Cablegate: Avian Flu Pandemic Preparedness: Gaps in Planning

This record is a partial extract of the original cable. The full text of the original cable is not available.

UNCLAS SECTION 01 OF 05 MANILA 004278

SIPDIS

STATE FOR EB/TPP/ABT FOR SPIRNAK AND GOETHERT
STATE FOR OES/IHA FOR JKAUFMANN
STATE FOR INR/EAP FOR JSTROTZ
STATE PASS USDA/FAS/ITP FOR SIMMONS, RICHEY, AND CLARKSON
ICD FOR PETLOCK
STATE PASS USAID FOR JLEWIS
DEPT OF INTERIOR FOR OSM RMCNEER
BANGKOK FOR REO JAMES WALLER
CIA FOR NATIONAL INTELIGENCE COUNCIL NIO/EA

E.O. 12958: N/A
TAGS: ECON PINR SOCI EAGR SENV TBIO TSPL RP
SUBJECT: AVIAN FLU PANDEMIC PREPAREDNESS: GAPS IN PLANNING
VS. CAPACITY

REF: A) STATE 151549

B) STATE 153802
C) MANILA 3883
D) MANILA 2053
E) 04 MANILA 622

Sensitive But Unclassified - Protect Accordingly

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Summary
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1. (SBU) Summary: Although there have been no reported
cases of avian influenza (H5N1) in the Philippines, the
GRP's capacity to respond to a potential outbreak is
limited by lack of resources in many areas. The GRP
lacks funds for materials such as protective gear and
stockpiles of Tamiflu. Key activities such as
surveillance in rural areas, public health information
campaigns, and other programs remain under funded. No
funds are available for indemnity payments to compensate
farmers. Countermeasures at international ports of entry
remain ineffective. A newly formed embassy task force
will host a second roundtable discussion on AI with
senior GRP officials and experts on September 16 (ref C)
for the purpose of identifying and possibly filling gaps
between planning and capacity. End Summary.

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AI is a High GRP Priority . . .
-------------------------------

2. (SBU) Responding to the potential treat of avian
influenza is a high priority for the GRP. The issue is
receiving attention at the cabinet level and the
secretaries of the Department of Agriculture (DA) and the

SIPDIS
Department of Health (DOH) are directly engaged on AI
planning and countermeasures. Both of these lead
agencies for AI have demonstrated their seriousness of
purpose by having developed comprehensive plans for
prevention and response. In view of this level of
attention, probably only the president herself could
raise the issue to a higher priority.

3. (U) The GRP's crisis manager for avian influenza is
DOH Secretary Francisco Duque, M.D. (ref B). Luningning
E. Villa, M.D., Program Manager for Emerging Infectious
Diseases, serves as DOH's point of contact. DA Secretary
Domingo Panganiban serves as co-crisis manager. Chief
Veterinary Officer Davinio Catbagan, D.V.M., serves as
DA's principal point of contact. Samuel Animas, D.V.M.,
National Coordinator for Avian Influenza Protection, also
serves as a point of contact at DA. Professional staff
at DA and DOH include competent and experienced
scientists and experts, some of whom were trained
overseas.

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. . . GRP Has a Strategy . . .
------------------------------

4. (U) AgCounselor met September 9 with Philippine Chief
Veterinary Officer, Davinio Catbagan, D.V.M., Bureau of
Animal Industry, Department of Agriculture (DA/BAI) to
discuss the GRP's four-staged response to avian influenza
(AI): (1) prevent the introduction of AI into the
Philippines from affected countries; (2) establish
counter-measures for an outbreak among domestic bird
flocks; (3) prevent transmission of AI from birds to
humans, and (4) prevent human-to-human transmission. The
DA is responsible for stages (1) and (2) while DOH is
responsible for stages (3) and (4).

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. . . But Lacks Resources
-------------------------

5. (SBU) Serious constraints remain with respect to
funding, training of officials, laboratory
infrastructure, and scope of monitoring potential AI
threats, especially in rural areas. The lack of an
indemnity fund could be a major problem here (and in
other developing countries) as cooperation diminishes
when producers they see their livelihoods threatened by
government regulators. Other weak links include lack of
effective countermeasures at ports of entry, inadequate
stockpiles of Tamiflu, and the absence of a public health
education campaign.

6. (SBU) BAI's budget for AI-related activities is 20
million pesos ($360,000), but DA's experts estimate that
about twice that amount would be required to effectively
prepare for an outbreak. DA also expends significant
resources on controlling other diseases such as foot-and-
mouth disease. Funding for various activities to
increase the efficiency of BAI's overall operations is
"slow in coming", Chief Veterinary Officer Catbagan
lamented. Resources also are needed to purchase
protective gear for inspectors and technicians.
Meanwhile, BAI is improving its information gathering,
analysis, and dissemination functions to ensure that
decision makers can respond quickly. BAI's field offices
are supposed to report to headquarters three times
weekly, but the system still contains flaws and appears
to be a work in progress.

7. (U) A recent improvement includes the GRP's upgraded
Animal Health Center laboratory where samples can now be
evaluated domestically. Fourteen regional laboratories
feed samples and data to the central lab in Manila.
Previously, samples were sent to Australia to the
Regional Reference Laboratory, Office International des
Epizooties.

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Progress at DOH on Prevention and Control
-----------------------------------------

8. (U) USAID/PHN Chief and RMO met September 7 with
Department of Health (DOH) officials Dr. Luningning E.
Villa, Program Manager for Emerging Infectious Diseases,
and Dr. Vito "Jojo" G. Roque, Jr., Surveillance Unit
Head, National Epidemiology Centre. The National Centre
for Disease Prevention and Control leads DOH's
initiatives in partnership with the National Epidemiology
Centre and the Research Institute of Tropical Medicine.
This partnership worked effectively during the SARS
pandemic of 2003. DOH's strategy focuses on prevention,
surveillance, and containment of suspected cases.

9. (U) The DOH has undertaken the following measures:

-- Developed surveillance systems for which the quality
of data is verified with methods similar to those used in
responding to SARS;
-- Designed prototypes of public health education and
information materials;

-- Made plans to stockpile Tamiflu;

-- Conducted trainings for service providers, public
health administrators, and program managers at regional
levels;

-- Set up Barangay emergency response teams with the
Department of Local Government (DILG) through an official
circular on preparedness for the local governments;

-- Designated regional hospitals as referral centers for
quarantine of infected human cases.

--------------------------------------------- ----
DOH Needs Tamiflu, Rural Surveillance, and Flyers
--------------------------------------------- ----

10. (SBU) Critical gaps include the lack of funds for:

-- Mass production of public health education and
information materials;

-- Procurement and stockpiling of Tamiflu;

-- Effective operation of sentinel surveillance systems,
especially in remote rural areas.

DOH has requested funds for these activities from the
Department of Budget and Finance.

-----------------------------------------
Surveillance of Human Subjects in Bulacan
-----------------------------------------

11. (SBU) DOH's plans include conducting surveillance of
human subjects in areas where migratory birds pass such
as Bulacan, where an undefined, low-pathogenic strain of
H5N was detected. DOH will sponsor a meeting at Subic
Bay September 21 - 23, to train 70 epidemiologists and
regional coordinators on surveillance, prevention, and
emergency response. The DOH also will improve capacities
for containment and case management at referral hospitals
including San Lazaro, the Lung Centre, Davao Medical
Centre, Vincente Sotto, and the Research Institute for
Tropical Medicine.

------------------------------
Special Challenges in Mindanao
------------------------------

12. (SBU) From October to February, 100 species of wild
birds will cross the 7000 islands of the Philippines on
their annual migratory routes. DA has identified 20
critical areas where BAI's regional offices are
redoubling their efforts to monitor developments. Some
of these areas are in conflict-affected regions of
Mindanao where BAI's officers face greater challenges.
For example, due to the absence of indemnity funds to
compensate producers, when duck raisers see BAI's
officers coming "they grab their flocks and head in the
opposite direction", Chief Veterinary Officer Catbagan
warned.

13. (U) About 17% of the country's poultry are produced
in Pampanga Province in Central Luzon, Region III. Many
producers in Pampanga raise ducks for "Balut," exotic
duck eggs. They transport ducks to other provinces or
regions to feed on snails and residual grain in newly
harvested rice paddies. This integrated pest management
practice works well for rice producers and duck raisers
alike, but travel and exposure increase the potential for
ducks to become vectors for the spread of AI. DA is
drafting new regulations to limit or prohibit such
movement of ducks within the country, although
implementation will be difficult without effective
monitoring. Region III, which comprises seven provinces,
produces 43% of the country's chicken and 40% of all duck
products.

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Embassy Task Force
------------------

14. (U) The Embassy's Task Force on Avian Influenza held
its first meeting September 2, chaired by USAID/Manila.
Membership includes RMO and representatives of FAS,
APHIS, Peace Corps, Econ, Pol, ACS, and JUSMAG. The
group convenes monthly to exchange information, refine
preparedness planning at post, and liaise with public
officials, scientists, donors, and international agencies
to monitor developments. The task force will hold post's
second roundtable discussion with senior officials and
experts from DOH, DA, and the private sector on September
16 at the American Chamber of Commerce to explore ways to
fill gaps between planning and capacity.

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Comment
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15. (SBU) In the event of an outbreak, presidential
leadership would probably become a key factor in imposing
quarantines, social distancing measures, and other
emergency steps. In large and densely populated cities
such as Manila, crowded buses and other mass transit
facilities would pose challenges for AI control, though
schools and public facilities could quickly be ordered
closed. Although the GRP could try to keep the lid on
news coverage of an outbreak, this type of development
would probably quickly receive TV and press coverage in
the open media environment of the Philippines. In July
2005, for example, we observed widespread media coverage
of suspected AI cases in the Philippines soon after the
government learned of them. (These suspected cases later
proved negative for AI.)

16. (SBU) The Armed Forces of the Philippines (AFP) have
on occasion been called on to assist with natural
disasters such as floods and landslides. The AFP never
has responded to an epidemic, but probably would be
capable of doing so, especially if urged through USG
political and military channels. Further encouragement
could be provided by possible offers of medical
assistance and training by experts in disease research
and quarantine procedures through U.S. military resources
such as the Army Medical Component-Armed Forces Research
Institute of Medical Sciences (USAMC-AFRIMS) in Bangkok.

JOHNSON

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