US embassy cable - 05COLOMBO1592

UNCLAS SECTION 01 OF 03 COLOMBO 001592 
 
SIPDIS 
 
SENSITIVE 
 
STATE FOR OES/PCI, NEA/IPA AND NEA/RA 
USDA FOR APHIS/US/NCIE 
HHS FOR OGHA 
CIA FOR NATIONAL INTELLIGENCE COUNCIL NIO/EA 
 
E.O. 12958: N/A 
TAGS: TBIO, ECON, PREL, SOCI, EAGR, CE, KSTH, WHO, Avian Flu 
SUBJECT: AVIAN FLU PREPAREDNESS IN SRI LANKA 
 
REF: STATE 153802 
 
1.  (SBU) Summary:  EconOff met with the Chief Epidemiologist 
for the Ministry of Health (MOH) as well as an officer working 
in the Colombo office of the World Health Organization (WHO) 
regarding reftel.  Sri Lankan officials and academics are 
watching for signs of avian flu and other illnesses with 
epidemic or pandemic potential.  However, with no sufficient 
laboratories on the island, as well as communication and 
language barriers, it is unclear whether detection would occur 
rapidly.  Following detection, the government is not ready for 
a coordinated and fast response. No exercises are planned to 
prepare for such incidents.  End Summary. 
 
FOCAL POINT:  MOH,S EPIDEMIOLOGY UNIT 
 
2.  (SBU) EconOff met with Dr. Nihal Abeysinghe, Chief 
Epidemiologist for the MOH, who identified his epidemiology 
unit as the focal point when contagious epidemics take place 
in Sri Lanka.  However, this does not mean that the 
epidemiology unit will have the authority that it may need 
for fast and sufficient response.  Per the WHO official, the 
MOH controls around 98 percent of all medical services in Sri 
Lanka, with the private sector only serving about 2 percent 
in urban areas. 
 
WATCHING FOR AVIAN FLU, BUT NOT EXPECTING ITS ARRIVAL 
 
3.  (SBU) Officials are watchful for the arrival of avian flu 
or other such diseases.  Per Abeysinghe, September is 
traditionally the month migratory birds arrive in Sri Lanka. 
Officials at the Veterinary Research Institute are monitoring 
the situation, on the alert for any unusual bird deaths. 
 
4.  (SBU) Abeysinghe added that Sri Lanka seems to be almost 
immune from some of the diseases that plague the region.  He 
noted that SARS did not affect Sri Lanka and that avian flu 
"seems to have been spreading to Mongoloid countries," but 
added that Sri Lanka still needs to be on the lookout for 
signs of the disease.  The WHO official noted that avian flu 
is "currently no threat" to Sri Lanka 
 
DETECTION:  COMMUNICATION AND DIAGNOSTIC PROBLEMS 
 
5.  (SBU) According to the WHO official, if an epidemic would 
begin in the urban center of Colombo, it is likely that 
detection (not/not diagnosis) of a disease could take as few 
as two or three days.  But Colombo comprises only a small 
portion of the country.  If an epidemic grew in a 
Sinhala-speaking rural area, the WHO official said that MOH 
might not hear of a problem until 15 or 20 cases are 
discovered.  This was the case when a myocarditis epidemic 
was not detected by the MOH until two weeks after it began. 
The WHO office was then advised only after 70 cases had been 
reported.  (Note:  The WHO official noted that the epidemic 
occurred in the MOH Minister's part of the country, implying 
that perhaps the WHO would have learned of the epidemic even 
more slowly if it had occurred elsewhere.  End Note.)  The 
WHO official noted that there were ultimately 200 true cases 
with 400 people appearing to be affected; yet no cause could 
be found and the epidemic subsided on its own. 
 
6.  (SBU) The WHO official identified the Northern and 
Eastern Provinces occupied by the Liberation Tamil Tigers of 
Eelam (LTTE) as especially problematic for detection due to 
language barriers.  These are Tamil-speaking areas and many 
health officials do not speak Tamil.  Per the WHO official, 
Tamil-speaking medical officers allegedly prefer living in 
Colombo.  (Note:  The security situation in those areas could 
prevent fast response.  End note.) 
 
7.  (SBU) Abeysinghe's office is in regular communication 
with MOH's Medical Research Institute, which conducts 
laboratory testing for various diseases.  However, its 
facilities are inadequate.  Alternatively, Abeysinghe 
contacts the CDC in Atlanta, the University of Hong Kong, and 
laboratories in India, and has transmitted specimens to those 
laboratories on various occasions.  Abeysinghe noted that 
transport of the viruses to these facilities is difficult. 
He articulated a desire to see Sri Lankan labs obtain 
adequate resources for timely diagnosis. 
 
8.  (SBU) Both Abeysinghe and the WHO official described Sri 
Lanka's isolation facilities as inadequate and inadequately 
maintained.  Abeysinghe speculated that in the event of a 
pandemic, perhaps a military hospital could assist, or the 
government could order/persuade another hospital to care for 
patients. 
 
RESPONSE TO EPIDEMIC COULD BE SLOW AND UNCOORDINATED 
 
9.  (SBU) Both Abeysinghe and the WHO official said that a 
lengthy response time may be required in the event of an 
epidemic or pandemic.  Abeysinghe first claimed that Sri 
Lanka has experienced "enough reality" with its floods, 
droughts, influenza, myocarditis, dengue and meningitis and 
therefore doesn't need exercises in epidemic management.  But 
later, he acknowledged that the Government of Sri Lanka (GSL) 
is not very good at coordinating activities.  "There are many 
stakeholders within the government," Abeysinghe said.  "It 
will take time to coordinate." 
 
10.  (SBU) Abeysinghe described a scenario in which a disease 
would first be detected somewhere in Sri Lanka, followed by 
diagnosis which might require transport of specimens to Hong 
Kong, India or the US.  Following diagnosis, he would need to 
contact the Minister of Health who may then contact the 
President to coordinate/mandate treatment, isolation, 
quarantine and other services.  (Note:  This is credible 
given Sri Lanka's heavily centralized structure.  Immediately 
after the Asia tsunami, it was the President's office that 
coordinated the GSL response, with many basic decisions going 
to the President for decision.  End note.)  Abeysinghe does 
not know whether the military would ever be called to 
quarantine an area.  He described one epidemic in which many 
people had fled from their homes to other parts of Sri Lanka 
before the MOH even arrived on site. 
 
PREVENTION:  FUTURE EFFORTS 
 
11.  (SBU) On September 12, Sri Lanka's Advisory Committee on 
Communicable Diseases will meet to discuss various matters. 
Following the 12 September meeting, Abeysinghe plans to make 
suggestions to the Health Education Bureau and the MOH press 
office on how to utilize the media to educate the public on 
prevention of flu.  He said that the media does "a good job 
in spreading information." 
 
12.  (SBU) Per the WHO official, the WHO's South East Asia 
Regional Office is coordinating a Pandemic Preparedness Plan 
and is pressing countries in the region to develop their own 
national pandemic plans.  Pandemic preparedness will be a 
part of the WHO biennial (2006-07) budget.  The MOH's 
epidemiology unit is working with the WHO on this project, in 
the hopes of what the WHO official called "harm reduction." 
However, the WHO official noted that the WHO invested heavily 
some time ago in an Emergency Action Plan in Sri Lanka.  That 
plan has never been implemented. 
 
13.  (SBU) COMMENT:  Chief Epidemiologist Abeysinghe appears 
to have experience in handling small epidemics in some parts 
of Sri Lanka but his philosophy that Sri Lanka might be 
"immune" is disturbing.  While putting past work in a positive 
light, he also appears to know his office's limits. Sri Lanka 
seems unprepared for a pandemic, which could spread long 
before it is even diagnosed in foreign laboratories. Upon 
diagnosis, the MOH and other government agencies do not seem 
ready to combat a pandemic in an efficient and coordinated 
manner.  Should a pandemic occur, assistance would most likely 
be accepted from bilateral and multilateral entities. 
LUNSTEAD