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Cablegate: Nigeria's Plan On Avian Flu Still in Initial Stage

This record is a partial extract of the original cable. The full text of the original cable is not available.





E.O. 12958: N/A

REF A: State 206992 B: State 206588

1. (SBU) Summary. In February 2004, Nigeria held a
consultative forum on Avian Influenza (AI), and Nigerian
President Obasanjo is "very aware" of the threat AI poses to
Nigeria. The Ministry of Health (MOH), in late October 2005
issued the third draft of the government's AI Position
Paper. On November 14th, 2005, the MOH inaugurated the
Health Sector Technical and expert Committee on AI. The
expected outcome of the Committee is a Nigeria AI
Preparedness and Response Plan. Difficulties the MOH faces
include political will, a lack of resources, Nigeria's poor
health and communications networks, and the country's loose
control over its borders. For these reasons the effects of
an AI outbreak in Nigeria could be catastrophic. End

2. (U) Nigeria has discussed since February 2004 making
preparations against AI. Nigerian President Obasanjo, who
owns a large chicken farm, is "very aware" of the threat AI
poses to Nigeria, and senior policymakers in Nigeria seem to
be aware of AI's potential implications, according to USAID
Nigeria. In February 2004, Obasanjo established a committee
of experts to come up with strategies to contain an AI
epidemic. The Department of Livestock, Ministry of
Agriculture, convened a consultative forum of experts on AI
on February 19, 2004.

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3. (U) After this forum, the Ministry of Health (MOH), the
Ministry of Agriculture, and other Nigerian entities began
to prepare for an AI pandemic. The MOH says it has
established a laboratory working group and an experts
committee composed of virologists, epidemiologists,
veterinary doctors, and clinicians under the MOH's
coordination. Nigeria has developed its evolving AI
national preparedness plan with guidance from the World
Health Organization (WHO) and the UN Food and Agriculture
Organization (FAO). The WHO is very involved in assisting
Nigeria's AI preparations, according to USAID/Nigeria.

4. (U) Nigeria's Minister of State for Health, its chief
epidemiologist (who is the focal point for AI in the MOH and
for the Nigerian Government), and representatives of the
Ministry of Agriculture could not attend the October 6-7
meeting of the International Partnership on Avian and
Pandemic Influenza (IPAPI), in Washington, D.C. These
officials, however, did attend the October AI ministerial in
Ottawa, Canada, to further refine Nigeria's national plan on
AI. While the MOH could not send a representative to the
IPAPI meeting, Nigerian officials participated representing
Nigeria's chairmanship of the African Union.

Third Draft of Policy Paper Sets Out the Plan

5. (U) The GON, led by the MOH, issued in late October 2005
the third draft of a position paper, "Global Cooperation for
Pandemic Influenza Preparedness." Though this paper says
coordination for combating an AI pandemic "rests squarely on
the shoulders" of the MOH, the Ministry of Agriculture will
also be putting together a separate plan, comprehensively
detailing the animal containment strategy of AI. This
committee is yet to be convened or inaugurated. It is
planned that the two plans (MOH and MOA) will be integrated
at a high level Ministerial Committee level which is to be
chaired by the Minister of Health, but is yet to be
inaugurated. According to the position paper, the GON will
employ an "all-inclusive communication and community
mobilization strategy involving civil society, NGOs, private
sector, and leveraging the resources of multinational oil,
communications conglomerates and the banks." Nigeria
intends to carry out simulations and exercises in strategic
locations across the country. "All relevant data will be
collected, collated, and analyzed using available
epidemiological and statistical software and tools."

But Significant, Wide-Ranging Difficulties Exist
--------------------------------------------- ----

6. (SBU) According to the Position Paper, the GON plans to
adopt a system for "electronic notification, e-surveillance,
or e-avian flu system to provide real-time information
exchange about new cases of avian influenza. Cross-border
health officials will be empowered to carry out clinical
examinations, and a "compulsory notification system" with
neighboring countries will be established. The GON's budget
for all of these activities, however, remains "to be worked
out." (Comment: These monitoring and communications goals
are far-fetched in a country lacking stable electric power,
functioning telephone and cellular phone networks, with
limited Internet connectivity. Many GON officials' offices
lack telephones, fax machines, Internet access, or all of
these. As for the MOH, its Web site is very basic and
permits only nine ministry officials to be contacted by e-
mail - and only at accounts administered by Hotmail or Yahoo
rather than the GON itself. End comment.)

7. (U) The MOH correctly notes the constraints it faces in
preparing for an AI pandemic: political will and the
political climate, including nationwide elections in 2007;
scarce financial resources and competition from priority
programs such as HIV/AIDS, polio, tuberculosis, and malaria;
Nigeria's "fragile" health system, including weak
surveillance and notification, poor logistics and
communications support to health-services delivery, and weak
laboratory field support; the health sector's "poorly
motivated" work force; and government officials' limited
access to information technology. The MOH acknowledges
Nigeria has porous borders with weak controls on the
movement of goods and people.

8. (U) Nigeria established a senior Technical and Expert
Committee on AI on November 14, 2005. It includes the
Ministry of Agriculture, the MOH, the Poultry Association of
Nigeria, the Veterinary and Medical Associations of Nigeria,
the WHO, university epidemiologists, WHO, UNICEF, the
Canadian International Development Agency, and
USAID/Nigeria. USAID/Nigeria will suggest that the committee
add the Ministry of Transport and civil-society groups from
both the human-health and animal sectors. USAID already has
encouraged the inclusion of Nigeria's private sector -
particularly oil and gas companies.

AI Plan To Build on Existing Structures

9. (SBU) Nigeria has an overall Integrated and Disease
Surveillance and Response Strategy for infectious disease,
but this network is patchy. The system reportedly tracks 21
priority diseases in Nigeria and was developed by the WHO,
which ostensibly oversees this system through the WHO's
technical leadership. The GON plan includes surveillance
activities for AI at the state level. Monthly state
surveillance meetings are held currently, and the MOH
anticipates using these meetings to train surveillance
officers on how to identify potential outbreaks of AI. The
MOH will base its surveillance system for AI on the
framework and strategies developed in 2003, when a suspected
case of severe acute respiratory syndrome (SARS) Nigeria's
teaching hospitals and port health services were mobilized,
and isolation centers and treatment facilities were
established, with one quarantine center opened in Lagos and
one in the country's north, in Kano.

Laboratories and Containment Measures Are Lacking
--------------------------------------------- ----

10. (SBU) Nigeria has some capacity to rapidly collect,
store, and transport samples of suspected animal and human
cases to the country's three reference and six zonal
laboratories. According to USAID Abuja, however, outside
donors would have to provide the GON significant support in
this area, given Nigeria's large size and extremely poor
transportation infrastructure. Nigeria does not receive any
donor assistance for AI, and the GON does not yet have
mechanisms for receiving AI donor assistance.

11. (SBU) Nigeria is not able to quickly mobilize effective
containment measures in response to outbreaks of AI among
animals. Given Nigeria's very weak health system and health
infrastructure, significant technical and financial support
will be required. The GON has discussed reimbursing farmers
whose infected animals or poultry must be destroyed, but it
has not adopted such a plan and no funding is likely to
identified. The GON currently does not employ vaccination as
a containment measure for animal infections. Although the
GON reports it has a plan for the early procurement and
stocking of Tamiflu vaccine, it is not clear what entity,
whether Nigerian or foreign, would fund Tamiflu purchases.

12. The plan identifies the need to establish a legal
framework as a basis for preventive and control measures. It
further notes the need to enforce existing public health
laws, and international health regulations and foresees the
possible invocation of quarantines and need to develop
disease prevention ordinances and to add avian flu
surveillance to the list of diseases covered by the national
network. The Plan makes no mention of coordinating with law
enforcement agencies or the military to carry out quarantine
or other control measures.

AI Public-Education Program Not Established

13. (SBU) The GON does not have a clear strategy to educate
the Nigerian public about AI, including case recognition,
prevention, risk behavior, or caring for persons infected.
While Nigerian national radio and television recently have
carried some news reports on the implications for Africa of
AI, there is a need for additional dissemination of
information on AI to increase public awareness. Embassy
Abuja's staff on November 8 in Abuja attended an AI lecture
for the general public given by Dr. L.H. Lombin, executive
director of the National Veterinary Research Institute in
Vom. Lombin was clear the GON must devote substantial
resources to prepare for AI.


14. (SBU) There is little reason to believe the GON's
response to the advent of AI would be effective - largely
because of the shortcomings noted by the MOH. As is the
case with most GON programs, funding for Nigeria's AI
effort, and the GON's ability to carry out programs, are the
weak links. Should cases of AI make their way to Nigeria,
the West African sub-region will be woefully ill-prepared to
contain the pandemic. Because of this, significant
resources - both technical and financial - would be required
to make even a marginal effort to limit fatalities. Nigeria
is not likely to provide these resources.

15. (SBU) Even if the GON developed a comprehensive national
AI plan, it is unlikely that Nigeria would be able to mount
an effective public-health response to an outbreak of AI
among humans, given the country's extremely deficient health-
care infrastructure, weak government, and ineffective
professional bureaucracies. Nigeria has a very limited
surge capacity to properly diagnose, manage, or treat
patients or to protect health workers in the case of an AI
pandemic. Though law enforcement and military bodies are not
yet engaged in planning, in the case of an outbreak, the
military would be likely to assume some kind of role in the

16. (SBU) Because of AI's high mortality rate, the effects
of its arrival in Nigeria could be horrific in this country
whose population may be as high as 150 million people. More
than 70% of the population is under stress from extreme
poverty, poor nutrition, HIV/AIDS, malaria and other endemic
diseases. With Nigerian life expectancy at a mere 44 years,
AI's effects in a country with barely functioning government
institutions could be catastrophic. As the most populous
state in Africa, and with one of the continent's weakest
health infrastructures, Nigeria could, as is the case with
other diseases such as malaria, polio, HIV/AIDS, and
tuberculosis, bear the brunt of West Africa's mortality
should AI make its way to this country.

17. (SBU) The U.S. Mission's most appropriate role, as led
by USAID/Nigeria on this issue, will be to focus efforts on
AI by taking an active role in Nigeria's Action Planning
Committee; by urging the addition of key organizations,
including from the private sector, to the Action Planning
Committee and by facilitating the engagement of civil-
society groups. The greatest assistance foreign donors
could provide would be to improve Nigeria's AI preparedness,
with technical assistance and funding, to mount an effective
response under the technical leadership of the FAO, the WHO,
and other key donors. Ultimately, however, it is the GON
itself that must carry out effectively these activities.

18. (SBU) The U.S. Mission will continue to monitor the
GON's progress in preparing to combat AI in Nigeria. The
Embassy EAC met on November 14 to begin discussion of
formulating tripwires and Mission responses. The Lagos EAC
will hold a similar meeting. FUREY

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