US embassy cable - 05MANILA4278

UNCLAS SECTION 01 OF 05 MANILA 004278 
 
SIPDIS 
 
STATE FOR EB/TPP/ABT FOR SPIRNAK AND GOETHERT 
STATE FOR OES/IHA FOR JKAUFMANN 
STATE FOR INR/EAP FOR JSTROTZ 
STATE PASS USDA/FAS/ITP FOR SIMMONS, RICHEY, AND CLARKSON 
ICD FOR PETLOCK 
STATE PASS USAID FOR JLEWIS 
DEPT OF INTERIOR FOR OSM RMCNEER 
BANGKOK FOR REO JAMES WALLER 
CIA FOR NATIONAL INTELIGENCE COUNCIL NIO/EA 
 
E.O. 12958: N/A 
TAGS: ECON, PINR, SOCI, EAGR, SENV, TBIO, TSPL, RP 
SUBJECT: AVIAN FLU PANDEMIC PREPAREDNESS: GAPS IN PLANNING 
VS. CAPACITY 
 
REF: A) STATE 151549 
 
     B) STATE 153802 
     C) MANILA 3883 
     D) MANILA 2053 
     E) 04 MANILA 622 
 
Sensitive But Unclassified - Protect Accordingly 
 
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Summary 
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1. (SBU) Summary:  Although there have been no reported 
cases of avian influenza (H5N1) in the Philippines, the 
GRP's capacity to respond to a potential outbreak is 
limited by lack of resources in many areas.  The GRP 
lacks funds for materials such as protective gear and 
stockpiles of Tamiflu.  Key activities such as 
surveillance in rural areas, public health information 
campaigns, and other programs remain under funded.  No 
funds are available for indemnity payments to compensate 
farmers.  Countermeasures at international ports of entry 
remain ineffective.  A newly formed embassy task force 
will host a second roundtable discussion on AI with 
senior GRP officials and experts on September 16 (ref C) 
for the purpose of identifying and possibly filling gaps 
between planning and capacity.  End Summary. 
 
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AI is a High GRP Priority . . . 
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2. (SBU) Responding to the potential treat of avian 
influenza is a high priority for the GRP.  The issue is 
receiving attention at the cabinet level and the 
secretaries of the Department of Agriculture (DA) and the 
 
SIPDIS 
Department of Health (DOH) are directly engaged on AI 
planning and countermeasures.  Both of these lead 
agencies for AI have demonstrated their seriousness of 
purpose by having developed comprehensive plans for 
prevention and response.  In view of this level of 
attention, probably only the president herself could 
raise the issue to a higher priority. 
 
3. (U) The GRP's crisis manager for avian influenza is 
DOH Secretary Francisco Duque, M.D. (ref B).  Luningning 
E. Villa, M.D., Program Manager for Emerging Infectious 
Diseases, serves as DOH's point of contact.  DA Secretary 
Domingo Panganiban serves as co-crisis manager.  Chief 
Veterinary Officer Davinio Catbagan, D.V.M., serves as 
DA's principal point of contact.  Samuel Animas, D.V.M., 
National Coordinator for Avian Influenza Protection, also 
serves as a point of contact at DA.  Professional staff 
at DA and DOH include competent and experienced 
scientists and experts, some of whom were trained 
overseas. 
 
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. . . GRP Has a Strategy . . . 
------------------------------ 
 
4. (U) AgCounselor met September 9 with Philippine Chief 
Veterinary Officer, Davinio Catbagan, D.V.M., Bureau of 
Animal Industry, Department of Agriculture (DA/BAI) to 
discuss the GRP's four-staged response to avian influenza 
(AI): (1) prevent the introduction of AI into the 
Philippines from affected countries; (2) establish 
counter-measures for an outbreak among domestic bird 
flocks; (3) prevent transmission of AI from birds to 
humans, and (4) prevent human-to-human transmission.  The 
DA is responsible for stages (1) and (2) while DOH is 
responsible for stages (3) and (4). 
 
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. . . But Lacks Resources 
------------------------- 
 
5. (SBU) Serious constraints remain with respect to 
funding, training of officials, laboratory 
infrastructure, and scope of monitoring potential AI 
threats, especially in rural areas.  The lack of an 
indemnity fund could be a major problem here (and in 
other developing countries) as cooperation diminishes 
when producers they see their livelihoods threatened by 
government regulators.  Other weak links include lack of 
effective countermeasures at ports of entry, inadequate 
stockpiles of Tamiflu, and the absence of a public health 
education campaign. 
 
6. (SBU) BAI's budget for AI-related activities is 20 
million pesos ($360,000), but DA's experts estimate that 
about twice that amount would be required to effectively 
prepare for an outbreak.  DA also expends significant 
resources on controlling other diseases such as foot-and- 
mouth disease.  Funding for various activities to 
increase the efficiency of BAI's overall operations is 
"slow in coming", Chief Veterinary Officer Catbagan 
lamented.  Resources also are needed to purchase 
protective gear for inspectors and technicians. 
Meanwhile, BAI is improving its information gathering, 
analysis, and dissemination functions to ensure that 
decision makers can respond quickly.  BAI's field offices 
are supposed to report to headquarters three times 
weekly, but the system still contains flaws and appears 
to be a work in progress. 
 
7. (U) A recent improvement includes the GRP's upgraded 
Animal Health Center laboratory where samples can now be 
evaluated domestically.  Fourteen regional laboratories 
feed samples and data to the central lab in Manila. 
Previously, samples were sent to Australia to the 
Regional Reference Laboratory, Office International des 
Epizooties. 
 
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Progress at DOH on Prevention and Control 
----------------------------------------- 
 
8. (U) USAID/PHN Chief and RMO met September 7 with 
Department of Health (DOH) officials Dr. Luningning E. 
Villa, Program Manager for Emerging Infectious Diseases, 
and Dr. Vito "Jojo" G. Roque, Jr., Surveillance Unit 
Head, National Epidemiology Centre.  The National Centre 
for Disease Prevention and Control leads DOH's 
initiatives in partnership with the National Epidemiology 
Centre and the Research Institute of Tropical Medicine. 
This partnership worked effectively during the SARS 
pandemic of 2003.  DOH's strategy focuses on prevention, 
surveillance, and containment of suspected cases. 
 
9. (U) The DOH has undertaken the following measures: 
 
-- Developed surveillance systems for which the quality 
of data is verified with methods similar to those used in 
responding to SARS; 
-- Designed prototypes of public health education and 
information materials; 
 
-- Made plans to stockpile Tamiflu; 
 
-- Conducted trainings for service providers, public 
health administrators, and program managers at regional 
levels; 
 
-- Set up Barangay emergency response teams with the 
Department of Local Government (DILG) through an official 
circular on preparedness for the local governments; 
 
-- Designated regional hospitals as referral centers for 
quarantine of infected human cases. 
 
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DOH Needs Tamiflu, Rural Surveillance, and Flyers 
--------------------------------------------- ---- 
 
10. (SBU) Critical gaps include the lack of funds for: 
 
-- Mass production of public health education and 
information materials; 
 
-- Procurement and stockpiling of Tamiflu; 
 
-- Effective operation of sentinel surveillance systems, 
especially in remote rural areas. 
 
DOH has requested funds for these activities from the 
Department of Budget and Finance. 
 
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Surveillance of Human Subjects in Bulacan 
----------------------------------------- 
 
11. (SBU) DOH's plans include conducting surveillance of 
human subjects in areas where migratory birds pass such 
as Bulacan, where an undefined, low-pathogenic strain of 
H5N was detected.  DOH will sponsor a meeting at Subic 
Bay September 21 - 23, to train 70 epidemiologists and 
regional coordinators on surveillance, prevention, and 
emergency response.  The DOH also will improve capacities 
for containment and case management at referral hospitals 
including San Lazaro, the Lung Centre, Davao Medical 
Centre, Vincente Sotto, and the Research Institute for 
Tropical Medicine. 
 
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Special Challenges in Mindanao 
------------------------------ 
 
12. (SBU) From October to February, 100 species of wild 
birds will cross the 7000 islands of the Philippines on 
their annual migratory routes.  DA has identified 20 
critical areas where BAI's regional offices are 
redoubling their efforts to monitor developments.  Some 
of these areas are in conflict-affected regions of 
Mindanao where BAI's officers face greater challenges. 
For example, due to the absence of indemnity funds to 
compensate producers, when duck raisers see BAI's 
officers coming "they grab their flocks and head in the 
opposite direction", Chief Veterinary Officer Catbagan 
warned. 
 
13. (U) About 17% of the country's poultry are produced 
in Pampanga Province in Central Luzon, Region III.  Many 
producers in Pampanga raise ducks for "Balut," exotic 
duck eggs.  They transport ducks to other provinces or 
regions to feed on snails and residual grain in newly 
harvested rice paddies.  This integrated pest management 
practice works well for rice producers and duck raisers 
alike, but travel and exposure increase the potential for 
ducks to become vectors for the spread of AI.  DA is 
drafting new regulations to limit or prohibit such 
movement of ducks within the country, although 
implementation will be difficult without effective 
monitoring.  Region III, which comprises seven provinces, 
produces 43% of the country's chicken and 40% of all duck 
products. 
 
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Embassy Task Force 
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14. (U) The Embassy's Task Force on Avian Influenza held 
its first meeting September 2, chaired by USAID/Manila. 
Membership includes RMO and representatives of FAS, 
APHIS, Peace Corps, Econ, Pol, ACS, and JUSMAG.  The 
group convenes monthly to exchange information, refine 
preparedness planning at post, and liaise with public 
officials, scientists, donors, and international agencies 
to monitor developments.  The task force will hold post's 
second roundtable discussion with senior officials and 
experts from DOH, DA, and the private sector on September 
16 at the American Chamber of Commerce to explore ways to 
fill gaps between planning and capacity. 
 
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Comment 
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15. (SBU) In the event of an outbreak, presidential 
leadership would probably become a key factor in imposing 
quarantines, social distancing measures, and other 
emergency steps.  In large and densely populated cities 
such as Manila, crowded buses and other mass transit 
facilities would pose challenges for AI control, though 
schools and public facilities could quickly be ordered 
closed.  Although the GRP could try to keep the lid on 
news coverage of an outbreak, this type of development 
would probably quickly receive TV and press coverage in 
the open media environment of the Philippines.  In July 
2005, for example, we observed widespread media coverage 
of suspected AI cases in the Philippines soon after the 
government learned of them.  (These suspected cases later 
proved negative for AI.) 
 
16. (SBU) The Armed Forces of the Philippines (AFP) have 
on occasion been called on to assist with natural 
disasters such as floods and landslides.  The AFP never 
has responded to an epidemic, but probably would be 
capable of doing so, especially if urged through USG 
political and military channels.  Further encouragement 
could be provided by possible offers of medical 
assistance and training by experts in disease research 
and quarantine procedures through U.S. military resources 
such as the Army Medical Component-Armed Forces Research 
Institute of Medical Sciences (USAMC-AFRIMS) in Bangkok. 
 
JOHNSON