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Cablegate: Avian Influenza France Update - 09/22/06

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Lucia A Keegan 09/25/2006 04:34:34 PM From DB/Inbox: Lucia A Keegan

Cable
Text:


UNCLAS SENSITIVE PARIS 06376

SIPDIS
cxparis:
ACTION: SCI
INFO: POL LABO ENGO ECSO AGR UNESCO AMBO SCIO DCM AMB
ECON ESCI

DISSEMINATION: SCIX
CHARGE: PROG

APPROVED: SCI:RDRY
DRAFTED: SCI:MHMASSING
CLEARED: CLEARED:NONE

VZCZCFRI410
RR RUEHC RUEAUSA RUEHRC RUEAHLC RUEHPH RUCNMEU
RUEHZN RUEHMRE RUEHSR
DE RUEHFR #6376/01 2651642
ZNR UUUUU ZZH
R 221642Z SEP 06
FM AMEMBASSY PARIS
TO RUEHC/SECSTATE WASHDC 1614
INFO RUEAUSA/DEPARTMENT OF HHS WASHDC
RUEHRC/DEPARTMENT OF AGRICULTURE WASHDC
RUEAHLC/HOMELAND SECURITY CENTER WASHINGTON DC
RUEHPH/CDC ATLANTA GA
RUCNMEU/EU INTEREST COLLECTIVE
RUEHZN/EST COLLECTIVE
RUEHMRE/AMCONSUL MARSEILLE 1332
RUEHSR/AMCONSUL STRASBOURG 0186

UNCLAS SECTION 01 OF 03 PARIS 006376

SIPDIS

SENSITIVE

STATE FOR OES/IHA, EUR/WE, CA, CA/OCS, G/AIAG
HHS FOR INTERNATIONAL BUDASHEWITZ
USDA FOR ITP/MACKE/THOMAS, CMP/DLP/WETZEL
USDA FOR FAS PASS FSIS AND APHIS
HOMELAND SECURITY FOR OIA

E.O. 12958: N/A
TAGS: KFLU TPHY TSPA TSPL KSCA FR
SUBJECT: AVIAN INFLUENZA FRANCE UPDATE - 09/22/06

REF: Paris 520 and Subsequent

NOT FOR INTERNET DISTRIBUTION

1. (U) Summary. France continues robust preparations for an avian
influenza (AI) pandemic: The GOF recently updated its national plan,
including with procedures to minimize economic disruption. After
focusing on technical matters such as stockpiling of medicine and
equipment, the GOF now acknowledges the need to include an ethical
component to the plan, addressing such issues as rationing, possible
restriction of individual freedoms, and protection of health care
workers. Embassy officers attended the First National Colloquium on
Ethics and Pandemic Flu on September 15. Additional public
discussions are scheduled in the coming months, partly inspired by
North American studies. While there has been scant AI media
coverage in recent months, the GOF continues to take the threat of a
pandemic very seriously. End summary.

-----------------------------------
AI Pandemic: Ethical Considerations
-----------------------------------

2. (U) On September 15, Health Minister Xavier Bertrand opened the
first national colloquium on AI and ethics. 250-300 key
representatives of the medical and research communities attended, as
did government officials from a number of French agencies. Speakers
focused on:
- Treatment of the animal population during a pandemic; - Role of
the research community;
- Role, duties, and rights of health professionals;
- Regulating access to treatment in a context of
scarce resources;
- Possible restriction of individual freedoms to avoid
spread of the virus (quarantine, travel
restrictions, compulsory vaccinations);
- Management of information in a pandemic situation
(role/responsibilities of media, positive/
negative role of the Internet);
- International cooperation and the role of WHO.

----------------------------------------
Maximizing Protection with Limited Means
----------------------------------------

3. (U) A number of health professionals stated that whatever the
level of preparedness, in case of AI pandemic in France, medical
supplies (anti-viral treatment, vaccines, access to intensive care
such as mechanical ventilation) will not be sufficient to cover the
needs of the population. Speakers highlighted that triage
mechanisms, both robust and transparent, would be required. "Triage
is not ethical," summarized Xavier Emmanualli, former President of
"Doctors without Borders," but it will be the mission of health care
workers and health authorities to "manage the penury" for the common
good.

--------------------
Who Gets Care First?
--------------------

4. (SBU) Decision-makers and health authorities debated the
conflict between equity and efficiency but agreed on the need to set
priorities and provide clear guidelines before the onset of any
pandemic. They thought that criteria for triage needed to be
discussed with and ratified by the medical sector. Besides public
order criteria (priority given to people capable of ensuring safety
and the provision of necessities), a number of prioritization
suggestions were advanced, based on the 'save-the-most-lives'
principle; the life-cycle allocation principle (each individual
should have an opportunity to live through all stages of life); and
the life investment principle (giving priority to people between
early adolescence and middle age). North American studies conducted
by the Joint Center for Bioethics at the University of Toronto (an
ethical guide for pandemic planning, based on lessons learned from
SARS), and by CDC Atlanta ('Citizen Voices on Pandemic Flu Choices -
Engagement Pilot Project on Pandemic Influenza, or PEPPPI) also
served as subjects for discussion.

---------------------
Health Workers Duties
---------------------
5. (SBU) The role and duties of health workers, foreseeable
dilemmas faced by physicians, and the level of risks they could
reasonably be expected to take generated much discussion. Several
participants spoke about the risk of insufficient mobilization of
health care professionals in the event of a pandemic. Several
referred to the "pandemic as war" and that, in the event of an AI
pandemic, medical staff might be forced into service. Some speakers
mentioned the pluses and minuses of the work of NGO's in a pandemic
environment.

---------------
Social Cohesion
---------------

6. (U) Speakers described behaviors likely to emerge during and
after a pandemic and the necessity to preserve confidence between
the general population and authorities throughout such a crisis. To
reach this goal, speakers insisted on the need for the government to
work with the general public in preparing a transparent ethical
framework. Public awareness about choices that would have to be
made and the notion of individual responsibilities were recurring
themes. Health Minister Bertrand, referring to his recent trip to
the U.S., noted that in the U.S. the "logic of individual
responsibility is more present," in contrast to France where the
authorities had emphasized the role of the government. In his
remarks Bertrand said that individual responsibility is just as
important as the role of the government.

-----------------------------------------
'Ethomics' or the Ethico-economic Dilemma
-----------------------------------------

7. (U) A number of speakers alluded to the fact that an AI
pandemic may never occur. They questioned whether it is justified
to invest so much public funding to prepare for a crisis that may
never occur. Generally participants felt that even if a pandemic
does not occur, efforts to prepare will not be in vain. Other
medical crises will sooner or later have to be faced and lessons
learned preparing for an AI pandemic can be useful in dealing with
those other crises.

----------------------------------
French Stockpiles (September 2006)
----------------------------------

8. (U) Protective masks: The GOF has stockpiled or delivered to
medical facilities to date 240 million masks, intended primarily to
protect health professionals (known as FFP2 masks). Another 47
million will be available by end 2006. France has also secured 700
million 'anti-projection' masks. By the end of the year, another
300 million, for a total of one billion, will be available.

9. (U) Antiviral medicine: France now possesses 14 million
antiviral treatments, enough for about one-fourth of the French
population. Within the next year, France will receive another 19
million treatments, for a total of 33 million antiviral treatments.
Furthermore, the GOF will order 10 million treatments of oseltamivir
(non-conditioned Tamiflu) to serve as a prophylaxis for health care
workers. Minister Bertrand noted these figures go beyond WHO
recommendations. He added that France is concerned to provide
treatment to foreigners in France and to minimizing the need for
rationing. End note.

10. (U) Vaccines: The GOF has bought and stockpiled 2.6 million
doses of a pre-pandemic H5N1 vaccine and has "reserved" 40 million
doses of a pandemic vaccine. They are also negotiating the
possibility of ordering another 23 million doses.

-----------------------------------------
National Plan Incorporates Economics
-----------------------------------------

11. (U) On September 1, the Ministry of Health presented an
updated version of France's AI plan, highlighting the need to avoid
economic disruption. The plan encourages private companies and
public agencies to establish continuity plans that recognize the
need to maintain business as usual while providing the maximum
security for employees.
-----------------------
Campaign for Prevention
-----------------------

12. (U) This fall, the GOF will launch a new prevention campaign
against risks related to infectious upper respiratory diseases in
French schools. This initiative, led by both the Ministries of
Health and Education, aims to promote among the younger generation
the development of a "risk prevention and risk management culture."
Health professionals will be targeted next, helping them to better
understand their role, protective measures available to them, and
how to deal with contaminated patients.

13. (U) The National Plan can be consulted on the GOF website
dedicated to avian influenza: http://www.grippeaviaire.gouv.fr
An English version is also available (January 2006 update).


Stapleton

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