US embassy cable - 05HANOI2398

UNCLAS SECTION 01 OF 04 HANOI 002398 
 
SIPDIS 
 
STATE FOR G; CA/OCS/ACS/EAP; EAP/EX; EAP/BCLTV; EAP/EP; INR; 
OES/STC (MGOLDBERG); OES/IHA (DSINGER AND NCOMELLA) 
BANGKOK FOR RMO, CDC, USAID/RDM/A (MFRIEDMAN) 
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (LSTERN) 
USAID FOQANE AND GH (DCAROLL, SCLEMENTS AND PCHAPLIN) 
STATE ALSO PASS HHS/OGHA (EELVANDER) 
 
 
E.O. 12958: N/A 
TAGS: AMED, AMGT, CASC, EAGR, PINR, SOCI, PGOV, TBIO, VM, HIV/AIDS 
SUBJECT: AMBASSADOR'S MEETING WITH MOH VM ON PEPFAR 
 
1. SUMMARY/COMMENT: The Ambassador met September 9 with Vice 
Minister of Health Nguyen Thi Xuyen to discuss the progress 
of the President's Emergency Plan for AIDS Relief (PEPFAR) 
in Vietnam, the activities leading to the development of the 
06 Country Operational Plan (COP), the development of a plan 
of action to guide the relationship between the USG PEPFAR 
Team and Vietnamese Ministry of Health (MOH) and concerns 
about the supply and cost of branded antiretroviral drugs. 
They agreed that since June, 2004 when Vietnam became the 
fifteen focus country, substantial progress has been made in 
establishing and refocusing programs to meet the PEPFAR 
country goals.  The VM acknowledged the need to continue 
programs started in the 05 COP but also noted that the 
program must meet the action plans outlined in Vietnam's 
National Strategy to Control HIV/AIDS.  The VM asked for 
support of seven priority areas in the 06 COP which would 
support and strengthen MOH's HIV/AIDS infrastructure. 
 
2. The Ambassador emphasized that the expenditures on ARV's 
will limit the possibility of expanding existing programs. 
He suggested that Vietnam has three possible options to 
increase access to ARV's: 1) leveraging funds from donors to 
purchase ARVs; 2) by working with STADA, the Vietnam-based 
pharmaceutical company that manufactures ARVs to obtain FDA 
approval for ARVs produced in Vietnam; and, 3) permitting 
the importation of FDA-approved generics into Vietnam.  MOH 
representatives of the Drug Administration, Therapy 
Department, the Vietnam Administration of HIV/AIDS Control 
(VAAC) and International Cooperation, as well as the 
Embassy's Health Attache also attended the meeting. 
 
3. This 75-minute meeting was frank and constructive.  We 
laid down clear markers about what PEPFAR can do and what is 
cannot do (i.e., purchase cars).  The two sides agreed that 
since June, 2004 when Vietnam became the fifteen focus 
country, substantial progress has been made in establishing 
and refocusing programs to meet the PEPFAR country goals. 
Lastly, and perhaps most importantly, we focused high-level 
attention on the critical ARV issues and explored several 
solutions that would help us overcome PEPFAR's budget 
shortfalls.  In the weeks ahead, we will continue to press 
hard for movement on the use of generics in Vietnam.  END 
SUMMARY/COMMENT. 
 
4. The Ambassador met with Vice Minister of Health Nguyen 
Thi Xuyen to discuss the progress of the President's 
Emergency Plan for AIDS Relief (PEPFAR) in Vietnam, the 
activities leading to the development of the 06 Country 
Operational Plan (COP), the development of a plan of action 
to guide the relationship between the USG PEPFAR Team and 
Vietnamese Ministry of Health (MOH) of the Socialist 
Republic of Vietnam and concerns about the supply and cost 
of branded antiretroviral drugs.  [NOTE: VM Xuyen has 
responsibility for PEPFAR within the MOH. END NOTE.] 
 
5. VM Xuyen opened the meeting by thanking the United States 
for naming Vietnam as the fifteen focus country and 
described Vietnam's system for HIV/AIDS control at the 
national, provincial and district levels.  The National 
Steering Committee for the Control of HIV/AIDS, Prostitution 
and Drug Abuse is chaired by Deputy Prime Minister Pham Gia 
Khiem and Minister of Health Tran Thi Trung Chien is the 
permanent co-chair.  People's AIDS Committees direct 
activities at the provincial and district level.  With 
respect to PEPFAR, the MOH has been delegated the 
responsibility to collaborate with the USG team.  In 
response, the MOH organized an Interministerial Coordinating 
Committee, which is supported by a Technical Committee and 
Secretariat composed of only MOH staff.  To facilitate a 
 
SIPDIS 
coordinated response to the epidemic, the MOH had recently 
reorganized their HIV/AIDS program under a new department, 
the Vietnam Administration of HIV/AIDS Control (VAAC). 
 
6. VM Xuyen then outlined a number of key issues and 
challenges.  The MOH and USG PEPFAR team have been working 
together on the framework for cooperation which is important 
to complete and must be submitted to the Government for 
approval.  The Technical Working Group is assigned to work 
with the USG Team to finalize the document.  While 
acknowledging the need to continue programs started in 2005, 
she stressed that the PEPFAR program must contribute to the 
action plans outlined in Vietnam's National Strategy to 
Control HIV/AIDS as well as the requirements of the Office 
of the Global AIDS Coordinator (OGAC).  Further, given the 
number of donors in Vietnam, the MOH recognizes need to 
balance resources and avoid duplication of effort.  The VM 
asked that the U.S. side consider additional support in the 
06 COP for infrastructure development at the national, 
provincial and district levels to improve care, treatment 
and diagnosis as well as to expand ARV acquisition and 
distribution and the transfer of technology from the United 
States to Vietnam for the production of ARV's to improve 
pharmaceutical manufacturing. 
 
7. VM Xuyen stressed that coordination and supervision of 
PEPFAR activities both by MOH and the USG team should be 
improved through submission of annual reports and periodic 
site visits of partner activities as well as evaluation of 
the success of the programs.  The Ambassador indicated that 
the USG team was agreeable to providing the MOH annual 
reports and noted that March 2006 marked the end of the 05 
COP activities and suggested that a program review at that 
time would be useful. 
 
8. The VM asked for support of seven priorities in the 06 
COP which would support MOH's HIV/AIDS infrastructure, in 
particular the establishment of the VAAC.  Dr. Nguyen Thanh 
Long, Deputy Director of VAAC noted that the MOH Technical 
Working Group meets with the USG PEPFAR team regularly to 
evaluate 05 activities and to plan for 06.  He requested 
support for: 1) the VAAC through the purchase of medical 
equipment, supplies, training including creation of a 
National Training Center, and for the PEPFAR Coordinating 
Committee and Technical Committee, particularly for site 
visits and program evaluation activities; 2) the Provincial 
HIV/AIDS offices in the form of facilities, lab equipment, 
vehicles and improving lab capacity; 3) the districts in 
severely affected areas by HIV/AIDS; 4) the expansion of 
access to ARV's to 20 provinces (currently USG plans to 
supply ARV's to six focus provinces); 5) the coordination of 
the distribution of ARV's from different donors, including 
the MOH; 6) the integration of HIV/TB programs, which are 
currently not well integrated; and, 7) the development of 
policies for improving the technologies of companies in 
Vietnam which are producing ARV's.  The Ambassador said he 
appreciates the need to expand care and treatment facilities 
and human capacity, but explained that PEPFAR is a target- 
driven program focusing on care, treatment and prevention. 
Not reaching the targets could jeopardize future funding. 
Many of the items included in the MOH list are being 
supported in part by the current program, and that the USG 
was happy to coordinate ARV distribution and would consider 
supporting the HIV/AIDS National Training Center.  Support 
for buildings, vehicles, computers and other items would not 
be available through PEPFAR, however for these needs.  He 
suggested that the MOH look to other donors such as the 
World Bank. 
 
9. The Ambassador complimented the Vice Minister on her good 
understanding of the PEPFAR program and noted that they both 
shared the same vision for the program.  He also has 
observed a great improvement in the dialogue between the USG 
PEPFAR team and the MOH.  He then described next steps for 
the collaboration including the development of an Action 
Plan, which establishes the working relationship between the 
MOH and the USG PEPFAR Team.  He noted the importance of 
keeping the language simple and avoiding duplication of 
language in the Bilateral Agreement on Economic and 
Technical Assistance signed during Prime Minister Phan Van 
Khai's trip to the United States in June 2005. 
 
10. The Ambassador emphasized the importance of coordination 
at all levels to enhance the prevention and control of 
HIV/AIDS.  Noting that the interministerial Coordinating 
Committee was key to bringing into the dialogue all 
government entities, he volunteered to meet with the 
Coordinating Committee and brief them on PEPFAR.  He noted 
that he meets regularly with other donors to discuss how to 
enhance donor coordination, and that the recent addition of 
the U.S. Embassy to the Country Coordinating Mechanism of 
Vietnam's Global Fund Program to Prevent AIDS, Malaria and 
Tuberculosis also provides another avenue to improve 
coordination. 
 
11. With respect to planning for 2006, the Ambassador 
emphasized that the continuation of successful, existing 
programs is vital and reported that although Vietnam PEPFAR 
will receive USD 6,000,000 over last year's budget, there is 
a critical need to ramp up access of ARV's to people living 
with HIV/AIDS.  However, due to the worldwide shortage of 
branded ARV's, the USG must purchase 18 months of ARV's from 
2006 funds to ensure coverage through the period.  Unless we 
find ways to reduce the cost of these essential drugs, the 
expenditures on ARV's will block any possibility of 
expanding existing programs.  Vietnam PEPFAR Program sees 
three possible options to increase access to ARV's: 1) 
leveraging funds from other donors to purchase ARVs; 2) 
working with STADA, the Vietnam-based pharmaceutical company 
that manufactures ARVs to obtain FDA approval for ARVs 
produced in Vietnam; and, 3) permitting the importation of 
FDA-approved generics into Vietnam. 
 
12. The MOH would welcome the Embassy's assistance in 
speeding up FDA approval of ARVs produced in Vietnam, VM 
Xuyen stressed. She assigned the Drug Administration to work 
with STADA and the USG PEPFAR team to apply for FDA 
approval.  Mr. Truong Quoc Coung, Director of MOH Drug 
Administrations, noted that drugs produced in Vietnam would 
be 300-400 percent cheaper than branded ARVs. 
 
13. VM Xuyen suggested that the United States consider a 
fourth approach for expanding ARV provision in Vietnam: 
having the MOH to purchase STADA ARVs that would then be 
distributed and administered through existing USG PEPFAR 
programs. 
 
14. The Ambassador responded that the Embassy would explore 
this idea and pledged to push hard to help STADA complete 
the FDA approval process.  He also asked the Vice Minister 
for written confirmation of MOH's position on the 
importation of generic drugs already approved by the FDA. 
 
15. The VM and Ambassador agreed that the November 2006 
visit to Vietnam by President Bush would be an opportunity 
to showcase the collaborative efforts of the two countries 
on HIV/AIDS and illustrate the success of the PEPFAR 
program. 
 
16. The Ambassador told the VM that he was always available 
to talk with her or her staff about PEPFAR and that he 
looked forward to having the Action Plan agreed upon and the 
06 COP finalized as soon as possible. 
 
17. Comment: The MOH continues to wrestle with how to 
organize its response to the HIV/AIDS threat.  At present, 
VM Xuyen is one of three Vice Ministers responsible for one 
aspect of the work or another.  (The other two are VM Tran 
Chi Liem, in charge of the USG-funded, Life Gap program, 
which predates PEPFAR, and VM Trinh Quan Huan, who handles 
overall HIV/AIDS policy and oversees other donor programs 
dealing with the epidemic.)  While this complicates our 
work, the USG PEPFAR team, assisted by the Ambassador, will 
overcome this handicap. 
 
18. Comment (continued).  This 75-minute meeting was frank 
and constructive.  We laid down clear markers about what 
PEPFAR can do and what is cannot do (i.e., purchase cars). 
The two sides agreed that since June, 2004 when Vietnam 
became the fifteen focus country, substantial progress has 
been made in establishing and refocusing programs to meet 
the PEPFAR country goals.  Lastly, and perhaps most 
importantly, we focused high-level attention on the critical 
ARV issues and explored several solutions that would help us 
overcome PEPFAR's budget shortfalls.  In the weeks ahead, we 
will continue to press hard for movement on the use of 
generics in Vietnam. 
 
MARINE