US embassy cable - 05KUWAIT4824

UNCLAS SECTION 01 OF 03 KUWAIT 004824 
 
SIPDIS 
 
STATE FOR OES/PCI, OES/IHA 
HHS FOR OGHA STEIGER/BHAT 
CDC FOR BLOUNT/JANI/LEDUC/NCOX/ARTHUR 
GENEVA FOR WHO 
USDA PASS FSIS AND APHIS 
 
E.O. 12958: N/A 
TAGS: TBIO, SENV, ECON, EAGR, EAID, PREL, XX, KU 
SUBJECT: RESPONSE TO DEPARTMENT TASKER ABOUT AVIAN 
INFLUENZA INFORMATION IN KUWAIT 
 
REF: A. REF A: STATE 206992 
     B. REF B: KUWAIT 4516 
     C. REF C: KUWAIT 4673 
     D. REF D: KUWAIT 4755 
 
1.  (U) This message is Post's response to the questions 
contained in Reftel A regarding the GOK's efforts to control 
Avian Influenza (AI), and its capability to respond to an AI 
epidemic.  Questions are answered in the order provided in 
reftel. 
 
-------------------- 
ANSWERS TO QUESTIONS 
-------------------- 
 
2.  (U) Answers. 
 
A)  PREPAREDNESS/COMMUNICATION 
 
-- The GOK has formed a committee of representatives from the 
Department of Public Health (DPH), Public Authority for 
Agricultural Affairs and Fish Resources (PAAAFR), the 
Infectious Disease Hospital, and the Ambulance Service to 
develop a comprehensive plan to prevent and/or manage an AI 
pandemic in Kuwait (Ref B).  The plan involves regular 
inspections by trained teams from the Animal Resources arm of 
the PAAAFR which take samples from farms, bird markets, and 
locations where migratory birds gather (Ref C).  The GOK has 
also banned the import of all live birds and poultry products 
from affected countries.  The PAAAFR has established a 
hotline for those encountering dead birds, to which the 
PAAAFR responds by sending a team to collect the carcasses. 
So far, Post has observed that this preventative inspection 
plan seems to work, evidenced by regular reports of farm and 
market inspections, and reports of samples taken at migratory 
bird areas (Ref D).  Additionally, Post has witnessed quick 
responses by bird collection teams when calling to report 
dead birds found on the Embassy compound. 
 
-- The GOK would likely be forthcoming in reporting any cases 
of AI among people.  Kuwait's vibrant press and outspoken 
MPs, who are often critical of the government, mean that the 
GOK would have great difficulty concealing any outbreak. 
Another factor influencing transparency is that, because 
Kuwait is the first GCC nation to have an AI incident (Ref 
D), other GCC countries are watching the situation closely 
and would not hesitate to raise alarms at any hint of a 
cover-up.  As we have seen in recent media reports, the 
PAAAFR has been open about infected birds found during 
inspections, and there is little reason to think that this 
openness would diminish. 
 
-- Preparations for AI appear to be high on the GOK's 
priority list.  Post has been told by both DPH and PAAAFR 
officials that the PM is very concerned about the issue.  The 
aforementioned planning committee, the GOK's order of 10 
million tablets of Tamiflu (enough to treat 1 million 
patients), and the relatively quick forming of PAAAFR 
inspection teams attest to the attention that AI is getting 
at decision-making levels (see Reftels B and C for more 
details).  Nominally, the "go-to" person in the GOK is 
Minister of Health (MOH) Sheikh Ahmed Al-Abdullah who heads 
the coordination committee, but Post's experience has been 
that Al-Abdullah's deputy, Assistant Undersecretary Ali 
Al-Seef, as well as Drs. Rashed Al-Owaish and Mussab Al-Saleh 
(Ref B) are the prime movers.  On the PAAAFR side, Sheikh 
Fahd Salem Al-Alki Al-Sabah, the PAAAFR Director, is in 
charge, but his deputy Dr. Mohammad Al-Muhanna, who is in 
charge of all animal health inspections, has been the most 
informed contact (Ref C). 
 
-- Post has no indication that any Kuwaiti laws will be 
impediments to AI detection, reporting, containment, or 
response. 
 
-- GOK officials at the MOH and PAAAFR have been in regular 
contact with the WHO and have repeatedly stated that they are 
following WHO planning and response guidelines.  In addition 
to the GOK's willingness to provide information at Post's 
request, Post understands that the GOK has also been 
providing information to the British Embassy and other EU 
nations.  DPH officials have previously inquired about USG 
assistance in obtaining anti-viral drugs (see Ref B, para 6 
for discussion of GOK concerns about the availability of 
Tamiflu).  Notwithstanding current GOK assertions that the 
public health infrastructure can handle an outbreak, it is 
Post's assessment that the GOK indeed would ask for foreign 
assistance.  Given GOK receptiveness and openness with Post's 
inquiries, multilateral approaches would not likely add much 
value. 
 
-- Kuwaiti hospitals currently administer annual flu shots, 
but Kuwait does not produce any influenza vaccines and has no 
capacity to develop an H5N1 vaccine.  Similarly, all vaccines 
for birds are imported. 
 
-- Because AI features prominently on the front pages of 
local newspapers every day, most of the population is likely 
aware of the issue.  However, DPH officials have expressed 
concern that the public may disregard or downplay the threat 
of AI because of previous public health threats (most notably 
SARS and bio-warfare concerns prior to the 2003 Iraq 
invasion) that were ultimately non-events (Ref B).  There is 
a certain risk of ill-informed third-country nationals (TCNs) 
working, and usually living, at Kuwaiti poultry farms not 
being fully aware of the threat, but the frequent appearance 
of PAAAFR inspection teams at such sites seems to mitigate 
that risk. 
 
B) SURVEILLANCE/DETECTION 
 
-- The PAAAFR has its own laboratory to test samples taken 
from farms, markets, and migratory birds (Ref C).  Hospitals 
also have in-house labs that can test for influenza A viruses 
(of which H5N1 is one) which would therefore give a positive 
result for AI.  The PAAAFR and Kuwaiti hospitals have limited 
ability to sub-type viruses, with the capability to test with 
methods appropriate for some, but not all, types of birds. 
(NOTE: A PAAAFR laboratory scientist has just completed a 
USDA training course in Athens, GA focusing on H5N1 
identification and diagnosis.  He is due to return to Kuwait 
on November 19)  The GOK has a long-standing relationship 
with the reference lab Veterinary Laboratories Agency in 
Weybridge, UK, to which samples are sent for verification. 
 
-- The most pressing gaps in Kuwait's ability to respond to 
an outbreak are the lack of anti-viral stockpiles and a 
shortage of isolation/ICU capacity.  According to DPH 
statistics, there are approximately 600 ICU beds in Kuwait, 
with roughly half in government hospitals and half in private 
hospitals (NOTE:  this total includes Cardiac Care Units 
(CCU), which constitute about 75% of the total ICU beds; CCUs 
can be effectively used as isolation beds in an AI outbreak. 
These numbers are DPH estimates of Kuwait's hospital 
capacity, but the DPH does not have exact figures; however, 
Post believes these estimates to be reasonably accurate). 
Given the DPH's estimate of 9,000-12,000 hospitalizations 
(Ref B), this indicates a serious lack of ICU capacity. 
Additionaly, there are only 4 negative-flow rooms in Kuwait. 
 
 
C) REPONSE/CONTAINMENT 
 
-- Although the Kuwaiti public health sector has adequate 
stocks of most medications, there is no stockpile of 
anti-viral drugs, particularly of Tamiflu or Relenza.  The 
GOK has ordered 10 million tablets (enough to treat 800,000 
patients) of Tamiflu which are due to arrive no earlier than 
June 2006, and according to hospital contacts, perhaps as 
late as September 2007.  Hospital contacts have said that, 
because of this delay, the GOK has placed an order for 
generic Tamiflu from Taiwan, which is due to arrive early in 
2006.  DPH officials have said that they propose to order the 
more widely-available drug Relenza, but no order has been 
placed yet (see Ref B for details). 
 
-- Kuwait has adequate supplies of Personal Protective 
Equipment (PPE). 
 
-- According to the plans in progress described by DPH and 
PAAAFR officials, especially on the animal side, GOK rapid 
response capacity appears to be adequate.  PAAAFR teams are 
already regularly disinfecting facilities and monitoring 
birds, and officials have repeatedly said that infected birds 
will be quickly culled.  Although the Council of Ministers 
has not decided on a specific amount, the GOK plans to 
include compensation to bird owners should a cull be 
necessary.  Regarding the GOK's capacity to handle an 
outbreak among humans, Post has concerns about the capacity 
of Kuwaiti hospitals to handle a surge of patients, but fewer 
concerns about the level of care available to those for whom 
there are beds. 
 
-- Post believes that the GOK is both capable and willing to 
impose quarantines and social distancing measures.  Any 
quarantine would not be enforced by the military, but would 
instead be enforced by the Ministry of the Interior (MOI) 
which oversees police forces. 
TUELLER