US embassy cable - 05NAIROBI4829

UNCLAS SECTION 01 OF 03 NAIROBI 004829 
 
SIPDIS 
 
DEPT FOR OES/IHA DSINGER AND RDALEY, INR FOR RLESTER 
 
SENSITIVE 
 
E.O. 12958:  N/A 
TAGS: TBIO, SENV, ECON, EAGR, EAID, PREL, PGOV, KE, Avian Flu 
SUBJECT:  KENYA INFORMATION ON AVIAN AND PANDEMIC 
INFLUENZA 
 
REF:  STATE 209622 
 
Sensitive-but-unclassified.  Not for release outside USG 
channels. 
 
1.  (U) Mission Nairobi responses to reftel follow: 
 
A) Preparedness/Communication 
----------------------------- 
2.  (SBU) The Kenyan government has established an inter- 
ministerial taskforce to create an action plan to address 
the threat of avian flu.  The taskforce is nominally 
headed by Mrs. Rachel A. Arunga, Permanent Secretary for 
Special Programs in the Office of the President.  Joint 
leadership for the taskforce is by Dr. James Nyikal, 
Director of Medical Services (DMS - the highest ranking 
medical professional in the Ministry of Health) and Dr. 
Joseph Musaa, Director of Veterinary Services (DVS), from 
the Ministry of Livestock Development.  Due to 
limitations in surveillance systems and program 
enforcement capacity, Kenya will face major challenges in 
fully implementing any comprehensive plan developed by 
the taskforce.  (A report on initial taskforce efforts 
will be sent septel.) 
 
3.  (SBU) U.S. Mission believes the GOK will likely be 
generally truthful and forthcoming on news of potential 
or confirmed cases of avian influenza in Kenya.  The DMS 
and DVS are viewed as sincere in trying to create a 
transparent process for monitoring and responding to this 
threat and actively seek the assistance of Mission 
agencies and UN officials.  Mission agencies -- Centers 
for Disease Control/Kenya (CDC), U.S. Army Medical 
Research Unit - Kenya (MRU), and USAID -- are 
participants in the GOK taskforce and would likely be 
appraised of any suspected or confirmed outbreak of avian 
flu in either animal or human populations.  Kenya's free 
and relatively dynamic press would pose a major barrier 
to any GOK effort to withhold information on significant 
bird deaths or a major outbreak of human illness. 
 
4.  (SBU) The Kenyan press has provided accurate coverage 
of the GOK avian flu taskforce.  Still, at this time, 
addressing the avian flu threat is not a priority for top 
policy makers.  With the country, and President Kibaki's 
Cabinet, strongly divided over a draft constitution, to 
be voted on in a November 21 referendum, gritty partisan 
politics overshadow most administration policy 
initiatives at this time.  Kenya will likely remain in 
political turmoil for weeks, perhaps months, after the 
referendum.  Political gridlock could continue through 
the 2007 presidential campaign.  Dealing with the range 
of campaign promises post referendum will require a great 
deal of the Cabinet's focus.  Because the Office of the 
President (OP) is only moderately active in the GOK 
taskforce and in the development of Kenya's avian flu 
action plan, coordination among ministries and law 
enforcement agencies is problematic.  It will likely take 
confirmed cases of human infection in Kenya or a 
neighboring country to move this issue above the existing 
GOK taskforce leadership as a policy priority. 
 
5.  (SBU) At this time, the DMS and DVS are effective 
interlocutors for U.S. assistance in developing an action 
plan.  The more senior key GOK officials for high-level 
engagement are Mrs. Arunga; COL Shem Amadi, Chief, 
National Disaster Operations Center, Office of the 
President; Hon. Mrs. Charity Ngilu, Minister of Health; 
and Hon. Joseph Munyao, Minister of Livestock 
Development.  In the face of a heightened risk for a 
human pandemic, the key coordinators of a GOK multi- 
ministerial response would be Hon. John Michuki, Minister 
of State for Internal Security and Joseph Kahindi, 
Minister of State for Provincial Administration. 
 
6.  (SBU) It is not known if the GOK has reviewed its 
laws to ensure they are consistent with international 
health regulations.  This issue can be raised with the 
GOK taskforce. 
 
7.  (SBU) Because of Mission agencies' leadership roles 
within the GOK taskforce, bilateral messages from the USG 
would be effective.  To date, other bilateral donors have 
not played a prominent role on this issue.  The GOK 
taskforce has been in touch with the FAO, WHO, and the 
World Bank.  Each of these multilateral institutions, as 
well as the Nairobi-based UN Environmental Program 
(UNEP), would be useful conduits for messages to top 
Kenyan officials.  Should avian influenza be confirmed in 
East Africa, it is likely that the East Africa Community 
(headquartered in Arusha, Tanzania) and COMESA would 
explore regional cooperation.  Any request from bilateral 
or multilateral donors for specific GOK responses or 
actions will be more effective if offers of funding are 
included. 
8.  (SBU) Annual influenza vaccines are available in 
Kenya, but are relatively expensive and have limited 
distribution.  Kenya does not have the capability for 
producing human influenza vaccine, and is not currently 
producing avian flu vaccine for poultry although it 
likely could do so.  Kenya is not working on developing 
an H5N1 vaccine, and likely does not have that capacity. 
Kenya generally does not permit suits related to legal 
drugs used in accordance with all prescriptions and 
applicable warnings.  However, this is likely not 
equivalent to a codified shield to foreign makers/donors 
of vaccines. 
 
9.  (SBU) In addition to reporting on the GOK taskforce, 
Kenyan newspapers have reprinted foreign press articles 
on recent developments and outbreaks of avian flu.  The 
GOK has a fairly good ability to deliver information to 
rural populations, both through public and private radio 
stations (including local language programming), and 
though multiple layers of local government, including 
veterinary extension officers. 
 
B) Surveillance/Detection 
------------------------- 
10.  (SBU) Kenya has some proven capacity for detecting 
new strains of influenza among both human and animal 
populations.  On the human side, the Kenya Medical 
Research Institute (KEMRI), with on-going assistance from 
CDC and MRU, has disease monitoring systems in place at 
several locations in the country.  For animal 
surveillance, the Department of Veterinary Services 
(within the Ministry of Livestock and Fisheries) has a 
fairly good network of rural partners who regularly 
report on unusual diseases in livestock populations, 
especially cattle, and this network is being utilized to 
report on suspicious bird die-offs.  In addition, the 
Cairo, Egypt-based U.S. Navy Medical Research Unit 3 
(NAMRU-3) has recently begun a modest surveillance 
program of migratory birds in Kenya, partnering with a 
couple of local ornithological hobby groups.  Both the 
Ministry of Health and the Ministry of Livestock have 
working hotlines for local officials or the public to 
report suspicious diseases. 
 
11.  (SBU) Accurate and timely diagnosis of new influenza 
strains is dependent on Kenya's highly variable health 
infrastructure, but the potential is in place. 
Laboratory facilities are limited, and diagnosing 
outbreaks in animal populations is likely more efficient 
than for human cases.  Tracing bird-to-human transmission 
in rural areas would be problematic.  CDC-Nairobi has the 
capacity to subtype influenza viruses, but the GOK's 
capacity is limited.  With additional support and 
training, labs at KEMRI (which hosts a WHO reference lab 
for influenza), ILRI, and the Kabete Veterinary 
Laboratories could do sub-typing.  These institutions do 
send samples to reference laboratories in the U.S. and to 
the WHO. 
 
12.  (SBU) Kenya's critical gaps for detecting new 
strains of influenza include the need for improved, 
sustainable surveillance of human cases and an enhanced 
capacity for testing potential virus samples, including 
additional information dissemination and training. 
 
C) Response/Containment 
----------------------- 
13.  (SBU) Kenya has limited stockpiles of medications, 
and likely no (or very limited) inventory of influenza 
antivirals.  There is no known plan to order excess 
quantities. The GOK has made the decision to order 
limited quantities of antivirals, but has not yet done 
so.  The GOK taskforce noted that the WHO is maintaining 
stockpiles of critical antivirals to respond to influenza 
outbreaks globally.  Kenya has a limited supply of pre- 
positioned personal protective gear but it is not well 
inventoried. 
 
14.  (SBU) The GOK taskforce noted an existing plan for 
rapid response to animal outbreaks, notably in livestock, 
but now will also expand to poultry.  This plan utilizes 
District Veterinary Officers and some local volunteers. 
The Ministry of Livestock keeps at least one vehicle for 
rapid response teams.  Rapid response for human outbreaks 
is more ad hoc, but possible in most of the country 
through District Medical Officers and the Disease 
Outbreak Management Unit within the Ministry of Health. 
The GOK taskforce also noted that it is considering the 
need for guidelines on poultry culling.  Animal vaccines 
are too expensive for wide use. 
 
15.  (SBU) The GOK is willing to impose quarantines and 
other social distancing measures, and has previously 
closed schools in the face of disease outbreaks.  The 
government's ability to impose widespread or sustained 
quarantine measures is limited.  While Kenya's military 
might be called upon to enforce such measures, its 
capacity to do so is likely restricted to areas near 
major army installations. 
 
ROWE