VZCZCXYZ0008
RR RUEHWEB

DE RUEHTV #0250 0311438
ZNR UUUUU ZZH (CCY ADX54FBEA MSI3055-623)
R 311438Z JAN 08
FM AMEMBASSY TEL AVIV
TO RUEHC/SECSTATE WASHDC 5226
INFO RUEHJM/AMCONSUL JERUSALEM 8973
RUEHEG/AMEMBASSY CAIRO 1532
RUEHAM/AMEMBASSY AMMAN 3562

UNCLAS TEL AVIV 000250 
 
SIPDIS 
 
C O R R E C T E D    C O P Y - - CHANGE REF(A),TEXT ADDED PARA 1, 6 
 
SENSITIVE 
SIPDIS 
 
DEPT FOR EUR/PGI TESSLER AND OES/IHB LAURITZEN 
CAIRO FOR ESTH 
AMMAN FOR ESTH 
 
E.O. 12958: N/A 
TAGS: TBIO SENV WHO IS EG JO
SUBJECT: ISRAELI COMPLIANCE WITH THE BERLIN DECLARATION ON 
TUBERCULOSIS 
 
REF: A) 08 STATE 6989; B) 07 STATE 1228 
 
¶1. (SBU) Summary. In response to Department inquiry (ref A), Israel 
appears to implement a model DOTS program, and observes Berlin 
Declaration commitments fully. The Ministry of Health (MOH) continues t 
assess Israel's successful National Tuberculosis Control Program (NTP). 
Israel is a signatory of the Berlin Declaration and WHO considers 
Israel a success story in its ability to diagnose, treat and 
follow up TB patients. While Israel has much it could 
teach to other countries about managing TB through a strong public 
health structure, the MOH Director of NTP is frustrated by 
the lack of contact with his Egyptian counterparts.  End Summary. 
 
¶2. (U) Between 1989 and 1995, the absolute number of TB patients in 
Israel nearly quadrupled, from 133 cases in 1989 to 500 cases in 
¶1991.  This was mainly due to mass immigration from high and 
moderate TB-prevalent countries, namely from the Former Soviet Union 
(FSU) and Ethiopia. During the early 90's, Israel was experiencing 
the impact of having-along with many other countries during the 
1980's-prematurely dismantled its TB treatment infrastructure.  In 
addition to a lack of health care workers experienced in managing TB 
patients, laboratory services were not defined, suceptability 
testing was not done routinely, drug supplies were erratic, and 
second-line drugs to deal with TB drug resistant strains were 
essentially nonexistent.  Further fragmentation occurred as a result 
of a decentralization of care from the MOH to four Israeli HMO's. 
 
¶2. (SBU) In 1995, a new National Tuberculosis Program (NTP) was 
recommended and then launched in April of 1997, ten years before the 
signing of the Berlin Declaration on TB.  The goal of the new 
program was to locate the disease in Israel, reduce and eliminate 
morbidity, and engage all health care workers in Israel in achieving 
the task.  The program incorporated the five elements of the 
Directly Observed Treatment (DOTS) strategy recommended by WHO: 
 
1) political commitment; 
2) laboratory diagnostic facilities; 
3) DOT of all patients; 
4) a consistent drug supply; and 
5) a permanent reporting system. 
 
¶3. (U) The political will to implement the NTP was evidenced by 
legal changes, new administrative directives and medical guidelines, 
and the establishment and funding of a National TB Unit (the 
Department of Tuberculosis and AIDS, known as DTA).  The MOH chose 
to limit TB treatment to nine designated centers using only 'DOT' to 
ensure expertise and to allow concentration of resources.  Two 
national reference laboratories were selected to process all 
specimens from patients followed at the TB centers, to assure 
consistency of testing quality.  This required some creativity 
allowing for financial incentives to improve compliance. 
 
¶4. (U) The DOT strategy in Israel is followed for the entire 
duration of treatment, not just for the initial 2-month period as in 
other countries.  Limiting treatment to a few sites assures a larger 
number of patients per physician, which in turn allows for the 
accumulation of experience and motivation that helps treat difficult 
patients (resistant TB cases-). The DTA has added a network of 
social workers in an attempt to deal with such cases. 
 
¶5. (SBU) A central supply agency delivers a regular supply of all TB 
drugs, and the DTA maintains a reserve cache of all drugs to ensure 
non-interruption of supplies.  TO enhance case tracking, TB 
notification to the MOH through District Health Offices was made 
mandatory for both physicians and laboratories. 
 
¶6. (SBU) In 1999, 86 percent of Israel's TB cases were of foreign 
origin, both recently arrived and some from years earlier, including 
a very small WWII Holocaust survivor group.  In response to Deparmtne 
inquiry (ref A), Israel appears to implement a model DOTS program, and 
observes Berlin Declaration commitments fully. Israel appears to 
implement a model DOTS program, and observes Berlin Declaration 
commitments fully. Admittedly their outreach program to 
other countries and international TB programs is weak; 
however, MOH Director of International Relations, Alex Leventhal, 
expressed readiness to share the GOI's experience with other 
countries, and is willing to do so within its 
financial capability.  Currently, there is good 
inter-regional cooperation on TB between Israel, the PA 
and Jordan.  He expressed continuing frustration with the 
on-going lack of cooperation by his neighboring Egyptian 
counterparts, which has also been expressed by the Public 
Health Service with respect to Avian Influenza cooperation. 
 
MORENO