US embassy cable - 05HOCHIMINHCITY855

UNCLAS SECTION 01 OF 03 HO CHI MINH CITY 000855 
 
SIPDIS 
 
 
SENSITIVE 
 
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 
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) 
DEPT PASS TO AID 
AMEMBASSY ROME PASS TO USMISSION FAO 
 
E.O. 12958: N/A 
TAGS: EAGR, ECON, AMED, TBIO, CASC, PGOV, SENV, SOCI, VM, AFLU 
SUBJECT: AVIAN FLU IN SOUTHERN VIETNAM 
 
1. (SBU) Summary:  Experts in southern Vietnam have begun to 
prepare for the possibility of an avian influenza (AI) outbreak 
during the cool season of December-February by focusing on poultry 
biosafety and vaccinations.  ConGen contacts report that the 
Ministry of Agriculture and Rural`QQ$Qpment has ordered 20 
million doses of poultry vaccine from China and the Netherlands 
and began inoculating chickens and ducks with these doses in 
August.  In addition, the Department of Health of Ho Chi Minh City 
(DoH HCMC) is addressing human health concerns by attempting to 
increase its supply of Tamiflu.  Currently, the DoH HCMC has a 
disaster plan that is limited to administering anti-viral drugs to 
a maximum of 1,000 persons infected with AI, which is generally 
assumed to be insufficient by international standards.  Challenges 
for local authorities include the implementation of the poultry 
vaccination program and enforcement of biosafety measures in the 
selling and production of poultry, particularly in outlying areas. 
Vietnam's ability to implement the poultry vaccination campaign 
will serve as a good barometer of its ability to handle this 
potential health and economic crisis.  End Summary. 
 
ADDRESSING THE VIRUS AT ITS SOURCE: TREATMENT OF POULTRY 
--------------------------------------------- ----------- 
 
2. (SBU) ConGen contacts report that Vietnam has addressed the 
problem of avian influenza in poultry by culling and is now 
undertaking a nationwide vaccination program.  More than 42 
million birds, or approximately 17 percent of Vietnam's poultry 
population, have been culled.  Authorities have also extended a 
ban on duck hatcheries at least until early 2006.  Several poultry 
vaccines have also been tested.  Based on the results of the 
vaccine tests, Department of Animal Health (DAH) Vice Director 
Pham Chung reported to EconOff that the Ministry of Agriculture 
and Rural Development (MARD) will begin the nationwide vaccination 
program in southern Tien Giang and northern Nam Dinh provinces. 
The inoculation effort will focus on waterfowl, with a range in 
size from large hatcheries to backyard poultry ranchers. 
 
3. (SBU) According to the Southern Representative Office of the 
Department of Animal Health (DAH), MARD has conducted a survey of 
poultry from 20 provinces across southern Vietnam, with sample 
sizes ranging from 1,000-2,000 birds each.  Preliminary results 
indicate that approximately 60% of birds show AI antibodies, 
suggesting that at some point these birds had been exposed to the 
virus. 
 
4. (SBU) The DAH explained that the MARD AI vaccination program in 
southern Vietnam began in August.  In July, the GVN ordered nearly 
20 million vaccination doses from China, and another 2 million 
from a Dutch company, Intervet.  DAH claimed that the vaccines 
will be free of charge, although Deputy General Manager Nguyen Huu 
Tin of Intervet reported that Intervet's vaccine would be sold to 
the larger foreign owned hatcheries (such as CP, Cargill, and 
Japfa).  The vaccination campaign -- which involves a course of 
two injections -- will focus on domestic ducks and three types of 
poultry:  parent stock, layers and broilers.  Parent stock and 
layers have longer life expectancy, so they are of primary 
importance.  The vaccination of ducks is significant because they 
can carry the virus without displaying symptoms and therefore shed 
the virus for a longer period of time. 
 
5. (SBU) The issue of which vaccine to use has been a source of 
some contention and confusion.  Beyond the two sources of vaccine 
for Vietnam noted above, the U.S. company Merial also produces a 
poultry vaccine, but MARD has declined to use this drug although 
the reasons are unclear.  Intervet has also raised questions about 
the quality of its Chinese competitor's vaccine and reported that 
Intervet has been unable to find any data about the Chinese 
vaccine's effectiveness.  The cost of the Chinese vaccine is 
200VND (0.0125 USD)/dose, while the Intervet vaccine costs 780VND 
(0.0494 USD)/dose. 
 
PROTECTING AND TREATING HUMANS 
------------------------------ 
 
6. (SBU) In addition to fighting the virus at its source, 
authorities in southern Vietnam are working to better protect and 
treat humans.  The Pasteur Institute in HCMC has been designated 
by the Ministry of Health as the institution responsible for the 
surveillance and control of infectious diseases in southern 
Vietnam, including AI.  According to the Pasteur Institute, during 
the first 6 months of 2005, ten people were diagnosed with AI in 
the south and all ten died (with the last death occurring in 
February). (Note: During the last few weeks, there have been 3 
more deaths from AI in the South. End Note.)  Districts are 
required to report any flu-like cases to their respective 
provinces, which in turn submit these standardized reports by fax 
to the Pasteur Institute.  Currently, these reports are submitted 
weekly, but during times of epidemic the reports are submitted 
daily.  In order to step up surveillance, the Pasteur Institute 
recommends more AI surveillance points at the district level.  The 
World Health Organization (WHO) established four such centers, the 
Centre for Tropical Diseases (Ho Chi Minh City), Pediatric 
Hospital No. 1 (Ho Chi Minh City), General Hospital in Khanh Hoa 
Province and General Hospital in Dak Lak Province. 
 
7. (SBU) HCMC has developed an interagency task force and 
procedures to address small- to medium-sized outbreaks of AI in 
humans.  The task force, organized by the HCMC People's Committee, 
is headed by a Vice Chairman and includes representatives from the 
fields of public health, agriculture, the market management board, 
animal health, and the police. The task force meets twice a month 
to evaluate, suggest and implement policies aimed at combating 
avian flu.  Vice Director Dr. Le Truong Giang of the HCMC DoH 
acknowledged that while HCMC has a strong grasp on the conditions 
in the central districts, outlying districts are harder to 
control.  Currently, DoH HCMC has three contingency plans based on 
the size of an outbreak of AI in humans, one for 10-30 patients, a 
second for 100-300 patients, and a third for 500-1,000 patients. 
HCMC is currently ill-equipped to effectively cope with an 
outbreak larger than 30 patients for several reasons:  the 
inability to isolate patients, a lack respirators, and the scarce 
quantity of Tamiflu doses to treat AI sufferers.  HCMC has 10,000 
doses of Tamiflu, enough for 1,000 people taking two doses a day 
for five days.  Dr. Giang is hopeful that HCMC will have 
additional Tamiflu, in a powdered form, by October.  DoH HCMC is 
interested in increasing the level of preparedness at local 
levels, but lacks experience and resources. 
 
8. (SBU) Comment:  The nationwide poultry vaccination program 
marks a first step in a proactive versus a reactive approach to 
combating avian influenza.  Vietnam's ability to implement this 
program will serve as a good barometer of its ability to handle 
this potential health and economic crisis.  Key areas of concern 
include the need to increase stores of Tamiflu vaccine in case of 
human epidemic; educate the public and convey policy decisions, 
particularly in outlying areas; control the production and sale of 
poultry; and enforce compliance with culling directives.  The 
current compensation of 15,000 VND (just under USD 1) per culled 
bird is approximately 50% of the bird's market value and takes 
three to five months to reach farmers, creating a disincentive for 
farmers to comply with government orders.  Public health safety is 
further hampered in southern Vietnam by the inability of HCMC DoH 
to handle outbreaks of more than a handful of patients, and by the 
lack of resources to expand surveillance in high-risk areas such 
as the Mekong Delta.  End Comment. 
 
WINNICK