Cablegate: U.S. Centers for Disease Control and Prevention (U. S.

VZCZCXRO3693
RR RUEHCN RUEHDT RUEHGH RUEHPB RUEHVC
DE RUEHBJ #2814/01 2792324
ZNR UUUUU ZZH
R 062324Z OCT 09
FM AMEMBASSY BEIJING
TO RUEHGT/AMEMBASSY GUATEMALA 0001
RUEHNR/AMEMBASSY NAIROBI 0383
RUEHEG/AMEMBASSY CAIRO 0371
RUEHBK/AMEMBASSY BANGKOK 6776
RUEHAST/USOFFICE ALMATY 0006
RUEHC/SECSTATE WASHDC 6317
INFO RUEHOO/CHINA POSTS COLLECTIVE
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHRC/DEPT OF AGRICULTURE WASHDC
RUCPDOC/DEPT OF COMMERCE WASHDC
RUEATRS/DEPT OF TREASURY WASHINGTON DC
RHMFIUU/DEPT OF HOMELAND SECURITY WASHINGTON DC
RUEKJCS/SECDEF WASHDC//USDP/ISA/AP//
RHEHNSC/NSC WASHDC
RUCNARF/ASEAN REGIONAL FORUM COLLECTIVE
RUEHPH/CDC ATLANTA GA

UNCLAS SECTION 01 OF 03 BEIJING 002814

HHS PASS TO MONOHAN AND MILLER
CDC ATLANTA FOR COGH, AND PASS TO BLOUNT, KELLY, DOWELL, COX, SIMONE
AND PINNER
AMEMBASSY GUATEMALA CITY FOR CDC AND PASS TO DANEL AND SCHOMOYER
AMEMBASSY NAIROBI FOR CDC AND PASS TO DECOCK, WHEELER AND BREIMAN
AMEMBASSY CAIRO FOR CDC AND PASS TO DUEGER
AMEMBASSY BANGKOK FOR CDC AND PASS TO MALISON, CHONG AND MALONEY
USOFFICE ALMATY FOR CDC AND PASS TO MORAN
STATE FOR EAP/CM, OES/PCI, AND OES/IHB

SENSITIVE
SIPDIS

TAGS: PREL SENV TBIO SOCI CH GT KE EG TH KZ
SUBJECT: U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION (U. S.
CDC) ENHANCES EMERGING INFECTIOUS DISEASE INVESTIGATION, RESPONSE
AND CONTROL IN CHINA

BEIJING 00002814 001.2 OF 003

1. (SBU) Summary: In mid-September, a request for technical
consultation by U.S. Centers for Disease Control and Prevention
(U.S. CDC), and U.S. Department of Health and Human Services (U.S.
HHS) experts working in China on 2009 pandemic influenza A (H1N1)
was made by Dr. WANG Yu, Director of the Chinese Center for Disease
Control and Prevention (China CDC). This request exemplifies the
strong and trusted relationship between China and U.S. public health
agencies at the critical beginning of an influenza season with
heightened global concern. This cable outlines the public health
capacities U.S. HHS/CDC has enhanced in China to help address
current global health threats. In order to continue the successful
partnership between U.S. and China's public health agencies,
attendance at the next U.S. HHS and MoH Collaborative Committee
Meeting of the China-US Collaborative Program on Emerging and
Re-emerging Infectious Diseases (EID) currently proposed in early
December 2009 (see paragraph 5) is crucial.

2. (SBU) On 22 September 2009, more than 20 U.S. Centers for
Disease Control and Prevention (CDC), U.S. Department of Health and
Human Services (U.S. HHS), and the Chinese Center for Disease
Control and Prevention (China CDC) experts met with Dr. WANG and
outlined a critical plan to address short-term emergent issues, such
as methods to improve detection of 2009 pandemic influenza A (H1N1)
cases in the upcoming months, and launching an agenda for neglected
public health problems, including obesity and chronic disease.

3. (U) The Global Disease Detection (GDD) program, funded by
Congress in 2004, works to protect the health of Americans and the
global community from the spread of emerging infectious disease
threats by collectively building a global network of public health
assets in support of the World Health Organization's (WHO)
International Health Regulations (IHR). The GDD program is working
to close the critical gap between global public health capacity and
the ability of many member states to meet their requirements as
stated in the IHR. GDD unites the resources of the U.S. and its
international partners to provide technical assistance, logistical
support, and funding through regional networks and intergovernmental
organizations.

4. (U) The GDD center in China is the U.S. CDC component of the
China-U.S. Collaborative Program on Emerging and Re-emerging
Infectious Diseases (EID), created under the terms of a
comprehensive Memorandum of Understanding (MoU) between the U.S. HHS
and the Chinese Ministry of Health (MoH) signed in 2005. EID
includes coordinated U.S. programs from CDC, the National Institutes
of Health, and the Food and Drug Administration.

5. (SBU) U.S. CDC experts in China represent a critical node of
CDC's GDD network, and serve as the crucial pipeline between U.S.
CDC and China CDC to rapidly share information and expertise to face
key public health issues, such as the expected surge of 2009
pandemic influenza A (H1N1) cases this winter. According to the
MoU, a Collaborative Committee Meeting of U.S. HHS and China CDC
should meet annually to steer this cooperative team. The China side
is headed by a representative of China Ministry of Health (China
MoH) and the U.S. side is headed by an American based representative
of HHS. The last meeting was on May 10, 2008 in Beijing and the U.S.
side was led by Dr William Steiger, former Special Assistant to the
Secretary for International Affairs. It is necessary to identify
who will head the U.S side and convene the Collaborative Committee
Meeting which is currently proposed for early December 2009,
particularly in the midst of a worldwide pandemic.

INFECTIOUS DISEASES ARE NO LONGER A LOCAL PROBLEM

BEIJING 00002814 002.2 OF 003

6. (U) With the advent and proliferation of worldwide air travel,
infectious diseases can no longer be considered problems local to
one area or country. One of the most prominent examples occurred in
2003, when Severe Acute Respiratory Syndrome, or SARS, spread
quickly from southern China throughout China, Asia, Europe and North
America. Another well known example is avian influenza A (H5N1),
where infected migratory wild birds fly across multiple continents,
and transmit avian influenza A (H5N1) to susceptible domestic birds,
which have then infected humans in multiple countries.

7. (U) Similar to the multi-pronged approach to combat infectious
public health threats in the U.S. such as 2009 pandemic influenza A
(H1N1), GDD works directly with Chinese counterparts to confront
disease in China on multiple fronts. Through its influenza
supported work, GDD and U.S. CDC Influenza Division provide crucial
technical assistance on influenza detection and control, and give
critical support for the national influenza surveillance system.
Because China CDC needs strong epidemiologic expertise, GDD helps
build epidemiological capacity through the Field Epidemiology
Training Program (FETP) which helps train future public health
leaders in China. To detect new and emerging diseases such as SARS,
GDD assists counterparts to build surveillance and laboratory
capacity through the International Emerging Infections Program
(IEIP) to monitor many organisms, including those that cause
diarrhea and pneumonia. To support Chinese authorities to properly
implement public health recommended education and behavior change,
GDD provides health communications expertise through the Health
Communications Program. Examples are implementing hand washing and
cough etiquette guidance to the public and communicating
evidence-based public health research findings to key decision
makers responsible for determining health policy.

GDD IN CHINA PRODUCES TANGIBLE RESULTS

8. (U) GDD has helped the China CDC build capacity. Since 2004,
GDD's FETP has trained more than 100 new epidemiologists to
investigate outbreaks and serve as public health leaders in China.
GDD's IEIP has helped establish salmonella surveillance in eight
provinces and trained provincial laboratory technicians on capacity
building and quality management. GDD and the U.S. CDC's Influenza
Program have worked with partners to create protocols for
prevention, detection, preparation and control of pandemic
influenza, and provided methods to determine drug resistance in
circulating strains.

9. (U) GDD has participated in Chinese investigations of disease
outbreaks and epidemiological research in China. Outbreak
investigation is critical to detecting and controlling emerging and
re-emerging diseases. GDD's FETP staff along with FETP trainees
have helped investigate outbreaks of acute disease ranging from
plague pneumonia transmitted from dogs in Qinghai province, to
cholera in Hainan province. To begin to understand the extent of
any disease or the impact of any intervention in China,
epidemiological research must be done. Due to poor infection
control practices in China, GDD's IEIP and the National Center for
Tuberculosis Control and Prevention have sought to determine the
number of healthcare workers infected with tuberculosis (TB) in
highly drug-resistant TB areas. In addition, GDD's Influenza
Program and Chinese experts have developed models that will be
necessary to determine the true, and not just reported, number of
deaths due to influenza during a pandemic.

10. (U) GDD's activities have resulted in crucial positive
guideline and policy changes, which are critical to sustainably

BEIJING 00002814 003.2 OF 003

prevent illness and control disease. GDD and the U.S. CDC's
Influenza Division have developed clinical guidelines for treatment
of avian influenza cases. GDD's IEIP, Influenza Division and Health
Communications Program have helped develop a respiratory infection
control curriculum, which has been adapted by the MoH. Recently,
the MoH decided to disseminate this curriculum nationwide using its
own funds and mechanisms. GDD's IEIP has helped shape national TB
treatment guidelines, which have now been ratified and are being
disseminated this year.

EQUALLY IMPORTANT, GDD IN CHINA PRODUCES INTANGIBLE RESULTS

11. (U) Health diplomacy has been established. In addition to the
high-level commitment between U.S. HHS and MoH, prior Collaborative
Committee Meetings of U.S. HHS, U.S. CDC, MoH, and China CDC staffs
have engendered cooperation on multiple projects. Day-to-day work
and interactions between U.S. CDC and China CDC have created
opportunities for dialogue about multiple other issues, including
food safety and implementing WHO's International Health Regulations,
which are pressing issues for China.

12. (U) Partners have been created. Multiple long-term high level
exchanges of staff have occurred, including an eight-month exchange
of key emerging infectious disease staff from China CDC to U.S. CDC,
which helped not only to foster understanding between the two
agencies, but also to advance China CDC appreciation of the need to
use evidence to establish health policy and practices. Furthermore,
multiple meetings of project collaborators each week promote rapid
exchange of information and expertise. Epidemiological partnerships
have also been created through co-authorship on scientific papers.

13. (U) Joint collaborations continue. Multiple joint trainings,
workshops, and meetings have been convened, and U.S. CDC experts
consult regularly on influenza, salmonella, pneumonia, and other
public health issues.

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