US embassy cable - 05HANOI1916

UNCLAS SECTION 01 OF 04 HANOI 001916 
 
SIPDIS 
 
STATE FOR FOR CA/OCS/ACS/EAP; EAP/EX; EAP/BCLTV; 
STATE FOR OES/STC (M.GOLDBERG); OES/IHA (D.SINGER AND 
N.COMELLA) 
BANGKOK FOR RMO, CDC, USAID/RDM/A (MFRIEDMAN) 
STATE PASS HHS, HHS/OFFICE OF GLOBAL HEALTH AFFAIRS 
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: AVIAN INFLUENZA TEAM VISITS VIETNAM TO DETERMINE 
POTENTIAL AREAS FOR USG FUNDING 
 
1. Summary:  A ten member U.S. Government Interagency 
Assessment Team visited Vietnam on July 18-19 to determine 
key priorities and appropriate responses; find potential 
partners; and, develop the next steps to implement U.S. 
assistance for the prevention and containment of H5N1 Avian 
Influenza (AI) in both humans and animals.  The AI team met 
with Vietnamese government (GVN) officials, international 
organizations, non-governmental organizations and foreign 
embassy officials to determine which activities should be 
funded by a $25 million appropriation from Congress for 
addressing AI in Asia.  Interlocutors suggested that 
additional funding should be used to provide immediate 
assistance to the GVN to craft quickly a pandemic 
preparedness plan; increase the capacity of the national lab 
system to do broader and more complex surveillance; improve 
communication; and help maintain the quality control in the 
upcoming GVN's poultry vaccination program.  The Minister of 
Agriculture and Rural Development requested that the United 
States send a special AI advisor to Vietnam to provide 
technical assistance to the GVN.  Mission Vietnam strongly 
endorses this request and hopes that the USG will promptly 
identify an AI specialist to visit Vietnam in the near 
future to help the Vietnamese complete and internalize their 
own AI plan.  End Summary. 
 
2. A ten member U.S. Government Interagency Assessment Team 
visited Vietnam on July 18-19 to determine key priorities 
and appropriate responses; find potential partners and 
develop the next steps to implement U.S. assistance for the 
prevention and containment of H5N1 Avian Influenza (AI) in 
both humans and animals.  The USG AI Team was led by Dr. 
Dennis Carroll of the U.S. Agency For International 
Development (USAID) and also included representatives from 
U.S. Department of Agriculture (USDA) and the U.S. 
Department of Health and Human Services (HHS).  During its 
two day visit to Hanoi, the AI Team met with representatives 
from the Ministry of Health (MOH), Ministry of Agriculture 
and Rural Development (MARD), MARD's Department of Animal 
Health (DAH), National Institute of Hygiene and Epidemiology 
(NIHE), World Health Organization (WHO), Food and 
Agriculture Organization (FAO), European Union (EU), Japan 
International Cooperation Agency (JICA), Vietnam Poultry 
Producers Association, CARE and Agronomes and Veterinaires 
Sans Frontieres (VSF). Econoff was the notetaker for these 
meetings. 
 
3. All parties agreed that AI is an integrated human and 
animal health issue and that both aspects need to be 
addressed immediately.  While each of those two sectors has 
a different focus on the areas that needed to be addressed, 
there appears to be a consensus that Vietnam needs to 
increase the breath and quality of surveillance, improve its 
communication strategy in the countryside, and carefully 
maintain the quality of the planned poultry vaccination 
program.  Most importantly, there remains the urgent need to 
prepare a countrywide pandemic preparedness plan, given the 
consequences that a pandemic could have for Vietnam in terms 
of overall growth, tourism and foreign investments.  The AI 
Team was encouraged by the leadership of MARD Minister Cao 
Duc Phat as he works across ministries to forge a 
coordinated plan and put it into place.  Having a well- 
crafted plan in place and made public as soon as possible 
and certainly no later than the end of September, would be 
both prudent and send a strong signal to the international 
community that Vietnam had taken the right preventive 
measures.  During the meeting with Minister Phat, he asked 
whether the USDA could arrange for a senior expert to 
quickly come out and assist the GVN in the preparation of 
such a plan.  In a separate meeting, the WHO also requested 
that international donors send health experts to work in 
country to help the GVN with its short- to medium-term 
efforts against AI. 
 
4. According to DAH, Vietnam has approximately 250 million 
poultry, including 20 to 60 million ducks and geese. 
Vietnam possesses the second largest number of ducks in the 
world after China and the AI virus is currently endemic in 
the poultry and water fowl population, DAH officials noted. 
Commercialized large-scale production of poultry is Vietnam 
is approximately 30 percent while 20 million farmers have 
fewer than 10 chickens each.  Most Vietnamese villagers on 
the local level make no effort to separate animals, and it 
is common practice to mix different animals together.  With 
20 million "backyard" farms, it is very common in Vietnam to 
have pigs, ducks, chickens and humans in close proximity. 
Most farmers grow poultry for their own consumption and it 
is difficult, according to the DAH, to "change old ways" and 
separate chickens from other animals in the countryside. 
DAH admits that disease surveillance is a weakness and that 
animal husbandry needs to be restructured, but this will be 
a multiyear effort.  Long-term efforts to stem the spread of 
AI include: barring live poultry in cities; constructing 
centralized slaughterhouses; educating farmers and 
consumers; and vaccinating all poultry. 
 
Surveillance 
------------ 
 
5. DAH recognizes that surveillance is an important tool 
that needs better coordination among all government 
ministries and other organizations to identify AI in 
Vietnam.  Coordination between both animal and human health 
authorities on a district and communal level is weak and 
needs to be addressed.  Human capacity is another issue that 
is lacking and both the NIHE and MOH agree that surveillance 
should be the number one priority in the fight against AI. 
In order to identify AI patterns and a potential outbreak, 
NIHE needs reliable surveillance data to identify AI and 
labs that have higher capabilities. 
 
6. In certain instances, NGOs who specialize in working on 
the local level are more easily able to determine the AI 
situation on the local and communal level and could play a 
potentially important role in AI surveillance.  Both CARE 
and VSF indicated that they have existing programs on the 
local levels in some parts of the country and could benefit 
from additional funding for AI surveillance.  The GVN is 
trying to expand its local surveillance capacity, but it 
obviously lacks the financial resources to do so.  According 
to MOH, it has already drafted an AI Action Plan that 
includes improving surveillance, but it lacks the financial 
resources to carry out any action plan. 
 
7. To improve its surveillance capacity in the laboratories, 
MOH's medium priorities include improving its lab network 
because AI samples that need complicated analysis now must 
be shipped overseas for testing.  The AI team agreed with 
MOH that Vietnam needs Bio-Security Level 3 (BSL3) Labs, 
which would greatly assist their efforts in identifying AI. 
The construction of five BSL3 labs for MOH with JICA funding 
is already in progress, the AI team learned.  WHO 
Representative Dr. Hans Troedsson urged that the provision 
of any lab equipment or commodities be accompanied by 
training assistance so that the equipment would be used 
effectively. 
 
Communication 
------------- 
 
8. The lack of communication among government ministries and 
with the general population was a recurrent concern 
throughout the AI Team's visit.  A broad public awareness 
campaign to change farmer behavior and educate the general 
population on the potential dangers of AI is urgently needed 
as well.  FAO stressed that the commune level has the power 
to influence local farmer animal husbandry techniques and 
provide basic information about AI and its effects.  FAO 
suggested that any assistance in this area be coordinated in 
some way at the commune level. 
 
9. The EU and WHO also stressed that the local population, 
health workers and hospitals have very little, if any, 
information about AI.  This needs to be addressed by the GVN 
and international community.  The WHO stressed that the 
GVN's two most important ministries responsible for the 
fight against AI, MARD and MOH, should better coordinate 
their AI strategies and programs in order to be effective. 
 
Poultry Vaccinations 
-------------------- 
 
10. The MARD and DAH outlined the GVN's pilot poultry 
vaccination project set to begin this August in Tien Giang 
and Nam Dinh provinces.  The purpose of this campaign is to 
curb avian influenza at its source and will target both 
commercial and private poultry farms.  This is in 
preparation for a nation-wide program to begin in October. 
To prepare for the program, the GVN has purchased 20 million 
doses of vaccine (18 million from the Harbin China Institute 
and 2 million from a Dutch company, Intervet).  The cost of 
the Chinese vaccine is approximately 200 VND/dose and the 
Dutch vaccine costs 750 VND/dose (USD $0.012 and $0.047, 
respectively). 
 
WHO and Other Areas for Consideration 
----------------------------- 
 
11. In addition to increasing surveillance, improving 
communications and having a poultry inoculation plan, the 
WHO underscored the urgency for Vietnam to develop a quality 
AI National Preparedness Plan.  It is apparent that such a 
plan would have to be in place no later than the end of 
September in case these are a resurgence of AI cases when 
the cool season begins in October.  According to WHO 
Representative Dr. Hans Troedsson, there are nine key areas 
where action must be taken and donor support would be 
welcome.  They are: 
 
--Preparedness Planning Preparations; 
--Rapid Response Team Development to quash or contain 
quickly any outbreak; 
--Development of an Effective Communication Strategy; 
--Improved Surveillance Capacity Developed Jointly for Human 
and Animal Health; 
--Strengthened Lab Capacity; 
--Improved AI Lab Sampling Capability; 
--Addressing the Legal and Policy Requirements Inherent in 
Any Preparedness Plan; 
--Additional and Better Drugs and Equipment; and 
--Improved AI Case Management. 
 
 
12.  The visit ended with a briefing for the Ambassador and 
interested members of the Country Team.  The AI team noted 
that they would be prepared to share with us a more detailed 
breakdown of the resources that would be committed to 
Vietnam by August 2. 
 
13.  Comment:  It is clear that the next 90 days is the 
period when Vietnam will make basic policy decisions on how 
it will address the threat of Avian Influenza both generally 
and in response to a potential outbreak.  As reported many 
times, one of the first prerequisites is that Vietnam has a 
strong pandemic preparedness plan in place prior to the 
onset of the flu season in October.  Fortunately, that task 
has now been entrusted with the Minister of Agriculture and 
Rural Development, one of the more able ministers in the 
government.  We have met with the Minister twice in the last 
ten days.  Each time he has said that he would be open to 
technical assistance for plan preparation or more generally 
determining the basic responses that need to be taken in the 
agricultural sector to deal with the threat.  We believe 
that the United States should take advantage of this 
opportunity.  The USDA representative on the team said she 
would look for expertise that might be available from her 
organization.  It would be helpful for our colleagues in 
Washington to discuss with other U.S. centers of excellence 
covering pandemic preparedness and response for someone who 
could come out quickly.  There maybe expertise in the 
Federal Emergency Management Agency (FEMA), HHS, CDC, NIH or 
state agencies that could have useful experience to offer 
the Vietnamese.  Promptly bringing a person or team with the 
experience and diplomatic tact for a month or so to act as 
an advisor would be relevant to Vietnam, take advantage of 
this unique time and help the Vietnamese to complete and 
internalize their own plan.  End of comment. 
 
MARINE