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Cablegate: A Review of Vietnam's Avian Influenza Poultry Vaccination

VZCZCXRO3999
RR RUEHCHI RUEHCN RUEHDT RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD
DE RUEHHI #2041/01 3391029
ZNR UUUUU ZZH
R 051029Z DEC 07
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 6828
INFO RUEHHM/AMCONSUL HO CHI MINH 4019
RUEHZS/ASEAN REGIONAL FORUM COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHUL/AMEMBASSY SEOUL 3209
RUEHKO/AMEMBASSY TOKYO 5783
RUEHHK/AMCONSUL HONG KONG 1299
RUEHGZ/AMCONSUL GUANGZHOU 0832
RUEHCN/AMCONSUL CHENGDU 0329
RUEHIN/AIT TAIPEI 1537
RUEAIIA/CIA WASHINGTON DC
RUEHPH/CDC ATLANTA GA
RUEHRC/DEPT OF AGRICULTURE WASHINGTON DC
RUEAUSA/DEPT OF HHS 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 04 HANOI 002041

SIPDIS

SENSITIVE
SIPDIS

STATE FOR EAP/MLS, EAP/EP, INR, OES/STC, OES/IHA, MED
STATE PASS TO USAID FOR ANE AND GH
HHS/OSSI/DSI PASS TO OGHA (WSTIEGER/LVALDEZ/DMILLER/CHICKEY) AND
FIC/NIH (RGLASS)
CDC FOR OGHA (SBLOUT/KMCCALL) AND DIV-FLU (NCOX/AMOHEN)
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (STERN)
USDA PASS TO APHIS, FAS (OSTA AND OCRA), FSIS
BANGKOK FOR RMO, CDC (MALISON), USAID (CBOWES/JMACARTHUR/MBRADY),
APHIS (NCARDENAS), REO(JWALLER)
BEIJING FOR HHS HEALTH ATTACHE (BROSS)
PHNOM PENH FOR CDC INFLUENZA COORDINATOR(WBRADY)
ROME FOR FAO
VIENTIANE FOR CDC INFLUENZA COORDINATOR (ACORWIN)

E.O. 12958: N/A
TAGS: TBIO AMED AMGT CASC EAGR PINR KFLU VM
SUBJECT: A REVIEW OF VIETNAM'S AVIAN INFLUENZA POULTRY VACCINATION
PROGRAM

REF: A. 2005 HANOI 3055 B. 2005 HANOI 1791

HANOI 00002041 001.2 OF 004


1. (SBU) Summary. Four years into its efforts to counter pandemic
influenza, the Government of Vietnam (GVN) has placed ongoing
emphasis on a vaccination program to limit the possible spread of
avian influenza (AI) caused by the highly pathogenic influenza A
H5N1 virus. The nationwide program focuses on high-risk poultry
populations, especially hatchling ducks and chickens, primarily
through a subsidized vaccine campaign. Despite the imperfect
balance between effectiveness and cost of vaccinations, the GVN
believes the program is an important short-term control measure that
has reduced (but not eliminated) the threat to Vietnamese poultry
and to the human population. End Summary.

Role of Vaccination Program
---------------------------

2. (SBU) The GVN recognizes that AI has now become endemic in
animals (i.e., enzootic) in Vietnam. Per Dr. Do Huu Dung, a
veterinary epidemiologist at the Department of Animal Health (DAH)
within the Ministry of Agriculture and Rural Development (MARD), the
GVN focuses on identifying and mitigating the most risky points in
the poultry market chain to protect animal health and prevent
possible transmission to humans. To minimize the risk of a human
epidemic (i.e., reduce the probability that the virus mutates into a
form that is transmissible from humans to humans), the GVN aims to
lower the viral load circulating among pultry and has selected an
aggressive vaccination program as a contributory means to accomplish
this goal. Dr. Hoang Van Nam, deputy Director of DAH,recently stated
that the GVN will continue the animal vaccination program for the
next five years, combined with other interventions including
measures to improve backyard poultry raising techniques and better
hygiene in poultry trade and slaughtering. The GVN views vaccination
as a necessary short- to medium-term activity until it can implement
longer-term measures, including strengthened surveillance and
laboratory capacity, increased biosecurity, and more complete
poultry industry restructuring to better monitor and reduce risk.
Dung noted that while Vietnam's vaccination program is designed to
prevent a widespread animal epidemic (i.e., epizootic), it cannot
eliminate scattered outbreaks, particularly among flocks of
unvaccinated and unregistered ducks far from commercial and urban
centers. Current vaccines prevent disease and reduce spread, but may
not curb shedding sufficiently to eliminate secondary AI infections
among susceptible animals.

Possible Impact of a Vaccination Program
----------------------------------------

3. (SBU) According to a presentation prepared by Dr. Nam, the GVN
believes that the vaccination program has played an important role
in limiting the spread of AI, though it acknowledges that it cannot
separate out the effects of the vaccine program from other measures.
.At the same time, a UN Food and Agricultural Organization
(FAO)-led evaluation of the 2005 vaccination campaign found that 54
percent of poultry flocks were effectively protected at one to two
months and 45 percent protected at three to four months post
vaccination[0]. 2006 results showed 56 percent protection at one to

HANOI 00002041 002.2 OF 004


two months and 33 percent protection at three to four months.
Initial results from the first 2007 campaing show 60 percent at
protection at one month. The absence of reports of disease in fully
vaccinated poultry, supports, but does not prove, vaccine efficacy.
The GVN maintains that vaccination has reduced the susceptibility of
a substantial part of the poultry population.

Constraints
-----------

4. (SBU) DAH acknowledged several short-term and long-term
constraints on its vaccination program. The need to import vaccines
from abroad puts Vietnam at a disadvantage. While prices have
dropped over the past few years and remain low, Vietnam faces the
risks of future price hikes. Once vaccines arrive in Vietnam, the
GVN must satisfy several logistical requirements to get the vaccines
to the field, including maintaining cold chains, training and paying
vaccinators, shipping vaccines to isolated areas, and maintaining
lab and field capacity to perform surveillance and monitor the
effectiveness of the program. During periods without outbreaks, the
DAH struggles to maintain farmer cooperation in the program, raising
concerns about continued sustainability. Further threatening
sustainability, the mass vaccination campaigns overtax the resoucres
of local DAH staff. Finally, the GVN cannot ensure that free
ranging ducks receive both vaccine doses needed for full protection,
as they move within and among provinces throughout their lifetimes.
If infected, these adult ducks can become a resevoir for the
disease, spreading AI to new generations of farm raised poulty with
which they come into contact.

History of Vaccination Program
------------------------------

5. (SBU) Beginning in late 2003 and lasting until mid-2005,
Vietnam's initial response focused on surveillance, rapid
destruction of birds at infected farms and at-risk farms, rapid
movement control and disinfection of infected premises, periodic
bans on hatching of water fowls, closures of live bird markets in
urban areas, and better communication (ref A). Though the bans and
closures were not completely enforced, these efforts, combined with
public education campaigns reduced consumer demand for poultry. In
August 2005, Vietnam added vaccination as a supplementary measure as
it could not contain outbreaks by other response measures such as
culling and disinfection (ref B). Initially implemented in provinces
covering most of the high risk populations of poultry, particularly
villages at which human infections had occurred, the GVN used
vaccines where it could not modify high-risk poultry rearing and
consumption behaviors.

Current Program
---------------

6. (SBU) Currently, the GVN implements three vaccine programs;
campaign, commercial, and hatchling, each designed to help limit the
spread of AI through the poultry population. Funding for the
program, including strategy development and post-vaccination
surveillance, comes from the government (estimated at USD 10 million

HANOI 00002041 003.2 OF 004


per round), as well as USAID, World Bank, and the UN Joint Program.
At this time, a state-owned company imports and distributes all
vaccines. According to DAH, Vietnam has considered domestic
production, but has hesitated to do so due to concerns about
long-term sustainability. If global efforts succeeded in
controlling AI, the GVN worries what it would do with this new and
expensive vaccine production facility. As the GVN imports such
large volumes, vaccine costs have moved steadily downward over time.
The GVN now is considering importing vaccines in bulk and then
bottling itself, which would limit concerns about shipment schedules
and allow Vietnam to stockpile resources. Dung stated that Vietnam
had not encountered any difficulties with counterfeit vaccines,
though the FAO has recommended that it begin quality assurance on
imported vaccines. Through the sharing of animal isolates, the
Centers for Disease Control and Prevention and the Department of
Agriculture) are providing technical assistance to help MARD with
molecular sequencing and evaluation of current vaccines in animal
models.

National Vaccination Campaign
-----------------------------

7. (SBU) The GVN subsidized AI animal vaccination mass campaigns
take place twice per year (March/April and
September/October/November) with supplemental vaccinations at other
times. If farmers or commercial poultry raisers want to obtain
vaccines outside the normal campaign cycle, they can do so, but need
to pay for the vaccines. The program continues to grow rapidly and
now focuses on 33 provinces in high risk areas (Red River and Mekong
River deltas) with vaccination of all long-lived poultry and all
poultry in villages. The program also vaccinates high risk poultry
in other provinces, i.e. those in border, urban or previously
infected areas. In 2005, some 166.3 million doses were given to
chickens and 78.1 million doses to ducks, for 81 percent coverage.
As the program expanded to two campaigns in 2006, the GVN provided
368 million doses to chickens and ducks combined, for 89 percent
coverage. The first 2007 vaccination campaign started in mid-March
and vaccinated 131.7 million birds by mid-May. The second campaign
began in September and has provided over 124.29 million doses.

8. (SBU) Though FAO provides technical assistance to the annual GVN
review of its vaccination strategy, the GVN determined that lack of
social mobilization prevented it from implementing FAO's suggestion
that it move to one mass vaccination campaign. Instead, on November
12, the MARD Minister approved the 2008 vaccination plan, which
envisions two mass campaigns and supplemental vaccinations covering
all chickens and ducks in 33 provinces. In other provinces, the GVN
will make vaccination compulsory for all ducks, all commercial and
semi-commercial chicken farms, and will recommend vaccinations for
all backyard farms. Citing concerns regarding the sustainability of
mass vaccination and reduced protection for poultry vaccinated at
improper ages, FAO had recommended the GVN focus on age-appropriate
vaccination available year round, with one mass campaign in November
to provide protection through the high-risk winter/Tet season[0].
Under this plan, provinces would pay for a second round, if deemed
necessary, with farmers increasingly bearing financial
responsibility for additional vaccinations.

HANOI 00002041 004.2 OF 004

9. (SBU) For its nationwide campaign, the GVN imports the vaccine
from China and in 2007 brought in 1.14 billion doses. According to
Dung, the campaign utilizes H5N1 inactivated virus from Harbin
Veterinary Research Institute sold commercially by Weike
Biotechnology Development Company to vaccinate chickens and ducks at
a cost of about 280 dong (approximately 0.017 USD) per dose. In the
past, DAH used H5N2 vaccine for chickens and H5N1 vaccine for ducks.
DAH recently also halted separate H5N9 (serum based) vaccines for
Muscovy ducks (though it had already imported 19 million doses in
2007), as the bottles were too unwieldy and the vaccine provided too
short an immunity duration. Chickens require one injection of the
H5N1 inactivated virus. Ducks require two injections, 28 days
apart. Chickens need to be over 8 days old, ducks over 14 days old.
DAH would prefer vaccines for newly hatched ducks, but this is not
yet available on the market. The campaign vaccine provides six
month immunity in chickens, five months in ducks -- more than the
normal life cycle for chickens and ducks raised for meat. DAH
believes that based on empirical criteria, the Chinese vaccines
produced "acceptable" levels of immunity one month post-vaccination.
According to virus sequencing work, minor changes in the structure
of avian influenza have not affected immunity.

Commercial and Hatchling Vaccine
--------------------------------

10. (SBU) The GVN provides an unsubsidized commercial vaccine,
usually to large farms, of which it imported 105 million doses in
2007. The H5N2 vaccine, under the trade name Nobilis from the
Intervet Company in the Netherlands, is used only for chickens at an
estimated cost of 650 dong (approximately USD 0.04) per dose. For
chicken hatchlings, the GVN imports H5N8 recombinant Trovax vaccine
from Merial Company.

Donor Analysis of Vietnamese Vaccination Program
--------------------------------------------- ---


11. (SBU) International experts generally approve of the Vietnamese
vaccination program and note that Vietnam's over-all strategy to
combat AI may have played a substantial role in the large decrease
in animal and human AI cases over the past four years. Poultry
vaccination not only helps prevent disease but also reduces the
viral burden and the amount and duration of viral shed. Given
Vietnam's limited biosafety capacity, the FAO believes Vietnam's
focus on vaccinations to be technically appropriate, and public
health practitioners have described it as a model for other
developing countries to follow. At the same time, donors agree that
additional studies must be performed to evaluate the program. To
that end, USAID will fund an FAO study on the effectiveness of
various vaccination strategies. Meaningful annual reviews designed
to improve efficiency and develop sustainability are a crucial
component of the program and USAID and FAO agree that the GVN needs
to develop an eventual exit strategy.

MICHALAK

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