US embassy cable - 05TAIPEI4852

C O N F I D E N T I A L SECTION 01 OF 02 TAIPEI 004852 
 
SIPDIS 
 
INFO GENEVA USMISSION 
 
STATE PASS AIT/W, GENEVA FOR DAVID HOHMAN 
 
E.O. 12958: DECL: 12/08/2006 
TAGS: AMED, CASC, SENV, TBIO, PREL, TW, ESTH, Foreign Policy 
SUBJECT: TAIWAN CDC DIRECTOR ON WHO, AVIAN FLU AND 
PREPAREDNESS 
 
REF: TAIPEI 4764 
 
Classified By: Dir for reasons 1.4 (b and d) 
 
1.  (U) Summary: Steve Kuo, Director General of Taiwan,s 
Center for Disease Control, met with AIT/T on December 1 and 
discussed aspects of Taiwan,s participation in the WHO, 
particularly those areas related to infectious disease 
control, Taiwan,s plans to construct a level 4 research 
laboratory, and efforts to stockpile Tamiflu. Kuo provided 
AIT/T a tour of TCDC,s Command Center. End summary. 
 
2. (U) AIT/T Econ Chief and new ESTH officer paid a courtesy 
call on CDC Director General Steve Kuo at his office on 12/1. 
 Kuo spent over an hour with AIT/T. 
 
WHO Participation 
----------------- 
 
3.  (C) We asked if he had any information on Taiwan,s plans 
to respond to the letter from WHO outlining the guidelines 
for Taiwan,s participation in the International Health 
Regulations.  Kuo said that Taiwan,s response to the letter 
would be coordinated by the Ministry of Foreign Affairs. He 
reiterated Taiwan,s policy that it needs to obtain some form 
of membership in WHO and that it could not accept the title 
of &Taiwan, China.8  However, as a practical matter, Kuo 
said that Taiwan has agencies that could, and do, cooperate 
with the WHO and confirmed that the WHO treats the TCDC as 
the focal point in Taiwan for issues regarding infectious 
diseases.  As an example, Kuo said that he and two other 
specialists from Taiwan attended the November WHO meeting in 
Geneva discussing Avian Influenza issues. 
 
PARTICIPATING IN GOARN 
---------------------- 
 
4. (U) Kuo said that Taiwan has been participating in a WHO 
mechanism for some time.  He cited GOARN (Global Outbreak and 
Response Network), saying that Taiwan health institutions 
have been active in GOARN for many years.  Taiwan,s 
participation, he said came about from work done with the 
USCDC when it established its Field Epidemiology Training 
Program in Taiwan in 1984.  Kuo said activities under GOARN 
are strictly technical sessions where Taiwan experts interact 
with experts from other places.  Kuo noted that in 2001, 
Taiwan tried to set up a meeting in Taiwan of GOARN members, 
but that the PRC had blocked Taiwan,s proposal. 
 
5.  (C) When Kuo visited Geneva in November he consulted with 
some WHO officials.  Kuo said that he discussed GOARN and 
other mechanisms of cooperation with Michael Ryan Director, 
WHO Office of Epidemic and Pandemic Response. Kuo said that 
Ryan stuck strictly to technical issues and told Kuo that the 
ground rules for Taiwan participation in WHO mechanisms and 
events are that Taiwan is not to introduce any political 
issues into the discussions. 
 
 
LEVEL 4 LAB 
----------- 
 
6. (C)  AIT/T noted that we have received information from 
U.S. firms bidding on contracts to supply services for 
Taiwan,s tender to build a level 4 ward.  Kuo confirmed that 
Taiwan is in the process of planning to build a level 4 lab, 
describing it as one of the most sophisticated medical 
isolation units in the world. Kuo said TCDC had run into 
negotiation difficulties with Battelle Corporation of 
Maryland over the bidding for construction of the project. 
According to Kuo, TCDC originally had budgeted NT$ 8 billion 
to build the lab and has divided the project into two phases: 
 
Phase I. A NT$30 million tender to write the design 
specifications and request for proposal for the project, but 
specifically not to include the design of the facility. 
 
Phase II. The remaining funds are for a separate tender for 
the actual design, construction and equipping of the 
facility. 
 
7. (C) Kuo said that Battelle,s bid for phase I was NT$60 
million and included design of the structure.  Kuo said that 
at twice the proposed budget, TCDC had no option but to 
reject this bid.   Kuo said he believes that Taiwan cannot 
move forward on this project without a clear indication that 
the USG approves of the project. Further, he believes that he 
must have U.S. firms involved in the construction of the ward 
to win USG approval. He said that he is prepared to cancel 
the project if there is no U.S. participation and that he has 
already started to draft such a recommendation for the 
Minister of Health.  Kuo explained that this project would 
involve joint research programs with scientists from other 
countries, particularly the U.S., and that it would be vital 
to have a facility that meets the most stringent standards. 
Just prior to meeting with AIT/T, Kuo said that he had 
received a last minute e-mail from the Trade Representative 
from the State of Maryland requesting further discussions 
with Battelle.  Kuo said that TCDC is considering its next 
steps and TCDC confirmed on December 9 that it is still 
discussing its options. 
 
TAMIFLU & Avian Influenza 
------------------------- 
8. (U) Taiwan issued a compulsory license to produce Tamiflu 
on 11/25 in spite of objections by Roche, the Swiss 
pharmaceutical company (reftel). Under the terms of the 
license, the Department of Health (DOH) must first exhaust 
Roche-supplied Tamiflu before distributing locally produced 
stock. Kuo said TCDC started in 2004 to procure sufficient 
courses of Tamiflu from Roche to cover 10 percent of the 
population. He could not guarantee that Taiwan would continue 
buying from Roche if the needs went beyond 10 percent of the 
population. He indicated that Taiwan thought it unlikely that 
Roche would be able to meet all of Taiwan's needs. He added 
that if a pandemic was evident then Taiwan drug companies 
would be allowed to make Tamiflu under the terms of the 
compulsory license. When asked about the 4-5 Taiwan firms 
that allegedly can produce Tamiflu, Kuo was non-committal, 
neither confirming the number nor providing names of the 
firms. 
 
9. (SBU) Kuo said that in the event of an avian influenza 
pandemic, TCDC,s leadership role is likely to diminish 
because Taiwan has established a formal plan to move decision 
making up to the Executive Yuan and the President as any 
pandemic increases in severity. But he believes that the 
Taiwan citizenry is well informed about contagious disease 
outbreaks because of the wide dissemination of information by 
the authorities during and since the SARS outbreak. He also 
felt that Taiwan was a leader in terms of preparedness 
against communicable diseases, particularly regarding Avian 
flu. 
 
TCDC Command Center 
------------------- 
 
10. At the end of the visit, Kuo provided a brief tour of the 
Command Center. It is an impressive office with monitors 
showing real-time images of incoming passengers being 
screened for fevers and Chiang Kai-shek International 
airport, data charts showing incidence of Avian Flu and other 
communicable diseases in foreign countries and in Taiwan. The 
office was well equipped with phones and computers and could 
be quickly staffed in the event of an emergency. It was very 
visiable display of preparation by Taiwan to combat not only 
AI, but also other communicable diseases and threats to 
public health. This is in stark contrast with the pre-SARS 
era arrangements, before AIT and USCDC became heavily engaged 
in helping Taiwan update its procedures and facilities. 
 
 
PAAL