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Cablegate: Meeting Between Ambassador Scobey and Minister of Health

VZCZCXYZ0000
RR RUEHWEB

DE RUEHEG #1524/01 1991319
ZNR UUUUU ZZH
R 171319Z JUL 08
FM AMEMBASSY CAIRO
TO SECSTATE WASHDC 9870

UNCLAS CAIRO 001524

SENSITIVE

SIPDIS

STATE FOR NEA/ELA
STATE FOR AIWG (WINN)
USAID FOR ME/MEA/MCCLOUD

E.O. 12958: N/A
TAGS: ECON EAID EAGR PGOV TBIO KIPR KSCA KFLU KWMN EG
SUBJECT: MEETING BETWEEN AMBASSADOR SCOBEY AND MINISTER OF HEALTH
AND POPULATION HATEM EL GABALY

REF: CAIRO 413

1. (SBU) Summary: Ambassador Scobey paid an introductory call on
Minister of Health and Population Hatem El Gabaly on June 29.
Discussion centered on ongoing health sector reform, graduate level
training for ministry staff in US and by U.S. universities in Egypt,
pharmaceutical intellectual property rights, follow up on the
National Population Conference, October visit by Secretary of Health
and Human Services Leavitt, and avian influenza. Minister El Gabaly
is a reformer and advocate of partnership with the US. He faces
significant challenges in tackling Egypt's woefully inadequate and
mismanaged health care system. The Ambassador was struck by El
Gabaly's failure to recognize the link between education for girls
and fertility rates, and to address this in the GOE's revived
population program. USAID will look for opportunities to update his
expertise in this area. EL Gabaly has invited Secretary Leavitt to
Egypt in October when Egypt is hosting the International Conference
on Avian and Pandemic Influenza; it is our understanding that
Secretary Leavitt plans to make the trip. End Summary.

2. (U) Ambassador called on Minister of Health and Population Dr.
Hatem El Gabaly on June 29, accompanied by USAID health officer.
Appointed in the 2006 cabinet reshuffle, El Gabaly is engaged in a
major effort to reform the health sector. He is an advocate of
partnership with the United States and has on many public occasions
recognized the superiority of graduate level education at US
universities and the global example the U.S. sets with its strong
work ethic.

HEALTH SECTOR REFORM
--------------------

3. (U) El Gabaly recognizes the need for continued GOE efforts to
reform the health sector, despite extensive public criticism and
negative media coverage. Given the high profile of education and
health, he acknowledged that public resistance and criticism are
posing a significant challenge, but that patience and continuing to
provide accurate information about the reforms are key. The
minister highlighted the need for social health insurance, given
high out of pocket expenses for healthcare. El Gabaly estimated
10-12 million Egyptians are at risk of sinking into poverty should
they experience a major medical condition. He said his ministry is
making some progress; the Ministry of Finance is doing actuarial
studies needed to underwrite the proposed social health insurance
from general revenues.

MANAGEMENT DEFICIT
------------------

4. (U) To address what he sees as a crippling lack of management
capacity at his ministry, El Gabaly is proposing the creation of a
"Leadership Academy." USAID is putting together a public-private
partnership between the pharmaceutical industry (PhRMA) and Harvard
University, which will provide the Egypt-based training. El Gabaly
is pleased with the progress of the seven ministry staffers now in
the US in USAID-funded MBA programs, and said nine more will go this
fall.

INTELLECTUAL PROPERTY RIGHTS
----------------------------

5. (U) El Gabaly discussed the ongoing work on IPR issues. In
response to a question on data exclusivity and length of
registration process, he described procedural changes at the
ministry. The minister said the 2006 ministerial decree governing
this process had substantially reduced the timeline for product
registration. He explained that many delays resulted from incomplete
files and the new website will ensure transparency in the process.
El Gabaly was surprised to hear that pharmaceutical companies are
still concerned about unnecessary delays in the registration
process, and said he had not heard any official complaints.

6. (SBU) COMMENT: El Gabaly's claim to be surprised by complaints
about registration delays is disingenuous; he has personally
acknowledged in the past that the ministry's new expedited approval
process is not working as intended. However, it is possible that
pharmaceutical companies' recent complaints have not percolated up
through the Ministry's bureaucracy. We will follow up with El
Gabaly to ensure he has the latest information on our continuing
concerns about registration delays. End comment.

7. (U) With the start of production by multinationals for Egypt's
generic market, El Gabaly expects that generics will take a larger
market share. He said that national expenditures on generics are
currently USD 2.1 billion, but the figure is expected to reach USD 5
billion by 2015. The projected increase, he said, should result
from higher GOE health expenditures, more awareness of treatment

options, and an aging population with greater pharmaceutical
requirements.

POPULATION PRESSURES
--------------------

8. (SBU) The Ambassador asked El Gabaly about President Mubarak's
recent remarks at the June 9-10 National Population Conference, in
which he called on Egyptians to have fewer children (See septel).
El Gabaly noted that Egypt's family planning program has stagnated
during the last five to seven years. Given the impact of a rapidly
growing population on economic development, infrastructure, water
use and land requirements, the GOE has decided to reinvigorate its
campaign to promote healthy family size. According to the minister,
the single most important factor for smaller families is addressing
the issue of "male dominance," adding that "the mind set of the male
must be addressed." He dismissed the impact of girls' education on
fertility. Comment: We are concerned about El Gabaly's dated
analysis of the impact of education for women on fertility rates.
USAID will seek opportunities to update his expertise, and that of
his ministry. End Comment.

AVIAN INFLUENZA AND THE IPAPI CONFERENCE
----------------------------------------

9. (U) El Gabaly reviewed positive results of Egypt's program to
combat avian influenza, and acknowledged U.S. contributions. In
planning for the October International Conference on Avian and
Pandemic Influenza, organized in collaboration with the
International Partnership on Avian and Pandemic Influenza, to be
held in Sharm el-Sheikh, El Gabaly is worried about "flu fatigue."
To combat this, El Gabaly would like a big name speaker for the
conference, citing, for example, Bill Gates as someone who might
draw international attention to the continuing problem of avian
influenza.

10. (SBU) Note: The minister raised the "flu fatigue" issue with
Ambassador Lange on June 8, repeating his request for assistance
with identification of a high profile speaker for the conference.
El Gabaly also discussed the conference with Health and Human
Services Secretary Leavitt at the World Health Assembly in May. At
that time, El Gabaly invited Secretary Leavitt to visit Egypt. It
is our understanding that Secretary Leavitt plans to attend the
conference in October, followed by visits to avian influenza-related
sites.
SCOBEY

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