US embassy cable - 05HANOI3038

UNCLAS SECTION 01 OF 06 HANOI 003038 
 
SIPDIS 
 
 
FOR USAID/RDM-A/BANGKOK PRIORITY 
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 (DCARROLL, 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: AVIAN INFLUENZA AND THE GOVERNMENT OF VIETNAM - 
READY OR NOT... 
 
REF: A) HANOI 2762, B) HANOI 2858, C) HANOI 3009 
 
1. (U) Summary.  This cable examines the Government of 
Vietnam's (GVN) overall strategy toward Avian Influenza (AI) 
and recent actions taken by GVN to plan for and respond to a 
potential AI pandemic in Vietnam.  The GVN has developed a 
broad, multi-agency approach following the advice of the 
World Health Organization (WHO) and the United Nations Food 
and Agriculture Organization (FAO), which includes 
conducting an aggressive nationwide poultry vaccination 
campaign; attempting to negotiate an agreement with Roche to 
produce Tamiflu in-country; ordering the state-run media to 
meet the public's demand for information and news on AI; and 
creating a national emergency action plan for AI.  While the 
international donor community has generously funded short- 
term interventions to support GVN's AI preparedness and 
prevention programs, foreign experts estimate that GVN will 
require at least USD 120 million of additional donor 
assistance as well as substantial recurrent costs for medium 
and long-term AI support for vaccinations; early warning; 
capacity building; long-term planning; and awareness raising 
and public information campaigns. 
 
2.   (SBU)  The leadership of Vietnam clearly recognizes 
that Vietnam may be prove to be ground zero for an H5N1 
pandemic.  While Vietnam is beginning to roll out and 
implement an emergency plan to respond to an influenza 
pandemic, like most countries, this poor, underdeveloped 
country is far from ready to sustain a direct hit. 
Development of strong and sustainable programs to build 
capacity on both the animal and human health side is an 
urgent need.  Further, support for testing and implementing 
a useable pandemic influenza preparedness plan is also 
critical. End Summary. 
 
WHAT IS SUCCESS? 
---------------- 
 
3. (U)  The start of the 2005-2006 influenza season in 
Vietnam is a suitable occasion to ask: Is the GVN adequately 
prepared for an Avian Influenza (AI) epidemic and what steps 
can be taken in Vietnam to bolster national and 
international efforts to detect, contain and limit the 
potential spread of the H5N1 virus?  This cable highlights 
some of the strengths and weaknesses of the GVN's overall 
strategy toward AI, including an analysis of Vietnam's draft 
National Emergency Plan for AI and Human Flu Pandemic 
(herein EAP), and recent actions taken by GVN to plan for 
and respond to a potential AI pandemic. 
 
4. (SBU)  But what is success?  What are the stop-gap 
measures that might contain an outbreak?  The H5N1 virus is 
now firmly entrenched in poultry in large parts of Asia. 
Computer modeling in Thailand, however, suggests the 
possibility, with immediate early aggressive coordinated 
international intervention, of stopping the further spread 
of a potential pandemic strain, which is analogous to 
quenching a small fire with forest-fire potential.  Once 
human-to-human transmission reaches a major metropolitan 
area, however, the past history of influenza pandemics 
indicates that the spread of the disease throughout the 
world can be expected to occur relatively quickly, perhaps 
in as little as a few weeks.  Most health authorities doubt 
that once a pandemic is underway, it can be stopped, bur 
rather only mitigated or limited.  Hence, the best way to 
prevent a pandemic would be to eliminate the virus from 
birds and, if so possible, to ensure that any human-to-human 
outbreak is contained before the virus reaches densely 
populated urban areas that serve as nodes of international 
commerce and transportation. 
 
STRONG POLITICAL WILL TO MOBILIZE THE COUNTRY AND COMBAT AI 
--------------------------------------------- -------------- 
 
5. (SBU)  Over the past three months, the authorities in 
Vietnam have demonstrated an increasing level of 
seriousness, commitment and action to prevent and, if 
necessary, control an AI epidemic.  As reported (ref A), 
responsibility for AI has risen to the Office of the Prime 
Minister and the chain of command has been streamlined. 
This heightened concern follows more than a year of line- 
agency efforts but little success in implementing an 
integrated, inter-agency AI campaign as advised by WHO, FAO 
and other concerned parties who were advising the GVN to 
take more aggressive action. 
 
6. (SBU)  The Vietnamese Communist Party apparatus, which is 
often characterized by single-minded agendas and sluggish 
response to international trends, has begun to mobilize "all 
government resources and the people" to combat the threat of 
AI.  In October, the Party Central Committee called in 
senior Ministry of Agriculture and Rural Development (MARD) 
officials and later issued a directive instructing lower 
level administrative units to implement AI prevention 
measures.  This is important as mobilization at the local 
level requires political pressure through the party organs. 
Meanwhile, the Prime Minister has tasked the Ministry of 
Culture and Information to focus the government-controlled 
mass media and public information systems on AI awareness 
raising and to provide the public with timely information on 
AI outbreaks, illnesses and deaths. 
 
7. (U)  Following the advice of WHO and FAO, the GVN has 
developed a broad, multi-agency approach with a focus on 
immediate short-term measures.  This includes conducting an 
aggressive nationwide poultry vaccination campaign; 
attempting to negotiate a landmark agreement with Roche to 
produce Tamiflu in-country; ordering the state-run media to 
meet the public's demand for information and news on AI; and 
drafting a national emergency action plan for AI. 
 
AGGRESSIVE POULTRY VACCINATIONS - THE FIRST LINE OF DEFENSE 
--------------------------------------------- -------------- 
 
8. (SBU)  In the Mission's discussions both within and 
outside the Government, the consensus is that the H5N1 virus 
could be virtually eliminated from domestic poultry 
populations in Vietnam.  Despite the preponderance of small, 
backyard operations with a mixing of poultry species and 
frequent human contact, a comprehensive poultry vaccination 
program that is sufficiently funded could work.  In 
countries with similar poultry production systems to 
Vietnam, such as China, such vaccination programs appear to 
have been effective in outbreak areas. 
 
9. (SBU)  However, Vietnam would need a sustained 
vaccination program that reaches enough of the poultry 
population, particularly asymptomatic ducks, for the virus 
to die out in the general poultry population.  The threshold 
could be as low as 70 percent of the population vaccinated. 
 The GVN's announced target is 85 percent.  At the same 
time, GVN would need to establish a system to identify and 
stop isolated cases from spreading as the vaccination 
program winds down.  Therefore, farmers need to be 
encouraged to implement biosecurity measures such as 
decontamination of their poultry areas, not to mix domestic 
poultry species and to keep ducks from ranging freely. 
These biosecurity measures would minimize new outbreaks and 
make effective response much easier. 
 
10. (U)  Continued technical assistance from outside experts 
would be helpful in strengthening Vietnam's AI control 
program. However, lack of long-term funding, especially for 
the recurrent and potential compensation costs, appears to 
be a more serious need.  The GVN requires funding to support 
the cost of vaccination workers, equipment and supplies and 
to compensate farmers when culling of poultry is required. 
Traditionally, these costs have fallen to the GVN rather 
than supported by the donors. 
 
11. (SBU)  As reported previously (ref C), the first phase 
of MARD's nationwide poultry vaccination campaign targeting 
high-risk bird populations has been completed in 50 of 64 
provinces in Vietnam.  Meanwhile, the GVN has temporarily 
banned all imports of live poultry, ornamental birds and 
their unprocessed (uncooked) products.  (NOTE: We are 
attempting to persuade GVN that there is no scientific basis 
or human health benefits to ban poultry products from 
sources without an H5N1 virus problem, such as in the United 
States). 
 
MINISTRY OF PUBLIC HEALTH - STRENGTHING THE WEAKEST LINK 
--------------------------------------------- ----------- 
 
12. (U)  Although still modest, the GVN has taken pro-active 
measures for early detection of AI in humans at provincial 
and district-levels, effectively shortening the previous 
amount of time taken to detect and respond to an AI 
outbreak, or reputed outbreak, in rural areas of Vietnam. 
Recently, the Ministry of Health (MOH) released an action 
plan to address a pandemic, which ordered hospitals to begin 
preparing for the possibility of admitting AI victims and to 
set up temporary hospitals, if needed.  The press has also 
announced that the MOH will work with the military and 
police forces to contain an AI outbreak (ref C).  Most 
importantly, the MOH has been more forthcoming in recent 
months in sharing information on possible AI-related human 
deaths and illnesses to the WHO and international community. 
This is a marked change from the more guarded attitude 
regarding prompt reporting of incidents a year ago. 
 
13. (U)  The GVN's enhanced, quick response capability on 
the animal side was demonstrated the week of November 7 in 
Bac Giang Province in northern Vietnam, where "drastic 
measures" where taken to contain AI outbreak in three 
communes.  According to "Tuoi Tre News," immediately after 
the discovery of AI in the poultry population, the province 
instructed local authorities to incinerate all poultry in 
the six infected villages and waterfowl in three communes, 
carry out strict hygiene and decontamination measures, 
strictly ban the sale of poultry throughout the province, 
and vaccinate all poultry.  Tuoi Tre also reported that the 
Chairman of Bac Giang's People Committee ordered strict 
monitoring of 200 people in the infected areas who are 
currently sick (symptoms unknown), and to quarantine those 
who begin to show signs of fever.  (Note: Secondary sources 
indicate that some of the chickens that died were vaccinated 
about 10 days before the incident.) 
 
14. (SBU)  Despite these positive measures, the GVN - and 
the MOH in particular - suffer from institutional challenges 
associated with non-decentralized, linear governance 
systems.  We believe the GVN will face significant 
challenges in its efforts to form multi-agency task forces 
and on-the-ground mobile response teams comprised of animal 
health, public health and market police units. 
 
TAMIFLU FOR VIETNAM? 
-------------------- 
 
15. (U) The British Broadcasting Corporation (BBC) has 
reported that Vietnam will become the first country to 
produce Tamiflu under a license agreement with Roche and 
that production in Vietnam would begin in two months. 
Nevertheless, a recent discussion between Minister of Health 
Tran Thi Chung Chien and the Ambassador (ref D) made clear 
that so far Roche has not agreed to license Vietnam to 
produce Tamiflu.  MOH sources confirm that the GVN has not 
received permission.  According to a recent New York Times 
article, Roche has entered negotiations with roughly eight 
of the 50 or so countries interested in negotiating a 
licensing agreement.  Roche reportedly confirmed that it was 
in talks with Vietnam to provide the finished active 
ingredients for Tamiflu.  (Note: Roche relies on a 
relatively rare Chinese spice, star anise, to make about two- 
thirds of the rare shikimic acid.  Star anise happens to be 
the special ingredient used in Hanoi's most famous dish, 
"pho bo" or beef noodle soup.) 
 
16. (SBU)  The Vietnam Pharmaceuticals Administration 
Department Director Cao Minh Quan estimates Vietnam needs to 
stockpile 25 million does of Tamiflu in the event an AI 
pandemic (reftel Hanoi B).  The WHO has pledged to 
immediately provide 3 million Tamiflu capsules (or 300,000 
courses of 10 tablets) if an AI epidemic occurs in Vietnam 
and, the press has also reported that Taiwan has donated 
600,000 capsules.  According to the BBC report, Roche also 
agreed to sell Vietnam 25 million capsules, enough to treat 
2.5 million people. The report further states that Vietnam 
will ultimately have the capacity to produce up to 20 
million Tamiflu capsules a year, which could also be sold to 
other countries in the region. 
 
17. (SBU)  Dr. Hans Troedsson, Chief Representative of the 
WHO in Vietnam, believes that a more pressing concern for 
GVN is how to distribute Tamiflu stocks effectively. 
 
A HUMAN AI VACCINE? 
------------------- 
 
18. (SBU)  On November 8, the Minister of Health also asked 
the Ambassador for U.S. help in finding a company to work 
with Vietnam to produce a human vaccine against AI, as 
discussed with HHS Secretary Leavitt in October. 
 
GVN EMERGENCY ACTION PLAN FOR AI - A GOOD START 
--------------------------------------------- -- 
 
19. (SBU)  GVN has developed a draft Emergency Action Plan 
for AI and Human Flu Pandemic (EAP), which is dated 
September 2005 but has not been officially approved nor 
shared publicly.  The 63-page draft EAP is comprehensive, 
though it needs to be supported by more technical protocols 
(e.g. quarantine and disinfection is ordered, but no 
specific guidelines are provided).  The draft EAP contains 
guidance for responding to various outbreak scenarios.  It 
includes immediate recommendations for procurement of 
veterinary and medical supplies and budgets for procuring 
minimum stockpiles of personal protective units, chemical 
disinfectants, antibiotics and Tamiflu.  The plan contains 
some discussion of how GVN's Tamiflu stockpile will be 
transported and administered, although again specific 
details are lacking. 
 
20. (SBU)  The draft EAP calls for all government offices, 
resources and people to be mobilized in the fight against 
the threat of an AI epidemic.  The plan directs each line 
ministry and province to develop its own Action Plan for AI, 
while each provincial health department is to submit a 
detailed plan to the respective provincial People's 
Committees. 
 
21. (SBU)  While the draft EAP provides broad instructions 
to investigate, monitor and prevent the spread of an AI 
epidemic, the document falls short in details that could 
assist provinces should they be required to implement such 
guidelines.  For example, the document states that "strict 
preventative measures such as Tamiflu should be taken by 
medical staff and other high risk people," but there is no 
discussion for who exactly will administer limited Tamiflu 
stocks and who precisely shall receive priority treatment. 
 
22. (SBU)  There are only a limited number of well-trained 
epidemiologists in Vietnam who could be called upon to 
monitor, analyze and respond should more than a few dozen AI 
cases occur simultaneously.  A general lack of well-trained 
technical and administrative staff at provincial levels will 
further challenge efforts by authorities to develop and 
execute effective AI action planning at provincial and local 
levels. 
 
INTERNATIONAL COMMUNITY EFFORTS TO BOLSTER GVN'S AI STRATEGY 
--------------------------------------------- ------ 
 
23. (U)  The GVN's AI response planning, including the draft 
EAP, has received support from the international donor 
community.  GVN is working with FAO and the World Bank to 
restructure the poultry industry while the WHO and the 
United States are supporting GVN to develop an H5N1 vaccine. 
The UNDP/WHO/FAO AI Program, which received funding from the 
USG and other bilateral donors, is fully funded for short- 
term AI activities.  However, UNDP estimates at least USD 
120 million of additional donor assistance as well as 
substantial recurrent costs is needed for long-term AI 
planning and response (ref C). 
 
Given the number of donors that want to assist, more intra- 
donor coordination will be required to reduce the burden on 
the GVN and allow decision-makers to focus on actual 
implementation rather than coordination.  The UNDP is 
currently recruiting a coordinator to help in this donor 
coordination effort. 
 
24. (U)  The UNDP/WHO/FAO AI Program Team believes there are 
five priorities for international support, namely: 1) 
Vaccinations; 2) Early Warning; 3) Capacity Building; 4) 
Long-Term Planning; 5) Awareness Raising and Public 
Information.  The USG currently funds activities in all five 
areas. 
 
CONCLUSION 
---------- 
 
25.  (SBU)  The leadership of Vietnam clearly recognizes 
that Vietnam may be prove to be ground zero for an H5N1 
pandemic.  While Vietnam is beginning to roll out and 
implement an emergency plan to respond to an influenza 
pandemic, like many countries, this poor, underdeveloped 
country is far from ready to sustain a direct hit. 
Development of strong and sustainable programs to build 
capacity on both the animal and human health side is an 
urgent need.  Further, support for testing and implementing 
a useable pandemic influenza preparedness plan is also 
critical. 
 
MARINE