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 005458
SIPDIS
STATE FOR OES/IHA FOR JKAUFMANN, DSINGER AND RDALEY
STATE FOR INR/EAP FOR JSTROTZ
STATE PASS USDA/FAS/ICD FOR ROSENBLUM
STATE PASS USDA/FAS/DL FOR MAGINNIS
STATE PASS USDA/FAS/ITP/AA FOR ALEXANDER
STATE PASS USDA/FAS/FAA FOR HAGER
STATE PASS USDA/APHIS/IS FOR HOFFMAN
STATE PASS USDA/APHIS/VS FOR DUVERNOY
STATE PASS USDA/ARS/SEPRL FOR SUAREZ
STATE PASS USAID FOR DCARROLL AND ACLEMENTS
BANGKOK FOR REO JAMES WALLER
CIA FOR NATIONAL INTELLIGENCE COUNCIL NIO/EA
E.O. 12958: N/A
TAGS: TBIO SENV ECON EAGR EAID PREL RP
SUBJECT: AVIAN FLU UPDATE
REF: A) STATE 209622
B) MANILA 5393
C) MANILA 5291
D) MANILA 5059
E) MANILA 4278
1. This cable responds to questions in Ref A. Post
previously reported on avian influenza preparedness (ref
E), the GRP's limited surveillance capacity (ref D), the
appointment of an Anti-Avian Flu Czar (ref C) and rising
public concern in the Philippines over Avian Flu (ref B).
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SUMMARY
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2. The GRP has made progress in Avian Flu preparedness,
but resource constraints continue to prevent
implementation. Although the Philippines remains free of
the H5N1 Highly Pathogenic Avian Influenza (HPAI) virus,
the country is vulnerable during the October-February
migratory bird season. President Arroyo recently took
several steps to raise public awareness and focus GRP
resources on prevention and containment of HPAI in
poultry. Arroyo highlighted these efforts at the November
18-19 APEC Summit and encouraged regional collaboration.
The Bureau of Animal Industry (BAI) has solicited U.S.
support to improve its poultry surveillance. USAID is
helping the Department of Health to prevent possible
human HPAI cases. The GRP has limited resources to
respond to a large HPAI outbreak. The GRP relies on
poultry farmers for HPAI surveillance, but has not
established an adequate indemnity fund to encourage their
cooperation. END SUMMARY
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PREPAREDNESS PLANNING
----------------------
3. The GRP has an Avian Flu preparedness plan available
at: www.doh.gov.ph/avian. The Department of Agriculture
website (www.da.gov.ph/BirdFlu) also has information on
Avian Flu preparedness including procedures for
prevention and containment of HPAI in poultry. As
reported in ref E, the Departments of Agriculture and
Health have divided responsibilities for four stages:(1)
preventing entry of the HPAI into the Philippines; (2)
containing HPAI outbreaks in poultry; (3) preventing
animal to human transmission of HPAI; and (4) preventing
human-to-human transmission of HPAI. The GRP's capacity
to effectively implement the plan is limited by budget
constraints, ill-equipped diagnostic laboratories, and
lack of indemnity funds for farmers.
4. Although the GRP has taken steps to procure limited
stockpiles of materials and establish regional teams to
prevent and contain HPAI outbreaks in poultry. The
capacity of regional response teams could quickly be
stretched in the event of a significant HPAI outbreak.
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TRANSPARENCY
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5. The GRP has publicly affirmed its commitment to
transparency and Post expects the Departments of
Agriculture and Health to adhere to this commitment in
reporting any confirmed HPAI cases among birds or people.
Given the free flow of information and the widespread use
of text messaging in the Philippines (noted in ref B), it
is also unlikely that any significant HPAI outbreak would
go unnoticed. GRP must overcome economic disincentives
to encourage cooperation of poultry farmers in reporting
and isolating potential AI cases.
6. The GRP is likely to delay any announcement of
possible HPAI cases in poultry until the completion of
confirmatory tests by the regional reference lab in
Geelong, Australia. The Bureau of Animal Industry (BAI)
estimates that these tests currently can take one week to
complete, but BAI is upgrading its testing capacity (as
reported in ref D), to allow more rapid identification of
the H5N1 virus. The July 2005 Calumpit incident, where
the human reference lab leaked incomplete information
about a suspected HPAI case (later considered negative
for HPAI) has led the government to more carefully manage
information about potential AI cases. Only the BAI
Director has the authority to announce a confirmed HPAI
case in poultry.
7. Improved diagnostic capability, including quality
control procedures, can also encourage prompt and
accurate reporting of HPAI cases in animals and people.
Indemnity funds could encourage cooperation from farmers
in reporting potential HPAI cases and containing
outbreaks. International cooperation to alleviate
potential economic costs of an HPAI outbreak can also
encourage further transparency.
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LEADERSHIP
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8. President Arroyo has taken a leadership role in
focusing GRP resources on AI preparedness. Per ref C,
Arroyo appointed Agriculture Secretary Panganiban as Anti-
Avian Flu Czar, leading the National Avian Influenza Task
Force (NAITF) to concentrate on stages 1 and 2:
prevention and containment of Avian Flu in poultry.
Health Secretary Duque manages HPAI prevention and
preparedness for human health. Arroyo also proposed to
allocate 2.5 billion pesos ($50 million) for stages 1 and
2 in the 2006 National Budget currently under
consideration by Congress. Arroyo's proposal would
source these funds from savings in debt service but some
legislators have suggested using U.S. PL-480 food aid
funds for this purpose.
9. At the operational level, Dr. Davinio Catbagan,
Director of the BAI, manages AI prevention and
preparedness for poultry, while Dr. Luningning Villa,
Program Manager for Emerging Infectious Diseases, serves
as the point person for AI preparedness in the DOH.
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LEGAL ISSUES
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10. The GRP has not reviewed national laws for
compatibility with HPAI preparedness, but it does not
anticipate legal obstacles to surveillance and control of
HPAI outbreaks. The NAITF was authorized by Executive
Order 280 to supervise HPAI preparedness. Based on its
experience during the SARS crisis, the GRP can invoke the
Sanitation Code and the Local Government Code to support
containment and quarantine measures. The Quarantine Act
of 2004 (Republic Act 9271) has strengthened the DOH's
authority to impose quarantines and expanded its scope to
cover public health emergencies of international concern.
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INTERNATIONAL COLLABORATION
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11. The GRP is working with several international
organizations on AI preparedness, notably the World
Health Organization (WHO), the United Nations Food and
Agriculture Organization, the International Organization
for Animal Health, the Asian Development Bank and the
World Bank. The Philippines has joined the International
Partnership on Avian and Pandemic Influenza (IPAPI). At
the November 18-19 APEC summit, President Arroyo
reaffirmed GRP support for regional programs to prevent
and control HPAI.
12. The GRP has solicited support from USDA to upgrade
its surveillance capacity and from USAID to support
preparedness for human HPAI cases. Although the GRP is
trying to allocate sufficient funds for HPAI
preparedness, it may solicit further bilateral or
multilateral assistance, particularly if the approval and
execution of the 2006 national budget is delayed.
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VACCINES
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13. GRP currently has no program or plans to administer
flu vaccines, so it does not procure these vaccines for
government use. The private health sector does provide
vaccines for its patients and some practitioners report
that demand is increasing but the current supply is
adequate for the private sector.
14. The DOH does not have any capacity to produce flu
vaccines for humans or poultry, but it produces three
other human vaccines. DOH estimates that the production
facility would require additional modules and at least
one year for conversion to flu vaccine production in an
emergency.
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PUBLIC AWARENESS
----------------
15. Public awareness of Avian Flu has increased since
the GRP launched an information campaign in November and
the Philippine media has increased coverage of Avian Flu.
The information campaign has sent eight teams to train
local AI task forces in 37 provinces to diagnose and
respond to potential HPAI cases. President Arroyo named
Secretary Cerge Remonde, Head of the Government Mass
SIPDIS
Media Group, to assist the NAITF in developing public
information campaigns on Avian Flu and enlisted the
support of U.S. firm McCann-Erickson to assist in the
campaign. The DOH has prepared information materials
covering prevention of Avian Flu and has been working
with the mass media. It is difficult to determine the
geographic coverage and effectiveness of these measures
to date.
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SURVEILLANCE/DETECTION CAPACITY
--------------------------------
16. Per ref D, the GRP is upgrading the Philippine
Animal Health Center (PAHC), its animal reference lab, to
establish a specialized AI diagnosis facility capable of
identifying the H5N1 virus. The PAHC currently conducts
screening tests and can isolate the virus, but must send
samples to Geelong, Australia to identify specific virus
types. This process can take up to one week. The BAI
conducts limited random surveillance of poultry in 20
critical areas where poultry are vulnerable to infection
from migratory birds. BAI also relies on regional
veterinarians to report potential AI outbreaks based on
high mortality rates in poultry and clinical symptoms
consistent with AI.
17. The Research Institute for Tropical Medicine (RITM)
has the capacity to isolate viruses and identify virus
types. The DOH has a surveillance system, through its
National Epidemiology Center to monitor human cases of
pneumonia or deaths related to poultry disease/deaths in
the 20 identified critical areas.
18. The GRP has solicited USDA support to train
technical staff and equip its new Avian Flu reference
laboratory for prompt diagnosis of HPAI virus types.
Indemnification funds will also be critical to encourage
the cooperation of poultry farmers in identifying
possible HPAI outbreaks. The GRP may solicit further
assistance in procuring personal protective equipment
(PPEs), anti-virals and other supplies for AI response
teams.
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ANTI-VIRALS AND PPEs
-----------------------
19. The DOH currently has no stockpile of Tamiflu but
expects 100,000 capsules to arrive by February 2006.
Through the WHO, the DOH made arrangement for the supply
of Tamiflu (worth $31,000). It also sent a Letter of
Intent to Roche Pharmaceuticals for the procurement of an
additional 8.5 million pesos ($154,000). The Philippine
International Trading Corporation has reached an
agreement with a local company, United Laboratories
(Unilab), for the manufacture of Tamiflu in the
Philippines in an emergency situation.
20. USDA contributed 100 sets of PPEs to equip BAI teams
and laboratory workers to contain an AI outbreak in
poultry. The DOH has retained PPEs from the SARS epidemic
for health care providers at regional hospitals.
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RAPID RESPONSE CAPACITY
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21. The GRP has developed the capacity to respond to
limited HPAI outbreaks, but this capacity would likely be
overwhelmed if an HPAI outbreak occurs in a major poultry
producing area near metro-Manila. The BAI has produced
guidelines for culling of birds and containment measures
(www.da.gov.ph/BirdFlu/ProtectionProgram/manu al).
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QUARANTINE CAPACITY
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22. The GRP is willing to impose quarantines and social
distancing measures as needed, but its capacity could be
quickly overwhelmed if a human pandemic occurs. The DOH
has limited capacity to isolate human HPAI cases. The
Research Institute for Tropical Medicine (RITM) has been
designated as the National Referral Hospital for bird flu
cases. RITM will use the negative pressure rooms used
during the SARS outbreak in 2004. Moreover, a portion of
the Lung Center of the Philippines, a sub-national
referral hospital, has been designated for tent hospitals
should a pandemic occurs. Ten other DOH hospitals have
the capacity to admit Avian flu cases (with PPEs and
isolation facilities). The DOH plans to establish
isolation facilities in all 16-17 regions. For limited
human HPAI cases, the GRP could draw on its experience
during the SARS epidemic to enforce a quarantine.
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COMMENT
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23. The GRP recently raised the profile of its Avian Flu
preparedness programs and it is making progress in
providing training and supplies to regional teams.
Although President Arroyo has proposed a ten-fold
increase in funding for Avian Flu preparedness, this
funding may be delayed if the Congress fails to approve
the 2006 budget. In the short term, the GRP will
continue to need assistance in improving surveillance
capacity, stockpiling Tamiflu and PPEs, training regional
response teams and establishing an indemnity fund to
encourage cooperation from farmers.
JONES