US embassy cable - 05ABUJA2234

UNCLAS SECTION 01 OF 04 ABUJA 002234 
 
SIPDIS 
 
SENSITIVE 
 
PASS HHS FOR OGHA STEIGER/BHAT 
CDC FOR BLOUNT/JANI/LEDUC/NCOX/ARTHUR 
GENEVA FOR WHO 
USDA/APHIS/US/NCIE FOR BURLESON 
USDA/FSIS FOR RHARRIES 
USDA/FAS/CMP/DLP FOR M FRANCOM 
 
E.O. 12958: N/A 
TAGS: TBIO, SENV, EAGR, AMED, CASC, EAID, XX, NI, WHO, FAO, AVIANFLU 
SUBJECT: NIGERIA'S PLAN ON AVIAN FLU STILL IN INITIAL STAGE 
 
REF A: State 206992  B: State 206588 
 
1. (SBU) Summary.  In February 2004, Nigeria held a 
consultative forum on Avian Influenza (AI), and Nigerian 
President Obasanjo is "very aware" of the threat AI poses to 
Nigeria.  The Ministry of Health (MOH), in late October 2005 
issued the third draft of the government's AI Position 
Paper. On November 14th, 2005, the MOH inaugurated the 
Health Sector Technical and expert Committee on AI. The 
expected outcome of the Committee is a Nigeria AI 
Preparedness and Response Plan.  Difficulties the MOH faces 
include political will, a lack of resources, Nigeria's poor 
health and communications networks, and the country's loose 
control over its borders.  For these reasons the effects of 
an AI outbreak in Nigeria could be catastrophic.  End 
summary. 
 
2. (U) Nigeria has discussed since February 2004 making 
preparations against AI.  Nigerian President Obasanjo, who 
owns a large chicken farm, is "very aware" of the threat AI 
poses to Nigeria, and senior policymakers in Nigeria seem to 
be aware of AI's potential implications, according to USAID 
Nigeria.  In February 2004, Obasanjo established a committee 
of experts to come up with strategies to contain an AI 
epidemic.  The Department of Livestock, Ministry of 
Agriculture, convened a consultative forum of experts on AI 
on February 19, 2004. 
 
3. (U) After this forum, the Ministry of Health (MOH), the 
Ministry of Agriculture, and other Nigerian entities began 
to prepare for an AI pandemic.  The MOH says it has 
established a laboratory working group and an experts 
committee composed of virologists, epidemiologists, 
veterinary doctors, and clinicians under the MOH's 
coordination.  Nigeria has developed its evolving AI 
national preparedness plan with guidance from the World 
Health Organization (WHO) and the UN Food and Agriculture 
Organization (FAO).  The WHO is very involved in assisting 
Nigeria's AI preparations, according to USAID/Nigeria. 
 
4. (U) Nigeria's Minister of State for Health, its chief 
epidemiologist (who is the focal point for AI in the MOH and 
for the Nigerian Government), and representatives of the 
Ministry of Agriculture could not attend the October 6-7 
meeting of the International Partnership on Avian and 
Pandemic Influenza (IPAPI), in Washington, D.C.  These 
officials, however, did attend the October AI ministerial in 
Ottawa, Canada, to further refine Nigeria's national plan on 
AI.  While the MOH could not send a representative to the 
IPAPI meeting, Nigerian officials participated representing 
Nigeria's chairmanship of the African Union. 
 
Third Draft of Policy Paper Sets Out the Plan 
--------------------------------------------- 
 
5. (U) The GON, led by the MOH, issued in late October 2005 
the third draft of a position paper, "Global Cooperation for 
Pandemic Influenza Preparedness."  Though this paper says 
coordination for combating an AI pandemic "rests squarely on 
the shoulders" of the MOH, the Ministry of Agriculture will 
also be putting together a separate plan, comprehensively 
detailing the animal containment strategy of AI. This 
committee is yet to be convened or inaugurated. It is 
planned that the two plans (MOH and MOA) will be integrated 
at a high level Ministerial Committee level which is to be 
chaired by the Minister of Health, but is yet to be 
inaugurated. According to the position paper, the GON will 
employ an "all-inclusive communication and community 
mobilization strategy involving civil society, NGOs, private 
sector, and leveraging the resources of multinational oil, 
communications conglomerates and the banks."  Nigeria 
intends to carry out simulations and exercises in strategic 
locations across the country.  "All relevant data will be 
collected, collated, and analyzed using available 
epidemiological and statistical software and tools." 
 
But Significant, Wide-Ranging Difficulties Exist 
--------------------------------------------- ---- 
 
6. (SBU) According to the Position Paper, the GON plans to 
adopt a system for "electronic notification, e-surveillance, 
or e-avian flu system to provide real-time information 
exchange about new cases of avian influenza. Cross-border 
health officials will be empowered to carry out clinical 
examinations, and a "compulsory notification system" with 
neighboring countries will be established.  The GON's budget 
for all of these activities, however, remains "to be worked 
out."  (Comment:  These monitoring and communications goals 
are far-fetched in a country lacking stable electric power, 
functioning telephone and cellular phone networks, with 
limited Internet connectivity.  Many GON officials' offices 
lack telephones, fax machines, Internet access, or all of 
these.  As for the MOH, its Web site is very basic and 
permits only nine ministry officials to be contacted by e- 
mail - and only at accounts administered by Hotmail or Yahoo 
rather than the GON itself.  End comment.) 
 
7. (U) The MOH correctly notes the constraints it faces in 
preparing for an AI pandemic: political will and the 
political climate, including nationwide elections in 2007; 
scarce financial resources and competition from priority 
programs such as HIV/AIDS, polio, tuberculosis, and malaria; 
Nigeria's "fragile" health system, including weak 
surveillance and notification, poor logistics and 
communications support to health-services delivery, and weak 
laboratory field support; the health sector's "poorly 
motivated" work force; and government officials' limited 
access to information technology.  The MOH acknowledges 
Nigeria has porous borders with weak controls on the 
movement of goods and people. 
 
8. (U) Nigeria established a senior Technical and Expert 
Committee on AI on November 14, 2005.  It includes the 
Ministry of Agriculture, the MOH, the Poultry Association of 
Nigeria, the Veterinary and Medical Associations of Nigeria, 
the WHO, university epidemiologists, WHO, UNICEF, the 
Canadian International Development Agency, and 
USAID/Nigeria. USAID/Nigeria will suggest that the committee 
add the Ministry of Transport and civil-society groups from 
both the human-health and animal sectors. USAID already has 
encouraged the inclusion of Nigeria's private sector - 
particularly oil and gas companies. 
 
AI Plan To Build on Existing Structures 
--------------------------------------- 
 
9. (SBU) Nigeria has an overall Integrated and Disease 
Surveillance and Response Strategy for infectious disease, 
but this network is patchy.  The system reportedly tracks 21 
priority diseases in Nigeria and was developed by the WHO, 
which ostensibly oversees this system through the WHO's 
technical leadership.  The GON plan includes surveillance 
activities for AI at the state level.  Monthly state 
surveillance meetings are held currently, and the MOH 
anticipates using these meetings to train surveillance 
officers on how to identify potential outbreaks of AI. The 
MOH will base its surveillance system for AI on the 
framework and strategies developed in 2003, when a suspected 
case of severe acute respiratory syndrome (SARS) Nigeria's 
teaching hospitals and port health services were mobilized, 
and isolation centers and treatment facilities were 
established, with one quarantine center opened in Lagos and 
one in the country's north, in Kano. 
 
Laboratories and Containment Measures Are Lacking 
--------------------------------------------- ---- 
 
10. (SBU) Nigeria has some capacity to rapidly collect, 
store, and transport samples of suspected animal and human 
cases to the country's three reference and six zonal 
laboratories.  According to USAID Abuja, however, outside 
donors would have to provide the GON significant support in 
this area, given Nigeria's large size and extremely poor 
transportation infrastructure.  Nigeria does not receive any 
donor assistance for AI, and the GON does not yet have 
mechanisms for receiving AI donor assistance. 
 
11. (SBU) Nigeria is not able to quickly mobilize effective 
containment measures in response to outbreaks of AI among 
animals.  Given Nigeria's very weak health system and health 
infrastructure, significant technical and financial support 
will be required.  The GON has discussed reimbursing farmers 
whose infected animals or poultry must be destroyed, but it 
has not adopted such a plan and no funding is likely to 
identified. The GON currently does not employ vaccination as 
a containment measure for animal infections. Although the 
GON reports it has a plan for the early procurement and 
stocking of Tamiflu vaccine, it is not clear what entity, 
whether Nigerian or foreign, would fund Tamiflu purchases. 
 
12. The plan identifies the need to establish a legal 
framework as a basis for preventive and control measures. It 
further notes the need to enforce existing public health 
laws, and international health regulations and foresees the 
possible invocation of quarantines and need to develop 
disease prevention ordinances and to add avian flu 
surveillance to the list of diseases covered by the national 
network. The Plan makes no mention of coordinating with law 
enforcement agencies or the military to carry out quarantine 
or other control measures. 
 
AI Public-Education Program Not Established 
------------------------------------------- 
 
13. (SBU) The GON does not have a clear strategy to educate 
the Nigerian public about AI, including case recognition, 
prevention, risk behavior, or caring for persons infected. 
While Nigerian national radio and television recently have 
carried some news reports on the implications for Africa of 
AI, there is a need for additional dissemination of 
information on AI to increase public awareness.  Embassy 
Abuja's staff on November 8 in Abuja attended an AI lecture 
for the general public given by Dr. L.H. Lombin, executive 
director of the National Veterinary Research Institute in 
Vom.  Lombin was clear the GON must devote substantial 
resources to prepare for AI. 
 
Comment 
------- 
 
14. (SBU) There is little reason to believe the GON's 
response to the advent of AI would be effective - largely 
because of the shortcomings noted by the MOH.   As is the 
case with most GON programs, funding for Nigeria's AI 
effort, and the GON's ability to carry out programs, are the 
weak links.  Should cases of AI make their way to Nigeria, 
the West African sub-region will be woefully ill-prepared to 
contain the pandemic.  Because of this, significant 
resources - both technical and financial - would be required 
to make even a marginal effort to limit fatalities.  Nigeria 
is not likely to provide these resources. 
 
15. (SBU) Even if the GON developed a comprehensive national 
AI plan, it is unlikely that Nigeria would be able to mount 
an effective public-health response to an outbreak of AI 
among humans, given the country's extremely deficient health- 
care infrastructure, weak government, and ineffective 
professional bureaucracies.  Nigeria has a very limited 
surge capacity to properly diagnose, manage, or treat 
patients or to protect health workers in the case of an AI 
pandemic. Though law enforcement and military bodies are not 
yet engaged in planning, in the case of an outbreak, the 
military would be likely to assume some kind of role in the 
crisis. 
 
16. (SBU) Because of AI's high mortality rate, the effects 
of its arrival in Nigeria could be horrific in this country 
whose population may be as high as 150 million people.  More 
than 70% of the population is under stress from extreme 
poverty, poor nutrition, HIV/AIDS, malaria and other endemic 
diseases.  With Nigerian life expectancy at a mere 44 years, 
AI's effects in a country with barely functioning government 
institutions could be catastrophic.  As the most populous 
state in Africa, and with one of the continent's weakest 
health infrastructures, Nigeria could, as is the case with 
other diseases such as malaria, polio, HIV/AIDS, and 
tuberculosis, bear the brunt of West Africa's mortality 
should AI make its way to this country. 
 
17. (SBU) The U.S. Mission's most appropriate role, as led 
by USAID/Nigeria on this issue, will be to focus efforts on 
AI by taking an active role in Nigeria's Action Planning 
Committee; by urging the addition of key organizations, 
including from the private sector, to the Action Planning 
Committee and by facilitating the engagement of civil- 
society groups.  The greatest assistance foreign donors 
could provide would be to improve Nigeria's AI preparedness, 
with technical assistance and funding, to mount an effective 
response under the technical leadership of the FAO, the WHO, 
and other key donors.  Ultimately, however, it is the GON 
itself that must carry out effectively these activities. 
 
18. (SBU) The U.S. Mission will continue to monitor the 
GON's progress in preparing to combat AI in Nigeria. The 
Embassy EAC met on November 14 to begin discussion of 
formulating tripwires and Mission responses. The Lagos EAC 
will hold a similar meeting. FUREY