US embassy cable - 05MANILA5458

UNCLAS SECTION 01 OF 05 MANILA 005458 
 
SIPDIS 
 
STATE FOR OES/IHA FOR JKAUFMANN, DSINGER AND RDALEY 
STATE FOR INR/EAP FOR JSTROTZ 
STATE PASS USDA/FAS/ICD FOR ROSENBLUM 
STATE PASS USDA/FAS/DL&P FOR MAGINNIS 
STATE PASS USDA/FAS/ITP/AA FOR ALEXANDER 
STATE PASS USDA/FAS/FAA FOR HAGER 
STATE PASS USDA/APHIS/IS FOR HOFFMAN 
STATE PASS USDA/APHIS/VS FOR DUVERNOY 
STATE PASS USDA/ARS/SEPRL FOR SUAREZ 
STATE PASS USAID FOR DCARROLL AND ACLEMENTS 
BANGKOK FOR REO JAMES WALLER 
CIA FOR NATIONAL INTELLIGENCE COUNCIL NIO/EA 
 
E.O. 12958: N/A 
TAGS: TBIO, SENV, ECON, EAGR, EAID, PREL, RP 
SUBJECT: AVIAN FLU UPDATE 
 
REF: A) STATE 209622 
 
     B) MANILA 5393 
     C) MANILA 5291 
     D) MANILA 5059 
     E) MANILA 4278 
 
 
1.  This cable responds to questions in Ref A. Post 
previously reported on avian influenza preparedness (ref 
E), the GRP's limited surveillance capacity (ref D), the 
appointment of an Anti-Avian Flu Czar (ref C) and rising 
public concern in the Philippines over Avian Flu (ref B). 
 
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SUMMARY 
--------- 
 
2.  The GRP has made progress in Avian Flu preparedness, 
but resource constraints continue to prevent 
implementation.  Although the Philippines remains free of 
the H5N1 Highly Pathogenic Avian Influenza (HPAI) virus, 
the country is vulnerable during the October-February 
migratory bird season.  President Arroyo recently took 
several steps to raise public awareness and focus GRP 
resources on prevention and containment of HPAI in 
poultry. Arroyo highlighted these efforts at the November 
18-19 APEC Summit and encouraged regional collaboration. 
The Bureau of Animal Industry (BAI) has solicited U.S. 
support to improve its poultry surveillance.  USAID is 
helping the Department of Health to prevent possible 
human HPAI cases. The GRP has limited resources to 
respond to a large HPAI outbreak.  The GRP relies on 
poultry farmers for HPAI surveillance, but has not 
established an adequate indemnity fund to encourage their 
cooperation. END SUMMARY 
 
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PREPAREDNESS PLANNING 
---------------------- 
 
3.  The GRP has an Avian Flu preparedness plan available 
at: www.doh.gov.ph/avian. The Department of Agriculture 
website (www.da.gov.ph/BirdFlu) also has information on 
Avian Flu preparedness including procedures for 
prevention and containment of HPAI in poultry.  As 
reported in ref E, the Departments of Agriculture and 
Health have divided responsibilities for four stages:(1) 
preventing entry of the HPAI into the Philippines; (2) 
containing HPAI outbreaks in poultry; (3) preventing 
animal to human transmission of HPAI; and (4) preventing 
human-to-human transmission of HPAI.  The GRP's capacity 
to effectively implement the plan is limited by budget 
constraints, ill-equipped diagnostic laboratories, and 
lack of indemnity funds for farmers. 
 
4.  Although the GRP has taken steps to procure limited 
stockpiles of materials and establish regional teams to 
prevent and contain HPAI outbreaks in poultry.  The 
capacity of regional response teams could quickly be 
stretched in the event of a significant HPAI outbreak. 
 
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TRANSPARENCY 
------------- 
 
5.  The GRP has publicly affirmed its commitment to 
transparency and Post expects the Departments of 
Agriculture and Health to adhere to this commitment in 
reporting any confirmed HPAI cases among birds or people. 
Given the free flow of information and the widespread use 
of text messaging in the Philippines (noted in ref B), it 
is also unlikely that any significant HPAI outbreak would 
go unnoticed.  GRP must overcome economic disincentives 
to encourage cooperation of poultry farmers in reporting 
and isolating potential AI cases. 
 
6.  The GRP is likely to delay any announcement of 
possible HPAI cases in poultry until the completion of 
confirmatory tests by the regional reference lab in 
Geelong, Australia.  The Bureau of Animal Industry (BAI) 
estimates that these tests currently can take one week to 
complete, but BAI is upgrading its testing capacity (as 
reported in ref D), to allow more rapid identification of 
the H5N1 virus.  The July 2005 Calumpit incident, where 
the human reference lab leaked incomplete information 
about a suspected HPAI case (later considered negative 
for HPAI) has led the government to more carefully manage 
information about potential AI cases.  Only the BAI 
Director has the authority to announce a confirmed HPAI 
case in poultry. 
 
7.  Improved diagnostic capability, including quality 
control procedures, can also encourage prompt and 
accurate reporting of HPAI cases in animals and people. 
Indemnity funds could encourage cooperation from farmers 
in reporting potential HPAI cases and containing 
outbreaks.  International cooperation to alleviate 
potential economic costs of an HPAI outbreak can also 
encourage further transparency. 
 
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LEADERSHIP 
----------- 
 
8.  President Arroyo has taken a leadership role in 
focusing GRP resources on AI preparedness.  Per ref C, 
Arroyo appointed Agriculture Secretary Panganiban as Anti- 
Avian Flu Czar, leading the National Avian Influenza Task 
Force (NAITF) to concentrate on stages 1 and 2: 
prevention and containment of Avian Flu in poultry. 
Health Secretary Duque manages HPAI prevention and 
preparedness for human health.  Arroyo also proposed to 
allocate 2.5 billion pesos ($50 million) for stages 1 and 
2 in the 2006 National Budget currently under 
consideration by Congress.  Arroyo's proposal would 
source these funds from savings in debt service but some 
legislators have suggested using U.S. PL-480 food aid 
funds for this purpose. 
 
9.  At the operational level, Dr. Davinio Catbagan, 
Director of the BAI, manages AI prevention and 
preparedness for poultry, while Dr. Luningning Villa, 
Program Manager for Emerging Infectious Diseases, serves 
as the point person for AI preparedness in the DOH. 
 
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LEGAL ISSUES 
------------ 
 
10.  The GRP has not reviewed national laws for 
compatibility with HPAI preparedness, but it does not 
anticipate legal obstacles to surveillance and control of 
HPAI outbreaks.  The NAITF was authorized by Executive 
Order 280 to supervise HPAI preparedness.  Based on its 
experience during the SARS crisis, the GRP can invoke the 
Sanitation Code and the Local Government Code to support 
containment and quarantine measures.  The Quarantine Act 
of 2004 (Republic Act 9271) has strengthened the DOH's 
authority to impose quarantines and expanded its scope to 
cover public health emergencies of international concern. 
 
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INTERNATIONAL COLLABORATION 
---------------------------- 
 
11.  The GRP is working with several international 
organizations on AI preparedness, notably the World 
Health Organization (WHO), the United Nations Food and 
Agriculture Organization, the International Organization 
for Animal Health, the Asian Development Bank and the 
World Bank.  The Philippines has joined the International 
Partnership on Avian and Pandemic Influenza (IPAPI).  At 
the November 18-19 APEC summit, President Arroyo 
reaffirmed GRP support for regional programs to prevent 
and control HPAI. 
 
12.  The GRP has solicited support from USDA to upgrade 
its surveillance capacity and from USAID to support 
preparedness for human HPAI cases.  Although the GRP is 
trying to allocate sufficient funds for HPAI 
preparedness, it may solicit further bilateral or 
multilateral assistance, particularly if the approval and 
execution of the 2006 national budget is delayed. 
 
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VACCINES 
--------- 
 
13.  GRP currently has no program or plans to administer 
flu vaccines, so it does not procure these vaccines for 
government use. The private health sector does provide 
vaccines for its patients and some practitioners report 
that demand is increasing but the current supply is 
adequate for the private sector. 
 
14.  The DOH does not have any capacity to produce flu 
vaccines for humans or poultry, but it produces three 
other human vaccines.  DOH estimates that the production 
facility would require additional modules and at least 
one year for conversion to flu vaccine production in an 
emergency. 
 
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PUBLIC AWARENESS 
---------------- 
 
15.  Public awareness of Avian Flu has increased since 
the GRP launched an information campaign in November and 
the Philippine media has increased coverage of Avian Flu. 
The information campaign has sent eight teams to train 
local AI task forces in 37 provinces to diagnose and 
respond to potential HPAI cases.  President Arroyo named 
Secretary Cerge Remonde, Head of the Government Mass 
 
SIPDIS 
Media Group, to assist the NAITF in developing public 
information campaigns on Avian Flu and enlisted the 
support of U.S. firm McCann-Erickson to assist in the 
campaign.  The DOH has prepared information materials 
covering prevention of Avian Flu and has been working 
with the mass media.  It is difficult to determine the 
geographic coverage and effectiveness of these measures 
to date. 
 
-------------------------------- 
SURVEILLANCE/DETECTION CAPACITY 
-------------------------------- 
 
16.  Per ref D, the GRP is upgrading the Philippine 
Animal Health Center (PAHC), its animal reference lab, to 
establish a specialized AI diagnosis facility capable of 
identifying the H5N1 virus.  The PAHC currently conducts 
screening tests and can isolate the virus, but must send 
samples to Geelong, Australia to identify specific virus 
types.  This process can take up to one week.  The BAI 
conducts limited random surveillance of poultry in 20 
critical areas where poultry are vulnerable to infection 
from migratory birds.  BAI also relies on regional 
veterinarians to report potential AI outbreaks based on 
high mortality rates in poultry and clinical symptoms 
consistent with AI. 
 
17.  The Research Institute for Tropical Medicine (RITM) 
has the capacity to isolate viruses and identify virus 
types. The DOH has a surveillance system, through its 
National Epidemiology Center to monitor human cases of 
pneumonia or deaths related to poultry disease/deaths in 
the 20 identified critical areas. 
 
18.  The GRP has solicited USDA support to train 
technical staff and equip its new Avian Flu reference 
laboratory for prompt diagnosis of HPAI virus types. 
Indemnification funds will also be critical to encourage 
the cooperation of poultry farmers in identifying 
possible HPAI outbreaks.  The GRP may solicit further 
assistance in procuring personal protective equipment 
(PPEs), anti-virals and other supplies for AI response 
teams. 
 
----------------------- 
ANTI-VIRALS AND PPEs 
----------------------- 
 
19.  The DOH currently has no stockpile of Tamiflu but 
expects 100,000 capsules to arrive by February 2006. 
Through the WHO, the DOH made arrangement for the supply 
of Tamiflu (worth $31,000).  It also sent a Letter of 
Intent to Roche Pharmaceuticals for the procurement of an 
additional 8.5 million pesos ($154,000).  The Philippine 
International Trading Corporation has reached an 
agreement with a local company, United Laboratories 
(Unilab), for the manufacture of Tamiflu in the 
Philippines in an emergency situation. 
 
20.  USDA contributed 100 sets of PPEs to equip BAI teams 
and laboratory workers to contain an AI outbreak in 
poultry. The DOH has retained PPEs from the SARS epidemic 
for health care providers at regional hospitals. 
 
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RAPID RESPONSE CAPACITY 
------------------------ 
 
21.  The GRP has developed the capacity to respond to 
limited HPAI outbreaks, but this capacity would likely be 
overwhelmed if an HPAI outbreak occurs in a major poultry 
producing area near metro-Manila.  The BAI has produced 
guidelines for culling of birds and containment measures 
(www.da.gov.ph/BirdFlu/ProtectionProgram/manu al). 
 
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QUARANTINE CAPACITY 
------------------- 
 
22.  The GRP is willing to impose quarantines and social 
distancing measures as needed, but its capacity could be 
quickly overwhelmed if a human pandemic occurs.  The DOH 
has limited capacity to isolate human HPAI cases.  The 
Research Institute for Tropical Medicine (RITM) has been 
designated as the National Referral Hospital for bird flu 
cases. RITM will use the negative pressure rooms used 
during the SARS outbreak in 2004.  Moreover, a portion of 
the Lung Center of the Philippines, a sub-national 
referral hospital, has been designated for tent hospitals 
should a pandemic occurs.  Ten other DOH hospitals have 
the capacity to admit Avian flu cases (with PPEs and 
isolation facilities).  The DOH plans to establish 
isolation facilities in all 16-17 regions.  For limited 
human HPAI cases, the GRP could draw on its experience 
during the SARS epidemic to enforce a quarantine. 
 
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COMMENT 
-------- 
 
23.  The GRP recently raised the profile of its Avian Flu 
preparedness programs and it is making progress in 
providing training and supplies to regional teams. 
Although President Arroyo has proposed a ten-fold 
increase in funding for Avian Flu preparedness, this 
funding may be delayed if the Congress fails to approve 
the 2006 budget.  In the short term, the GRP will 
continue to need assistance in improving surveillance 
capacity, stockpiling Tamiflu and PPEs, training regional 
response teams and establishing an indemnity fund to 
encourage cooperation from farmers. 
 
JONES