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

UNCLAS SECTION 01 OF 09 HANOI 002824 
 
SIPDIS 
 
SENSITIVE BUT UNCLASSIFIED - DO NOT POST ON THE INTERNET 
 
STATE FOR G; CA/OCS/ACS/EAP; EAP/EX; EAP/MLS; EAP/EP; INR; 
OES/STC (PBATES); OES/IHA (DSINGER AND NCOMELLA) 
BANGKOK FOR RMO, HHS/CDC, USAID/RDM/A (MFRIEDMAN) 
USDA FOR FAS/PASS TO APHIS 
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (LSTERN) 
USAID FOR ANE AND GH (DCARROLL, SCLEMENTS AND PCHAPLIN) 
HOMELAND SECURITY COUNCIL FOR RVENKAYYA 
NSC FOR FSHIRZAD, JMELINE 
STATE PASS USTR (ELENA BRYAN) 
STATE ALSO PASS HHS/OGHA (EELVANDER) 
USMISSION GENEVA FOR HEALTH ATTACHE 
ROME FOR FAO 
 
E.O. 12958: N/A 
TAGS: AMED AMGT CASC EAGR PINR SOCI PGOV TBIO VM AFLU HIV AIDS
SUBJECT: HHS SECRETARY LEAVITT'S MEETING WITH THE VIETNAMESE 
MINISTER OF HEALTH 
 
¶1. (SBU) Summary:  U.S. Secretary of Health and Human 
Services (HHS) Michael Leavitt met with Vietnamese Minister 
of Health (MOH) Tran Thi Chung Chien on October 14 at the 
Ministry to discuss avian influenza (AI) issues and ways to 
improve U.S.-Vietnam cooperation to combat AI more 
effectively.  After a brief MOH presentation to provide data 
on the AI and HIV/AIDS situation in Vietnam, Minister Chien 
and HHS Secretary Leavitt identified Vietnam's top health 
needs and priorities.  They also discussed new programs, 
cooperation and funding the United States will provide to 
assist those needs.  After the meeting, the two officials 
signed a "Letter of Intent on Cooperation between the 
Vietnamese Ministry of Health and the Department of Health 
and Human Services of the United States of America" (see 
text, para. 22) to express their mutual commitment to 
improving cooperation on all health issues of concern.  End 
Summary. 
 
OPENING REMARKS: LET US BE FRANK 
-------------------------------- 
 
¶2. (SBU) On October 14, U.S. HHS Secretary Michael Leavitt 
met with Vietnamese MOH Minister Tran Thi Chung Chien at the 
Ministry for 80 minutes, the first of a series of meetings 
with Vietnamese officials that day and the following day on 
improving U.S.-Vietnam health cooperation.  A full list of 
participants follows in paragraphs 23, 24 and 25.  Minister 
Chien began the meeting by emphasizing how important U.S.- 
Vietnam cooperation on emerging health issues like avian 
influenza (AI) and HIV/AIDS is to Vietnam and to its ability 
to control and prevent the spread of these diseases.  She 
said she wanted to conduct the meeting in an "open 
atmosphere," with frank exchanges and discussion for the 
benefit of future U.S.-Vietnam health cooperation efforts. 
 
¶3. (SBU) The Secretary replied that this visit is a 
reflection of the strong relationship the United States and 
Vietnam have built in recent years.  He thanked Minister 
Chien for her welcome, and also for the support of the 
Government of Vietnam (GVN) and the Vietnamese people for 
American victims of Hurricane Katrina and Hurricane Rita. 
The Secretary described this generosity as "warming to our 
spirits," and noted that Vietnam's contribution had also 
assisted in aiding the many Vietnamese-Americans in 
Louisiana affected by the storms.  He expressed his 
condolences for the human and economic losses Vietnam had 
suffered from AI, and noted that "no nation on earth can 
avoid" this disease if it establishes the ability to move 
efficiently from human to human.  The Secretary emphasized 
that if AI mutates to enable sustained human-to-human 
transmission, it has the potential to kill millions of 
people and alter the customs, prosperity, and way of life of 
billions of people all over the world.  Thus, he welcomed 
Minister Chien's interest in speaking candidly about the 
reality of and solutions for combating AI. 
 
AI: THE NUMBERS 
--------------- 
 
¶4. (SBU) Following the Secretary's remarks, Vice Minister of 
Health Trinh Quan Huan provided a PowerPoint presentation on 
the AI and HIV/AIDS situations in Hanoi.  He described the 
history of the H5N1 AI strain in Vietnam as follows: 
 
-The first outbreak had a four-month duration, from December 
2003-April 2004, across 13 provinces, with a total of 23 
human cases and 16 human deaths.  In all, 57 of the 64 
Vietnamese provinces reported AI outbreaks in poultry. 
 
-The second outbreak had a two-month duration from July 2004- 
August 2004, spread across three provinces, where there were 
four human cases and four human deaths.  In all, 17 of the 
64 provinces in the country reported AI outbreaks in 
poultry. 
 
-The third outbreak had a seven-month duration from January 
2005-July 2005, spread across 25 provinces, with 64 human 
cases and 21 human deaths.  In all, 36 of the 64 Vietnamese 
provinces reported AI outbreaks in poultry. 
 
¶5. (SBU) Huan emphasized that all human AI cases had 
previously been in contact with poultry, and that these 
human AI cases only occurred in provinces that had also had 
AI outbreaks in poultry.  He attributed this to the low 
levels of knowledge rural people have about AI and their 
poor awareness of appropriate control measures.  There are, 
he stressed, no proven human-to-human cases of transmission 
in Vietnam. 
 
¶6. (SBU) According to Huan, the GVN faces several challenges 
in combating AI, namely improving surveillance, establishing 
Bio-Safety Level 3 (BSL-3) laboratories at the National 
Institute of Hygiene and Epidemiology (NIHE) of the MOH in 
Hanoi and the Pasteur Institute in HCMC, increasing public 
awareness about AI and its methods of transmission, and 
training medical workers in proper containment and treatment 
procedures. 
 
HIV/AIDS: THE NUMBERS 
--------------------- 
 
¶7. (SBU) Huan then presented an overview of the HIV/AIDS 
situation in Vietnam.  All 64 provinces, 90 percent of the 
districts and 50 percent of the communes in Vietnam have 
reported cases of HIV/AIDS, he said, but the prevalence rate 
varies by region.  Quang Ninh Province, for example, has 
just fewer than 600 cases per 100,000 people, one of the 
highest rates. 
 
¶8. (U) HIV/AIDS is predominantly present in drug users in 
Vietnam.  According to MOH statistics, 54 percent of 
intravenous drug users in the country have HIV/AIDS, whereas 
less than three percent of prostitutes have the disease. 
This distribution, however, also varies by region, according 
to the Ministry, with a higher rate of HIV/AIDS infection 
among drug users in Hanoi and a higher rate of infection 
among prostitutes in HCMC.  The Ministry estimates that 
eighty percent of all HIV/AIDS cases in Vietnam exist among 
20-29-year-olds, which is also the most important age group 
for labor productivity. 
 
¶9. (SBU) The Vice Minister emphasized that the projects and 
training the GVN will implement from 2005-2010 require large 
amounts of money, which the GVN and contributions from the 
British Government, the Global Fund, and other donors cannot 
completely cover.  According to the MOH, the total 2005-2010 
budget shortfall is USD 498,606,352 million. 
 
¶10. (SBU) Finally, Huan reviewed the educational capacity of 
the GVN in health and pharmacology.  There are 14 
universities, four medical colleges, and 74 pharmacology 
schools in Vietnam, which annually produce approximately 
3,000 postgraduate students, 6,200 medical college 
graduates, 18,800 college graduates, and 14,500 pharmacology 
school graduates.  The GVN hopes to improve these graduation 
rates to meet its 2010 social development target of seven 
doctors and .5 pharmacologists per 100,000 people.  Huan 
stated that the GVN would also like to expand cooperation 
and assistance to develop capabilities in molecular biology, 
information technology, genetics, immunology, bio-safety 
laboratories, biotechnology, vaccine research and transplant 
techniques.  (Note: Huan did not distribute copies of his 
slides, and moved through them very quickly.  The 
information above comes directly from his presentation.  End 
Note.) 
 
MOH'S MAIN REQUESTS OF THE USG 
------------------------------ 
 
¶11. (U) After Huan finished speaking, Minister Chien 
reviewed the progress the GVN has made in developing a 
National Plan for Emergency Preparedness, as well as 
training courses for health personnel.  The MOH drafted the 
plan, she added, by using the lessons learned from the 
experience of combating Severe Acute Respiratory Syndrome 
(SARS).  The plan also includes district- and commune-level 
support, as well as coordination with the army and the air 
force in case their assistance in transportation is needed. 
Media cooperation is another important aspect of the plan, 
since television and radio communication, especially with 
rural areas and in local languages, is important to 
increasing awareness and distributing critical information. 
The GVN has also taken into account the linguistic 
differences of some minority groups, and has prepared for 
translating messages into appropriate tongues.  All 
Ministries and other elements of the GVN involved in this 
plan now meet twice a year to discuss and improve their 
response to national disasters and emergency situations. 
 
¶12. (SBU) Madame Chien then listed the top priorities and 
concerns of the MOH, including areas in which the GVN would 
like to increase cooperation with and assistance from the 
United States.  First, she encouraged more foreign direct 
investment (FDI) in the Vietnamese health sector for 
training, health care and high-technology development, 
especially FDI from U.S. pharmaceutical corporations. 
Second, developing an effective human vaccine against the 
H5N1 influenza virus is a top priority for the GVN.  Third, 
the GVN wants its two main laboratory facilities - NIHE 
under the MOH and the Pasteur Institute - to have BSL-3 
capabilities.  The GVN also needs basic medical supplies and 
equipment to better respond to potential AI outbreaks. 
Minister Chien concluded by noting the GVN wants to become 
self-reliant in its ability to develop vaccines against 
influenza and other disease and conduct testing and clinical 
trials that are up to international standards. 
 
U.S. SUPPORT FOR MOH REQUESTS 
----------------------------- 
 
¶13. (SBU) After thanking Minister Chien for the helpful 
presentation and her suggestions, the Secretary explained 
the details of ongoing and future U.S. assistance to Vietnam 
for combating AI and HIV/AIDS.  The United States continues 
to value and encourage opportunities for Vietnamese and U.S. 
professionals in disease control to exchange ideas and visit 
testing facilities.  Many of these exchanges have been going 
on for some time, and the United States will continue to 
expand this effort, he said. 
The Secretary asked several of his delegation members to 
explain these efforts in detail. 
 
SURVEILLANCE PROGRAMS 
--------------------- 
 
¶14. (SBU) Dr. Julie Gerberding, Director of the HHS Centers 
for Disease Control and Prevention (CDC), explained that the 
United States will commit USD 2.6 million out of Fiscal Year 
2005 emergency supplemental funding to assist surveillance 
programs in four specific areas.  First, it would fund 
prevention and education programs as well as training for 
epidemiologists and other scientists.  Second, it would 
focus on detection, by helping rural people understand how 
to identify and report potential AI cases.  Third, it would 
help the GVN develop rapid-response teams that could move 
quickly to assist people at the local level.  Finally, it 
would also support vaccine and antiviral development.  In 
addition to the USD 2.6 million from HHS/CDC, the U.S. 
Agency for International Development (USAID) will also 
provide USD 3.4 million out of Fiscal Year 2005 emergency 
supplemental funding to help combat AI by improving animal 
health efforts and communications between health and 
agricultural officials at the national and provincial 
levels. 
 
USAID HIV/AIDS PREVENTION PROGRAMS 
---------------------------------- 
 
¶15. (SBU) Dr. Kent Hill, Acting Assistant Administrator for 
Global Health at USAID, then described a second area of U.S. 
assistance funded by his agency.  Noting that President 
Bush's designation of Vietnam as the fifteenth focus country 
in his Emergency Plan for AIDS Relief (PEPFAR) demonstrated 
the depth of U.S. commitment in this area, Hill said that in 
Fiscal Year 2005, USAID will provide a total of USD 16 
million for HIV/AIDS programs in Vietnam and USD 20 million 
in 2006.  (NOTE.  As part of the President's Emergency Plan, 
HHS will also spend USD xxx in Fiscal Year 2005 for HIV/AIDS 
programs in Vietnam, which brings the total USG investment 
in Vietnam under the Emergency Plan in Fiscal Year 2005 to 
USD xxx.) 
 
USDA ASSISTANCE WITH POULTRY PROGRAMS 
------------------------------------- 
 
¶16. (SBU) Dr. James Butler, Under Secretary for Farm and 
Foreign Agricultural Services at the U.S. Department of 
Agriculture (USDA), said that USDA will also cooperate on 
and contribute to AI efforts by sending scientists to 
Vietnam to help with the diagnosis of AI in animals and 
providing equipment and resources to assist vaccination 
programs.  Butler said USDA will continue to work closely 
with the Vietnamese Ministry of Agriculture and Rural 
Development (MARD) on these programs. 
 
U.S.  EFFORTS IN VACCINE RESEARCH 
---------------------------------- 
 
¶17. (SBU) Dr. Anthony Fauci, Director of the National 
Institute of Allergy and Infectious Diseases (NIAID) within 
the HHS National Institutes of Health, explained that the 
U.S. vaccine development efforts had found humans respond 
differently to the H5N1 virus than they do to regular, 
seasonal flu strains, and that clinical trials are very 
important in the development of an H5N1 human vaccine, its 
safety, and its appropriate dosage.  He promised that HHS 
would continue to work closely with Vietnam in these 
efforts. 
 
THE INTERNATIONAL PARTNERSHIP 
----------------------------- 
 
¶18. (SBU) Under Secretary of State for Global Affairs Paula 
Dobriansky welcomed Vietnam's participation in the 
International Partnership to Combat Avian Influenza, and 
noted that the Partnership is committed to surveillance, 
transparency and the sharing of information.  She thanked 
the Minister for the GVN's participation in the Senior 
Officials' meeting held in Washington on October 6-7, and 
expressed appreciation for the Vietnamese delegation's 
endorsement of the core principles of the Partnership.  She 
emphasized that AI is not just a health issue but also 
something that will have social, economic and security 
implications in Vietnam and around the world. 
 
THE IMPORTANCE OF TRANSPARENCY 
------------------------------ 
 
¶19. (SBU) Secretary Leavitt emphasized that the most 
important aspect of U.S.-Vietnam cooperation on health 
issues is transparency.  He appealed to the Minister that 
Vietnam must provide an absolute commitment to cooperation 
and transparency when the GVN discovers cases of H5N1. 
HHS/CDC Director Gerberding explained that when a case of 
H5N1 AI is discovered, the United States needs to know three 
things and know them quickly.  First, the United States must 
know the "who, what, when, where and how" of each case. 
Second, we must understand the illness, the clinical 
conditions and treatment of each patient, and his or her 
response.  Finally, without specific samples and information 
on the virus, we cannot make an appropriate vaccine.  She 
urged the GVN to share as much of this information directly 
with the USG as soon as possible. 
 
¶20. (SBU) To emphasize this point, the Secretary asked Dr. 
Margaret Chan, Assistant Director-General for Communicable 
Diseases at the World Health Organization (WHO), to address 
the delegations.  Dr. Chan, who had commanded the response 
to SARS in Hong Kong while she was head of the Health 
Department there, shared that, in her experience, 
transparency and rapid response were the most important 
weapons against disease.  She said the WHO Secretariat and 
its Regional Office in Manila would continue to assist 
Vietnam in fighting AI. 
 
¶21. (U) Following the conversation, HHS Secretary Leavitt 
and Minister Chien then signed a Letter of Intent to pledge 
their mutual support to addressing health issues.  (NOTE: 
Post and HHS intend to pursue negotiations to turn the 
Letter of Intent into a more binding Memorandum of 
Understanding underneath the U.S.-Vietnam Science and 
Technology Agreement.  END NOTE.) 
 
¶22. (U) Begin text of Letter of Intent: 
 
"Letter of Intent on Cooperation between the Ministry of 
Health of the Socialist Republic of Viet Nam and the 
Department of Health and Human Services of the United States 
of America" 
 
     The Ministry of Health of the Socialist Republic of 
Viet Nam and the Department of Health and Human Services of 
the United States of America, hereinafter referred to as the 
"Participants": 
 
      Guided by the willingness to develop fruitful 
     cooperation between their respective countries in the field 
     of health and medical sciences; 
 
      Considering the importance of international cooperation 
     to ensure an enhanced focus on influenza, emerging 
     infectious diseases and other important public health 
     issues; 
 
      Noting the commitment both countries have to preparing 
     for a pandemic of infectious diseases; 
 
      Desiring to work in the spirit of transparency, mutual 
     benefits and accurate and timely exchange of information; 
 
Intend to negotiate an Agreement to outline the forms of 
cooperation between the Participants. 
 
s. 
 
Negotiations under this letter of Intent are to commence 
upon signature by both Participants. 
 
Signed at Ha Noi, in duplicate, this fourteenth day of 
October, 2005, in the English and Vietnamese languages; all 
texts being equally authentic. 
 
End Text. 
 
PARTICIPANTS 
------------ 
 
¶23. (U) U.S. Participants: 
U.S. HHS Secretary Michael Leavitt 
Dr. Paula Dobriansky, Under Secretary of State for Global 
Affairs 
U.S. Ambassador Michael Marine 
Kerry Weems, HHS Deputy Chief of Staff 
Dr. Kent Hill, Acting Assistant Administrator for Global 
Health, USAID 
Dr. James Butler, Under Secretary for Farm and Foreign 
Agricultural Services, USDA 
Dr. Julie Gerberding, Director, HHS/CDC 
Dr. Anthony Fauci, Director, HHS/NIH/NIAID 
Suzy De Francis, Assistant Secretary for Public Affairs, HHS 
Dr. William Steiger, Special Assistant for International 
Affairs, HHS 
Dr. Vaughan Turekian, Special Assistant to Under Secretary 
Dobriansky 
Allyson Bell, Director of Scheduling and Advance, HHS 
HHS Hanoi Health Attach Marie Sweeney 
HHS/CDC Chief of Party Mitchell Wolfe 
USDA/FAS Hanoi Attach John Wade 
 
¶24. (U) Vietnamese Participants: 
MOH Minister Tran Thi Trung Chien 
MOH Vice Minister Trinh Quan Huan 
MOH International Cooperation Department (ICD) Director Dr. 
Tran Trong Hai 
MOH Department of HIV/AIDS Control Director Nguyen Huy Nga 
MOH Department of Science and Training Director Truong Viet 
Dung 
MOH Department of Therapy Director Ly Ngoc Kinh 
MOH Drug Administration Director Cao Minh Quang 
National Institute of Hygiene and Epidemiology (NIHE) 
Director Nguyen Tran Hein 
Institute of Clinical Research of Tropical Diseases Director 
Nguyen Duc Hien 
Hanoi Medical University Director Nguyen Lan Viet 
Public Health University Director Le Vu Anh 
MOH ICD Officer Nguyen Thi Minh 
Ministry of Foreign Affairs (MOFA) America Department 
Director Nguyen Duc Hung 
Ministry of Agriculture and Rural Development (MARD) Deputy 
Director Hoang Van Nam 
Hanoi Health Department Deputy Director Pham The Tuan 
 
 
¶25. (U) International Organization Participants: 
Dr. Margaret Chan, Assistant Director-General for 
Communicable Diseases, World Health Organization (WHO) 
Dr. He Changchui, Assistant Director-General, Food and 
Agriculture Organization (FAO) 
Dr. Alejandro Thiermann, Special Representative to the 
Director-General of the World Animal Health Organization 
(OIE) and Chairman of the OIE Terrestrial Animal Health 
Standards Commission 
WHO Country Representative Hans Troedsson 
FAO Country Representative Anton Rychener 
 
¶26. (SBU) The Secretary's party has cleared this cable. 
 
BOARDMAN