US embassy cable - 05ACCRA2402

UNCLAS SECTION 01 OF 03 ACCRA 002402 
 
SIPDIS 
 
SENSITIVE 
 
OES FOR DR. DANIEL SINGER AND REBECCA DALEY 
STATE PASS USAID 
 
E.O. 12958: N/A 
TAGS: AMED, CASC, CMGT, KHIV, TBIO, XA, GH, SENV, ECON, EAGR, EAID, PREL, XX, SEC, health 
SUBJECT: AVIAN FLU: GHANA'S PLAN OF ACTION 
 
REF: A. STATE 209622 
 
     B. STATE 206588 
 
Summary 
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1. (SBU) The GoG's response to the threat of an Avian Flu 
outbreak has so far been measured and pro-active.  The 
Ministries of Health and Agriculture are working closely with 
USAID/Ghana and the World Health Organization (WHO) to create 
a comprehensive preparedness plan, which includes an 
assessment of the GoG's capacity to execute the plan in the 
event of an outbreak. In response to reftels, post submits 
answers to the questions posed in Ref A regarding the GoG's 
current state of preparedness. End Summary. 
 
2. (SBU) Question posed in Ref A and Post's responses. 
 
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. 
 
USAID/Ghana, FAO and the WHO have formed a technical working 
group with Ghana's Ministries of Health (MoH), Food and 
Agriculture (MinAg), and Forests and Land Development to 
finalize a plan by the end of November in accordance with WHO 
Avian Flu guidelines.  Two USAID-funded consultants have 
completed an assessment of the needs and capabilities of the 
GoG to respond to an outbreak.  The consultants submitted 
their draft plan to the technical working group, and also 
provided a set of suggested tripwires for the Embassy EAC. 
The Ministers of Health and Agriculture will present the plan 
to the Cabinet November 30, and brief President Kufuor and 
other donors by December 7. (NOTE: USAID's consultants 
believe the GoG would have difficulty implementing the plan 
as drafted without assistance.  END NOTE.) 
 
-- 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? 
 
The GoG would be as truthful about an outbreak in the human 
population as it is technically capable of being.  Years of 
capacity building in rural health make it more capable than 
its neighbors.  USAID's contractors reported that an outbreak 
in the animal population would be much more difficult to 
detect, and local chicken producers would likely be reluctant 
to forward information to MinAg because they are skeptical 
about the GoG's ability to compensate them for their losses. 
Donor commitments to support financially the culling of 
domestic birds would be a strong incentive to ensure truthful 
reporting (although no donor has announced any plans to do 
so).  There is no reason to believe the GoG would withhold 
any information it has about an outbreak in either the human 
or animal population. 
 
-- 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? 
 
The GoG's willingness to cooperate with bilateral and 
international donors as well as the speed with which it has 
responded to the threat of an outbreak shows that Avian Flu 
is a top priority at this time.  USG officials should engage 
Minister of Health Courage Quashigah, in coordination with 
USAID/Ghana and the Avian Flu technical working group, on any 
issues related to Avian Flu.  (NOTE:  USAID-Ghana's Health 
Team Leader, BethAnne Moscov, is the Coordinator of Post's 
Avian Influenza Task Force, which the DCM chairs and is 
comprised of officers from Econ, RSO, Heath Unit and other 
agencies.  END NOTE) 
 
 -- 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? 
 
USAID's contractors reviewed Ghana laws and found no barriers 
to Avian Flu detection, reporting, or response. 
 
-- 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? 
 
The GoG is working closely with the WHO and FAO on this 
issue.  GoG leaders will likely ask for assistance once the 
response plan has been adopted and gaps in capacity and 
resources have been identified.  Ghana's donor community will 
review requests in close coordination to eliminate 
duplication of effort.  GoG leaders are always receptive to 
messages from U.S. leaders on a bilateral approach.  USAID's 
involvement in the planning process makes it the best conduit 
for communication with the GoG on this issue. 
 
-- 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? 
 
Ghana does not administer annual flu shots.  Ghana would 
consider administering flu shots if funds were made available 
for distribution and supplies.  Post is not aware of any 
capacity to produce human influenza or poultry vaccines in 
the country.  There is no liability shield for foreign makers 
or donors of vaccines, although the GoG has been quick to 
enact legislation in the past when it was clearly in its 
favor to do so. 
 
--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? 
 
The GoG has already begun to inform the population through 
print and radio reports about Avian Flu since the banning of 
poultry from affected areas.  This information has sensitized 
the population and laid a good foundation for the future. 
The information has been accurate and comprehensive.  A 
formal public relations plan is expected to be part of the 
overall response plan currently being drafted.  UNICEF and 
other donors can further disseminate information through 
their health workers in rural areas if the need arises. 
 
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? 
 
Ghana's medical sector is much more capable of detecting a 
new strain of influenza than the agricultural sector.  The 
capacity and presence of donor and MoH health workers in 
rural communities enhances this capability.  The chances of 
detecting a new strain in the south -- where it is estimated 
one could be detected in two to four weeks -- are higher than 
in the sparsely populated northern regions, where it would be 
possible for a new strain to go undetected for a much longer 
period.  It may be possible for Ghana's Noguchi Medical 
Research Institute to detect a new strain.  A researcher from 
the U.S. Naval Medical Research Unit (NAMRU) works full-time 
at the Noguchi institute and is involved in the Avian Flu 
technical working group.  It is possible that samples could 
be tested at NAMRU's facility in Cairo if the need arises. 
 
 
-- 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? 
 
Ghana needs more trained medical personnel in its sparsely 
populated northern regions, to enhance detection.  Any 
personnel deployed to the north will need access to 
communications equipment to overcome the lack of telecom 
infrastructure.  Ghana's greatest needs will be funding for 
training of health workers and financial backing for culling 
activities and the compensation of farmers.  USAID will host 
a meeting to brief donors next week, which will help raise 
greater awareness and identify potential needed areas for 
donor support. 
 
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? 
 
Although Tamiflu and Relenze are prescribable antiviral 
medications in Ghana, there are no stockpiles of them or any 
other antiviral medications and no funds to acquire them with. 
 
--DOES THE COUNTRY HAVE A STOCKPILE OF PRE-POSITIONED 
PERSONAL PROTECTIVE GEAR? 
 
Ghana has no stockpile of personal protective gear. 
 
--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? 
 
Ghana's capacity to respond to a human outbreak is low, but 
growing as plans are finalized and donors coordinate with the 
GoG.  Ghana has no capacity to respond to an animal outbreak 
at this time.  Although the MinAg recently announced its 
plans to compensate farmers for the cost of culling and 
replacing animals in an outbreak, no provision was made in 
the annual budget presented last week to parliament.  Both 
USAID and the Econ Section believe that any culling activity 
would be stopped once it becomes known that the GoG has no 
money set aside to fund it.  Moreover, USAID's contractors 
reported that MinAg is not technically capable of culling the 
estimated 29 million domesticated chickens in Ghana itself, 
or monitoring their destruction by owners if it is ordered. 
 
-- 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? 
 
The GoG is very willing to impose quarantines and social 
distancing measures.  Government's capability will be higher 
in the south.  Porous land borders and the incentives to 
smuggling brought on by quarantines will make enforcement 
difficult to impossible in northern regions.  If Ghana's 
National Security Council decided a quarantine was necessary, 
the first line of enforcement would fall to the Police, and 
the second line to the Ghana Armed Forces. 
 
Comment 
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3. (SBU) The GoG has responded quickly to the threat of an 
outbreak, despite the fact that it may never happen.  Many of 
the plans being developed are building upon the work the GoG 
did to develop an emergency preparedness plan to respond to 
SARS.  Coordination at the technical working group level has 
been good, and this same group will work together in the 
event of an outbreak.  Once the technical working group's 
plan is finished, a second-level inter-agency working group, 
consisting of a larger number of concerned Ministries and 
donors, will be convened to review the plan.  All the 
coordination and work underway should result in the GoG being 
capable of handling a limited outbreak of Avian Flu. Ghana's 
geography and resource constraints, however, make it unlikely 
that a major outbreak could be contained.  End Comment. 
 
BRIDGEWATER