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Cablegate: Guangdong's Ai Strategy: Expanding Vaccination And

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R 280751Z JAN 08
FM AMCONSUL GUANGZHOU
TO RUEHC/SECSTATE WASHDC 6826
INFO RUEHOO/CHINA POSTS COLLECTIVE
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RUEKJCS/SECDEF WASHINGTON DC//USDP/ISA/AP//
RUEKJCS/CJCS WASHINGTON DC//J2/J3/J5//
RHHMUNA/CDR USPACOM HONOLULU HI//J00/J2/J3/J5//
RUEORDA/DIRAFMIC FT DETRICK MD//MA-1A//

UNCLAS SECTION 01 OF 03 GUANGZHOU 000047

SIPDIS

SENSITIVE
SIPDIS

STATE FOR EAP/CM, CA/OCS/ACS/EAP, AIAG, OES/IHA, MED
STATE PASS TO USAID FOR ANE AND GH
CDC FOR OGHA AND DIV-FLU
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP
HHS PASS TO FIC/NIH
USDA PASS TO APHIS, FAS (OSTA AND OCRA), FSIS
BANGKOK FOR RMO, CDC, USAID
BEIJING FOR HHS HEALTH ATTACHE AND RMO
PHNOM PENH FOR CDC INFLUENZA COORDINATOR
VIENTIANE FOR CDC INFLUENZA COORDINATOR

E.O. 12958: N/A
TAGS: TBIO AMED AMGT CASC EAGR PINR KFLU CH
SUBJECT: Guangdong's AI Strategy: Expanding Vaccination and
Enhancing Surveillance

REF: A. Guangzhou 1048; B. Guangzhou 1070; C. Guangzhou 1075; D.
Guangzhou 1279; E. Beijing 7401; F. Beijing 7567; G. Guangzhou 0043

1. (U) Summary: As part of its five-point AI prevention strategy
(Ref G), Guangdong is implementing a compulsory vaccination program
which aims for 100 percent coverage of domestic poultry.
Significant resources and manpower have been invested in this
prevention strategy and to strengthening the testing and
surveillance regime, but challenges remain, given the remoteness of
many rural farms, the inability of ducklings to develop antibodies
if vaccinated too soon and the quality control necessary for
ensuring that vaccines are used prior to their expiry date. End
Summary.

-------------------------------------
More than Just an Ounce of Prevention
-------------------------------------

2. (U) Following the 2004 H5N1 AI outbreaks, Guangdong implemented a
compulsory vaccination program. This program, which calls for
scheduled vaccinations, is more stringent than the national
vaccination strategy which only requires emergency vaccinations in
the event of an outbreak, as well as rapid culling. The program is
headed by the provincial Veterinary Center for Epidemic Prevention
and Control (VCEPC), a component of the Department of Agriculture.
Under this vaccination program, all farm-raised poultry, including
broilers and breeders, will receive at least one vaccination before
being sold in the market. Breeders with a longer production cycle
will receive two or possibly three vaccinations in order to maintain
a healthy level of immunity. In 2006, Guangdong VCEPC administered
1.5 billion doses of H5N1 vaccines to a poultry population of 1.35
billion, and claimed that the province achieved a 100% vaccination
rate, based on the dose-to-poultry population ratio.

3. (SBU) Thus far, Guangdong's provincial government has invested
RMB 150 million (approx. USD 21.5 million) in its vaccination
program, which is estimated to cost RMB 400-500 million (approx. USD
57-71 million) a year. According to YU Yedong, Director of the
Guangdong VCEPC, the provincial, municipal and district governments
pay for 80% of the total cost, with the remainder subsidized by the
central government. In contrast to Guangdong, other provinces with
more limited resources normally receive a larger central government
subsidy.

---------------------------
Vaccine Efficacy is the Key
---------------------------

4. (SBU) Under its current program, Guangdong province administers a
recombinant inactivated H5N1 vaccine (extracted from chicken eggs)
to farm-raised poultry. The current vaccine targets the H5N1 virus
of the 1996 Guangdong strain. The same H5N1 vaccine is also widely
used in other parts of China and purchased by Vietnamese
authorities. YU told us the Guangdong vaccine has proven to be
effective in protecting all poultry if given sufficient time to
develop immune response. Thus far, there have been no indications
that the H5N1 virus circulated in Guangdong has mutated in a way
that would render the current vaccine ineffective. Previously, an
H5N2 vaccine and a Newcastle Disease Virus-H5N1 (ND-H5N1) vaccine
were used in Guangdong; however, YU revealed that these vaccines are
now less effective and no longer used.

--------------------------------------------- ---
Controlled Vaccine Manufacturing and Procurement
--------------------------------------------- ---

5. (U) Vaccines administered as part of the AI vaccination program
adhere to stringent supply controls. For example, vaccines are only

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procured from seven Chinese Ministry of Agriculture-approved H5N1
vaccine manufacturers, two of which are located in Guangdong
province. Guangdong Department of Agriculture uses vaccines from
three of the seven approved locations, Harbin Veterinary Research
Institute, Zhaoqing Dahuanong Biological Medicine Company, and
Guangdong Yongshun Bio-pharm Company Ltd. This strategy safeguards
against shortages and production or storage failure.

6. (U) Under Guangdong's AI vaccination program, the government pays
for the procurement, storage, distribution, and administration of
the vaccines. Veterinary vaccine supply stations, scattered
throughout the province, maintain cold chain supplies. In
constructing this distribution infrastructure, Guangdong provincial
government invested RMB 20 million (USD 2.8 million), which included
importing mobile storage units from the United States. In general,
large poultry farms obtain their AI vaccines from these supply
stations and employ their own veterinary technicians to administer
the vaccines. In the countryside, government-trained grassroots
workers administer vaccines for small-scale poultry farmers.
Distributing and administering vaccines prior to their expiration
date remains a constant challenge.

7. (U) AI vaccines are regulated under the national laws for
"Management Methods in Business with Veterinary Bioproducts",
"Animal Epidemic Prevention Law", and the "Regulations on
Administration of Veterinary Drugs". AI vaccine production must
comply with the requirements of the Good Manufacturing Practice
(GMP) standards for animal vaccines, regulated by China Institute of
Veterinary Drug Control (CIVDC) under the Ministry of Agriculture.
Each production batch must meet the criteria established by CIVDC
for H5N1 vaccine and pass inspection for safety and efficacy. The
Guangdong Department of Agriculture and the Veterinary Drug
Inspection Department of the Ministry of Agriculture (Beijing)
station inspectors in vaccine factories to monitor the production
and product release processes.

--------------------------------------------- ---
Enhancing Veterinary Monitoring and Surveillance
--------------------------------------------- ---

8. (SBU) Approximately 20,000 certified animal disease prevention
and treatment workers provide technical support and vaccinations in
village areas. These grassroots workers, subsidized by the
government, are trained by the provincial Department of Agriculture
to administer vaccines and issue vaccination records. They also
check vaccination records and monitor possible AI virus mutation
precursors or outbreaks. In addition, technicians collect both
routine and unscheduled samples of poultry serum and swabs for
testing. The standard methods and reference reagents for performing
the tests are provided by the National AI Reference Lab (Harbin
Veterinary Research Institute). Yu Yedong, Director of the
Guangdong VCEPC, told us that these reagent standards and test
methods comply with guidelines set by the International Organization
for Animal Health (OIE). As of November, authorities tested 108,000
poultry serum samples and 19,000 swab samples in 2007 alone. In
addition, 13 batches of 'surprise' poultry checks have been
conducted to ensure that poultry producers are in compliance with
vaccination regulations and that vaccination records are accurate.


-------------------------------------
Challenges - Vast Scale and Ducklings
-------------------------------------

9. (SBU) Guangdong has a large poultry industry and a high
poultry-to-human density ratio of approximately 15:1. Of the 1.35
billion poultry produced in 2007, 30-35% of them were raised in
rural and remote areas rather than on industrial poultry farms.

GUANGZHOU 00000047 003 OF 003


These small-scale farms pose a significant challenge to achieving
the "100% vaccination" goal. YU mentioned that an electronic
information system similar to the framework of the U.S. National
Animal Information System (NAIS) for animal premises registration,
identification (including vaccination records), movement and disease
tracing, is being considered for poultry. A similar pilot program
was just recently initiated for large farm animals, including
cattle, pigs, sheep, and goats; it is unclear when the pilot program
might be expanded to poultry.

10. (U) Successful vaccination among ducks, the source of the
September 2007 outbreak, remains a great concern (Ref A). In
general, ducks are farm-raised for 40 days before being sold on the
market. Sufficient protective antibodies can normally be attained
20 days after vaccination with the current H5N1 vaccine. Ducklings
under 20 days of age do not respond with sufficient protective
antibodies if given the vaccine too early. Thus, vaccination in
ducks remains the weakest link in this program unless an improved
vaccine that could mount a much more efficient immune response in
ducks can be deployed.

GOLDBERG

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