US embassy cable - 05BANGKOK6596

UNCLAS SECTION 01 OF 06 BANGKOK 006596 
 
SIPDIS 
 
SENSITIVE 
 
DEPT FOR EAP/BCLTV; OES/IHA (DSINGER AND NCOMELLA) 
DEPT PASS TO USAID FOR ANE AND GH 
STATE PASS HHS 
USDA FOR FAS/PASS TO APHIS 
ROME PLEASE PASS TO FAO 
KATHMANDU FOR REO KOCH 
 
E.O. 12958: N/A 
TAGS: TBIO, OVIP, PREL, EAGR, EAID, TH 
SUBJECT: SECRETARY LEAVITT'S OCTOBER 10-11 VISIT TO THAILAND 
 
1. (U) Summary:  In meetings with interlocutors during his 
visit to Thailand October 10 and 11, HHS Secretary Leavitt 
underscored the importance of transparency and 
international cooperation in confronting the threat of 
avian influenza (AI) and in planning containment and 
pandemic preparedness efforts.  The composition of the 
Secretary's delegation - which included the Director of the 
 
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U.S. Centers for Disease Control and Prevention (CDC), the 
Director of the U.S. National Institute for Allergy and 
Infectious Disease (NIAID), the Director General of the 
World Health Organization (WHO), the Assistant Director 
General of the Food and Agriculture Association(FAO), and 
the President of the International Animal Health Code of 
the World Organization for Animal Health (OIE) - itself 
represented a model for international animal and human 
health collaboration.  Major topics for discussion included 
the stockpiling of anti-virals (Tamiflu), human AI vaccine 
research and production, training at the Thailand Field 
Epidemiology Training Program (FETP), and continued close 
collaboration between the Thai Ministry of Public Health 
(MoPH) and the Bangkok-based U.S. CDC team.  Secretary 
Leavitt's activities in Thailand included a meeting with 
Deputy Prime Minister Pinij Jarusombat, a meeting with 
Minister of Health Dr. Suchai Charoenratanakul, 
participation in a ceremony marking the 25th anniversary of 
the Thailand MoPH-U.S. CDC Collaboration, a roundtable 
discussion with International Organizations, and a visit to 
Charoen Pokphand Foods PCL (CP), a large, commercial 
poultry farm approximately 65 miles north of Bangkok.  End 
summary. 
 
MoPH: IPAPI, Tamiflu Stockpile, Vaccines, and Training 
--------------------------------------------- --------- 
 
2. (U) The meeting at the MoPH was more like a roundtable 
discussion with participation by the Secretary, CDC Director 
Dr. Julie Gerberding, NIAID Director Dr. Anthony Fauci, WHO, 
FAO, OIE, the Minister, and several heads of sections of 
MoPH.  Minister Suchai opened the meeting by stating that 
Thailand appreciates the ten core principles of the 
International Partnership on Avian Pandemic Influenza 
(IPAPI) and intends to join the partnership.  He also opened 
the discussion of stockpiling anti-viral medications 
(Tamiflu) by acknowledging that production capacity cannot 
possibly meet current worldwide demand.  (Swiss company 
Roche is the sole producer of Osteltamavir, trade name 
Tamiflu.)  Minister Suchai said that the global shortage of 
anti-virals creates a need for countries to pool their 
resources to create a regional stockpile.  He said that 
Thailand would contribute 35,000 Tamiflu capsules, 
representing 5 percent of Thailand's total stock, to a 
Southeast Asia regional stockpile.  He urged other 
countries, including the U.S., to make a similar 
contribution.  He offered Thailand as a "staging point" for 
a regional stockpile run by WHO, but said Thailand would 
accept any location that countries in the region could agree 
upon.  (Note: Thailand's commitment to make a substantial 
contribution to a regional stockpile even if not located on 
Thailand's soil is an extraordinary step for Thailand to 
make in terms of regional cooperation.) 
 
3. (U) Secretary Leavitt agreed that the first step in 
preventing an AI pandemic is international cooperation and 
coordination.  He said HHS was committed to supporting the 
close relationship with the FETP.  He also said that 
containment of an outbreak within a specific locality is a 
top priority, and acknowledged that pre-positioning of 
supplies would be important in this effort.  To that effect, 
the Secretary said the U.S. can commit to contributing 
personal protective equipment.  He added, however, that HHS 
was still considering whether to contribute to a regional 
stockpile of Tamiflu. 
 
4. (U) The Secretary and NIAID Director Dr. Fauci briefed 
Minister Suchai on recent AI vaccine trials in the U.S.  Dr. 
Fauci said that preliminary results were promising - a 
vaccine provided in a 4-dose regimen provided an immune 
response that was predictive for protection against the 
virus.  In response to Thai long-standing requests to 
collaborate with the U.S. on AI vaccine trials, the 
Secretary and Dr. Fauci stated that the U.S. will share the 
 
SIPDIS 
results of its own trials with the Thais when they are 
available, and that it will seek collaboration with Thailand 
for a future trial.  At this time, however, there is not 
enough clinical material on hand to expand the trial to 
other countries.  The Secretary added that he would like to 
see Thailand produce its own human vaccine, since even after 
U.S.-Thai collaboration on trials takes place, production 
capacity will still be limited. 
 
5. (U) Minister Suchai asked for U.S. assistance to expand 
the number of students from countries in the region to 
attend the epidemiological training course offered at 
Thailand's Field Epidemiology Training Program (FETP).  The 
Secretary said he was very gratified by the past success of 
 
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this program and noted that several high-level health 
officials from governments in the region are graduates of 
the program.  He said he is equally impressed by Thailand's 
quick restructuring of the course content to focus on AI to 
enhance the ability of healthcare workers in the region to 
detect and investigate AI outbreaks.  He said he will be 
pleased to increase U.S. support in order to build up a 
regional network of epidemiologists trained through the 
program. 
 
6. (U) Other participants at the meeting expressed their 
views, as well: WHO Director General Jong-Wook Lee 
emphasized the importance of transparency and timeliness in 
reporting surveillance activities.  FAO Assistant Director 
General He Changchui encouraged good interagency 
cooperation, especially between the MoPH and Ministry of 
Agriculture and Cooperatives (MoAC).  The President of OIE's 
Terrestrial Animal Health Standards Commission Alejandro 
Thiermann noted that efforts to contain AI should focus 
activities to break the two most vulnerable links of 
transmission - segregation of domestic poultry from wild 
waterfowl and minimized contact between humans and poultry. 
 
UN Organizations: More on IPAPI, Vaccines, and Stockpiles 
--------------------------------------------- ------------ 
 
7. (U) At a luncheon and working meeting hosted by WHO and 
attended by the Secretary and his delegation, the Thai MoPH, 
and UN and other International Organizations, the earlier 
discussions at the MoPH carried over on the same topics, 
often by the same individuals.  Secretary Leavitt led off 
the meeting with a discussion of IPAPI, urging governments 
to work closely with WHO and FAO and to follow open, 
transparent, and timely reporting of animal and human cases 
of AI.  The Secretary added that current focus on AI should 
not cause governments to neglect other infectious diseases 
such as tuberculosis, malaria, and HIV/AIDS. 
 
8. (U) WHO Director Lee welcomed the IPAPI initiative and 
said that WHO and nations of the world must work closely 
with the United States government to address the AI problem. 
He emphasized that the economic effects of an avian flu 
pandemic would be as severe as the cost in human lives.  The 
economic costs of the SARS outbreak several years ago has 
been estimated to be greater than $30 billion globally, he 
said, whereas the economic costs of an avian flu pandemic 
would likely dwarf that figure.  To prevent the enormous 
costs in lives and damage to the global economy, nations 
must act in collaboration to "pounce" on outbreaks with anti- 
virals, culling, quarantine, and other measures to contain 
an outbreak at its earliest stage. 
 
9. (U) FAO Assistant Director General He Changchui agreed 
that the primary emphasis should be to address an outbreak 
at its source - in animals.  To that end, he said that FAO 
has been working closely with Southeast Asian governments, 
WHO, the OIE and others.  He said that FAO has spent $5.5 
million since February 2004 on technical cooperation 
projects addressing AI in animals with Thailand's MoAC and 
with other government ministries in the region. 
 
10. (U) The President of OIE's Terrestrial Animal Health 
Standards Commission Alejandro Thiermann said that small 
farmers in the region have paid the biggest price so far, 
seeing their flocks culled often with inadequate or no 
compensation.  He said that the means to interrupt AI virus 
transmission - segregating wild waterfowl from domestic 
poultry, culling and vaccinations to prevent AI transmission 
among domestic poultry, and minimizing human-poultry 
interaction - are difficult to implement in Southeast Asia 
where wild birds, poultry, and humans often live in close 
proximity.  He suggested that the smallest investment with 
the biggest impact would be technical assistance to build 
capacity in the region for surveillance, detection, and 
prevention of outbreaks in animals. 
 
11. (SBU) There followed a general discussion on vaccine 
production.  Margaret Chan, WHO Assistant Director General 
& Representative of the Director General for Pandemic 
Influenza, expressed concern about regulatory, licensing, 
and liability issues, as well as a potential market failure 
as traditionally companies worry about overproduction of 
vaccines and slack demand.  Presently, there is not enough 
supply to meet worldwide demand, but will that demand be 
sustained?  NIAID Director Fauci agreed that sustained 
demand for vaccine was an important issue that companies 
will examine before ramping up production.  Increasing 
international demand for seasonal human influenza vaccines 
is one approach to encourage vaccine manufacturers to 
increase their vaccine production capacity.  Such increased 
capacity would become particularly important in the event 
of a pandemic where hundreds of millions of doses would 
need to be produced very rapidly. 
 
12. (SBU) Thailand does not presently produce its own 
influenza vaccines but does produce other human 
vaccinations.  Secretary Leavitt repeated his desire to see 
Thailand and other countries in the region develop their 
own vaccine manufacturing capacity.  Secretary Leavitt said 
that the U.S. was prepared to offer technical assistance to 
Thailand and other nations to develop vaccine production 
capacity.  (Note: At a reception later that evening, the 
Secretary emphasized to World Bank Thailand Country 
 
SIPDIS 
Director Ian Porter the importance of building Thailand's 
capacity to produce a human AI vaccine.  Mr. Porter, 
listened, understood, but was non-committal on WB support.) 
 
13. (SBU) Minister Suchai repeated his assertion that the 
number one priority for Thailand was the creation of a 
regional stockpile of Tamiflu.  WHO Director General Lee 
said that WHO has an MOU with Roche on a "virtual 
stockpile" of Tamiflu whereby Roche has agreed to dispatch 
up to 30 million doses (3 million treatment courses) of 
Tamiflu anywhere in the world at WHO request should a human- 
to-human outbreak occur.  WHO would expedite customs 
clearance in the host country and rush the shipment to the 
local site of the outbreak.  Dr. Lee expressed concern 
about pooling of national resources because "when an 
outbreak occurs, the reality is that countries will worry 
about their own people first." 
 
14. (SBU) Secretary Leavitt voiced his own concerns: The 
U.S. uses stockpiling for several types of commodities, he 
said, and this has not always been a workable strategy.  He 
noted that work still needs to be done on containment 
strategies at the local level.  For example, how do we 
decide if an outbreak is containable?  NIAID Director Fauci 
added that another question should be addressed - are 
current containment plans effective or realistic enough so 
that stockpiling would have the desired impact?  There 
needs to be assurance, he said, that political will at the 
top levels can be matched by implementation capability at 
operational levels. 
 
DPM: Thailand Helping Neighboring Countries 
--------------------------------------------- ---- 
 
15. (U) During his meeting with Deputy Prime Minister (DPM) 
Phinij Jarusombat, who formally welcomed Secretary Leavitt 
to Thailand on behalf of PM Thaksin, who was on travel to 
Europe, Secretary Leavitt outlined the reasons for his visit 
to Thailand, citing the urgency of the avian flu situation. 
Secretary Leavitt noted he was accompanied by WHO Director 
 
SIPDIS 
General Lee and a staff of noted epidemiologists, which 
underscored the gravity the AI situation.  "An avian flu 
case anywhere is a threat everywhere," said the Secretary, 
as he expressed appreciation to the Royal Thai Government 
for its efforts to combat the disease and its cooperation 
internationally. 
 
16. (U) The Deputy Prime Minister thanked Secretary Leavitt 
and the U.S. government for its technical cooperation with 
Thailand, and noted that Thailand itself has assisted 
neighboring, less developed countries, with technical 
cooperation.  "Each country should help according to its 
needs," he said.  Noting that Thailand had not suffered a 
human AI case since September, 2004, the DPM wished 
Secretary Leavitt a productive visit. 
 
SIPDIS 
 
17. (U) At the close of the meeting, Secretary Leavitt said 
the U.S. government welcomed PM Thaksin's decision, during 
his recent meeting with President Bush, to lift Thailand's 
ban on U.S. beef imports, and asked DPM Phinij how the 
decision would be implemented.  DPM said the decision would 
be enacted following proper procedures, and cited the 
Ministry of Agriculture's jurisdiction over the process. 
 
Thailand MoPH-U.S. CDC Collaboration: 25 Year Anniversary 
--------------------------------------------- ------------ 
 
18. (U) Secretary Leavitt, CDC Director Gerberding, and MoPH 
Minister Suchai spoke at a colorful outdoor celebration of 
the 25th anniversary of the Thailand MoPH-U.S. CDC 
Collaboration.  In his remarks, Minister Suchai reviewed the 
history of the Collaboration and noted that the 
Collaboration's activities in Thailand have focused mainly 
on epidemiology training at the FETP, HIV/AIDS research and 
programmatic activities through the HHS Global AIDS Program 
and early-warning disease detection through HHS/CDC's 
International Emerging Infections Program.  Because of the 
long MoPH-CDC partnership, he said, the Collaboration was 
able to focus immediate attention on the avian influenza 
outbreak last year and work together closely to answer 
epidemiological, surveillance, and other important research 
and public health questions. 
 
19. (U) Secretary Leavitt praised the U.S.-Thai health 
cooperation over the past quarter-century, especially on 
infectious diseases such as HIV/AIDS, tuberculosis, severe 
acute respiratory syndrome (SARS), and pandemic influenza. 
He expressed condolence to Thailand for the heavy economic 
and human costs Thailand has experienced recently from the 
tsunami, as well as avian influenza, and thanked the Thai 
 
SIPDIS 
government for its offers of assistance after Hurricane 
Katrina. 
 
20. (U) CDC Director Gerberding said that the Thailand MoPH- 
U.S. CDC Collaboration was the "jewel in the crown" of 
international health collaborations and was pleased with the 
success of the FETP.  At the conclusion of the ceremony, a 
placard carrying the logo of the Thailand MoPH-U.S. CDC 
Collaboration was launched high into the sky by numerous 
helium balloons of red, white, and blue - the colors of both 
the Thai and U.S. flags. 
 
Large-Scale Commercial Poultry Farm Visit: High Biosecurity 
--------------------------------------------- -------------- 
 
21. (U) Secretary Leavitt and his delegation also visited a 
large-scale commercial poultry farm owned and operated by 
Charoen Pokphand Corporation (CP), the largest agricultural 
company in Thailand and a leading exporter of chicken 
products.  The purpose of this visit was to demonstrate that 
the commercial poultry industry in Thailand, which is geared 
towards exports, has a self-serving interest in keeping AI 
under control in Thailand as well as in neighboring 
countries that could serve as virus reservoirs. 
 
22. (U) The Secretary observed the operations of one of the 
largest, vertically integrated commercial chicken farms and 
processing plant in Thailand, and was particularly impressed 
by the first rate biosecurity measures practiced at the 
farm.  CP company agreed to allow the Secretary and his 
delegation inside the facilities only because the chickens 
were only two days away from scheduled slaughter and 
processing so that contamination was less of a concern than 
would be the case if the chickens were younger.  Even then, 
the Secretary was made to don a hat, face mask, gown, and 
two changes of boots, as well as undergo a disinfectant 
spray before entering the facilities. 
 
23. (U) Once inside CP officials briefed the Secretary on 
farm procedures, emphasizing their care to ensure complete 
segregation of their chickens from wild birds from the time 
they are day-old chicks to birds ready for harvest.  Contact 
with human farm workers is also minimized through the use of 
automated feeding and watering devices, and monitoring of 
the temperature-regulated building through closed circuit TV 
monitoring.  The biosecurity features cut costs as well - a 
single human overseer can look after more than 100,000 
chickens. 
 
24. (U) CP officials told the Secretary that because of the 
possible negative impact on its poultry exports, Thailand 
preferred these strict biosecurity measures to poultry 
vaccinations - vaccinated poultry are difficult to 
distinguish from poultry that have been exposed to AI, and 
importing countries such as the EU would not import such 
birds.  Other countries in the region, by contrast, produce 
poultry almost entirely for domestic consumption, and thus 
are more interested in [developing and] using AI vaccines 
for poultry. 
 
25. (U) CP officials also noted that approximately 80 
percent of Thailand's chicken meat exports (Thailand exports 
only processed meat) come from large-scale farms.  About 20 
percent come from medium-sized farms that often have less 
stringent biosecurity practices.  CP officials emphasized, 
however, that the threat from AI - to the general public and 
to their own business - comes from the millions of families 
engaged in "backyard" chicken farming where a family might 
raise a dozen or less poultry for its own consumption.  In 
these types of households, chickens, ducks, and humans, 
often share the same living space - a perfect setting for AI 
transmission.  When asked by the Secretary whether public 
behavior could be modified so that "backyard" chicken 
farming could eventually be phased out altogether and 
chickens raised only under biosecure conditions, the CP 
officials were not optimistic.  This would require a change 
in culture, they said, and even though it might be possible 
to fathom such a change in Thailand, it is unlikely to occur 
in our lifetimes in rural areas in other countries in the 
region. 
 
26. (U) Another item worth noting at the CP visit was the 
comment by one of the company officials that they (CP) 
regard the MoAC as an important "middle man" in getting the 
biosafety word out to the larger community.  This is an 
interesting contrast to the U.S. model where agribusinesses 
act as the community multiplier of good agricultural 
practices and the government is the source of research and 
policies. 
 
27. (U) Secretary Leavitt and his delegation visited a 
contract farm that provides some 8,000 birds to CP and 
follows the biosafety methodologies developed by the larger 
company.  CP only buys some twenty percent of its birds from 
farms provided they show adequate animal health practices. 
Meeting the CP standards is not easy and CP plans to reduce 
the number of contract farmers that it uses, eventually 
bringing all bird production back under its own roof. 
 
28. (U) Secretary Leavitt and the delegation did not have an 
opportunity to clear this message. 
 
Boyce