must be at least 75-80 percent, but even 100 
percent reimbursement will not be fully effective. Rychner 
believes it may be difficult to translate this to action 
since MARD is a weak Ministry especially at the provincial 
and local levels.  For drastic action to take place in the 
provinces, be it in the culling of poultry stocks or other 
significant initiatives, clear direction must come from 
senior political leadership in Hanoi, Rychner stressed. 
 
6.  (SBU) The WHO, FAO, and UNDP and Fukuda agree that the 
GVN needs to define and prioritize its needs and focus on 
developing response plans.  Fukuda and the WHO both note 
that the Ministry of Health (MOH) seems to be more fully 
engaging recently and are hopeful that the MOH will be more 
responsive in the coming weeks.  The MOH has improved its 
information sharing on human cases and research, but its 
contributions to the plan for coordinated response and 
assistance developed jointly by FAO, WHO and the GVN (Hanoi 
875) are still minimal and slow.  The MOH has yet to 
identify its overall priorities for resources relative to 
AI.  MOH's National Institute of Hygiene and Epidemiology 
(NIHE) seems more prepared and responsive.  NIHE Director 
Dr. Nguyen Tran Hien has outlined priorities and has made 
requests to the Department of Health and Human Services to 
meet NIHE's needs.  The result is that the current plan is 
reasonably informative on the poultry and agricultural steps 
that MARD plans, but does not address the health side.  Dr. 
Fukuda reported that his discussions appear to have 
convinced MOH hardliners that the situation needs rapid and 
sustained attention, but that communication between the MOH 
and MARD at the technical level remains weak. 
 
7. (SBU) WHO Country Representative Hans Troedsson noted 
that the lack of a Pandemic Emergency Response Plan is 
critical.  He explained that should a human pandemic occur, 
there would be a one to two week window of opportunity, when 
the number of cases would jump from tens to hundreds of 
cases, in which it might be possible to halt further spread 
of the pandemic.  Beyond this window, once the number of 
cases gets into the thousands and spreads geographically, 
the pandemic will be out of control and cannot be contained. 
He stressed the need for the GVN to develop a plan that can 
be quickly enacted in this brief window of opportunity, to 
limit travel, public movement and public exposure in order 
to contain a pandemic. 
 
8. (U) The WHO experts noted the risk that the Government's 
attention may dwindle as the weather warms and the number of 
new human cases and poultry outbreaks drops.  The lack of 
new cases would be purely a seasonal trend.  The virus is 
fully entrenched in Vietnam and the threat of pandemic is 
not gone.  WHO asked all governments to raise the issue at 
high-level visits and meetings and to urge the GVN to 
maintain momentum and focus on the issue. 
 
Possible Change in Virus 
------------------------ 
 
10. (SBU) Fukuda and the team of international experts 
believe that they are seeing a change in the virus in the 
north of Vietnam, but this has not yet been proven in 
laboratory tests and is purely theoretical at this point. 
They point to various factors including:  a divergence in 
epidemiology between the north and south of Vietnam, a 
change in the age groups affected, a widening of the age 
range among those infected (in the north three children 
under the age of one were infected), a decreased fatality 
rate, a widening range of symptoms reported, an increased 
number of mild or non-symptomatic cases, an increased number 
of clusters in the north, a widening gap in the time to 
onset of disease between cases in clusters, and the fact 
that the disease is lasting longer this year.  There may be 
other explanations, such as improved surveillance and 
reporting, but taken together, Fukuda and his team believe 
these factors may indicate that the virus has changed in the 
north.  WHO concurs with this assessment and now believes 
the cases surrounding the Thai Binh cluster may indeed be 
considered to be a fourth outbreak in humans.  (Note: By 
this definition, the first outbreak was from December 2003 
to March 2004.  The second occurred in July 2004.  The third 
began in December 2004 in the south of Vietnam and has not 
yet concluded. End Note.) 
 
11. (U) Based on Fukuda and his team's observations, WHO 
will arrange a second, more comprehensive assessment of the 
data by international influenza experts, including 
epidemiologists and virologists in Manila. The meeting is 
tentatively scheduled for the week of May 2 and there are 
plans to include representatives from Cambodia and Thailand. 
 
12. (SBU) If this change in the virus proves to be true, it 
could mean an increased risk of a human pandemic.  The 
increased numbers of clusters may indicate improved 
transmissibility.  The decreased fatality rate and increased 
number of mild or non-symptomatic cases may reduce detection 
and containment.  Finally, the changes now being detected 
could be the first of more dramatic changes to come. 
According to WHO's Hans Troedsson, if the virus has indeed 
changed in the northern Vietnam, then that region is at 
highest risk to be the source and epicenter of any global 
pandemic. 
 
13. (U) In an alternate explanation for the longer lasting 
season this year, World Bank Representative Laurent Msellati 
pointed out that seasonality may not simply be tied to the 
weather and the environment.  There are market seasons, 
holiday seasons, and even economic trends that may come and 
go just as the seasons do. 
 
Other Information on the Disease 
-------------------------------- 
 
14. (SBU) Fukuda provided some additional information.  For 
example, of the confirmed cases, 70 percent have known 
contact with birds but 30 percent have not had contact with 
birds; this pattern does not have seemed to have changed 
since last year.  Further, based on conversations with 
physicians at Bach Mai Hospital, which has seen 
approximately 40 AI patients, they appear to be harder to 
treat successfully than SARS patients. Also, the physicians 
note that antivirals (such as Oseltamivir) are not the 
panacea.  The consultation team asked the Bach Mai team to 
organize their data as soon as possible.  Finally, the 
mortality difference between ducks and chickens - infected 
chickens are dying rapidly while infected ducks appear 
assymptomatic - is disconcerting.  Ducks can spread AI virus 
more widely into the environment over a long period of time. 
 
15. (SBU) Minister Phat told the DCM that, based on serology 
and virus isolation, there appears to be a change in the 
pattern of the disease in poultry, which international 
experts need to reassess. Observed changes include a drop in 
the mortality rate in chickens from more than a 99 percent 
in 2004 to identifying living, but infected chickens in 2005 
and, in ducks, changes include assymptomatic, but infected 
birds, and a change in the serologic pattern.  Phat 
suggested the observations might be real or also an artifact 
of sampling errors and laboratory limitations. 
 
Vaccination 
----------- 
 
16. (U) Poultry Vaccine:  It is unclear whether the GVN has 
decided to begin officially a poultry vaccination campaign. 
On April 26, MARD reported that Vietnam had not decided yet 
on an official policy.  However, the World Bank's Msellati 
said that MARD requested financial assistance for an 
official vaccination campaign on April 22.  Minister Phat 
noted that MARD is still testing vaccine effectiveness, but 
would like to begin vaccinating before next winter.  He said 
that they would be using imported vaccines because Vietnam's 
capacity to develop a vaccine is limited. He requested the 
assistance of U.S. animal vaccine experts to work with MARD 
to help in planning for roll out of their vaccination 
program. 
 
17. (U) Human Vaccine:  WHO's Troedsson reported that U.S. 
development of a human vaccine is proceeding well.  If there 
are no glitches, it should be approved for use by the end of 
this year.  Production capacity and a delivery schedule were 
not discussed.  He expressed concern that the GVN does not 
have a plan for who will receive the vaccine or how to 
distribute it.  Vietnam is also developing a human vaccine, 
but its development is slower and Vietnam does not have 
sufficient capacity for mass production. 
 
18.  (SBU) Comment:  The Vietnam Mission shares the view of 
WHO and FAO that the next six months will be critical to 
Vietnam's efforts to devise and implement an effective 
strategy to control AI in poultry and prevent a more serious 
outbreak in humans.  Post recommends that the USG speed up 
its consideration of a positive response to WHO and FAO's 
call for donor assistance. End Comment. 
 
MARINE