US embassy cable - 05HANOI2192

UNCLAS SECTION 01 OF 06 HANOI 002192 
 
SIPDIS 
 
USAID WASHDC PRIORITY/GH/ANE 
 
SENSITIVE BUT UNCLASSIFIED 
 
STATE 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 (ABHAT) 
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:  A/S SIMONSON DISCUSSES COOPERATION ON AVIAN 
INFLUENZA 
 
1. (SBU) Summary:  Assistant Secretary (A/S) Stewart 
Simonson of the Department of Health and Human Services 
(HHS) visited Vietnam on August 14-17 to discuss a 
memorandum of understanding (MOU) on cooperation between HHS 
and the Ministry of Health (MOH), as well as to discuss 
Vietnam's efforts to combat Avian Influenza (AI).  The 
Government of Vietnam (GVN) wants a binding agreement rather 
than an MOU.  HHS is willing to consider an agreement 
provided it can obtain first the necessary legal authority. 
GVN officials told the Assistant Secretary that they were 
eager to cooperate with the United States in developing 
Vietnam's monitoring capacity and preparing for a possible 
outbreak of AI.  A/S Simonson stressed the critical need to 
establish a Rapid Response Protocol (RRP), and committed the 
USG to keeping information on possible outbreaks that the 
GVN shares with it confidential.  A/S Simonson also met with 
representatives from the United Nations agencies to hear 
their assessment of Vietnam's anti-AI efforts and their 
proposed joint program.  The A/S left Vietnam optimistic 
that HHS and MOH could conclude a cooperative agreement in 
time for the planned visit of HHS Secretary Michael O. 
Leavitt, now delayed, for mid-October.  End Summary. 
 
2. (U) A delegation led by Stewart Simonson, Assistant 
Secretary for Public Health Emergency Preparedness at the 
 
SIPDIS 
U.S. Department of Human and Health Services (HHS) visited 
Vietnam August 14-17 to discuss a Memorandum of 
Understanding (MOU) on health and medical sciences 
cooperation between HHS and the Ministry of Health (MOH), as 
well as efforts to prevent and contain the H5N1 Avian 
Influenza (AI) virus.  Accompanying the Assistant Secretary 
were Dr. Amar Bhat, HHS Director of the Office of Asia and 
the Pacific, HHS Office of Global Health Affairs; Dr. James 
Le Duc, Director, Division of Viral and Rickettsial 
Diseases, National Center for Infectious Diseases, 
HHS/Centers for Disease Control and Prevention (CDC); and 
Dr. Mary Chamberland, Medical Officer, HHS/CDC.  During the 
visit to Hanoi, the delegation met with representatives from 
the MOH, the Ministry of Agriculture and Rural Development 
(MARD), the Ministry of Planning and Investment (MPI) and 
key United Nations agencies.  Ambassador Marine or Acting 
DCM Sam Watson, and Health Attache Dr. Marie Haring Sweeney 
accompanied the Assistant Secretary to his meetings. 
 
Productive Discussions with the MOH on the MOU 
--------------------------------------------- - 
 
3. (U) A/S Simonson and his delegation held discussions on a 
draft MOU on HHS-MOH cooperation with a GVN team led by MOH 
Vice Minister Trinh Quan Huan.  A/S Simonson stated that he 
considers AI to be an extremely important issue for the HHS 
Office of Public Health Emergency Preparedness.  U.S. and 
other experts believe that there is a narrow window of time 
when medical and physical intervention can stop a pandemic. 
The main reason for the Assistant Secretary's visit was to 
determine what tools would be necessary for Vietnam to 
respond during this critical period.  He expressed his 
appreciation for Vietnam's cooperation and the level of 
transparency achieved to date, and his hope to build on this 
foundation. 
 
4. (U) The GVN proposed language that would change the 
document under discussion from a MOU into a binding 
agreement.  The A/S said that he would be amenable to this 
change, but stressed that the discussions would have to 
proceed with the understanding that any agreement reached 
would have to be approved by Washington.  Both sides agreed 
to bracket all words in the text that would constitute a 
binding agreement pending the interagency concurrence on 
Circular 175 authority for such an agreement.  A/S Simonson 
concluded by stating that the U.S. objective is to reach 
agreement on a document for Secretary Leavitt to sign during 
his planned visit in the fall. 
 
The MOU:  Need for Speedy Response and Confidentiality 
--------------------------------------------- --------- 
 
5. (SBU) The A/S stressed that rapid response at the first 
sign that the virus is changing is critical to have a chance 
to prevent a pandemic.  The United States and Vietnam would 
have to agree on the general principles for rapid response 
in the cooperation document, and to follow up with a more 
detailed Rapid Response Protocol (RRP).  These steps would 
not only improve Vietnam's readiness in the event of a 
pandemic, but would also help to identify possible U.S. 
funding to fight AI in Vietnam.  Vice Minister Huan 
expressed the concern that Vietnam might be criticized 
should the GVN announce an outbreak of AI prematurely, as 
has happened in the past.  A/S Simonson reassured the Vice 
Minister that the intent of the United States is to enter "a 
partnership with trust and confidence," in which information 
shared between the two governments would be treated with the 
utmost confidentiality, with no penalty for false alarms. 
He repeated this message in subsequent meetings with other 
ministries. 
 
The MOU:  Unresolved Issues 
--------------------------- 
 
6. (U) The MOH asked to strike language in the agreement 
relating to the President's Emergency Preparedness for AIDS 
Relief (PEPFAR), arguing that it potentially duplicates the 
PEPFAR paper that Vietnam is currently negotiating with the 
United States.  Noting that this language had been added at 
Office of the Global AIDS Coordinator's request, A/S 
Simonson agreed to convey Vietnam's concerns to Washington, 
but stressed that he could not make any assurances that the 
change would be accepted.  The A/S agreed to include in 
brackets Vietnam's proposal to expand language on 
cooperation to include the areas of injury prevention and 
rehabilitation, pharmaceutical regulatory issues, and food 
safety.  He noted, however, that these issues fall beyond 
his mandate and within the jurisdiction of other HHS 
agencies. 
 
Joint FAO/WHO/UNDP Program 
-------------------------- 
 
7. (U) On August 15, A/S Simonson met with UNDP 
Representative Jordan Ryan, Dr. Peter Horby and Hitoshi 
Murakami of the World Health Organization (WHO), Anton 
Rychener and Dr. Astrid Tripodi1 from the Food and 
Agriculture Organization (FAO) and a representative of the 
World Bank.  They provided a copy of the latest version of 
the proposed Joint FAO/WHO/UNDP program to strengthen public 
health emergency management in Vietnam, with a focus on AI. 
Developed in response to a request from the GVN, the 
proposal is now before Prime Minister Khai, who is expected 
to approve it soon.  The estimated budget required for the 
program is USD 18.9 million over two years.  A number of 
donors have indicated interest in contributing funds.  FAO's 
Rychener emphasized that, while the GVN welcomed 
international help, it wants the help to be "low key" and 
supplemental to GVN's own efforts. 
 
8. (U) FAO's representatives described the GVN's massive 
pilot program to vaccinate poultry in two provinces.  It is 
important to get a first round of vaccinations nationwide 
well underway by October, before the flu season and well 
before the Tet holiday.  In response to a question from the 
Ambassador, Dr. Tripodi (FAO) said that the GVN has devised 
a good system to reach all producers, including small 
farmers, but pointed out that lack of funding is a problem. 
The GVN has had to rely on volunteers to complete the first 
round of vaccinations, a solution that is not viable in the 
long run. 
 
9. (U) Dr. Horby (WHO) emphasized that surveillance is 
essential to evaluate the effects of the first round, and 
that with adequate data, it may be possible to do focused 
vaccinations in subsequent rounds.  A/S Simonson asked if 
there was a consensus among international experts that a 
massive poultry vaccination campaign would be the best 
approach.  Both FAO and WHO representatives emphasized that 
the vaccination program was based on a consensus of experts. 
Dr. Horby said that WHO believes the vaccination program 
will reduce human fatalities; the question is whether the 
program will be sustainable in the long run. 
 
10. (U) According the WHO representatives, the GVN has been 
committed to using its own strain of virus to develop a 
human vaccine.  However, the WHO hopes the Ministry of 
Science and Technology (MOST) will decide to use a strain 
provided by the WHO.  For the time being, MOST has blocked 
the start of human trials.  WHO noted that although Vietnam 
can develop a vaccine, it lacks the manufacturing capacity 
to produce it in the required quantities, even for domestic 
use alone.  A/S Simonson suggested that one option might be 
producing the vaccine in a country with greater 
manufacturing capacity. 
 
11. (SBU) The UNDP, FAO and WHO representatives hope to see 
a draft of Vietnam's National Emergency Plan in early 
September.  The agencies' advice is to think through the 
full range of options, such as quarantine and closing 
schools.  Expressing doubt that MOH fully understands the 
concept of rapid response, Horby called for greater 
Vietnamese focus on training in that area.  The plan would 
not work if it exists only on paper.  A public education 
campaign is also important, since awareness among rural 
farmers is low and their behavior has not changed.  The only 
outreach thus far has been a few posters and leaflets. 
 
12. (SBU) In response to a question from the A/S, Dr. Horby 
said it might take seven to ten days to diagnose a case of 
AI that occurs in a remote area.  On average, it would be 
about five days before a sick person would be hospitalized, 
usually in a district hospital.  If the illness persisted, 
the patient would be transferred to a provincial or tertiary 
hospital and only then would samples be taken.  Results from 
the samples would take a day or more and would initially be 
reported to MOH and only then to the hospital.  If the 
hospital has not previously had a case of human AI, the 
illness might not be recognized immediately.  Since early 
detection of AI is crucial, this delay in identifying cases 
is a serious problem, Dr. Horby concluded. 
 
13. (SBU) Lack of diagnostic capacity is another serious 
concern. Vietnam has only six diagnostic laboratories of 
which two can perform the full range of tests.  Only 20-50 
samples can be processed per day, and inaccurate results are 
a problem.  The GVN has been reluctant to send samples 
abroad for testing, in part because of an incident in which 
a WHO lab in Tokyo provided results of their testing to a 
scientific journal (Nature).  The results indicated that the 
Vietnamese tests resulted in a disproportionate number of 
false negatives. As a result the GVN suspended all shipment 
of samples for two months and the WHO had to work to 
reestablish trust.  The Minister of Health must now approve 
sending positive samples abroad for retesting and does not 
approve sending negative samples for retesting. This action 
has implications for quality assurance. 
 
Support for AI Cooperation from MPI 
----------------------------------- 
 
14. (U) The A/S expressed appreciation to Ministry of 
Planning and Investment (MPI) Vice Minister Cao Viet Sinh, 
for the Ministry's interest and involvement in the Agreement 
for Economic and Technical Cooperation between the United 
States and Vietnam.  He stated that the purpose of his visit 
is to identify additional investments that the United States 
could make to help Vietnam fight AI, and asked whether there 
were ways the United States could make the process smoother. 
VM Sinh was well informed about the AI situation in Vietnam; 
he responded that approval of U.S. investment in AI 
containment efforts is a government priority, and that 
implementing an agreement would have support at the highest 
levels.  Stressing that AI is the most dangerous threat 
faced by the agricultural sector, the VM assured the A/S 
that MPI was ready to cooperate. 
 
15. (U) The VM stated that since the agricultural sector in 
Vietnam is not industrialized, raising AI awareness among 
small farmers is a critical component of an RRP.  He also 
singled out investments in personnel and equipment as 
priorities.  Regarding reporting, VM Sinh pointed to the 
lack of communication links to small farms.  At the end of 
the meeting, A/S Simonson stressed that the United States is 
interested in exchanging information in a confidential 
manner. 
 
Informal Discussion at the Ambassador's Residence 
--------------------------------------------- ---- 
 
16. (U) The Ambassador hosted an August 16 luncheon in honor 
of the A/S. Attendees included VM Trinh Quan Huan and other 
officials from the Ministry of Health, VM Bui Ba Bong of the 
Ministry of Agriculture and Rural Development, and Dr. Tran 
Ngoc Thang, Head of Planning, International Cooperation and 
Science Division at the Department of Animal Health. The A/S 
said that he felt his meetings had been very constructive, 
and that consensus on broad issues had been reached, 
including on the critical issue of the need for rapid 
response. 
 
17. (U) Noting that farmers in two provinces had 
participated in the pilot vaccination program very well, VM 
Bong said that Vietnam would start a nationwide vaccination 
program in September.  The two biggest challenges will be 
reaching small farmers and providing funding for the 1,000 
staff needed in each province to administer the program.  As 
it stands, local governments are responsible for paying 
staff salaries.  2Dr. Nguyen Tran Hien, Director of the 
National Institute for Hygiene and Epidemiology, stated that 
the highest risk of transmission is through exposure to sick 
birds.  He also noted another risky behavior: Vietnamese eat 
some bird parts uncooked. 
 
18. (U) GVN representatives described a high level of 
cooperation between the central and local, or commune level, 
governments on AI.  VM Bong and A/S Simonson agreed on the 
importance of further research into the mode of transmission 
of the virus in order to plan for prevention and treatment. 
Dr. Hien said that Vietnam is working to develop a vaccine 
using both domestically produced monkey kidney cells and 
cells provided by the WHO.  Noting concerns previously 
raised by international organizations over the use of 
primary monkey kidney (PMK) cells, he stated that the GVN 
will follow WHO established methods, but would also continue 
working with the PMK. 3 
 
In a side conversation with Dr. Sweeney, VM Huan indicated 
that he was given the area of AI as part of his 
responsibilities as Vice Minister.  Up until now, Vice 
Minister Liem was responsible for AI. 4 
 
Meeting at the MARD 
------------------- 
 
19. (U) The Ambassador accompanied A/S Simonson to a meeting 
with Minister Cao Duc Phat of the Ministry of Agriculture 
and Rural Development (MARD).  Minister Phat said that 
although AI outbreaks have greatly decreased in recent 
months compared to the same period last year, he considers 
the situation extremely serious, particularly as the winter 
flu season approaches.  He is also concerned that infected 
chickens and ducks are increasingly asymptomatic. 
 
20. (U) The Minister said that MARD had just initiated a 
program to vaccinate all poultry in the country before 
winter.  The initial response of farmers has been very 
encouraging, with the great majority willing to bring their 
birds for vaccination.  MARD also has implemented an 
information campaign aimed at all types of producers, 
particularly small backyard farmers, who own 65 percent of 
all poultry.  In the longer term, the MARD would like to 
encourage larger production operations where there is less 
contact between poultry and humans. 
 
21. (U) Minister Phat echoed other officials in emphasizing 
the need for increased monitoring capacity.  He said the 
most pressing need is for human resources, and the presence 
of qualified technicians in the provinces as well as in 
Hanoi.  The Minister has made a request to the WHO, FAO, and 
the U.S. Government to provide experts who will be able to 
advise and assist the GVN with the vaccination program, and 
monitoring of the disease. 
 
22. (U) A/S Simonson said that he is working with the MOH on 
an emergency plan to have resources ready in the event the 
disease acquired increased transmissibility. He hopes the 
plan will be ready in time for the visit by Secretary 
Leavitt.  He also noted the importance of looking at the AI 
problem as both an animal and human health problem.  In 
answer to a question from the Ambassador, Minister Phat said 
that MARD has not seen the disease spreading to other 
species, although they have sent swine samples to Hong Kong 
for testing. 
 
Concluding Thoughts 
------------------- 
 
23. (SBU) At an out-briefing with the Ambassador, A/S 
Simonson stated that he felt very positive about his visit. 
Besides working on the cooperative agreement, the delegation 
had discussed ideas for building surveillance and response 
capacity in Vietnam, and agreed that one possibility would 
be to work with retired U.S. scientists and public health 
officials.  The Ambassador recommended that the USG focus on 
bringing experts to Vietnam for extended TDY stints, 
preferably three months or longer.  He noted that the 
primary need is for public health experts who could assist 
in overseeing and coordinating survey work and sample 
processing, rather than for research scientists. 
Additionally, the language barrier can be significant; 
interpreters should be hired to facilitate the efforts of 
U.S. experts. 
 
24. (U) A/S Simonson and his party cleared this message. 
 
MARINE 
_______________________________ 
1check spelling 
2Best to delete this statement as it 
3Dr. Hien actually said that they would be working on both 
the WHO and the PMK cell line. 
4Is this important enough to add