US embassy cable - 05BOGOTA10967

UNCLAS BOGOTA 010967 
 
SIPDIS 
 
SENSITIVE 
SIPDIS 
 
STATE FOR OES/IHA (SINGER/DALEY) 
HHS FOR INTERNATIONAL STEIGER/BUDASHEWITZ 
 
E.O. 12958: N/A 
TAGS: TBIO, SENV, ECON, EAGR, EAID, PREL, CO 
SUBJECT: AVIAN AND PANDEMIC INFLUENZA INFORMATION - COLOMBIA 
 
REF: STATE 209622 
 
Sensitive but unclassified. Not for internet distribution. 
 
1.  (U) In response to reftel, Embassy provides the following 
responses regarding avian and pandemic influenza preparedness 
in Colombia. 
 
-------------------------- 
PREPAREDNESS/COMMUNICATION 
-------------------------- 
 
2.  (SBU) 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. 
 
The Government of Colombia (GOC) issued a Prevention and 
Mitigation Plan Against the Impact of an Influenza Pandemic 
in September 2005 (September 2005 Plan or Plan).  The Plan 
was written by the Ministry of Social Protection, which has 
responsibility for public health issues.  The September 2005 
Plan is more of a framework or a "to do" list than a concrete 
plan of action.  Since issuing the Plan, the GOC has taken 
few steps to implement it, but has determined that it will 
cost more than 10 billion Colombian pesos (approximately USD 
4.5 million).  The GOC has not yet allocated these funds. 
The September 2005 Plan can be found at the Ministry of 
Social Protection,s website in Spanish: 
www.minproteccionsocial.gov.co.  An English translation of 
the Plan has been e-mailed to OES/IHA and WHA/AND. 
 
3.  (SBU) 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? 
 
Recent experience indicates that the GOC is truthful in 
reporting disease outbreaks.  In early October 2005, the GOC 
announced the discovery of a strain of H9 avian flu (later 
confirmed to be H9N2, which has a low pathogenicity and is 
not harmful to humans) on three farms in Tolima Department. 
The Minister of Agriculture immediately sent letters to his 
counterparts in the Andean region; the GOC made a general 
announcement, which also was carried by local and 
international news, a few days later.  GOC representatives 
told Poloff that they would follow a similar procedure should 
there be a human disease outbreak: immediate notification of 
neighboring countries followed by a more general announcement. 
 
According to APHIS representatives at post, however, the 
international response to Colombia's expeditious and 
transparent announcement has caused the poultry industry, 
which funds most avian flu surveillance, to be wary of 
sharing information about future outbreaks.  Within a week of 
the Colombian announcement, all neighboring countries closed 
their borders to Colombian chicken imports -- before the 
scientific assessment of the Tolima strain had been 
completed.  At a meeting with Poloff and USAID officers, 
representatives from several GOC Ministries expressed concern 
(and frustration) about the economic effects of announcing 
disease outbreaks.  They said such consequences would chill 
international transparency and asked for U.S. assistance in 
encouraging countries not to make major trade decisions 
without full scientific information. 
 
4.  (SBU)  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? 
 
Given Colombia's ongoing efforts to restore peace and 
security after more than 40 years of internal conflict, 
demobilize illegal armed groups and control narcotics 
trafficking, preparations for an avian flu human pandemic are 
not among the GOC's top priorities at this time.  In initial 
conversations about avian and pandemic influenza with Poloff 
in August/September 2005, GOC representatives were concerned, 
but considered the possibility of an outbreak in South 
American unlikely.  The possibility of a pandemic has been 
given more attention since the Tolima outbreak and recent 
discovery of the H5N1 virus in Europe. 
 
According to GOC representatives, the "go-to" person for the 
USG/Department is Minister of Social Protection Diego PALACIO 
Betancourt. 
 
5.  (SBU) 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? 
 
According to the GOC, the September 2005 Plan is consistent 
with strategic measures for dealing with all phases of an 
influenza pandemic -- before, during and after -- recommended 
by the World Health Organization (WHO).  The Plan calls for 
the harmonization of national legislation with "international 
sanitation regulations" and the on-going adaptation of the 
Plan to ensure consistency with any new WHO recommendations. 
In addition, the Plan calls for the evaluation and 
modification of existing laws to facilitate emergency 
measures, which could include the declaration of sanitary 
alerts, quarantines, the use of private infrastructure (such 
as hospitals) and travel restrictions.  To date, the GOC has 
not started work on this aspect of the September 2005 Plan. 
 
6.  (SBU) 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 A MESSAGE FROM U.S. 
LEADERS THROUGH A BILATERAL APPROACH, AT A MULTILATERAL FORUM 
SUCH AT 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? 
 
The GOC is working with regional and international 
organizations, as well as the USG, to improve its avian and 
pandemic influenza preparedness.  The GOC receives most 
assistance on avian flu surveillance and detection issues 
from the Pan-American Health Organization (PAHO) and the USG, 
primarily through APHIS.  In addition, APHIS provides support 
to the Colombian Agricultural and Livestock Institute (known 
by its initials in Spanish, ICA) to improve surveillance of 
animal diseases.  This support is provided under a bilateral 
agreement signed by the U.S. Secretary of Agriculture and the 
Colombian Minister of Agriculture.  Under the terms of this 
agreement, APHIS provides about $800,000 per year toward the 
purchase of vehicles, computers, GPS equipment, as well as 
operational support.  At present, most of this assistance is 
focused on foot and mouth disease (FMD).  Embassy APHIS 
representatives said some funds may be reprogrammed for avian 
flu surveillance assistance because the incidence of FMD has 
declined in recent years.  (APHIS has also heard that the 
Inter-American Development Bank is considering giving 
Colombia USD 500,000 toward technical assistance for animal 
surveillance.) 
 
On a regional level, the GOC is a leading partner in the 
Andean Technical Committee for Animal Health, which is 
comprised of Bolivia, Colombia, Ecuador, Peru and Venezuela. 
This Committee has established a set of technical norms to 
analyze samples and interpret results.  The Committee has 
also funded training.  On October 21, 2005, Health Ministers 
from six countries (Bolivia, Chile, Colombia, Ecuador, Peru 
and Venezuela) met in Lima to prepare an Andean Contingency 
Plan for avian influenza.  According to GOC sources, the 
discussion focused on a coordinated plan to prevent the entry 
of avian influenza into the region, as well as joint measures 
to be taken in the event of a pandemic. 
 
The GOC has expressed a preference for handling avian and 
pandemic influenza issues through multilateral fora.  The GOC 
sent a representative, from its Embassy in Washington, to the 
International Partnership for Avian and Pandemic Influenza 
(IPAPI) Senior Officials Meeting (SOM) in early October more 
to observe the proceedings than to show support for the 
undertaking.  While the GOC agrees with the core principles 
of IPAPI, the GOC is concerned that such efforts will 
undermine the authority of international organizations 
already working on avian and pandemic influenza issues, 
derail efforts to develop a coordinated international 
response and confuse countries as to the source of 
authoritative information about preparedness and disease 
transmission.  GOC representatives told Poloff they were 
comforted by the participation of many multilateral 
organizations, including the WHO, at the IPAPI SOM. 
 
Embassy believes, however, the GOC would welcome offers of 
bilateral assistance, from the USG and others, as it fleshes 
out the September 2005 Plan.  Various Ministry 
representatives told Poloff and USAID officers that the GOC 
would welcome both technical assistance and more training 
from the United States.  To date, there has been no official 
GOC request for USG assistance. 
 
7.  (SBU) 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? 
 
The GOC offers annual flu shots; vaccination centers are 
located throughout the country.  The September 2005 Plan 
calls for the immunization of all children between 6 and 24 
months of age and 5 percent of all senior citizens over the 
age of 65 through the administration of 5.4 million doses of 
influenza vaccine from 2005-2008.  The Plan also calls for 
the eventual vaccination of other people, including high risk 
populations such as health care workers.  The September 2005 
Plan does not specify the source of these doses. 
 
Colombia currently does not produce influenza vaccines for 
humans or poultry.  According to INVIMA (the Colombian FDA 
equivalent), there is no liability shield for drug companies, 
foreign or domestic.  However, in the event of an emergency, 
Colombian law permits, under Decree 677 of 1995, the 
commercialization of medications and vaccines that have not 
been approved by INVIMA, as long as the medication or vaccine 
has been approved and registered in its country of origin. 
 
8.  (SBU) 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 Tolima outbreak has served to highlight the potential 
threat of avian influenza in Colombia.  Following the Tolima 
outbreak, national news coverage of the issue increased 
dramatically.  Despite this increased awareness, the GOC has 
not made efforts to educate civil society about avian and 
other pandemic influenza preparedness or mitigation measures. 
 
 
The national federation of chicken producers (known as 
FENAVI) funds ICA seminars to train poultry producers on 
reporting and handling bird infections.  There are no 
GOC-sponsored programs designed to educate or inform other 
target populations.  GOC representatives have identified this 
as a critical gap in the Plan. 
 
---------------------- 
SURVEILLANCE/DETECTION 
---------------------- 
 
9.  (SBU) 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 WHO, 
AND IF NOT WHERE ARE THEY SENT? DOES THE COUNTRY SEND SAMPLES 
TO A WHO/EU/US REFERENCE LABORATORY? 
According to the September 2005 Plan, the GOC recognizes the 
importance of surveillance and early detection of influenza 
and calls for intensified surveillance of atypical 
respiratory illness as well as atypical or unexplained 
mortality associated with at risk populations groups 
(including health workers and workers in the poultry or pork 
industries). 
 
Based on conversations with the GOC and human and animal 
health experts at the Embassy, the GOC has the technical 
capability to detect new strains of influenza among people 
and animals.  On the human health side, the GOC has employed 
a sentinel watch surveillance strategy to detect influenza 
outbreaks (with a specific focus on respiratory illness) 
since an outbreak of Type A influenza (H3N2) in 1996.  The 
sentinel watch surveillance strategy was implemented in March 
1997 and consists of taking samples/specimens from patients 
who appear to have influenza-like symptoms within the first 
three days of possible infection.  Six regions are the focus 
of this active surveillance: Baranquilla, Bogota, Huila, 
Manizales, San Jose del Guaviare and Valle.  Samples are sent 
to one of five laboratories in the National Laboratory 
Network that are able to perform influenza fluorescence 
diagnoses as well as subtyping.  Samples are also sent to the 
CDC in Atlanta for confirmation. 
 
On the animal health side, ICA has been engaging in both 
active and passive surveillance of poultry for the last three 
years.  Passive surveillance involves routine, random testing 
of asymptomatic birds.  Active surveillance involves the 
examination of dead or symptomatic birds.  The October 2005 
H9N2 outbreak in Tolima Department was discovered through 
ICA,s passive surveillance.  According to APHIS, however, 
ICA needs to further develop and refine its laboratory 
techniques, but lacks the funding to do so.  FENAVI, the 
national federation of chicken producers, funds nearly all 
laboratory work.  (APHIS representatives are aware that 
FENAVI paid for a Mexican avian influenza expert to spend a 
month in Colombia assessing ICA's laboratory facilities and 
techniques.  The expert is currently in Colombia finishing 
this assessment.) 
 
Despite this comparatively extensive experience in monitoring 
disease outbreaks in both humans and animals, the GOC is 
limited by the lack of a local laboratory that is capable of 
subtyping avian influenza viruses.  The only lab in the 
hemisphere capable of subtyping avian influenza is the NVSL 
in Ames, Iowa.  The Colombians were able to determine that 
the virus found in Tolima Department was H9, but specimens 
had to be sent to Ames to determine the N2 subtype.  In 
addition, the testing that is completed in Colombia requires 
reagents that must be imported from the United States. 
 
10. (SBU) 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? 
 
It is critical that the GOC transform the September 2005 Plan 
from a "to do" list to a detailed -- and implemented -- plan 
of action.  The Plan does not provide any details as to how 
the GOC would deal with a disease outbreak.  Further, the 
Plan needs to better articulate the roles of responsibilities 
of the various involved Ministries. 
 
In the GOC,s assessment, one of the most critical gaps is 
the lack of local/regional laboratories capable of subtyping 
avian influenza.  (Comment.  The GOC's interest in a lab with 
this capability is as much for economic as for scientific 
reasons.  If such a lab had existed in Colombia at the time 
of the Tolima outbreak, the GOC may have been able to 
determine that the Tolima virus had a low pathogenicity more 
quickly, preventing the exclusion of Colombian chicken from 
the regional market.  End Comment.)  In addition, the GOC is 
concerned about the lack of appropriately trained medical and 
animal health professionals.  According to representatives 
from ICA, there is only one animal health specialist in the 
country who has received the most up-to-date training on 
avian flu detection.  (His training in the U.S. was funded by 
APHIS.) 
 
In addition, Ministry of Social Protection representatives 
told Poloff and USAID officers that they were particularly 
concerned about the lack of public information about avian 
and other flu.  The September 2005 Plan calls for the 
establishment of a communications network to disseminate 
information about avian and other pandemic influenza, but the 
GOC currently does not have an information dissemination 
system. 
 
-------------------- 
RESPONSE/CONTAINMENT 
-------------------- 
 
11. (SBU) 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? 
 
The September 2005 Plan calls for vaccinating at-risk 
populations.  The Plan also calls for the development of a 
policy for the use of antiviral medications during a pandemic 
and ensuring a supply and proper distribution of antiviral 
medications.  To date, however, the GOC has no stockpile of 
medications and has not placed an ordered for any 
medications. 
 
12. (SBU) DOES THE COUNTRY HAVE A STOCKPILE OF PRE-POSITIONED 
PERSONAL PROTECTIVE GEAR? 
 
At present, there is no stockpile of pre-positioned personal 
protective gear.  The September 2005 Plan does not address 
the issue of a supply stockpile. 
 
13. (SBU) 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? 
 
The Embassy's medical unit assessment is that the GOC lacks 
the capacity to respond rapidly to any human outbreaks. 
There are insufficient stocks of medication and supplies, as 
well as hospital beds, to deal with a pandemic in Colombia. 
 
There are no guidelines currently in place for the culling 
and vaccination of birds, disinfection of facilities or 
limitations on animal movement.  According to APHIS, the 
birds in Tolima Department that have H9N2 have not yet been 
culled because the various Ministries cannot agree as to 
where and how to carry this out.  Moreover, there are no 
guidelines -- and insufficient funds -- for compensating the 
owners of culled birds.  The cost of culling the birds in 
Tolima, most of which are breeder chickens, is estimated at 
USD 5 million.  The owners have resisted culling because the 
GOC has no funds with which to indemnify them. 
 
14. (SBU) 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 GOC is willing to impose quarantines and other measures. 
The September 2005 Plan calls for the design and development 
of public health measures to control the transmission of 
avian and other pandemic influenzas.  These measures may 
include social isolation, quarantine, the closing of 
establishments and the prohibition of mass meetings. To date, 
however, there has been no further explication of how these 
measures would be implemented. 
DRUCKER