Cablegate: Bahrain: Avian and Pandemic Influenza Information

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

201339Z Dec 05

UNCLAS MANAMA 001874

SIPDIS

STATE FOR OES/DSINGER AND RDALEY, NEA/ARPI

E.O. 12958: N/A
TAGS: TBIO SENV ECON EAGR EAID PREL BA ECTRD ROW
SUBJECT: BAHRAIN: AVIAN AND PANDEMIC INFLUENZA INFORMATION

REF: A. SIMPSON-DALEY E-MAIL OF NOVEMBER 30

B. STATE 209622
C. MANAMA 1605

This cable responds to Ref B questions regarding local avian
influenza and pandemic influenza preparedness.

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PREPAREDNESS AND COMMUNICATION
------------------------------

Q: DOES THE GOVERNMENT HAVE A PREPAREDNESS PLAN/STRATEGY FOR
PREVENTING AVIAN FLU FROM BECOMING A PANDEMIC AND
CONTAINING A PANDEMIC ONCE IT OCCURS?

A: Bahrain lies in the autumnal migratory path for birds from
infected Asian regions and expects to confront cases of avian
influenza bird infection. The GOB is deploying elements of a
robust precautionary program (Ref. B), including restrictions
on bird importation and inoculations of farm bird
populations. In addition, the GOB has crafted a
comprehensive national strategy to be approved and
implemented by a committee headed by Undersecretary of
Agriculture Affairs Kadhem Hashim Al Hashimi and composed of
officials from the Ministries of Agriculture, Health,
Interior, and Industry and Commerce. The government has thus
far allocated BD 448 thousand (approximately $1.2 million) to
combat Bird Flu and other animal diseases.

Q: IF THE COUNTRY HAS A STRATEGY, HOW CAPABLE IS IT OF
IMPLEMENTING IT?

A: Bahrain is well situated to implement many precautionary
aspects of its program at a pre-pandemic stage. Although the
draft strategy has yet to be approved, several key elements
have already been implemented. The Ministry of Agriculture
has dispatched teams to inoculate farm poultry. It says it
has already administered some 800,000 doses of H9N2 vaccine
of the planned four million doses set to be administered to
the nation's poultry stock, farms are being disinfected, and
the importation of birds has been restricted.

Q: PLEASE PROVIDE A COPY OF THE PLAN OR THE INTERNET ADDRESS
FOR THE PLAN.

A: Post provided an advance draft of the plan on November 30
(Ref A). The GoB has not yet established an avian influenza
website, though officials plan to do so in the near future.

Q: HOW TRUTHFUL WILL THE GOVERNMENT BE IN REPORTING THE SCOPE
OF ANY DISEASE OUTBREAK AMONG PEOPLE AND/OR ANIMALS

A: Post believes that Ministry of Health officials have been
and will continue to be truthful in government-to-government
contacts. Post's Avian Influenza Working Group assesses that
there is some potential for the GOB to minimize public
reporting of an outbreak if the scope were sufficient to lead
to an erosion of public confidence. The greater danger would
be that cases might not be diagnosed in a timely manner.
(See Surveillance/ Detection below.)

Q: WHAT INCENTIVES COULD BE OFFERED THAT WOULD LIKELY RESULT
IN MORE TRANSPARENCY?

A: Post will maintain working-level contact with Ministry of
Health interlocutors to promote continued information access
and exchange. To encourage public openness, the GOB has
announced that it will establish a fund to compensate poultry
farmers whose birds are culled as the result of an outbreak.
This should help mitigate any economic disincentive to
identify and report symptomatic birds.

Q: WHERE DOES PREPARING FOR AN AVIAN FLU HUMAN PANDEMIC RANK
AMONG GOVERNMENT PRIORITIES? WHO AND WHAT WOULD MOST
INFLUENCE THE COUNTRY TO GIVE THE ISSUE A HIGHER PRIORITY?

A: Because the GOB expects to see cases of avian influenza,
it has taken the need to prepare quite seriously and the
Prime Minister has explicitly stated that avian flu
preparation ranks among the highest national priorities. GOB
planning and preparations are also being developed in
coordination with the GCC. Given its existing resources,
Post assesses that the current level of priority assigned to
the avian influenza threat is appropriate.

Q: WHO IS THE KEY "GO-TO" PERSON, OFFICE OR DEPARTMENT (I.E.
MINISTER FOR HEALTH, PRIME MINISTER, ETC.) FOR USG OFFICIALS
TO ENGAGE ON THIS ISSUE?

A: Ministry of Health Director of Public Health Dr. Samir
Khalfan.

Q: HAVE NATIONAL LAWS BEEN REVIEWED TO ENSURE THAT THEY ARE

CONSISTENT WITH INTERNATIONAL HEALTH REGULATIONS AND DO NOT
POSE BARRIERS TO AVIAN INFLUENZA DETECTION, REPORTING,
CONTAINMENT, OR RESPONSE?

A: The GOB has modeled its national strategy on WHO
guidelines and has specifically evaluated its national laws
with respect to the handling and disposal of infectious
waste.

Q: IS THE HOST COUNTRY ALREADY WORKING WITH INTERNATIONAL
ORGANIZATIONS OR OTHER COUNTRIES ON THE AVIAN FLU ISSUE?

A: The GOB is currently coordinating with the GCC and the WHO.

Q: ARE GOVERNMENT LEADERS LIKELY TO ASK FOR ASSISTANCE FROM
THE US OR OTHER COUNTRIES?

A: They have already done so. The Ministry of Health has
requested USG information on currently available H5N1
vaccines for birds, including the advisability of the use of
live-attenuated vaccine.

Q: WOULD GOVERNMENT LEADERS BE RECEPTIVE TO MESSAGES FROM US
LEADERS THROUGH A BILATERAL APPROACH, AT A MULTILATERAL FORUM
SUCH AS THE UN WHO, FAO, ETC OR APEC, OR THROUGH BILATERAL
CONTACTS BY A THIRD COUNTRY?

A: GOB leaders are receptive to US messages, in particular on
the subject of avian influenza. The Ambassador and Emboffs
have engaged GOB officials on avian influenza preparedness on
several recent occasions and have found them highly
receptive. Minster of Health Dr. Nada Abbas Haffadh told the
Ambassador November 27 that she welcomed future collaboration
with USG officials on this topic. Multilateral cooperation
with the WHO and the GCC is also in evidence. The US-GOB
relationship is such that it would not be necessary to
solicit third country intervention. The GOB consults closely
with the UK on a range of issues. The draft Master Plan for
Confronting Avian Influenza was drawn up with substantial
assistance from UK experts under WHO auspices.

Q: DOES THE COUNTRY CURRENTLY ADMINISTER ANNUAL FLU SHOTS?

A: Seasonal flu shots are currently available at public and
private hospitals for patients who seek them. With the
exception of poultry workers, the GOB does not have a
campaign in place to proactively immunize its population
against seasonal flu.

Q: IF NOT, MIGHT IT CONSIDER DOING SO?

A: The GOB has considered and rejected any change to its
standard practice on this question, believing its resources
are better directed to other preventive aspects of its plan.

Q: WHAT IS THE PRODUCTION CAPABILITY FOR ANNUAL TRIVALENT FLU
VACCINE?

A: Bahrain does not produce annual trivalent flu vaccine. It
is currently imported from Malaysia.

Q: DOES THE COUNTRY PRODUCE INFLUENZA VACCINE FOR POULTRY?

A: Bahrain does not produce poultry vaccine. It is currently
imported from Holland.

Q: IS THERE A LIABILITY SHIELD FOR FOREIGN MAKERS/DONORS OF
VACCINES?

A: No.

Q: IF NOT, ANY PROSPECTS OF ONE BEING ENACTED?

A: At present, the GOB has not proposed such legislation.
Unless it were to appear necessary as a condition for
obtaining needed vaccine, such a measure is unlikely.

Q: HOW WELL INFORMED IS THE POPULATION ABOUT THE AVIAN FLU
THREAT AND ABOUT MEASURES THEY SHOULD TAKE TO MITIGATE THE
THREAT?

A: Much of the information currently available to the public
from press and official sources focuses on publicizing
precautionary measures being undertaken by the GOB. There is
also an emphasis on advice for detecting symptoms in birds,
e.g., production of soft-shelled eggs, hemorrhaging under the
skin, etc. Preventative measures such as hand-washing are
still under-emphasized at present.

Q: WHAT MECHANISMS ARE AVAILABLE FOR PROVIDING ADDITIONAL
INFORMATION TO THE POPULATION, PARTICULARLY IN
RURAL AREAS, AND HOW EFFECTIVE ARE THESE MEASURES?

A: The GOB initiated a fresh public awareness campaign
December 5 to better educate its citizens on the nature of
the threat. Officials are addressing students at schools and
colleges and distributing leaflets in public places in
support of the effort. The GOB has established a citizen
hotline to answer questions regarding avian influenza and
reports that after an initial rush, call volume has declined.

----------------------
SURVEILLANCE/DETECTION
----------------------

Q: HOW CAPABLE ARE THE MEDICAL AND AGRICULTURE SECTORS IN
DETECTING A NEW STRAIN OF INFLUENZA AMONG ANIMALS OR PEOPLE
RESPECTIVELY?

A: The Ministry of Agriculture has begun testing for Bird Flu
at farms throughout the country on a continuous basis. The
Ministry of Health is reportedly ramping up its facilities to
be able to test humans for Bird Flu.

Q: HOW LONG MIGHT IT TAKE FOR CASES TO BE PROPERLY DIAGNOSED?

A: Ministry of Health officials advise that their current
laboratory tests would diagnose avian influenza within 36
hours. A test for the virus would be administered to any
patient displaying symptoms consistent with avian influenza
and who reported having exposure to poultry livestock within
the past 10 days.

Q: CAN INFLUENZA VIRUSES BE SUBTYPED IN THE COUNTRY?

A: Yes

Q: IF SO BY WHOM?

A: The Ministry of Health has adopted an Integrated Capacity
Development Program for laboratory specialists with direction
from the WHO. The Ministry of Health has recently acquired
laboratory equipment allowing local subtyping.

Q: DOES THE COUNTRY SEND SAMPLES TO A WHO/EU/US REFERENCE
LABORATORY?

A: In the event of an avian influenza outbreak in Bahrain,
samples will be sent to the WHO.

Q: WHAT ARE THE CRITICAL GAPS THAT NEED TO BE FILLED IN ORDER
TO ENHANCE THE COUNTRY'S DISEASE DETECTION AND OUTBREAK
RESPONSE CAPABILITIES?

A: MED Emboff, who has worked in Manama for many years as a
health practitioner, evaluates that the GOB real world
ability to detect new influenza strains is limited. Emboff
cautions that in the past, limitations of personnel,
expertise and technology have limited the Ministry of
Health's ability to implement plans as laid out on paper.
Emboff observes that one important medical facility, the
Salmaniya Hospital complex, is already straining to meet
current demand, with insufficient beds or staff to meet daily
needs. However, local private hospitals currently have
excess capacity and could absorb some increased activity.

Q: WHAT IS THE COUNTRY'S GREATEST NEED IN THIS AREA FROM THE
US OR INTERNATIONAL ORGANIZATIONS?

A: Assistance in acquiring more fast-reacting diagnosis kits
would be useful. Though some Tamiflu capsules are expected
to arrive soon, the GOB has expressed apprehension that
ordered supplies may not materialize. In that event,
officials have requested US assistance in identifying
alternative licensed sources of the oseltamivir phosphate
antiviral (Tamiflu). See Response Containment below.

--------------------
RESPONSE/CONTAINMENT
--------------------

Q: DOES THE COUNTRY HAVE A STOCKPILE OF MEDICATIONS,
PARTICULARLY OF ANTIVIRALS, AND IF SO HOW MUCH?

A: Bahrain presently has no antiviral stockpiles, but expects
delivery of one million capsules of adult dosage Tamiflu and
500 thousand capsules of child dose Tamiflu in coming days.

Q: IF SOME HAS BEEN ORDERED, HOW MUCH AND WHEN IS IT EXPECTED?

A: Additional capsules have been ordered but are not expected
to be delivered until February 2006.

Q: DOES THE COUNTRY HAVE A STOCKPILE OF PRE-POSITIONED
PERSONAL PROTECTIVE GEAR?

A: Bahrain does have a stockpile of disposable N-95
respirator face pieces, face shields, goggles, and disposable
blood pressure cuffs.

Q: WHAT IS THE RAPID RESPONSE CAPACITY FOR ANIMAL AND HUMAN
OUTBREAKS?

A: In conjunction with its Integrated Capacity Development
Program, Bahrain is currently working to enhance the
expertise of key laboratory personnel to quickly identify
emerging subtypes, including biosecure facilities.

Q: ARE GUIDELINES IN PLACE FOR THE CULLING AND VACCINATION OF
BIRDS, DISINFECTION OF FACILITIES, AND LIMITATIONS ON ANIMAL
MOVEMENT?

A: Upon detection of a single infected bird, all birds within
a three kilometer radius are to be disposed of. A nationwide
bird vaccination program is already under way. The Ministry
of Agriculture's animal and avian quarantine center is
currently under expansion. The center presently has the
capacity to house twenty thousand birds. Only those
countries certified as free of Bird Flu by the WHO are
allowed to export poultry meat to Bahrain and the Prime
Minister has issued a decree banning the importation of live
birds from any country. Ministry of Agriculture officials
are stationed at all major national entry points, including
the Bahrain International Airport, the King Fahad Causeway
and all sea ports. Any live birds intercepted are killed on
the spot or returned to their country of origin. However,
the GOB acknowledges these measures to be ineffective in
stemming the entry of wild birds into Bahrain, though the
Ministry of Agriculture has begun testing wild bird
populations in the Al Areen Wildlife Preserve.

Q: HOW WILLING AND CAPABLE IS THE GOVERNMENT TO IMPOSE
QUARANTINES AND SOCIAL DISTANCING MEASURES (CLOSING SCHOOLS,
PUBLIC GATHERINGS, MASS TRANSIT)?

A: The draft national strategy indicates a willingness to
impose appropriate quarantines and social distancing
measures, including the curtailment of public gatherings and
the closure of land, sea and air transport. It is unclear
how public prayers and mosque services would be affected.
The GOB plans to quarantine Avian Influenza patients in
airborne isolation rooms (AIR) and has a detailed symptom and
vulnerability assessment plan. However, only 60 AIR rooms
have been built.

Q: WOULD ITS MILITARY ENFORCE QUARANTINES?

A: The draft national strategy makes no mention of military
or law-enforcement quarantine support. However, GOB working
level officials advise Emboffs that the Ministry of Interior,
including law-enforcement personnel, would support quarantine
efforts. Posts assesses that if military support became
necessary, it would be available.

ZIADEH

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