VZCZCXRO9343
RR RUEHAST RUEHBI RUEHCI RUEHDBU RUEHDH RUEHHM RUEHLH RUEHLN RUEHMA
RUEHNEH RUEHPB RUEHPOD RUEHPW RUEHSL RUEHTM RUEHTRO
DE RUEHNE #1671/01 2230851
ZNR UUUUU ZZH
R 110851Z AUG 09
FM AMEMBASSY NEW DELHI
TO RUEHC/SECSTATE WASHDC 7655
INFO RUCNCLS/ALL SOUTH AND CENTRAL ASIA COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHPH/CDC ATLANTA GA
RHMCSUU/CDR USCENTCOM MACDILL AFB FL
RHMCSUU/CDR USJFCOM NORFOLK VA
RUCUWSU/USSTRATCOM OFFUTT AFB NE
RUEAIIA/CIA WASHDC
RUEHRC/DEPT OF AGRICULTURE WASHDC
RUCPDOC/DEPT OF COMMERCE WASHDC
RHEBAAA/DEPT OF ENERGY WASHDC
RUEAUSA/DEPT OF HHS WASHINGTON DC
RHMCSUU/DEPT OF HOMELAND SECURITY WASHINGTON DC
RULSDMK/DEPT OF TRANSPORTATION WASHINGTON DC
RHEFDIA/DIA WASHDC
RUEHC/DEPT OF INTERIOR WASHDC
RHMCSUU/FAA NATIONAL HQ WASHINGTON DC
RHMCSUU/FBI WASHINGTON DC
RHHMUNA/HQ USPACOM HONOLULU HI
RHMCSUU/HQ USSOCOM MACDILL AFB FL
RHHJJAA/JICPAC HONOLULU HI
RUEKJCS/JOINT STAFF WASHDC
RUEANQA/NGA HQ BETHESDA MD
RHMCSUU/NGIC INTEL OPS CHARLOTTESVILLE VA
RHEHNSC/NSC WASHDC
RHEHAAA/WHITE HOUSE WASHDC

UNCLAS SECTION 01 OF 04 NEW DELHI 001671 
 
SENSITIVE 
SIPDIS 
 
HHS FOR OGHA AND PASS TO ANNE CUMMINGS AND DANIEL MILLER 
CDC ATLANTA FOR CCID AND PASS TO NANCY COX, STEPHEN BLOUNT, ANN MOE 
AND STEVE REDD 
PASS TO NIH FOR ROGER GLASS, THOMAS MAMPILLY, JAMES HEDDINTON AND 
GRAY HANDLEY 
PASS TO FDA FOR MAC LUMPKIN AND MARY LOU VALDEZ 
PASS TO AIAG FOR AMBASSADOR ROBERT LOFTIS, HELEN REED ROWE, AND 
CRAIG SHAPIRO 
USDA PASS APHIS AND FAS 
DOT PASS SHATLEY 
FAA PASS TNASKOVIAK 
 
E.O. 12958: N/A 
TAGS: KFLU AEMR ASEC CASC KFLO TBIO KSAF KPAO PREL PINR
AMGT, MG, EAGR, EAIR, ECON, PREL, SOCI, IN 
SUBJECT: INDIA - FIRST PANDEMIC H1N1 DEATHS 
 
REF: A. NEW DELHI 860 
 ¶B. NEW DELHI 879 
 ¶C. HYDERABAD 63 
 ¶D. NEW DELHI 1286 
 ¶E. STATE 82155 
 
¶1. (SBU) SUMMARY: India experienced its first confirmed pandemic 
H1N1 influenza related death on 3 August, and has had a total of 
seven reported deaths over the past week.  The number of positive 
cases rose to 959 as of 10 August.  The Ministry of Health and 
Family Welfare (MOH) has announced new home quarantine procedures 
for self-reporting patients, though incoming air travelers reporting 
flu-like symptoms will still be subject to quarantine in a 
government facility.  Under Indian law, state governments retain 
primary control for dealing with the outbreak and some are clashing 
with central government recommendations.  The Government of India 
(GOI) is pushing to produce its own pandemic H1N1 vaccine by 
September, as well as exploring potential new sources for a key 
Tamiflu ingredient.  Significant U.S. Mission intervention has 
resulted in much improved, albeit spartan, government quarantine 
facilities.  The Mission is reviewing tripwires and procedures in 
light of lessons learned.  END SUMMARY 
 
FIRST DEATH INCITES PUBLIC PANIC, CASES CONTINUE TO RISE 
 
¶2. (U) On Monday August 3, a 14-year-old girl who had presented with 
severe illness and was misdiagnosed as having pneumonia died from 
H1N1-related complications in Pune.  Since then, the MOH has 
confirmed three additional deaths in Pune, one in Mumbai, one in 
Chennai, and one in Gujarat (a U.S. LPR) for a total of seven 
pandemic H1N1-related deaths as of 10 August.  Following the highly 
publicized deaths, and exaggerated newspaper accounts of potential 
H1N1 risks, hospitals have reported being overwhelmed with the 
worried well.  In Mumbai, for example, Kasturba Hospital noted that 
over 600 people had self-reported for testing in recent days.  Many 
of the patients told the press that while they lacked symptoms or 
their private practice doctors did not believe they had H1N1, 
newspaper stories had prompted them to seek testing and treatment in 
order to "not take chances."  The number of samples has increased 
sufficiently to overwhelm one of the two government-approved testing 
facilities; the GOI previously claimed that additional laboratories 
would be made available for diagnostic testing, but Mission has seen 
no indications this has actually happened. 
 
¶3. (U) The number of cases continues to rise rapidly, with a total 
of 959 as of Monday 10 August.  An Embassy review of MOH reports 
suggests an increasing trend towards in-country contact transmission 
over imported cases.  Data on the recent deaths is not yet clear, 
though in at least some of the cases underlying co-morbid conditions 
contributed to the fatalities.  In addition, diagnostic test results 
are being impacted in some areas by the normal flu season.  Some of 
the severe cases tested for pandemic H1N1 are coming back positive 
 
NEW DELHI 00001671  002 OF 004 
 
 
for seasonal influenza, forcing the GOI to reexamine its assumptions 
about the danger of seasonal flu outbreaks and somewhat complicating 
the public health response effort to pandemic H1N1.  (NOTE: Northern 
India has bi-modal influenza season that typically peaks in 
July-August and again in November-December, while Southern India has 
year-round flu with smaller peaks in November-December. END NOTE) 
 
NEW HOME QUARANTINE GUIDELINES, INTERNAL TRAVEL RESTRICTIONS 
 
¶4. (SBU) The MOH released on August 6 new quarantine guidelines 
directing that for self-reporting patients, a designated medical 
officer at a government facility will conduct a clinical assessment 
and decide on the need for testing.  Except in cases of severe 
illness, the patient will be allowed to await results at home.  If 
the sample tests positive for H1N1 and the symptoms are mild, the 
patient will be given the option of admission into the hospital or 
home isolation and treatment.  Patients opting to stay at home will 
be provided with detailed guidelines and safety measures to be 
followed by the entire household.  The designated medical officer 
will have the final decision regarding hospital admission 
requirements.  According to Embassy contacts, the MOH internally 
discussed discontinuing airport health screening procedures because 
they are ineffective at preventing the spread of pandemic H1N1. 
However, press leaks about the conversation created a political 
uproar and they were forced to step back and declare that screening 
would continue.  (NOTE: This example of political pressure 
interfering with medically sound practice is not isolated, and we 
expect politics will continue to exert a heavy hand, and even trump 
medical facts, in India's responses to the pandemic.  END NOTE) 
 
¶5. (SBU) Despite the new GOI guidelines, State governments continue 
to make their own decisions about quarantine procedures. 
-- In Chennai the Director of Public Health invalidated the MOH's 
guidelines and said his state would continue their quarantine 
procedures. 
-- Hyderabad continues to follow the previous quarantine procedures. 
 
-- In the state of Jharkhand, media reports in general are 
sensationalized, particularly in one case where a patient with a 
positive test was reported to have gone missing.  The Jharkhand 
state government, currently under president's rule since it cannot 
form a government, sent contradictory messages about whether or not 
the patient was under quarantine. 
-- Following India's first pandemic H1N1 death, the Government of 
Maharashtra invoked the Epidemic Act in Pune and Satara, which 
allows health authorities to forcibly admit and quarantine suspected 
H1N1 patients.  With state assembly elections scheduled in October, 
it appears unlikely that the State of Maharashtra will heed the 
GOI's dictates for handling and treating pandemic H1N1 patients.  In 
addition, the State of Maharashtra issued guidelines for schools 
which explain that H1N1 came to India "through tourism" and that 
children who have traveled and have flu symptoms should report to 
 
NEW DELHI 00001671  003 OF 004 
 
 
the designated public quarantine hospital, Kasturba, for testing, 
but that others should be treated at home.  Local press reports the 
voluntary closure of some local schools after a student tested 
positive for H1N1. 
 
¶6. (U) The GOI has issued no further travel restrictions.  However, 
the Tamil Nadu State Government issued a travel advisory this week 
warning people to avoid the districts of Pune and Satara in 
Maharashtra. 
 
PUSHING FOR INDIGINOUS VACCINE AND TREATMENT OPTIONS, BUT NERVOUS 
ABOUT QUALITY 
 
¶7. (SBU) India has accelerated its efforts to develop an indigenous 
pandemic H1N1 vaccine.  In addition to working with an imported H1N1 
strain, the GOI has approved three companies - Bharat Biotech, the 
Serum Institute, and Panacea Biotech - to develop vaccines.  Two of 
those companies have reportedly assured Dr. Srivastava, Director 
General of Health Services (DGHS,) that they would be able to 
produce the vaccine in India by the end of September.  Recent ESTOFF 
conversations with Dr. Sumathy, Associate Director R&D of Bharat 
biotech, and an ESTOFF visit to the Panacea Biotech facility suggest 
that while both are actively and intensely engaged in H1N1 vaccine 
development, neither have a definite timeline for completion of the 
vaccines or associated safety and efficacy testing. 
 
¶8. (SBU) Prof. Ramanan Uma Shankar from the Department of Crop 
Physiology at the University of Agricultural Science, Bangalore 
claims to have discovered in the Indian Western Ghats seven plants 
whose leaves produce shikimic acid, a key ingredient used to make 
Tamiflu.  Professor Shankar told ESTOFF that only 100 Kg of leaves 
were required to produce 5 Kg of shikimic acid, and that these new 
sources would result in a more sustainable and less expensive 
process.  The veracity of this reported discovery remains to be 
seen. 
 
¶9. (SBU) Despite their push for indigenous treatment capabilities, 
GOI officials have also indicated to EMBOFFs that they are worried 
about the quality of home-grown diagnostic reagents that would be 
used for identification of the virus.  The officials indicated they 
would prefer to either acquire the reagents from U.S. companies at a 
lower cost, or to be given a waiver of patent rights so that they 
can produce the proven reagents themselves.  (NOTE: This is not a 
new request.  The GOI has consistently held that patent waivers 
and/or low cost medications and vaccines should be made available 
for developing nations like India to deal with pandemics and other 
health and disease concerns.  END NOTE) 
 
MISSION HELPED IMPROVE HOSPITAL CONDITIONS, STILL NOT THE TAJ 
 
¶10. (U) On a positive note, active intervention by the Mission with 
the Central and State governments has directly resulted improved 
 
NEW DELHI 00001671  004 OF 004 
 
 
government hospital quarantine facilities.  While the facilities 
remain very basic by U.S. standards, they now generally follow 
better hygiene practices, and the staffs have improved their patient 
interaction practices to prevent miscommunications and cultural 
misunderstandings.  In addition, many of the facilities have become 
much more proactive about contacting Mission staff about pandemic 
H1N1 cases involving potential American Citizens.  Mission remains 
engaged with Indian government officials, as well as other foreign 
missions, on these issues. 
 
MISSION ACTIVITIES 
 
¶11. (SBU) Mission is reviewing procedures, including pandemic 
tripwires, internal Mission education practices, and external 
websites for public dissemination of information, in response to our 
lessons learned and Reftel E State guidance.  In addition, our 
Public Affairs section continues a timely campaign to educate the 
Indian media on how to accurately report on pandemic diseases. 
Mission Medical Officers have been in touch with representatives 
from our American Schools in New Delhi and Mumbai to clarify testing 
and treatment options, including school closures. 
 
ROEMER