US embassy cable - 05RANGOON1323

UNCLAS SECTION 01 OF 04 RANGOON 001323 
 
SIPDIS 
 
STATE FOR EAP/MLS; PACOM FOR FPA; USDA FOR FAS, APHIS 
 
E.O. 12958: N/A 
TAGS: EAGR, EAID, PGOV, PHUM, PREL, SENV, SOCI, TBIO, BM, Avian Influenza 
SUBJECT: BURMA: RESPONSES TO AVIAN AND PANDEMIC INFLUENZA 
 
REF: A. STATE 209622 
     B. RANGOON 1275 
     C. RANGOON 1157 
     D. RANGOON 1036 
 
1. Burma has made some strides in preparing for a potential 
avian influenza (AI) pandemic, but much more needs to be 
done.  Our responses to questions in ref A follow: 
 
PREPAREDNESS /COMMUNICATION 
 
2. 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. 
 
Response: The Ministry of Health established a task force to 
formulate a "Contingency Plan for Preventing and Controlling 
an Avian Influenza Epidemic in Myanmar" dated on December 31, 
2004.  The Plan of Action was published in January 2005. 
Since then a National Pandemic Plan has been prepared by 
various sub-committees and submitted to the National Health 
Committee.  The National Health Committee endorsed both the 
National Influenza Pandemic Plan and the Plan of Action.  The 
Government of Burma (GOB) subsequently formed a 
multi-sectoral National Steering Committee on Prevention, 
Management, and Control of Avian Influenza with six 
sub-committees. 
 
The capability of the GOB to implement their plan is 
doubtful.  According to the Minister of Health, the GOB will 
attempt to fight AI to the best of its ability despite its 
"meager resources" (ref B).  The Ministry of Health is 
cooperating closely with the WHO on AI issues, which gives 
hope that the GOB will receive at least some sound guidance. 
The sudden move of the government from Rangoon to a new 
administrative capital in Pyinmana comes at a season when 
Burma is most vulnerable to incoming migratory birds.  The 
ongoing move could divert the attention of the Ministry of 
Health and other relevant ministries from AI outbreaks and 
reduce their ability to respond rapidly.  Post has obtained a 
copy of the GOB plan and is translating it into English; we 
will forward it to OES and EAP upon completion. 
 
3. 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? 
 
Response: According to the Minister of Health, his ministry 
is committed to transparency and has shared details of 
several recent suspect outbreaks that it investigated and 
concluded they were caused by other infectious diseases, not 
AI.  The FAO in Burma has informed us on several occasions 
that they are not aware of any outbreaks of AI among animals 
in Burma to date and report good cooperation from the 
Livestock and Fisheries Ministry.  However, the culture 
discourages forwarding bad news, so individuals outside of 
the capital might decide to suppress reports of suspicious 
outbreaks.  The Minister of Health has specifically asked us 
whether the United States could provide rapid laboratory test 
kits for use in suspected outbreaks of AI among humans (ref 
B).  Since it is in our interests to contain an outbreak of 
AI wherever it occurs, it will be helpful to explore ways the 
U.S. or international agencies could meet this request. 
 
4. 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? 
 
Response: In recent weeks, the GOB appears to be paying more 
attention to AI issues and has disseminated more media 
reports to raise awareness among the public.  However, 
relocating the capital and other command and control 
operations is the top priority now and could distract senior 
officials' attention away from AI.  Burma's neighbors 
probably have the most influence in getting the GOB to give 
AI a higher priority, especially China and the ASEAN.  The 
Minister of Health is the best person in the GOB to contact 
on AI issues.  Absent reliable contacts with GOB officials, 
our key interlocutors on this issue remain the WHO and the 
FAO. 
 
5. 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? 
 
Response: We are not aware that any national laws have been 
reviewed in light of current AI threats.  However, the GOB 
relies heavily on guidance from the WHO on AI issues and has 
incorporated WHO guidelines into their national plan for 
combating AI. 
 
6. 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 U.S. 
or other countries?  Would government leaders be receptive to 
messages from U.S. 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 U.S. in return for its efforts? 
 
Response: The GOB works closely with WHO, FAO, and regional 
countries on AI issues.  The Prime Minister recently attended 
the Ayeyarwaddy-Chao Phraya-Mekong Economic Cooperation 
Strategy (ACMECS) summit in Bangkok.  He stated on national 
television that the GOB will participate with regional 
countries to fight AI and other diseases.  The Minister of 
Health has requested the international community, including 
the U.S., to assist his ministry with rapid laboratory test 
kits for suspected AI cases among humans.  The GOB has 
received assistance from Japan for testing suspected AI 
outbreaks among animals.  The Minister of Health said that if 
someone could help him with rapid laboratory test kits he 
would ask for nothing more (ref B). 
 
7. 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? 
 
Response: The government does not administer annual flu shots 
to the public or to its civil servants or military.  Flu 
vaccine is only available at two private clinics in Rangoon 
in very limited amounts, for approximately US$ 25 per dose, 
which is equal to the average monthly salary of a Burmese 
civil servant.  The country does not produce trivalent flu 
vaccine nor is it developing H5N1 vaccine. 
 
8. 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? 
 
Response: The population is not well informed about the 
threat of AI and what they can do to mitigate it.  The GOB 
has been increasing its coverage recently about AI issues on 
its officially-controlled radio, television, and print media. 
 Many people in Burma rely on foreign radio broadcasts (VOA, 
RFA, BBC, DVB) for their news.  This avenue offers an 
excellent medium for increasing knowledge among rural 
populations about what they can do to mitigate the threat of 
AI. 
SURVEILLANCE / DETECTION 
 
9. 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? 
Response: The Livestock Breeding and Veterinary Department of 
the Ministry of Livestock and Fisheries has some rapid 
laboratory test kits for detecting new strains of influenza 
among animals.  The Ministry of Health lacks this capability 
for humans, although it has assigned its Central Epidemiology 
Unit as the focal point for surveillance.  The WHO has 
informed us that in-country laboratories do not meet 
international standards.  Influenza viruses cannot be 
identified easily by subtype in the country, therefore 
specimens are normally sent to Bangkok for analysis.  In a 
recent suspected outbreak of AI among humans, which turned 
out to be Influenza A, the Ministry of Health cooperated 
closely with the WHO, which transferred blood samples from 
the victims to Bangkok within 24 hours of the samples being 
collected.  WHO is the primary reference laboratory for 
samples collected in Burma. 
 
10. 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 U.S. or international organizations? 
Response: 
 
-- The population, 75% of whom live in rural areas with 
minimal access to information, needs to be better informed 
about being alert to deaths among wild bird and domestic bird 
populations and how to report such deaths; 
 
-- The communication channels from grassroots areas to the 
central government need to be improved for rapid transmission 
of reports; 
 
-- The Ministry of Health needs rapid laboratory test kits to 
be able to quickly diagnose suspected cases among human 
populations; 
 
-- The country needs sufficient stockpiles of antiviral drugs 
to administer to populations that may live in the area of an 
outbreak. 
 
RESPONSE / CONTAINMENT 
 
11. 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? 
 
Response: The Ministry of Health says it does not even have 
sufficient stockpiles of antiviral drugs to provide 
prophylaxis to its health personnel who are responsible to 
care for AI victims, but claims it is in the process of 
stockpiling 10,000 doses of Tamiflu.  The WHO donated the 
Tamiflu they currently have.  The GOB has appealed to other 
countries for donations of antivirals and believes that China 
will provide some once it has established its own production 
capacity.  The GOB also counts on access to WHO's regional 
stockpile of antivirals in the event of an AI outbreak in 
Burma. 
 
12. Does the country have a stockpile of pre-positioned 
personal protective gear? 
 
Response: The GOB has very limited stocks of personal 
protective gear for use by field investigation teams and 
health care providers in designated isolation wards and 
medical facilities only. 
 
13. 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 movements? 
Response: The Ministry of Health and the Ministry of 
Livestock and Fisheries have AI rapid response teams 
reportedly on standby to respond to new suspected outbreaks 
around the country (ref B).  These teams were reportedly 
activated several times in recent weeks.  Their 
investigations revealed other diseases, not AI.  Rapid 
response teams have also been formed at the international 
airports in Rangoon and Mandalay to screen passengers and 
triage suspect cases.  According to the Ministry of Health, 
personnel at border crossing points with China and Thailand 
are conducting ongoing surveillance.  We are awaiting 
translation of the "Contingency Plan for Preventing and 
Controlling an Avian Influenza Epidemic in Myanmar" before we 
can comment on specific guidelines for culling, vaccinating, 
disinfecting and curtailing animal movements.  We believe the 
GOB has established guidelines for three of the four areas, 
excluding vaccination of birds. 
 
14. 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? 
 
Response: The authoritarian, military-dominated regime is 
both willing and capable of imposing quarantines if it deems 
such measures expedient.  Recent events have revealed the 
senior leadership to be unpredictable, yet able to suddenly 
uproot its civil service and move them 240 miles north of 
Rangoon. 
VILLAROSA