US embassy cable - 05HANOI2709

UNCLAS SECTION 01 OF 03 HANOI 002709 
 
SIPDIS 
 
FOR USAID/RDM-A/BANGKOK 
 
SENSITIVE 
 
STATE FOR G; CA/OCS/ACS/EAP; EAP/EX; EAP/MLS; EAP/EP; INR; 
OES/STC (PBATES); OES/IHA (DSINGER AND NCOMELLA) 
BANGKOK FOR RMO, CDC, USAID/RDM/A (MFRIEDMAN) 
USDA FOR FAS/PASS TO APHIS 
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (LSTERN) 
USAID FOR ANE AND GH (DCAROLL, SCLEMENTS AND PCHAPLIN) 
STATE PASS USTR (ELENA BRYAN) 
STATE ALSO PASS HHS/OGHA (EELVANDER) 
ROME FOR FAO 
 
E.O. 12958: N/A 
TAGS: AMED, AMGT, CASC, EAGR, PINR, SOCI, PGOV, TBIO, VM, AFLU 
SUBJECT: APEC OFFICIAL MICHALAK'S WHO MEETING ON AVIAN 
INFLUENZA 
 
SENSITIVE BUT UNCLASSIFIED 
 
1. (SBU) Summary:  U.S. Senior Official for the Asia Pacific 
Economic Cooperation (APEC) Michael Michalak met with Dr. 
Hans Troedsson, World Health Organization (WHO) 
Representative to Vietnam, on October 10 to discuss avian 
influenza (AI) issues, including Vietnam's response plans, 
current control efforts and future response capabilities. 
Troedsson noted the Government of Vietnam (GVN) had made 
significant progress on control measures, but not in 
planning and response capabilities.  He and Michalak 
discussed potential solutions and mechanisms for improving 
donor coordination to better assist the Vietnamese in 
improving their capacity for rapid response to a potential 
AI outbreak during the upcoming December flu season.  End 
Summary. 
 
DECEMBER 2005: THE NEXT OUTBREAK IN VIETNAM? 
-------------------------------------------- 
 
2. (SBU)  U.S. Senior Official for the Asia Pacific Economic 
Cooperation (APEC) Michael Michalak met with Dr. Hans 
Troedsson, World Health Organization (WHO) Representative to 
Vietnam, on October 10 to discuss avian influenza (AI) 
issues.  Troedsson began by explaining that AI outbreaks in 
Vietnam are seasonal:  the first outbreak occurred from 
December 2003 until March 2004.  The second outbreak began 
in December 2004 and ended in July 2005, though the July 
case was not confirmed until August.  No AI cases have been 
found in Vietnam since then.  Dr. Troedsson cautioned that 
it was "very likely" a third outbreak will occur beginning 
in December 2005. 
 
GVN PLANNING, CONTROL, AND TRANSPARENCY: SLOW BUT IMPROVING 
--------------------------------------------- -------------- 
 
3. (SBU) Though he acknowledged progress has been very slow, 
Troedsson's current evaluation of the GVN's AI preparedness 
planning was guardedly positive.  With WHO help, the GVN has 
drafted a national preparedness plan that significantly 
improves inter-ministerial coordination and lays out a 
reasonable response to an AI outbreak.  The GVN, he said, is 
finally thinking of AI as an issue that can affect multiple 
sectors, not just health.  Troedsson also affirmed that the 
GVN's control capabilities have greatly improved.  The GVN 
has been stockpiling Tamiflu, begun efforts to develop a 
human vaccine, and is receiving advice and technical 
assistance from teams of independent experts.  Mass poultry 
vaccinations conducted by GVN officials are decreasing the 
virus load in the country. 
 
4. (SBU) According to Troedsson, the GVN's level and quality 
of cooperation with the WHO and other donors has also 
dramatically improved.  The GVN now shares samples with the 
WHO as well as other information, such as suspected cases, 
in a more timely manner.  The Prime Minister and Deputy 
Prime Minister, rather than lower-ranking officials at a 
single ministry, are now involved in the decision-making on 
AI response.  Even the Ministry of Health (MOH), which has 
been very unresponsive in its initial response to AI, is 
improving its cooperation with the WHO and other bilateral 
and multilateral agencies, he explained. 
 
GVN TECHNICAL CAPACITY IS BETTER... 
---------------------------------- 
 
5. (SBU) Troedsson laid out in detail the two main 
components of the GVN's AI efforts in the field.  The first 
is the sentinel program, where eight regional laboratories 
around the country conduct blood tests on any Vietnamese 
with flu-like symptoms and send those specimens for further 
confirmation testing to the National Institute of Hygiene 
and Epidemiology (NIHE) in Hanoi or the Pasteur Institute in 
HCMC.  Four of these sites are in the north and four in the 
south.  There are no sentinel sites in the Central region 
because there have been no reported cases of AI from this 
area.  The second component is a surveillance program where 
any health facility in the country that sees a suspicious 
case will try to take samples and send them on for further 
testing.  Troedsson confirmed the GVN does have the 
capability, despite some earlier problems, to identify both 
the H5 and the N1 parts of the AI virus using the CDC 
Atlanta's PCR Step One methodology.  It also has adequate 
laboratory and technical capacity to carry out the sentinel 
and surveillance program testing.   According to Troedsson, 
there is now a "critical mass" of knowledge in these labs. 
 
...BUT THERE ARE STILL NO MEANS FOR RAPID RESPONSE 
--------------------------------------------- ----- 
 
6. (SBU) While response planning and coordination has 
improved and the technical capacity for control and 
detection of AI has become more sophisticated, Troedsson 
acknowledged that the GVN still does not have the ability to 
respond rapidly to a large outbreak, especially in more than 
one area.  In light of this, the WHO has been proposing that 
the GVN and donors create and deploy expert teams stationed 
in the provinces that can make a first assessment in the 
field without having to ship or transport specimens for 
testing in Hanoi.  Questions remain about team composition 
(domestic, international or mixed), but the purpose is 
clear:  these teams would quickly identify the virus and 
initiate response plans immediately, hopefully containing 
the spread of the virus.  Troedsson warned that even with a 
contained outbreak, the GVN will immediately encounter 
capacity problems with inadequate numbers of beds, medical 
personnel, Tamiflu and quarantine facilities.  Thus, the 
donors have to help the GVN expand this capacity now so that 
health services, particularly at the provincial level, can 
manage any future outbreak. 
 
THE DONOR ROLE: MORE FOCUSED COORDINATION 
----------------------------------------- 
 
7. (SBU) Troedsson emphasized that because flu season 
usually begins in December and since Vietnam has only a few 
trained, qualified epidemiologists, there is a limited 
window for financial and technical assistance from donors to 
really have an impact.  To do so at all will require 
significant donor coordination.  In response to Michalak's 
question about whether or not the donors needed a new donor 
mechanism to administer aid and assistance in order to meet 
this urgent need, Troedsson noted that in the short-term the 
UN has taken on a coordinating role and is developing an 
efficient funding mechanism and steering committee.  As for 
long-term coordination to combat AI, this is still an 
evolving issue that requires more work and effort.  He 
emphasized that Vietnam needs it own coordinating body and 
that since it cannot be immediately funded and created, the 
UN Development Program (UNDP) office in Hanoi will continue 
to be the focal point for donors right now. 
 
8. (SBU) Looking ahead, Troedsson suggested that Vietnam 
might need donor coordination at the country level and 
possibly at the regional and international level as well. 
Acknowledging that an international coordinating body risked 
creating a global AI fund, which would not be the most 
efficient means of responding, Troedsson stated he believed 
long-term donor assistance for Vietnam needed to start at 
the country level and build up from there. 
 
9. (U) Mr. Michalak has cleared this cable. 
 
MARINE