US embassy cable - 05ALMATY4159

UNCLAS  ALMATY 004159 
 
SIPDIS 
 
 
DEPARTMENT FOR EUR/CACEN (JMUDGE), OES (DSINGER, RDALEY) 
TASHKENT FOR ESTH (EPUTNAM) 
DTRA FOR CTB 
CDC FOR SLBOUNT, EMCCRAY 
 
SENSITIVE 
E.O. 12958: N/A 
TAGS: TBIO, SENV, ECON, EAGR, EAID, PREL, PGOV, KZ, Avian Influenza 
SUBJECT: KAZAKHSTAN: RESPONSE TO AVIAN AND PANDEMIC 
INFLUENZA RFI 
 
REF: STATE 206992 
 
1. (SBU) Summary:  This cable responds to Reftel. The 
Embassy assesses that the Government of Kazakhstan (GOK) 
appreciates the severity of the threat of avian and pandemic 
influenza and is taking rational, concrete steps to address 
that threat.  The GOK is realistic and basically transparent 
in its actions and public statements.  However, the 
country's preparation for and response to avian and pandemic 
influenza are somewhat hampered by considerable material 
needs in the health sector (both human and veterinary) that 
will not be fixed immediately, and a slow, inefficient 
bureaucratic process.  End summary. 
 
2. (SBU) Answers to the questions in paragraph 4 of Reftel 
follow: 
 
A) 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. 
 
Answer: The GOK has a basic preparedness plan and is 
developing a more comprehensive plan in collaboration with 
CDC and the World Bank, utilizing other national 
preparedness plans as models, particularly Thailand's. 
Broadly speaking, Kazakhstan has good prospects for 
preventing isolated incidents of avian influenza from 
developing into a human pandemic and to contain a possible 
pandemic, not least because of the considerable distances 
separating virtually all human population centers from one 
another.  These distances serve to increase the 
effectiveness of quarantine measures. 
 
-- 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? 
 
Answer: The GOK has been truthful in reporting the scope of 
human AI disease.  There was one suspected human case in 
Kazakhstan during the August 2005 outbreak.  USG personnel 
from the Centers for Disease Control and Prevention (CDC) 
and Naval Medical Research Unit 3 (NAMRU-3) had access to 
the patient and all diagnostic samples taken from him. 
Official public reporting of the patient's condition and 
infection status, which was ultimately negative, was 
accurate and truthful. 
 
The GOK would likely be truthful in reporting outbreaks on 
large poultry farms or of mass deaths among migratory birds. 
However, it is likely that outbreaks on small farms would 
not be detected by the government and would therefore go 
unreported. 
 
-- WHERE DOES PREPARING FOR AN AVIAN FLU HUMAN PANDEMIC RANK 
AMONG 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? 
 
Answer: The GOK has made avian flu preparedness a priority. 
A standing interagency commission chaired by the Ministry of 
Emergency Situations exists, and includes the Ministries of 
Health, Agriculture, Interior, the security services and 
Customs.  The GOK would likely base its sense of urgency in 
a given situation on what it observes happening in Russia 
and/or China, although that is not to say that Kazakhstan 
views either of those countries' surveillance capabilities 
or preparedness as better than its own.  The Ministry of 
Health (the Minister and the Deputy Minister responsible for 
the Sanitary and Epidemiology Service) are the "go to" 
people on this issue, followed by the head of the veterinary 
service of the Ministry of Agriculture.  All of these 
individuals are Embassy contacts. 
 
 -- 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? 
 
Answer: The Embassy is not aware of any prospective changes 
to legislation that are responsive to the August incidents 
of avian influenza.  However, changing legislation under any 
circumstances in Kazakhstan is a time-consuming and opaque 
process.  We do not know of any active laws that serve as 
barriers to avian flu detection, reporting, containment or 
response.  In fact, the GOK was willing to share the strain 
of H5N1 AI collected in Kazakhstan with very little 
bureaucratic fanfare, while it has resisted transfer or 
sharing of strains in other circumstances. 
 
-- 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? 
 
Answer: The GOK has been open to cooperation with 
international organizations working on the avian flu issue. 
WHO and OIE (the international epizootic bureau) have both 
sent representatives to observe Kazakhstan's response and 
have contributed advice to the GOK. 
 
-- 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? 
 
Answer: Flu shots are widely available to the public through 
the private sector. The national government recommended that 
the oblast governments administer flu shots to high risk 
individuals, but vaccine was only available for 50% of those 
deemed to be high risk. 
 
There is currently no vaccine production capability in 
Kazakhstan. 
 
--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? 
 
Answer: The population is generally well-informed about 
avian influenza.  There is no sense of panic.  The GOK went 
to considerable lengths to get officials out to the poultry- 
raising regions of the country to educate farmers about the 
danger of the disease and proper prophylaxis.  We consider 
these measures to be basically effective. 
 
B) SURVEILLANCE/DETECTION 
 
-- HOW CAPABLE ARE THE MEDICAL AND AGRICULTURE 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 WHOM, 
AND IF NOT WHERE ARE THEY SENT? DOES THE COUNTRY SEND 
SAMPLES TO A WHO/EU/US REFERENCE LABORATORY? 
 
Kazakhstan's medical, veterinary and wildlife sectors are 
capable of detecting and suspecting disease based upon 
clinical signs and history.  However, the medical sector 
does not have a well-formed capability to detect a new 
strain of influenza by laboratory testing. Current 
diagnostic procedures and equipment can detect cases of 
influenza, but cannot differentiate particular strains. DTRA 
is planning to provide the Ministry of Health with equipment 
 
and test reagents to detect avian influenza virus H5N1 by a 
specific polymerase chain reaction (PCR) test that will 
provide results within 1 to 2 hours. DTRA will also provide 
the training that Kazakhstani specialists will need to 
operate this equipment. 
 
The National Veterinary Center (NVC, located in Astana) of 
the veterinary service of the Ministry of Agriculture, as 
well as the Scientific Research Agricultural Institute 
(SRAI, located in Otar in southeastern Kazakhstan) of the 
Ministry of Education and Science both have polymerase chain 
reaction (PCR) equipment that was provided by DTRA. 
Reagents and training to detect avian influenza H5N1 virus 
have been provided by DTRA to both organizations. 
 
The PCR tests specific to H5N1 are not yet approved by the 
United States Food and Drug Administration, the Department 
of Agriculture or by Kazakhstani entities for diagnosis of 
the disease in people or animals.  Samples from cases 
identified by PCR could be sent to NAMRU 3, CDC or USDA for 
further testing by classical means and to determine the 
genetic sequence of the influenza virus. However, no 
standing agreement with the Government of Kazakhstan for 
transferring specimens to any of these organizations is 
currently in place. These tests cannot be performed in 
Kazakhstan at this time. 
 
During the outbreak in August, SRAI provided animal 
specimens and the Republican Sanitary Epidemiological 
Service provided human specimens to the NAMRU-3 laboratory 
in Cairo.  CDC collected 175 specimens from individuals in 
the village where H5N1 was identified (Golubovka village in 
Pavlodar oblast). These specimens were subsequently sent to 
CDC in Atlanta through an agreement with the Government of 
Kazakhstan.  The DTRA and CDC offices in Almaty are 
facilitating collaboration between Ministry of Health and 
the Ministry of Education and Science to perform joint 
research on human diagnostics at SRAI. 
 
-- WHAT ARE THE 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? 
 
Answer: The critical gaps include: strengthening the 
surveillance systems for both animals and humans; the lack 
of avian and human vaccines; and medications.  In response 
to the avian influenza situation, DTRA is expediting 
delivery of a PCR to the Ministry of Health that was ordered 
under the Threat Agent Detection Response (TADR) program. 
The Government of Kazakhstan, through the Ministry of 
Health, has already requested and received assistance from 
CDC in developing preparedness plans, improving regulatory 
policies, conducting outbreak investigations, strengthening 
surveillance activities, and improving human capacity for 
laboratory diagnosis. 
 
C) 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? 
 
Answer: The Government of Kazakhstan allocated money from 
the 2005 budget to create a stockpile of antivirals. 
However, the amount is only enough to treat 30,000 cases. 
While this money has been allocated, the orders for the 
medications have not yet been placed. 
 
--DOES THE COUNTRY HAVE A STOCKPILE OF PRE-POSITIONED 
PERSONAL PROTECTIVE GEAR? 
 
Answer: Yes.  The government purchased large quantities of 
personal protective gear as well as disinfectants, during 
the August outbreak. 
 
--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? 
 
 
Answer: Based on the outbreaks in August, the GOK's rapid 
response capability appears adequate, if yet untested by a 
truly widespread epidemic. 
 
-- HOW WILLING AND CAPABLE IS THE GOVERNMENT OF IMPOSING 
QUARANTINES AND SOCIAL DISTANCING MEASURES (CLOSING SCHOOLS, 
PUBLIC GATHERINGS, MASS TRANSIT)? WOULD ITS MILITARY ENFORCE 
QUARANTINES? 
 
Answer: The GOK is definitely capable of imposing 
quarantines, and the natural geographic sparseness of the 
country is an added advantage.  The GOK imposed effective 
quarantines in several oblasts (main regional subdivisions) 
during the August outbreak.  The GOK is undoubtedly capable 
of restricting travel between cities if necessary, as both 
rail and air transport are fully or partially under state 
control.  The Kazakhstani military would not be likely to 
participate in quarantine enforcement; however, the 
paramilitary formations of the Ministry of Internal Affairs 
would undoubtedly play a role.  However, there is no bar to 
the military participating if the GOK desired. 
 
3. (U) Minimize for Dushanbe considered. 
 
Ordway 
 
 
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