US embassy cable - 05SANAA3290

C O N F I D E N T I A L SECTION 01 OF 03 SANAA 003290 
 
SIPDIS 
 
PASS TO OES SENIOR HEALTH ADVISOR DR. DANIEL SINGER, POLICY 
ADVISOR REBECCA S. DALEY, INR SENIOR ANALYST RAYMOND LESTER 
 
E.O. 12958: DECL: 11/23/2015 
TAGS: TBIO, SENV, ECON, EAGR, EAID, PREL, YM, ENVIRONMENT/S&T 
SUBJECT: YEMEN INFORMATION ON AVIAN AND PANDEMIC INFLUENZA 
 
REF: SECSTATE 206992 
 
Classified By: DCM NABEEL KHOURY FOR REASONS 1.4(B) AND (C) 
 
1. (U) Summary: This cable describes 
ROYG preparations and capabilities in the event of an avian 
influenza pandemic; responses are keyed to reftel questions. 
End Summary. 
 
2. Preparedness/Communication 
 
-- Does the government have a preparedness plan/strategy 
for preventing avian flu from becoming a pandemic and 
containing a pandemic once it occurs?  If the country has a 
strategy, how capable is it of implementing it?  Please 
provide a copy of the plan or the Internet address for the 
plan. 
 
The Yemeni Government does have a preparedness strategy 
approved by parliament.  The government is currently not 
capable of fully implementing the policy, but is slowly 
moving toward a greater level of capability in 
identifying a threat.  Due to poor medical facilities and 
lack of resources, both monetary and technical, the ROYG is 
unable to handle a pandemic. 
 
-- How truthful will the government be in reporting the 
scope of any disease outbreak among people?  Among 
animals?  What incentives could be offered that would 
likely result in more transparency? 
 
The government will likely be truthful in reporting the 
scope of the disease to the best of their capabilities. 
The Yemeni Government has expressed a strong interest in 
maintaining the utmost level of transparency in regard to 
avian influenza. 
 
-- Where does preparing for an avian flu human pandemic 
rank among the government priorities?  Who and what would 
most influence the country to give the issue a higher 
priority?  Who is the key "go-to" person, office or 
department (i.e. Minister for Health, Prime Minister, etc.) 
for USG officials to engage on this issue? 
 
Preparing for a pandemic is high on the list of government 
priorities.   The primary offices are the Ministry of 
Health and the Ministry of Agriculture, which are working in 
concert on this issue. The government has also set up an 
operations center disease surveillance unit.  The main 
contacts are Dr. Majid al-Gunaid, who is the Deputy Minister 
of Public Health and Population, Yahia Al-Areshi with the 
Ministry of Agriculture and Irrigation, and Mr. Nabil 
Shaiban of the Ministry of Planning and International 
Cooperation. 
 
-- Have national laws been reviewed to ensure that they are 
consistent with the international health regulations and do 
not pose barriers to avian influenza detection, reporting, 
containment, or response? 
 
There are no Yemeni laws that pose barriers.  As part of 
their Plan of Action (POA), the government implemented two 
new laws aimed at addressing the prevention of disease from 
the animal source 
and at preventing the spread of the flu. 
 
-- Is the host country already working with international 
organizations or other countries on the avian flu issue? 
Are government leaders likely to ask for assistance from 
the US or other countries?  Would government leaders be 
receptive to messages from US leaders through a bilateral 
approach, at a multilateral forum such as the UN (WHO, 
FAO, etc.) or APEC, or through bilateral contacts by a 
third country?  What would the country want from the US in 
return for its efforts? 
 
The Yemeni Government has already worked closely with WHO 
to develop the current POA.  FAO and the Animal Health 
Organization have also assisted the government.  The 
government is seeking to coordinate with members of the Gulf 
Cooperation 
Council, as well. 
The government has sought additional technical and monetary 
assistance directly from USAID and is likely to seek 
assistance from other countries. 
 
-- Does the country currently administer annual flu shots? 
If not, might it consider doing so? What is the production 
capability (i.e. how many doses of the annual trivalent flu 
vaccine can the country make) for human influenza vaccines 
in the country?  Does the country produce influenza vaccine 
for poultry and if so how much?  If the country is 
developing an H5N1 vaccine, where is it in production and 
testing?  Any licensing issues? Is there a liability shield 
for foreign makers/donors of vaccines?  If not, any 
prospects of one being enacted? 
Yemen does not currently administer annual flu shots and is 
not likely to consider doing so in the future.  The 
government does not spend large amounts of money on health 
and curative medicine is of a greater priority than 
preventative medicine.  Yemen currently does not produce 
any vaccines and has no production capabilities for either 
human or poultry influenza vaccinations.  Post is unaware 
of any liability shield or prospects of one being enacted. 
 
-- How well informed is the population about the avian flu 
threat and about measures they should take to mitigate the 
threat?  What mechanisms are available for providing 
additional information to the population, particularly in 
rural areas and how effective are these measures? 
 
The general population has limited information about the 
threat.  Part of the POA addresses raising awareness among 
veterinarians, technical staff and poultry breeders.  There 
is an initiative to inform farmers and fisherman along the 
main migratory bird route.  So far, however, the 
information has been limited to instructions to bring dead 
birds to a local laboratory. There is currently no larger 
initiative to educate the public on ways to protect 
themselves in the event of a pandemic or ways to prevent 
the spread of the disease if an outbreak occurs.  This is 
particularly true of rural areas where poultry to human 
contact is prevalent.  The Yemeni public has gained its 
information about AI through local and international media 
outlets. 
 
3. Surveillance/Detection 
 
-- How capable are the medical and agricultural sectors of 
detecting a new strain of influenza among people or animals 
respectively?  How long might it take for cases to be 
properly diagnosed, given other endemic diseases?  Can 
influenza viruses be subtyped in the country, if so by who, 
and if not where are they sent?  Does the country send 
samples to a WHO/EU/US reference laboratory? 
 
The Ministry of Agriculture has procured test kits, but 
post has no information that they are currently being 
used.   Yemen uses the NAMRU 3 regional lab out of 
Alexandria, Egypt.  Yemen has very primitive scientific and 
health capabilities.  The POA seeks to increase the 
capabilities of the Central Public Health Laboratory. 
 
-- What are critical gaps that need to be filled in order 
to enhance the country's disease detection and outbreak 
response capabilities?  What is the country's greatest need 
in this area from the US or international organizations? 
 
In general, Yemen is a very poor country with a failing 
health care system.  Even absent a pandemic, the Yemeni 
Government will be hard pressed to deal with many issues 
such as financing, technological necessities and access to 
affected areas.  Public education needs to be increased, 
particularly in rural areas where much of the poultry food 
is raised.  In the event cases are found in the poultry 
food population, it is very likely that affected farmers 
will  underreport, and likely actively fight 
against government actions or restrictions, especially if 
large scale culling is deemed necessary. 
 
4. Response/Containment 
 
-- Does the country have a stockpile of medications, 
particularly of antivirals, and if so how much?  If some 
has been ordered, how much and when is it expected? 
 
The country currently has enough Tamiflu on stock for 2000 
people.  The Ministry of Health estimates a need for enough 
to cover 20 percent of the population (approximately 5-6 
million people). 
 
-- Does the country have a stockpile of pre-positioned 
personal protective gear? 
 
Yemen has a very limited protective gear stockpile.  The 
POA calls for an increase in stockpiles and the WHO has 
expressed intentions to assist the Ministry of Health in 
acquiring more. 
 
-- What is the rapid response capacity for animal and human 
outbreaks?  Are guidelines in place for the culling and 
vaccination of birds, disinfection of facilities, and 
limitations on animal movement? 
 
Although the government expresses a high level of confidence 
in 
its ability to rapidly respond to an outbreak, absent a 
stronger central government and a comprehensive plan to 
compensate affected farmers, the government is likely to 
face tough resistance from affected farmers.  No current 
guidelines exist for any rapid response reaction. 
 
-- How willing and capable is the government of imposing 
quarantines and social distancing measures (closing public 
schools, public gatherings, mass transit)?  Would its 
military enforce quarantines? 
 
The government is willing to impose quarantines.  The POA 
includes 
the outfitting of a national fever hospital and local fever 
hospitals in each of the governorates.  The military would 
attempt to enforce quarantines, but given the weak central 
government, resistance to large-scale quarantine is almost 
assured outside of the large cities. 
 
5. Given Yemen's location on a major migratory bird route, 
the large number of poultry food farms, and the high 
incidence of human to poultry contact, an outbreak of 
avian influenza, even if restricted to animals, would have 
serious ramifications on the Yemeni economy.  While the 
government 
has prepared a Plan of Action, absent an influx of 
funding or technical assistance, Yemen will be ill-equipped 
to deal with even a small-scale pandemic. The government is 
actively seeking assistance bilaterally, multilaterally and 
through international organizations, and post recommends that 
it be accorded due support. 
Krajeski