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Cablegate: Revision of Vietnam's Avian Influenza Action Plan

VZCZCXRO2887
RR RUEHCHI RUEHDT RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD
DE RUEHHI #1727/01 2741417
ZNR UUUUU ZZH
R 011417Z OCT 07
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 6433
INFO RUEHHM/AMCONSUL HO CHI MINH 3748
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHZS/ASEAN REGIONAL FORUM COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEAIIA/CIA WASHINGTON DC
RUEHPH/CDC ATLANTA GA
RUEHRC/DEPT OF AGRICULTURE WASHINGTON DC
RUEKJCS/SECDEF WASHINGTON DC//USDP/ISA/AP//
RHMFISS/CJCS WASHINGTON DC//J2/J3/J5//
RHEFDIA/DIA WASHINGTON DC//DHO-3//
RHMFIUU/CDR USPACOM HONOLULU HI//J00/J2/J3/J5//
RHEFAFM/DIRAFMIC FT DETRICK MD//MA-1A//
RUEHSUN/USUN ROME IT

UNCLAS SECTION 01 OF 03 HANOI 001727

SIPDIS

SENSITIVE
SIPDIS

STATE FOR EAP/MLS, OES/IHA
STATE PASS TO HHS/OGHA (STIEGER/VALDEZ/BELL/HICKEY)
CDC FOR OGHA (BLOUT/MCCALL) AND DIV-FLU (COX/MOHEN)
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (STERN)
HHS PASS TO FIC/NIH (GLASS)
USDA PASS TO APHIS, FAS (OSTA AND OCRA), FSIS
BANGKOK FOR RMO, CDC (MALISON), USAID (MACARTHUR/BRADY)
BEIJING FOR HHS HEALTH ATTACHE (ROSS)
PHNOM PENH FOR CDC INFLUENZA COORDINATOR(BRADY)
ROME FOR FAO
VIENTIANE FOR CDC INFLUENZA COORDINATOR (CORWIN)

E.O. 12958: N/A
TAGS: TBIO AMED EAGR CASC KFLU VM
SUBJECT: REVISION OF VIETNAM'S AVIAN INFLUENZA ACTION PLAN

REF A: HANOI 1551, REF B: HANOI 687

HANOI 00001727 001.2 OF 003


1. (U) Summary: The Ministry of Health (MOH) recently organized a
workshop to discuss revisions of the Government of Vietnam (GVN)
action plan on the prevention and control of human influenza. Under
the cooperative agreement between U.S. Centers for Disease Control
(CDC) of the Department of Health and Human Services (DHHS) and MOH,
CDC supported the workshop, which focused on means to better
coordinate and communicate between the animal and human health
sectors and to more effectively use available resources. The GVN
intends to take the recommendations from this workshop and from
additional CDC supported gatherings as one set of inputs into the
GVN process to revise the plan under the National Steering Committee
on Avian Influenza (NSCAI). CDC and DHHS welcomed the opportunity to
provide input and suggested that the GVN maintain a robust and open
process to strengthen the plan and increase donor support. A
successful amended action plan should more strongly emphasize
monitoring and evaluation and better focus training for health care
providers. End Summary.

Vietnam Action Plan
-------------------

2. (U) Three documents set forth GVN planning on avian influenza
and pandemic preparedness. In November 2005, in response to global
and national outbreaks of avian influenza, Vietnam developed a
"National Plan of Action on Human Influenza Pandemic Prevention and
Control in Vietnam," which only pertains to the human sector.
Essential elements of this national action plan are contained in two
widely distributed documents, both of which address both the human
and animal sectors: Vietnam's Integrated National Plan for Avian
Influenza Control and Human Pandemic Influenza Preparedness and
Response, 2006-2008 (also known as the "Red Book") and the Vietnam
Integrated National Operational Programme for Avian and Human
Influenza (OPI), 2006-2010 (known as the "Green Book") (See Ref B
for additional details). The national action plan, together with the
Red Book and the Green Book, contributed to the successful control
of outbreaks of avian influenza and resultant isolated cases of
human infection. However, after two years of implementation, the GVN
and its donor partners have discovered gaps in coverage. Both agree
that the national action plan needs modification to better address
ongoing challenges and to recognize that Vietnam's response to avian
influenza has switched from basic crisis management to a new stage,
i.e., emergency preparedness.

Ministry of Health Avian Influenza Workshop
-------------------------------------------

3. (U) On September 11, 2007 in Ho Chi Minh City, the MOH's Vietnam
Administration of Preventive Medicine (VAPM) organized a workshop to
revise the national action plan to prevent and control human
influenza. CDC supported the workshop, which included participants
from MOH, regional institutes of hygiene and epidemiology, central
hospitals, 20 southern provincial health services and preventive
medicine centers, university and research institutes. Pursuant to a
cooperative agreement with the MOH to assist GVN efforts to amend
its national action plan, CDC will fund additional GVN-led
workshops, including one in Hanoi on October 5 to obtain input from
a wider selection of interested parties.

GVN Strategy to Revise the National Action Plan
--------------------------------------------- --

4. (SBU) MOH/VAPM convened this workgroup as part of the GVN
process to revise the national action plan, pursuant to the
Partnership Framework for Avian and Human Influenza (PAHI), the
non-binding partnership between the GVN, donors and NGOs signed in

HANOI 00001727 002.2 OF 003


November 2006 and which provides the overall framework for donor
coordination to support the GVN's Avian Influenza efforts. An
earlier September meeting, hosted by the Ministry of Agriculture and
Rural Development (MARD) and the U.N. Food and Agricultural
Organization, also provided comments on how to best update the
national action plan (Ref A). According to PAHI staffers and the
CDC Influenza Coordinator, this process will include additional
workshops to collect information and solicit opinions from other
stakeholders, experts, and consultants. These workshops are
principally supported by CDC's cooperative agreement with VAPM,
"Surveillance and Response to Avian and Pandemic Influenza in
Vietnam."

5. (SBU) Following the end of this workshop, participants continue
to work on VAPM draft changes and workshop suggestions, which will
then circulate within MOH for comments. The GVN will use input from
these workshops (along with information from GVN agencies, field
interviews and consultants) in its internal deliberations on how
best to modify the national action plan. Specifically, working
level officials from the MARD and MOH will analyze workshop
suggestions (and follow on comments), synthesize them, and then plug
in selected and vetted ideas from these meetings into deliberations
by the NSCAI, chaired by MARD Minister Cao Duc Phat.

6. (SBU) Once a subcommittee of NSCAI has compiled a draft amended
plan, the document will be circulated to relevant GVN agencies for
official comment, but will not include comments from donors and
other interested parties. The Minister of Health needs to sign off
on the final revisions before implementation. The GVN expects to
produce a final version of the new, amended plan in 2008, which will
then be released to bilateral and international partners.

Gaps in the Action Plan
-----------------------

7. (SBU) Workshop participants noted gaps in coverage that
prevented fully effective action and emphasized the need to modify
the plan to reflect the current situation. Contributors
specifically highlighted the need to improve coordination between
the health and agricultural sectors, the importance of providing
updated knowledge about AI to health workers, more effective use of
health care facilities and medications, greater attention to border
and remote areas, and more timely provision of funds. HHS attendees
commented that the draft reviewed at the workshop did not yet
provide for sufficient monitoring and evaluation and did not
adequately match proper training to specific groups of health care
practitioners. Importantly, several participants urged the GVN to
better explain to the general public and affected individuals the
necessity of continued preparations and research even though a
pandemic has not yet occurred.

Suggested Modifications
-----------------------

8. (U) Led by VAPM, workshop participants agreed to several possible
revisions to the national action plan, tied to a Vietnamese proposal
to add an additional stage to the WHO system of pandemic stages in
order to cover the possibility of human pandemic influenza first
occurring in another country and the GVN's need to organize a
response to prevent the spread of the pandemic into Vietnam.
Participants supported proposed language focusing on animal to human
transmission of pandemic influenza and the concurrent need to better
link the human health and animal health sectors. All agreed to
include language on linkages between the four cross cutting areas of
preventive medicine, communication, treatment, and financial
resources, along with the need to stress on-site containment and
treatment and district-level taskforces. Other agreed to changes in

HANOI 00001727 003.2 OF 003


the action plan include more investment for facilities, training,
and communication materials for district hospitals and preventive
medicine units. The draft amended action plan also highlights the
importance of international partnership.

9. (SBU) Comment: While there will be no formal "review period" for
international comment, USG agencies at post have helped drive this
revision process from before "day one." We are confident that,
while a GVN product, it will reflect our concerns and result in a
stronger plan. The "emergency preparedness" phase of the AI
response is more complicated in some ways than the initial "crisis
response" phase. By better coordinating the human and animal health
sides of the issue, and by focusing greater attention on building
long-term capacity in both, the new plan should help Vietnam build a
sustainable capacity across critical areas, which will add strength
to the national response, while enhancing the system's ability to
respond flexibly to new situations. We will continue to help direct
and closely monitor this process.

MICHALAK

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