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Cablegate: Israeli Compliance with the Berlin Declaration On

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RR RUEHWEB

DE RUEHTV #0250 0311438
ZNR UUUUU ZZH (CCY ADX54FBEA MSI3055-623)
R 311438Z JAN 08
FM AMEMBASSY TEL AVIV
TO RUEHC/SECSTATE WASHDC 5226
INFO RUEHJM/AMCONSUL JERUSALEM 8973
RUEHEG/AMEMBASSY CAIRO 1532
RUEHAM/AMEMBASSY AMMAN 3562

UNCLAS TEL AVIV 000250

SIPDIS

C O R R E C T E D C O P Y - - CHANGE REF(A),TEXT ADDED PARA 1, 6

SENSITIVE
SIPDIS

DEPT FOR EUR/PGI TESSLER AND OES/IHB LAURITZEN
CAIRO FOR ESTH
AMMAN FOR ESTH

E.O. 12958: N/A
TAGS: TBIO SENV WHO IS EG JO
SUBJECT: ISRAELI COMPLIANCE WITH THE BERLIN DECLARATION ON
TUBERCULOSIS

REF: A) 08 STATE 6989; B) 07 STATE 1228

1. (SBU) Summary. In response to Department inquiry (ref A), Israel
appears to implement a model DOTS program, and observes Berlin
Declaration commitments fully. The Ministry of Health (MOH) continues t
assess Israel's successful National Tuberculosis Control Program (NTP).
Israel is a signatory of the Berlin Declaration and WHO considers
Israel a success story in its ability to diagnose, treat and
follow up TB patients. While Israel has much it could
teach to other countries about managing TB through a strong public
health structure, the MOH Director of NTP is frustrated by
the lack of contact with his Egyptian counterparts. End Summary.

2. (U) Between 1989 and 1995, the absolute number of TB patients in
Israel nearly quadrupled, from 133 cases in 1989 to 500 cases in
1991. This was mainly due to mass immigration from high and
moderate TB-prevalent countries, namely from the Former Soviet Union
(FSU) and Ethiopia. During the early 90's, Israel was experiencing
the impact of having-along with many other countries during the
1980's-prematurely dismantled its TB treatment infrastructure. In
addition to a lack of health care workers experienced in managing TB
patients, laboratory services were not defined, suceptability
testing was not done routinely, drug supplies were erratic, and
second-line drugs to deal with TB drug resistant strains were
essentially nonexistent. Further fragmentation occurred as a result
of a decentralization of care from the MOH to four Israeli HMO's.

2. (SBU) In 1995, a new National Tuberculosis Program (NTP) was
recommended and then launched in April of 1997, ten years before the
signing of the Berlin Declaration on TB. The goal of the new
program was to locate the disease in Israel, reduce and eliminate
morbidity, and engage all health care workers in Israel in achieving
the task. The program incorporated the five elements of the
Directly Observed Treatment (DOTS) strategy recommended by WHO:

1) political commitment;
2) laboratory diagnostic facilities;
3) DOT of all patients;
4) a consistent drug supply; and
5) a permanent reporting system.

3. (U) The political will to implement the NTP was evidenced by
legal changes, new administrative directives and medical guidelines,
and the establishment and funding of a National TB Unit (the
Department of Tuberculosis and AIDS, known as DTA). The MOH chose
to limit TB treatment to nine designated centers using only 'DOT' to
ensure expertise and to allow concentration of resources. Two
national reference laboratories were selected to process all
specimens from patients followed at the TB centers, to assure
consistency of testing quality. This required some creativity
allowing for financial incentives to improve compliance.

4. (U) The DOT strategy in Israel is followed for the entire
duration of treatment, not just for the initial 2-month period as in
other countries. Limiting treatment to a few sites assures a larger
number of patients per physician, which in turn allows for the
accumulation of experience and motivation that helps treat difficult
patients (resistant TB cases-). The DTA has added a network of
social workers in an attempt to deal with such cases.

5. (SBU) A central supply agency delivers a regular supply of all TB
drugs, and the DTA maintains a reserve cache of all drugs to ensure
non-interruption of supplies. TO enhance case tracking, TB
notification to the MOH through District Health Offices was made
mandatory for both physicians and laboratories.

6. (SBU) In 1999, 86 percent of Israel's TB cases were of foreign
origin, both recently arrived and some from years earlier, including
a very small WWII Holocaust survivor group. In response to Deparmtne
inquiry (ref A), Israel appears to implement a model DOTS program, and
observes Berlin Declaration commitments fully. Israel appears to
implement a model DOTS program, and observes Berlin Declaration
commitments fully. Admittedly their outreach program to
other countries and international TB programs is weak;
however, MOH Director of International Relations, Alex Leventhal,
expressed readiness to share the GOI's experience with other
countries, and is willing to do so within its
financial capability. Currently, there is good
inter-regional cooperation on TB between Israel, the PA
and Jordan. He expressed continuing frustration with the
on-going lack of cooperation by his neighboring Egyptian
counterparts, which has also been expressed by the Public
Health Service with respect to Avian Influenza cooperation.

MORENO

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