This record is a partial extract of the original cable. The full text of the original cable is not available.

UNCLAS SECTION 01 OF 03 ANKARA 006481 
 
SIPDIS 
 
STATE FOR EUR/RUS, OES/STC, EB/TPP/ATP, EB/TPP/BTA 
STATE ALSO PASS USAID FOR BLANCHET AND CARROLL 
HHS FOR WSTEIGER/PBUDASHEWITZ 
FAS FOR ITP/MACKE/THOMAS, CMP/DLP/WETZEL 
FAS PASS FSIS AND APHIS 
VIENNA PASS APHIS 
BRUSSELS PASS APHIS/FERNANDEZ 
GENEVA PASS HEALTH ATTACHE 
 
SENSITIVE 
 
E.O. 12958:N/A 
TAGS: ETRD EAGR KPAO TBIO AMED
SUBJECT:  TURKEY: AVIAN INFLUENZA AND PREPAREDNESS RAPID 
ASSESSMENT 
 
Ref:  (A) ANKARA 6430 AND PREVIOUS SIT-REPS 
      (B) ANKARA OCTOBER 19 E&E INITIAL RESPONSE ON AI 
 
Sensitive but unclassified.  Not for Internet Distribution. 
 
¶1.  (SBU) Summary.  Turkey experienced one confirmed 
outbreak of the H5N1 strain of Avian Influenza in Balikesir 
in northwestern Turkey in early October without reports of 
human illness or deaths.  The Ministry of Health has taken a 
leadership role in contingency planning for a potential 
pandemic, but inter-agency coordination may be a weak area. 
Turkey could use technical assistance and training in 
laboratory testing capacity and kits and surveillance as the 
first line of defense.  According to the Health Ministry, 
the GOT would welcome cooperation from USID or the CDC.  End 
summary. 
 
Planning and Preparedness: 
-------------------------- 
 
¶2.  (SBU) Turkey is located on a major bird fly-way between 
Africa, Russia and the Black Sea.  The Turkish Ministry of 
Agriculture and Rural Affairs (MARA) has the lead for 
surveillance and containment of potential avian influenza 
cases, and has received good marks for its containment, 
culling, and quarantine procedures implemented in the one 
outbreak so far discovered in the Balikesir area, located 
near the Sea of Marmara in northwestern Turkey .  The 
Ministry of Health (MOH) coordinated with MARA on 
prophylaxis, surveillance, and treatment of workers.  The 
two agencies are working closely with private industry to 
implement regular controls and tracking for industry 
workers.   MARA has only one reference lab near Izmir and 
does not have capability to test for H5N1. 
 
¶3.  (SBU) In a meeting on October 20, MOH official Yildirim 
Bayazit described a newly drafted national plan for a 
potential pandemic.  It was developed under close 
supervision with the WHO.  According to Beyazit, the plan 
provides for the following key elements: 
 
-Creation of a 70-member multi-agency (Health, Agriculture, 
Universities, Military, Pharmaceuticals, etc.) task force. 
In the event of a crisis, he said MOH would take the lead 
with the National Crisis Center which is under the Prime 
Ministry (per normal disaster assistance procedures). 
-Action plan for providing information to the public. 
-Action plan for provision and coordination of health 
services, including surveillance, protection, isolation, 
precautions, triage, anti-viral measures, and extraordinary 
measures, such as increasing hospital bed capacity and/or 
identifying special hospitals for isolation or care (and 
closing public institutions, etc.) 
 
¶4.  (SBU) Comment: While the task force exists in draft on 
paper, it is not clear whether it has been approved more 
broadly within the Turkish government, let alone tested. 
Key spokespeople are not yet clearly designated.  MOH 
appears engaged, but admits that there are deficiencies and 
need for drills to hone the national plan.  MOH said it 
would welcome technical support, testing kits, training, 
and/or information sharing on surveillance and laboratory 
testing capacity.  The Turkey Emergency Management Agency 
has not been involved in the drafting of the MOH plan, 
indicating it may be more of a MOH, rather than, national 
plan.  (TEMA, under the Prime Ministry, would normally lead 
crisis management in Turkey.)  End Comment. 
 
Surveillance and Diagnosis: 
--------------------------- 
 
¶5.  (SBU) MARA has first level responsibility for 
surveillance for AI outbreaks in animals.  While MARA has 
told the Embassy that it has implemented active 
surveillance; it is difficult to assess the quality of the 
surveillance.  (Are no new outbreaks discovered based on no 
new AI cases, or does it reflect inadequate surveillance?) 
The GOT has been quick to investigate and then dismiss false 
outbreaks elsewhere in the country (Ref A).  MOH also told 
Embassy that it is actively carrying out surveillance; it 
has two virology labs (Ankara National Influenza Center and 
Istanbul Medical School Viral Institute).  Both MARA and MOH 
have extensive regional networks, but their level of inter- 
agency coordination may be weak and/or untested.  Both 
agencies could use more laboratory and testing capacity, as 
well as testing kits.  There is no capacity to test for H5N1 
in Turkey. 
 
Communications: 
--------------- 
 
¶6.  (SBU) Both MARA and MOH have identified communications 
and public awareness as a critical area.  Both have told 
Embassy that they are actively engaged in communicating with 
the public, farmers, and poultry workers on education, 
surveillance, and precautions.  The general public is very 
concerned about the threat of avian influenza and has a 
lingering distrust of the government.  Poultry consumption 
is sharply down and the industry is asking for government 
assistance.  Communications is a key aspect of MOH 
contingency planning.  In the event of a pandemic, MOH would 
distribute posters, brochures, and other materials.  MOH 
aims to establish a regular internet-based AI bulletin as of 
November 7. 
 
Response 
-------- 
 
¶7. (SBU) The GOT responded quickly to the Balikesir 
outbreak, establishing a 3 km quarantine zone and culling 
about 6000 birds (Refs).  Farmers were compensated for their 
birds and the GOT has announced increased funding for 
contingency compensation reserves.  In the event of multiple 
AI outbreaks the adequacy of the funds might be tested and 
the capacity of the MARA and MOH to respond and coordinate 
may be challenged.  The GOT has not employed wide animal 
vaccination as a containment measure, relying instead on 
surveillance.  The MOH has generated a national pandemic 
plan, but in the event of a public health crisis would 
likely not have adequate surge capacity.  The MOH aims to 
identify potential high risk groups and stockpile adequate 
masks, antivirals, and other medicines, including special 
protective equipment for health workers.  There are plans to 
work with the Red Crescent to increase hospital bed capacity 
and mobile units.  The GOT currently has 5,000 boxes of 
Tamiflu and has written a letter of intent to Roche to seek 
to acquire one million treatments.  WHO has announced 
support to Turkey, but the nature of this support has not 
been determined. 
 
Other Partners 
-------------- 
 
¶8.  (SBU) The GOT at first did not seek any foreign 
assistance after the AI outbreak.  Soon after, however, the 
GOT accepted an EU expert team to visit the outbreak site. 
The generally good marks given to the GOT for its 
containment are at least partly due to earlier cooperation 
with the EU on training and testing.  Part of the credit of 
the discovery of the outbreak was good awareness in the 
poultry industry.  The GOT has sought to work with private 
companies to improve surveillance capacity.  In many parts 
of the country, there are many smaller, less-organized 
family farms, where birds are kept outside, sometimes under 
limited control.   It is not clear whether the GOT has 
actively reached out to other NGO's or civil society, other 
than universities.  An MOH official attended the recent 
International AI and Pandemic Partnership meeting in 
Washington D.C.  MOH applied to the World Bank to receive 
funding for posters and brochures on AI under the WB's 
Health Transformation Project in Turkey.  MOH official 
Bayazit said the Ministry would be particularly interested 
in help from the USG and/or CDC for technical assistance to 
increase lab capacity, to procure more test kits, and to 
exchange and gain training, information, and experience. 
MCELDOWNEY