US embassy cable - 05YEREVAN2053

C O N F I D E N T I A L SECTION 01 OF 05 YEREVAN 002053 
 
SIPDIS 
 
E.O. 12958: DECL: 11/18/2015 
TAGS: TBIO, SENV, ECON, EAGR, EAID, PREL, AMED, AM, WHO 
SUBJECT: ARMENIA:  RESPONSE TO AVIAN AND PANDEMIC INFLUENZA 
REQUEST FOR INFORMATION 
 
REF: A) STATE 206992 B) YEREVAN 1562 C) YEREVAN 1730 
 
Classified By: Amb. John Evans for reasons 1.4 (b,d). 
 
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SUMMARY 
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1. (SBU) Armenia is ill-prepared to respond to an avian 
influenza (AI) outbreak in either the animal or the human 
population.  There is no active surveillance system in place 
and the GOAM currently lacks basic diagnostic capacity to 
evaluate any potential AI outbreak.  There is, however, some 
scientific equipment and expertise available that could be 
adapted to respond to the AI threat.  The GOAM recognizes the 
nature of the AI threat, is likely to cooperate with the 
international community and is open to both bilateral and 
multilateral assistance.  This cable presents a brief summary 
of the poultry sector in Armenia in paragraph 2 and responds 
to ref A questions in paragraph 3.  End Summary. 
 
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BACKGROUND 
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2. (SBU) From November 12 to 19, at the GOAM's request, USAID 
sponsored poultry expert Dr. Elizabeth Krushinskie to assess 
preparedness to combat AI in the agricultural sector.  The 
Food and Agriculture Organization (FAO) considers Armenia to 
be a high-risk country for AI because of bird migratory 
patterns.  According to Krushinskie, Armenia's vulnerability 
is limited because there are few live bird markets in Armenia 
and the domestic poultry industry is relatively small. 
Commercial poultry farmers in Armenia raise chickens in 
enclosures so they do not come into contact with wild birds. 
Backyard chicken farmers often allow their birds to roam 
outdoors but generally do not allow chickens, pigs and other 
livestock to enter their homes.  The Minister of Agriculture 
told us that 75 percent of domestic poultry in Armenia, 
approximately seven to eight million birds, is raised for 
personal consumption on backyard farms.  The remaining 25 
percent is raised on one of six commercial poultry farms. 
The Ministry estimates that 50 percent of chicken consumed in 
Armenia is imported, primarily from the U.S. and South 
America.  In response to the AI threat, the Ministry has 
banned poultry imports from Russia, Turkey, Romania, Iran and 
Southeast Asia.  The Ministry of Environment has banned wild 
bird hunting, but local hunters routinely violate the ban. 
Post's point of contact on avian flu is Economic Affairs 
Officer Elizabeth Pelletreau who can be reached at 
PelletreauEX@state.gov or via telephone at (347-10) 467-000 
ext. 4402. 
 
3. (C) Post's responses to the questions in ref A follow: 
 
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PREPAREDNESS/COMMUNICATION 
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Q.  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? 
 
A.  The Armenian Ministry of Health has taken the lead on 
drafting a National Preparedness Plan, with other Ministries, 
including the Ministry of Agriculture, tasked to draft 
annexes for their specific area.  In October, a 
representative from the Ministry of Health traveled to 
Copenhagen to review the Preparedness Plan with a group of 
World Health Organization (WHO) experts.  The plan provides a 
progressive response depending on the nature of the threat 
and includes provisions for the ban of poultry sales, mass 
exterminations of birds in infected areas, limits on travel 
and tourism, stockpiling of antiviral medication and banning 
of public events.  The plan does not discuss compensation for 
farmers if there is a need to cull local flocks.  The 
Ministry of Agriculture is developing a specific agricultural 
plan with the FAO, but this plan is significantly less well 
developed than the Ministry of Health's plan.  The greatest 
constraint on implementation of the National Preparedness 
Plan, which the Ministry of Health expects will be approved 
in the near future, will likely be a lack of financial 
resources.  Per ref A, copies of both plans have been sent 
via unclassified e-mail to Armenia Desk Officer Kami Witmer, 
OES Senior Health Advisor Dr. Daniel Singer, Policy Advisor 
Rebecca Daley and INR Senior Analyst Raymond Lester. 
 
Q.  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? 
 
A.  The GOAM will likely cooperate with the WHO and World 
Organization for Animal Health (OIE) in the event of an 
outbreak among either humans or animals.  Diagnostic capacity 
in Armenia, however, remains extremely limited.  The Armenian 
press has repeatedly quoted representatives from the 
Ministries of Health and Agriculture reassuring the general 
public that there is no avian flu in Armenia, but no active 
surveillance or diagnostic testing is being done to support 
that claim.  The GOAM has a passive surveillance system 
whereby farmers and hunters are encouraged to report dead 
birds.  When dead birds are found, the GOAM collects live 
birds from the same area for observation assuming that if the 
disease has spread, the birds under observation will also 
die.  The GOAM does not have the capacity to test for H5N1 
and rural inspectors would need training on how to collect 
and transport samples before any active surveillance system 
is put in place.  International assistance to develop an 
active surveillance system and diagnostic capacity would 
allow the GOAM to collect reliable data to share with the 
international community.  Should there be an avian flu 
outbreak, there will also be a need to convince the GOAM to 
allocate funding to support culling and compensation efforts. 
 
Q.  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 for USG 
officials to engage on this issue? 
 
A.  The Ministries of Agriculture and Health place a high 
priority on preparing for an AI outbreak.  It is not clear 
whether the Ministry of Finance is willing, or able, to 
provide the necessary financial resources to ensure an 
appropriate response.  The following Ministries sit on an 
inter-ministerial AI task force:  Agriculture, Health, 
Environment, Foreign Affairs, Territorial Administration and 
the Department for Emergency Situations.  The head of the 
task force, and key "go-to" person, is Deputy Minister of 
Agriculture Levon Rukhkian.  Former Chief of Public Health 
and Sanitation at the Ministry of Health, Prof. Vladimir 
Davidyants has been our key contact for AI and human health 
issues.  As of November 21, Davidyants was reassigned to the 
National Institute of Health.  His replacement, Artyom 
Vanyan, will likely become our new key contact within the 
Ministry of Health. 
 
Q.  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? 
 
A.  To the best of our knowledge, there has been no such 
review.  According to a representative from the Ministry of 
Health, many of Armenia's health laws are out-of-date and the 
Ministry has drafted a new consolidated public health law 
which it hopes will be adopted in the next six to eight 
months. 
 
Q.  Is the host country already working with international 
organization 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 through 
bilateral contacts by a third country?  What would the 
country want from the U.S. in return for its efforts? 
 
A.  The Ministry of Health is collaborating with the WHO on a 
National Preparedness Plan.  Prior to the WHO review, the 
Ministry of Health also requested that the USG provide a 
Centers for Disease Control (CDC) expert to review the plan 
(refs B and C).  The Ministry of Agriculture is working with 
the FAO.  Due to funding constraints, however, FAO 
programming on this issue has been, and is likely to be, 
extremely limited.  According to the FAO country 
representative, the FAO has allocated USD 400,000 to support 
avian flu preparedness for 13 countries in the region.  The 
European Commission (EC) is supporting a food safety project 
at the Ministry of Agriculture and the project coordinator 
says that the EC might be able to reallocate funding to 
combat AI as well. 
 
At the Ministry of Agriculture's request, USAID sponsored 
poultry expert Dr. Elizabeth Krushinskie to assess 
preparedness within the agricultural sector.  She traveled in 
Armenia from November 12-19.  The Ministry of Agriculture was 
extremely cooperative and facilitated Krushinskie's visits to 
local poultry farms, regional veterinary centers and two 
national labs.  The GOAM is likely to want both technical and 
financial assistance from the USG to implement Krushinskie's 
recommendations.  The Ministry of Agriculture has requested 
bilateral support for laboratory equipment from the U.S. and 
Germany and appears to be open to working on both a bilateral 
and multilateral basis. 
 
Q.  Does the country currently administer annual flu shots? 
If not, might it consider doing so?  What is the production 
capability for human influenza vaccines in country? 
 
A.  The GOAM does not regularly administer annual human flu 
shots and it is difficult and costly to obtain annual flu 
vaccines on the local market.  There is no local vaccine 
production in Armenia and all vaccines are imported either 
from Europe or Russia.  In response to the avian flu threat, 
the GOAM has ordered 55,000 doses of vaccine from the German 
pharmaceutical company Solvay and expects delivery on 
December 15.  The GOAM plans to provide these vaccines to 
people who work in poultry farms and to villages which are on 
bird migration routes.  According to representative from the 
Ministry of Health Prof. Vladimir Davidyants, there is a 
shortage of this year's flu vaccine on the international 
market.  Davidyants told us the GOAM would be willing to 
purchase and distribute additional human flu vaccines if 
necessary.  He explained that there is a network of 
polyclinics throughout the country and said that distribution 
would be simple if vaccines were available.  The Embassy 
Health Unit conducted an informal survey assessing 
availability of annual human flu vaccines in Yerevan and 
discovered that the annual flu vaccine was not available in a 
number of hospitals and when the vaccine was available it was 
often prohibitively expensive costing more than an average 
month's wages for a single shot. 
 
Q.  Does the country produce the 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? 
 
A.  Armenia does not produce and is not developing a poultry 
vaccine.  Foot-and-mouth vaccine is produced locally and 
Armenia has equipment and technical experts who would likely 
be capable of producing vaccine if needed.  We have no 
information about a liability shield for foreign 
makers/donors of vaccines, but according to representatives 
from UNICEF and USAID, there has never been a lawsuit against 
an international aid agency concerning vaccines. 
 
Q.  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? 
 
A.  The general public is highly aware of AI, but poorly 
informed.  Basic food safety standards are low and public 
consumption of poultry has decreased by 25 percent or more 
over the past few months.  The GOAM has distributed 5,000 
posters, based on information provided by USDA, detailing 
ways to limit the spread of AI.  The impact of this campaign, 
however, remains unclear.  Local television stations have 
aired shows about AI on at least two occasions, but the 
thrust of this programming and the public announcements made 
by the Ministries of Health and Agriculture has been to 
reassure the public that there is no avian flu in Armenia. 
Candid and accurate television programming and a public 
information campaign including newspapers and posters would 
be two ways to educate the Armenia public about AI and 
general food safety.  It would also be helpful to teach 
regional representatives from the Ministry of Agriculture how 
to conduct local-level training for farmers on food safety, 
AI and proper slaughter and dressing techniques. 
 
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SURVEILLANCE/DETECTION 
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Q.  How capable are the medical and agriculture sector of 
detecting a new strain of influenza among people or animal 
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/U.S. reference laboratory? 
A.  Armenia has no capability to detect new strains of 
influenza among either people or animals.  The GOAM has an 
ELIZA testing unit, but when USAID-sponsored poultry expert 
Krushinskie visited the lab where it is located, the unit was 
not attached to a computer, lacked appropriate lenses for 
testing and the lab staff had not been properly trained on 
how to use the equipment.  The GOAM also has a Polymerize 
Chain Reaction (PRC) unit, but Krushinskie said the unit was 
old and could not be used to test for AI.  The Veterinary 
Animal Breeding Research Center, according to Krushinskie, 
might be able to test for avian flu using agar gel 
immunodiffusion (AGID) testing.  According to Krushinskie the 
scientists at the center are well trained and well versed 
with AGID and virus isolation techniques.  Furthermore, the 
scientists at this lab are producing vaccine for 
foot-and-mouth disease and have some equipment which could be 
used for AI diagnostic testing.  Armenia particularly needs 
increased diagnostic capacity because exotic Newcastle 
disease is endemic and the GOAM has no way to distinguish 
bird deaths caused by exotic Newcastle from bird deaths 
caused by avian flu.  The GOAM does not currently send 
samples abroad.  Deputy Minister of Agriculture Rukhkian told 
us the GOAM would be willing to send samples to the Vladimir 
Laboratory south of Moscow or to the Weybridge Laboratory in 
the U.K., but they are not currently in contact with either 
lab and it is not clear that they have the capacity to safely 
collect or transport samples. 
 
Q.  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? 
 
A.  USAID-suported poultry expert Krushinskie recommends the 
following immediate, stop-gap measures to improve 
surveillance and detection capability.  Armenia needs: 
protective clothing for poultry farm inspectors; training and 
supplies for sample collection and shipment, including cold 
shipment, to international laboratories; field screening 
rapid antigen detection kits; reagents, disposable supplies 
and training to enhance in-country AGID testing capacity; 
data base management supplies and training so that samples 
are tracked and that inspectors can identify where positive 
samples were collected; and funding to support a public 
awareness campaign focused on food safety, ways to limit the 
spread of avian flu and proper techniques for killing and 
dressing wild birds and chickens in a backyard setting.  In 
addition to these immediate measures, Krushinskie is drafting 
a report based on her November 12-19 rapid assessment 
detailing how best to improve preparedness within the 
agricultural sector.  We expect to receive Krushinskie's 
report by the end of November and will share it with 
Washington as soon as it is available. 
 
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RESPONSE/CONTAINMENT 
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Q.  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? 
 
A.  The GOAM has sufficient Tamiflu at the Yerevan Infectious 
Disease Hospital to treat twenty people.  The Tamiflu was 
donated by members of the Argentinean-Armenia Diaspora.  It 
is not clear if the GOAM plans to purchase additional stocks. 
 According to the Ministry of Health, there are no other 
stockpiles of Tamiflu or antivirals in Armenia.  Tamiflu is 
not available on the local market. 
 
Q.  Does the country have a stockpile of pre-positioned 
personal protective gear? 
 
A.  The Ministry of Agriculture has no protective gear in 
stock and agricultural inspectors do not wear protective 
clothing when visiting area farms.  Visiting poultry expert 
Krushinskie donated 14 coveralls with boots to USDA for its 
use when visiting farms.  According to the Armenian Ministry 
of Health, health care workers have standard protective masks 
and gowns which they used during regular annual flu 
outbreaks, but they do not have special protective gear for 
any potential avian flu outbreak. 
Q.  What is the rapid response capacity for animal and human 
outbreaks?  Are guidelines in place for the culling and 
vaccination of birds, disinfecting of facilities and 
limitations on animal movement? 
 
A.  The rapid response capacity is minimal.  There are no 
specific guidelines for culling and vaccinating birds, 
disinfecting facilities or limiting animal movement.  The 
National Preparedness Plan does discuss culling as an option 
but does not provide any detail about how it will be done and 
does not make any provision for compensating affected 
farmers.  There is also a lack of basic supplies, such as 
protective equipment, plastic bags and duct tape in rural 
areas. 
 
Q.  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? 
 
A.  The Ministry of Health has the authority to close public 
facilities in the event of an outbreak.  In 1992 the Ministry 
of Health delayed the opening of public schools for two weeks 
in order to limit the spread of annual human influenza and in 
1998 the Department of Emergencies and police jointly 
quarantined the village of Zartok in response to a cholera 
outbreak.  The National Preparedness Plan also includes 
provisions for banning public events and disinfecting the 
public transportation system. 
 
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COMMENT 
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4. (C) There is no effective AI surveillance system in 
Armenia and the GOAM currently lacks the capacity to 
accurately diagnose potential AI cases.  Armenia needs 
immediate assistance to increase surveillance and diagnostic 
capacity and to provide flu vaccines for at-risk populations. 
 Should there be an outbreak, Armenia will likely need 
international assistance to isolate the disease, cull flocks 
and compensate farmers.  Despite a serious lack of financial 
resources, Armenia does have basic laboratory equipment and a 
group of scientists with technical expertise who could be 
trained to diagnose AI cases.  The GOAM is also a willing 
partner and is likely to cooperate with the international 
community in responding to this threat. 
EVANS