US embassy cable - 05DUBLIN1434

UNCLAS SECTION 01 OF 03 DUBLIN 001434 
 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: TBIO, SENV, ECON, EAGR, EAID, PREL, EI 
SUBJECT: IRELAND INFORMATION ON AVIAN AND PANDEMIC INFLUENZA 
 
REF: SECSTATE 209622 
 
1.  On November 21, Emboffs reviewed reftel with Brian 
Mullen, Principal Officer for Community Health in the 
Department of Health and Children and also the GOI 
point-of-contact on avian flu issues.  The following 
information, drawn principally from our discussion with 
Mullen, is keyed to reftel's questions. 
 
Preparedness/Communication 
-------------------------- 
 
2.  The GOI is drafting Ireland's national avian flu 
preparedness plan and aims to publish the document in late 
December/early January, said Mullen.  The plan will draw from 
the GOI's 2002 Influenza Pandemic Report and the 2004 Public 
Health Emergency Plan, which are not publicly available.  The 
plan also incorporates input from the WHO.  The Health 
Service Executive (HSE), a government body that manages 
Ireland's health care system, is the plan's lead drafter and 
is finalizing an implementation strategy covering over 100 
health system actions that would be required in the event of 
a pandemic outbreak. 
 
3A.  Mullen said that preparedness for an avian flu pandemic 
ranks among the government's highest priorities, a view 
echoed by Deputy Prime Minister and Minister of Health and 
Children Mary Harney and Minister of Agriculture and Food 
Mary Coughlan in regular public remarks on the pandemic 
threat.  As evidence of GOI attention to the issue, Minister 
Coughlan introduced legal measures on October 27 to: ban the 
collection of poultry and captive birds for poultry markets, 
shows, exhibitions, and cultural events (consistent with the 
EU Commission Decision of October 21); require reporting and 
record-keeping on unusual or unexplained patterns of bird 
mortality at commercial premises; and, register with the 
Department of Agriculture and Food all poultry flock-owners 
and owners of premises where captive birds are kept for sale 
or sporting purposes. 
 
3B.  The GOI "go-to" person for USG officials is Department 
of Health and Children Secretary General Michael Scanlon 
(353-1-635-4154).  Scanlon chairs the Public Health Emergency 
Group, the locus of GOI decision-making on avian flu that is 
comprised predominantly of Health, Agriculture, and HSE 
officials, including, notably, Gavin Maguire, HSE Head of 
Emergency Planning.  The Group is advised by the Influenza 
Pandemic Expert Group, a committee of academics and doctors 
with expertise in influenza science.  The Public Health 
Emergency Group, moreover, meets regularly with an 
inter-agency standing committee with responsibility for avian 
flu-related actions that fall under the members' respective 
Departments.  For example, the representative for the 
Department of Communications, Marine, and Natural Resources 
coordinates public outreach on the GOI's avian flu measures. 
Lastly, the Public Health Emergency Group works with (though 
is separate from) the Irish Department of Defense-chaired 
National Emergency Planning Task Force, which has 
responsibility for GOI response to disasters in general. 
 
 
4.  Mullen said that Irish laws were consistent with 
international health regulations and were guided by the best 
available medical/veterinary advice at both the national and 
EU levels.  He added that laws governing the detection, 
reporting, containment, and response to avian influenza were 
being reviewed in conjunction with the drafting of the 
national preparedness plan. 
 
5.  The GOI works regularly with the WHO, EU, and other 
organizations to monitor international developments 
concerning avian flu, said Mullen.  Ireland, for example, 
participated in the October 24-26 Copenhagen avian flu 
conference hosted jointly by the EU Commission and WHO, and 
also in the WHO/FAO/World Bank Geneva conference on November 
7-9.  Mullen commented that Ireland currently did not see a 
need for U.S. assistance, but would be receptive to bilateral 
approaches from USG officials. 
 
6.  Ireland currently administers an annual flu shot, giving 
approximately 550,000 doses of a trivalent vaccine to 12-15 
percent of the population, namely, high-risk individuals such 
as the elderly and those with vulnerable immune systems. 
Ireland obtains the vaccine through tenders at the EU level, 
usually from multiple manufacturers.  Ireland does not 
produce any vaccines of its own.  In addition, the country 
does not produce, nor is developing, an influenza vaccine for 
poultry.  Mullen noted that while there is no liability 
shield in Ireland for foreign makers of the vaccine, the 
possibility of enacting such a shield is an issue under 
examination for the national preparedness plan. 
 
7.  The Irish populace is generally well-informed about the 
pandemic threat, having access to regular print, radio, and 
television reporting on the subject.  The website of the 
Health Protection Surveillance Center (an HSE office at 
www.hspc.ie) provides the most comprehensive information on 
avian flu.  Websites for the Department of Health and 
Children and the Department of Agriculture and Food also have 
avian flu pages, though the Health Department's information 
is only current as of January 2004.  Mullen said that a 
public information campaign would feature in the national 
preparedness plan and would rely on all available media 
outlets.  In a November 8 discussion with visiting U.S. 
Deputy Secretary of Health and Human Services Alex Azar, 
Deputy Prime Minister Harney noted challenges in providing 
information on the pandemic threat without adding to public 
anxiety (septel). 
 
Surveillance/Detection 
---------------------- 
 
8.  Laboratories attached to the Department of Agriculture 
and Food and the Department of Health and Children are fully 
capable of identifying on short notice new strains of 
influenza in animals and humans, respectively, according to 
Mullen.  Ireland is also able to sub-type influenza viruses 
and therefore does not usually send samples to WHO/EU/U.S. 
reference laboratories, although Irish officials would do so 
if requested by such laboratories. 
 
9A.  Mullen identified the health sector's surge capacity as 
the most significant concern in Ireland's efforts to 
formulate a national preparedness plan.  He also mentioned 
that the GOI was attempting to calculate the likely 
economic/social losses that would accompany an expected 
30-percent attack rate on the national labor force in the 
event of a pandemic outbreak.  A specific concern related to 
this expected attack rate would be the health sector's 
ability to function without 30 percent of its labor force. 
 
9B.  Comment: Post wishes to highlight that Ireland's health 
sector has not kept pace with the country's rapid economic 
rise.  Ireland's "mixed" health care system features public 
and private hospitals and entitles persons over 70 or who 
fall within the poorest one-third of the population to free 
health services and medicine.  The system, however, has 
several high-profile deficiencies, including, most visibly, 
long waiting times in hospital facilities, a problem that 
would be exacerbated by a pandemic outbreak.  A shortage of 
hospital beds (3 per 1,000 population, versus the EU average 
of 4.4) has contributed to this problem.  The Irish health 
system also has a perceived inequity issue, insofar as 
persons with private insurance (roughly 52 percent of the 
population) enjoy speedier access to care and have incentives 
to maximize treatments in subsidized public facilities. 
Public hospitals often ring-fence up to 20 percent of beds 
for private use, even when uninsured patients on waiting 
lists have greater medical need -- again, a problem that 
would affect surge capacity in a pandemic scenario.  Lastly, 
the health system suffers from administrative confusion, 
which centers on the fact that the Department of Health and 
Children has responsibility for overall health care policy 
and implementation, though the HSE controls the government's 
euro 10 billion health care budget (roughly 20 percent of 
total government spending). 
 
Response/Containment 
-------------------- 
 
10.  Between now and early 2006, Ireland is expecting the 
arrival of one million doses of tamiflu, which would cover 20 
percent of the population (of four million) at a cost of euro 
15 million.  Mullen expects 600,000 of those doses to arrive 
the week of November 28 and 400,000 to follow in early 
January.  There are no plans to purchase more tamiflu beyond 
these anticipated shipments.  The GOI is also considering 
purchasing other anti-viral medications, though, similarly, 
there are no specific plans at the moment. 
 
11.  Mullen said that there was not enough personal 
protective gear in the current stockpile, and the national 
preparedness plan would outline the quantities needed.  In 
terms of essential protective gear, Mullen said the GOI was 
focusing almost exclusively on face masks. 
 
12.  Rapid response guidelines in the national preparedness 
plan would encompass movement restrictions on animals, the 
culling of birds, and the availability of anti-viral 
treatments for persons handling potentially infected animals, 
according to Mullen.  As noted in para 3A, the Department of 
Agriculture and Food recently unveiled legal measures 
requiring the registration of all flock-owners and premises 
that keep or sell captive birds, so that the GOI might be 
able to localize a possible outbreak. 
13.  Mullen observed that the GOI was willing to enact 
quarantines creating social distancing, such as closing 
schools and restricting public gatherings.  Police 
enforcement of quarantines is incorporated into the national 
preparedness plan, but Mullen does not anticipate any 
military involvement, except as an exceptional measure. 
KENNY