US embassy cable - 05KUWAIT4516

UNCLAS KUWAIT 004516 
 
SIPDIS 
 
SENSITIVE 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: AMED, CASC, KSCA, SENV, TBIO, KU 
SUBJECT: KUWAITI PREPARATIONS FOR AVIAN INFLUENZA 
 
Sensitive but Unclassified.  Not for Internet distribution. 
 
1.  (U) SUMMARY  On October 17, Emboffs met with officials of 
the Department of Public Health (DPH) to discuss the GOK's 
preparations for a possible Avian Influenza (AI) outbreak in 
Kuwait.  A recently formed committee has been charged with 
formulating the GOK's preparations to combat AI.  The 
committee is tasked to present a comprehensive plan to the 
Prime Minister within three weeks' time.  DPH believes that 
Kuwait is at "high risk" for a pandemic both because of the 
large number of expatriate workers from Asia and the 
extensive international travel common to Kuwaitis.  At this 
time the GOK does not have any supplies of Tamiflu (the 
anti-viral drug used to treat AI) but has on order doses for 
one million people.  END SUMMARY 
 
2.  (U) On October 17, Econcouns, Medoff, and Econoff 
(notetaker) met with Director of Public Health Dr. Rashed 
Al-Owaish and Head of the Communicable Disease Control Unit 
Dr. Mussab Al-Saleh of the Department of Public Health to 
discuss the GOK's preparations for a possible Avian Influenza 
(AI) outbreak in Kuwait.  Al-Owaish explained that he heads a 
committee comprised of himself, Al-Saleh (who is the 
committee coordinator), the Director of the Public Health 
Laboratory, the head of the Infectious Disease Hospital, the 
Director of the Ambulance Service, a representative from the 
private hospitals in Kuwait, and two representatives from the 
drug industry.  This committee is charged with planning and 
coordinating the GOK's preparations for, and response to, any 
AI outbreak.  The committee, which has met twice within the 
last week and had another meeting scheduled for October 18, 
uses WHO guidelines for responding to an epidemic as well as 
the GOK's 2003 experience in preparing for bio-warfare, and 
later for Sudden Acute Respiratory Syndrome (SARS). 
Al-Owaish said he anticipates the creation "soon" of a higher 
level AI committee organized by the Cabinet of Ministers and 
staffed by all major ministries at the undersecretary level. 
 
3.  (U) Both Al-Owaish and Al-Saleh agreed that Kuwait is at 
a "high risk" for AI, citing the high number of expatriate 
workers (about 60% of the population, many of them from Asia) 
and the frequency with which Kuwaitis travel.  To that end, 
once the WHO declares a Stage 1 pandemic, cameras and 
infrared temperature monitors, previously used during the 
SARS outbreak, will be re-deployed at the airport.  Travelers 
on flights originating from affected countries, as well as 
those with passports indicating travel to those same 
countries, will receive additional screening.  Al-Saleh said 
that the PM is seriously concerned about AI, especially the 
economic impact on government services and Kuwait's oil 
industry if large numbers of workers get sick.  Al-Owaish 
stated that the PM's interest ensures that the committee's 
planning recommendations are likely to be adopted. 
 
4.  (U) Al-Saleh estimated that an AI pandemic in Kuwait 
would likely affect 900,000 people overall, with 400,000 
needing medical attention, as many as 9,000-12,000 requiring 
hospitalization, and up to 3,000 deaths.  He said that 
Kuwaiti hospitals currently have about 4,700 beds (80% in 
government hospitals) and that the capacity could be pushed 
to 6,000 beds by using the Ambulance Service's medical tents. 
 Responding to Medoff, Al-Saleh said that Kuwaiti hospitals 
have very few rooms with "negative flow" ventilation and a 
relatively small number of isolation rooms in Intensive Care 
Units (ICU); there are about 650 ICU beds in Kuwait. 
Although the number of beds is well below his own projection 
of the number of potential persons needing hospitalization, 
Al-Saleh insisted that the Kuwaiti hospital system can handle 
a pandemic with a quarantine and at-home treatment 
supplementing the hospitals. 
 
5.  (U) Responding to Econcouns's query about what 
preparations are now underway, Al-Saleh said that the 
committee is working on a public information campaign 
composed of Arabic language brochures and also preparing 
lectures for doctors and other medical personnel.  Econoffs 
suggested that brochures in English would be useful as well, 
given that most of Kuwait's residents speak more English than 
Arabic.  Additionally, the committee is formulating 
quarantine and treatment protocols by which hospitals can 
process affected patients in the most efficient way. 
Al-Saleh said that DPH epidemiologists are resident in each 
hospital and that initial cases would be sent to the 
Infectious Disease Hospital for quarantine.  If and when the 
Infectious Disease Hospital reaches capacity, each hospital 
would establish an isolation ward; Al-Saleh said that 
designating specific hospitals as AI-only would upset 
Kuwaitis who likely would demand that they be allowed to go 
to the nearest hospital regardless of its designation. 
 
6.  (U) Al-Owaish said that the GOK does not have any Tamiflu 
stocks at present but has ordered 10 million tablets, enough 
to treat 1 million patients.  However, because of the 
worldwide shortage of AI anti-viral drugs he does not expect 
to receive the drugs until June 2006.  Because of this delay, 
Al-Owaish said, the committee intends to propose that the GOK 
order the drug Relenza, which has been effective in some 
cases and is more widely available.  Al-Saleh reiterated that 
the PM is very interested in the response planning, and said 
that the initial proposal was for buying 6 million tablets, 
and that the PM told them to "make it 10 million." 
Additionally, Al-Saleh said that Kuwait is in line for the AI 
vaccine that is being developed and has 5 million doses on 
order.  Al-Saleh worried that, in the event of a serious 
pandemic and a continued shortage of anti-viral drugs, AI 
might come to be seen as a national security issue, and that 
some countries may declare all drugs and vaccines produced in 
those countries for domestic use only, severely restricting 
the ability of nations without pharmaceutical industries to 
obtain medications.  He said that both Germany and France, 
traditional medical suppliers for Kuwait, have banned export 
sales in the past due for national security reasons. 
 
7.  (U) Reflecting reftel concerns, Econcouns noted GOK's 
preparations for educating the general public as well as 
health care professionals; and the committee's plans to test, 
isolate, and report suspected AI cases to the WHO and other 
responsible international bodies promptly.  When asked what 
obstacles he sees to the GOK's response, Al-Saleh noted his 
concern that medical professionals may downplay the 
seriousness of an AI pandemic, which would hamper efforts to 
coordinate quarantines.  He related that some doctors think 
the DPH is "crying wolf" about health threats, particularly 
after stockpiles of anthrax vaccines (obtained prior to the 
Iraq invasion) were never used, and because SARS was a 
non-event in Kuwait despite DPH warnings.  Al-Saleh also said 
that he was concerned about panic among the general 
population should an outbreak occur. 
 
8.  (U) Econ/C asked what help the USG might provide.  Both 
officials were primarily concerned with the availability of 
drugs.  Al-Owaish asked that the U.S. help speed their order 
of Tamiflu, press for a suspension of IPR protections to 
allow generic firms to manufacture Tamiflu, and to share U.S. 
stockpiles of the drug.  Al-Saleh also said that any planning 
assistance from CDC would be welcome. 
LEBARON