US embassy cable - 05AMMAN9093

UNCLAS SECTION 01 OF 03 AMMAN 009093 
 
SIPDIS 
 
STATE PASS USAID FOR GLOBAL HEALTH/K HILL, D CARROLL 
USDA FOR APHIS 
 
SENSITIVE 
 
E.O. 12958: N/A 
TAGS: TBIO, KHIV, AMED, EAGR, ECON, PGOV, PREL, JO 
SUBJECT: Jordan Seriously Engaging on Avian Influenza 
Preparedness and Prevention 
 
Refs:   A) State 209622 
        B) Amman 8696 
        C) Amman 8041 
 
1. (SBU) Summary: The Government of Jordan (GOJ) and other 
national players are engaging in a committed effort to 
prepare for pandemic flu and to prevent the spread of H5N1 
avian flu within Jordan should it appear.  Human, financial 
and capital resources are adequate for the current 
situation, but could be quickly overwhelmed if the crisis 
expands.  Rumor control will be a problem, despite official 
efforts at public awareness.  The presence of a USAID health 
team and Regional Medical Office at Embassy Amman has given 
post crucial windows into Jordan's avian flu preparedness. 
End summary. 
 
Preparedness and Communication 
------------------------------ 
 
2.  (U) Governmental Committees: The GOJ has created three 
entities to manage preparation and response to avian and 
pandemic influenza: a National Steering Committee (chaired 
by the Prime Minister), a National Committee (minister 
level), and a National Technical Committee for Pandemic 
Influenza Preparedness (ref B).  The Prime Minister heads 
the National Steering Committee, which includes the 
Ministers of Agriculture, Health, Environment, Public 
Security, and Civil Defense. 
 
3.  (U) Jordan created the National Committee as their 
initial mechanism for managing avian influenza, but it was 
superseded in authority by the creation of the Steering 
Committee when the avian flu crisis continued to escalate 
elsewhere.  The National Committee is chaired by the 
Minister of Health, and includes the Secretaries-General of 
all related ministries. 
 
4.  (U) The National Technical Committee is chaired by the 
Minister of Health, and includes all members from the 
National Committee, plus the Jordan University Hospital, 
Jordan University of Science and Technology, the Royal 
Medical Services, USAID, the Association of Physicians, and 
the Association of Veterinarians.  Consultants are added ad 
hoc to meet specific needs. 
 
Leadership, Key Personnel, Truthfulness 
--------------------------------------- 
 
5.  (SBU) Given the competing demands in Jordan's current 
security milieu, avian flu has gotten a surprisingly high 
level of attention and support from the top levels of the 
GOJ.  A generous budget allocation of $8.5 million was 
quickly made (Ref B) despite record deficits, and government 
officials at the working level appear to have political 
support from the country's leadership to engage on avian 
flu. 
 
6.  (SBU) Post believes that GOJ reporting on avian flu in 
poultry, and on pandemic flu in humans, would be transparent 
and open, and more limited by capacity to report information 
than by willingness.  Larger obstacles to transparent 
reporting would be found among private poultry farmers and 
others in the poultry industry.  The Ministry of Agriculture 
has created a plan to reimburse farmers for losses due to 
avian flu.  These financial incentives would reduce but not 
eliminate this problem.  Post needs to examine this plan in 
detail and get reaction from the farmers themselves. 
 
7.  (U) In the event of a widespread outbreak of avian flu 
among poultry or of pandemic influenza, King Abdullah would 
be the ultimate decision maker, with the Prime Minister and 
Health Minister being the likely key advisors.  The Prime 
Minister would be the central figure in implementing the 
policy. 
 
Preparedness Plan 
----------------- 
 
8.  (SBU) The National Technical Committee (NTC) is drafting 
an emergency preparedness plan.  ESTH FSN spoke to NTC 
spokesman Khalid Abu Rumman from the Ministry of Health's 
Disease Surveillance Department on November 17; Abu Rumman 
agreed to provide draft documents in Arabic to the Embassy. 
Note: The promised documents had not arrived as of November 
23.  End note.  He said that Jordan does not intend to 
produce an English version of the preparedness plan.  The 
document has not yet been approved for public release, and 
there is no electronic or Internet version at this time. 
Post is not aware of any obstacles in Jordan's legal system 
that pose a barrier to avian influenza, reporting and 
response. 
 
Hospital Capacity, Vaccinations and Vaccines 
-------------------------------------------- 
 
9.  (SBU) The GOJ has designated three hospitals (one in 
northern Jordan, one in central Jordan, and one in the 
south) as quarantine facilities in the event that pandemic 
influenza should occur.  Jordan does not have a large-scale, 
public flu vaccination program.  Flu vaccinations are done 
by private physicians at the expense of the recipient.  We 
do not have an estimate of the total number of vaccinations, 
but it would represent a small fraction of the population. 
Jordan does not have indigenous capacity for producing 
either human or animal vaccines, although it does have a 
successful pharmaceutical industry and good laws for 
protection of intellectual property rights. 
 
International Engagement 
------------------------ 
 
10.  (U) Jordan has been proactively reaching out to its 
immediate neighbors, including Israel, Syria, and the 
Palestinian Authority for coordination talks on managing 
avian influenza (Ref B).  GOJ officials are well connected 
with international health officials at the WHO and with 
animal health officials at World Animal Health Organization 
(OIE).  Post's USAID Mission and Regional Medical Office 
have numerous strong contacts around the health field in 
Jordan.  Post feels that multilateral engagement with Jordan 
through the WHO and the International Partnership on Avian 
and Pandemic Influenza (IPAPI) would be the most effective 
means of support. 
 
Public Communication 
-------------------- 
 
11.  (U) The National Steering Committee has been proactive 
in providing factual information on avian flu to the public 
through the media and the Internet and, through the 
Technical Committee, to doctors and farmers.  USAID has a 
specific project on public health communications where Johns 
Hopkins University works directly with the Ministry of 
Health.  That project has generated a website on avian 
influenza (http://www.healthcomm.gov.jo/aindex.asp).  Jordan 
is a small country with roughly 40% of its population in 
greater Amman.  Media penetration to all but the most 
isolated rural residents is rapid and widespread. 
 
Surveillance and Detection 
-------------------------- 
 
12.  (SBU) Surveillance Systems and Lab Capacity:  Jordan 
has good capacity in human health surveillance, assisted by 
CDC's Field Epidemiology Training Program.  Animal health 
reporting systems are somewhat weaker but are still fair to 
good.  Points of excellence exist within both animal and 
human health systems, but the overall quality level is 
uneven.  The spottiness would affect Jordan's ability to 
quickly and accurately report and respond to an animal or 
human health emergency.  Jordan does not have the lab 
capacity to determine virus subtypes, although it does have 
the capacity to do diagnosis.  Jordan has relationships with 
the WHO and with OIE reference labs in Italy for the most 
sophisticated types of lab work.  This need to go elsewhere 
for high-end lab services would add time to any evaluation 
and response. 
 
13.  (SBU) Gaps: Jordan has small numbers of well-trained 
individuals in animal and human health surveillance systems, 
but lacks capacity at the lower levels.  The same is true 
for its laboratories: Jordan has a small number of well- 
equipped, well-staffed labs but not many of them, and they 
cannot handle the highest level of analysis. 
 
Response and Containment 
------------------------ 
 
14.  (SBU) Medical Capacity: The GOJ is behind the curve on 
procurement of Tamiflu.  It has ordered one million courses 
of Tamiflu (10 million 75 mg capsules) to cover 20% of the 
expected epidemic, but delivery times are estimated in the 
fourth quarter of 2006.  The Jordan Armed Forces approached 
post's Defense Attache Office for Embassy assistance in 
obtaining 10,000 courses of Tamiflu for its personnel, 
particularly those in locations overseas where avian flu is 
endemic.  DAO responded by telling the Jordan Armed Forces 
to handle their procurement issues through the Ministry of 
Health.  Post is not aware of large stockpiles of personal 
protective gear in Jordan. 
 
15.  (SBU) The Ministry of Agriculture has guidelines for 
culling, vaccination and disinfection.  We are not aware of 
quarantine systems in place for animals.  However, given 
Jordan's geography, post believes that animal quarantine 
systems could be put in place rapidly.  Post also believes 
that the GOJ is willing and capable of imposing human 
quarantines and other social controls if necessary. 
16.  (U) Comment: Jordan has among the most effective, well- 
trained and well-equipped health systems in the region, but 
it lacks the "bench" of numerous, qualified personnel and 
effective systems that integrate at all levels.  Post's view 
is that Jordan would be able to respond well to a small- 
scale emergency by throwing its top assets at the problem, 
but that these people and resources would quickly be 
overwhelmed by a larger crisis. 
 
RUBINSTEIN