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

UNCLAS SECTION 01 OF 04 ANKARA 006884 
 
SIPDIS 
 
STATE FOR EUR/RUS, OES/STC, EB/TPP/ATP, EB/TPP/BTA 
STATE ALSO PASS USAID FOR BLANCHET, TROSTLE 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 
 
E.O. 12958:N/A 
TAGS: TBIO SENV ECON EAGR EAID PREL AMED TU
SUBJECT:  TURKEY: AVIAN INFLUENZA - ADDITIONAL INFORMATION 
RESPONSE 
 
Ref: (A) STATE 209622 - REQUEST FOR INFORMATION ON AI 
     (B) ANKARA 6838 - USAID ASSESSMENT AND RECOMMENDATION 
     (C) ANKARA 6481 - AI AND PREPAREDNESS ASSESSMENT 
     (D) ANKARA 6605 AND PREVIOUS SIT-REPS 
     (E) ANKARA OCTOBER 19 E&E INITIAL RESPONSE ON AI 
 
¶1.  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.  Turkey has received generally high 
marks for its transparency, response, and containment of the 
outbreak, and could serve as a model country in the region 
(Refs).  Following a USAID assessment visit, we concluded 
that Turkey needs to improve: 1) inter-agency coordination - 
including creation of a supra-ministerial AI czar; 2) its 
ability to respond to potential multiple outbreaks; 3) 
communication and education to farmers and consumers; 4) 
grassroots AI surveillance, and 5) surveillance of wild 
birds.  Embassy has recommended that USAID work through the 
Embassy to focus support on AI surveillance/containment 
training and communication (Ref B).  This cable responds 
comprehensively to Ref A request for information.  End 
summary. 
 
Preparedness/Communication: 
-------------------------- 
 
¶2.  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. 
 
¶3.  In collaboration with the EU, MARA has developed an 
emergency contingency plan for limiting potential spread of 
AI (copy provided to USAID expert).  Through an EU 
"twinning" project, training and emergency simulation 
activities were carried out by chance in Balikesir just one 
month before the outbreak, contributing to the quick and 
transparent response.  It is not clear if the GOT would be 
able to respond to simultaneous multiple outbreaks.  In 
addition there is some concern about the GOT's ability to 
provide compensation to farmers, particularly small 
landholders (private industry arranged for compensation for 
the Balikesir outbreak).  Most outside and multinational 
organizations note the absence of a supra-ministerial body 
or czar that would be able to direct several independent 
ministries to take coordinated action in the event of a 
major animal or human outbreak.  Finally, there is some 
concern with the GOT's ability to monitor wild bird 
populations and migrations. 
 
¶4.  The MOH has worked with WHO to develop a national 
pandemic plan.  Although MOH officials described detailed 
elements of the plan, Embassy was unable to obtain a copy of 
the draft and it does not appear to be shared, approved, or 
tested by other parts of the GOT. 
Key elements are as follows: 
-Creation of a 70-member multi-agency (Health, Agriculture, 
Universities, Military, Pharmaceuticals, etc.) task force. 
In the event of a crisis, MOH would take the lead in tandem 
with the National Crisis Center which is under the Prime 
Ministry (Turkey National Emergency Agency; 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.) 
 
¶5.  Preparing for AI appears to be a high priority for the 
GOT; although, the lifting of the one outbreak quarantine 
has lowered some urgency, particularly in non-lead GOT 
agencies.  The GOT will need assistance in generating 
effective communication to farmers and consumers.  Turkish 
people do not have faith in the truthfulness of their 
government's reporting and assurances.  Adequate 
compensation will be critical in ensuring that farmers 
accurately report potential cases.  Embassy has not been 
able to review national laws, but understands that 
compensation for AI by the GOT is not clear in the law. 
 
¶6.  The international response to the Turkish outbreak has 
been robust.  The EU and FAO both sent teams to Turkey in 
the aftermath of the outbreak.  The World Bank is assessing 
requests from the GOT for assistance in combating both 
animal and possible human outbreak.  FAO and the EU have 
been providing some training to Turkish veterinarians and 
Thailand and Canada have sent specialists to provide some 
technical assistance and information about AI.  There are 
two collective concerns:  1) technical assistance in the way 
of information sharing and training should be provided in 
rural and local levels.  2) training should be conducted on 
a recurring basis and not as a single event.  International 
observers lament the lack of a supra-ministerial czar or "go 
to" position, although MARA and MOH officials have 
separately been very helpful. 
 
¶7.  Turkey administers annual flu shots.  Turkey does not 
produce WHO approved human trivalent influenza vaccine.  The 
country does not produce- and for the moment- does not have 
plans to use influenza vaccine for poultry.  The country is 
not developing an H5N1 vaccine. 
 
¶8.  Both MARA and MOH have identified communication 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 public is deeply 
concerned about AI, and is distrustful of GOT assurances; 
consumption of chicken has dropped dramatically.  There is a 
need for better and more frequent communication from the GOT 
to farmers and consumers.  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 
 
Surveillance/Detection: 
---------------------- 
 
¶9.  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.  The GOT has been 
quick to investigate and then dismiss false outbreaks 
elsewhere in the country.  MARA has only one reference lab 
near Izmir and does not have capability to test for H5N1; it 
sent samples to the UK to gain the positive for H5N1.  MOH 
also told Embassy that it is actively carrying out 
surveillance among people; 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. 
 
¶10.  Both agencies have made requests to multilateral 
organizations for more laboratory and testing capacity, as 
well as testing kits.  For equipment, the GOT and industry 
have requested incinerators to dispose of large numbers of 
animals, animal vaccines, protective equipment for workers, 
and upgrading of diagnostic equipment.  On the human health 
side, the government is requesting protective equipment for 
health workers and supplies of antibiotics including 
Tamiflu.  Most of the equipment and medicines will be 
provided under existing programs operated by the World Bank 
and European Union. 
 
¶11.  The two critical gaps that Post has identified it might 
play a role are local training/assistnace for MARA for 
surveillance/containment and communication.  For technical 
assistance, the GOT has indicated that it would appreciate 
some type of technical training for local veterinarians and 
farmers.  Most officials indicate that knowledge levels at 
central government offices, particularly in Ankara, Istanbul 
and Izmir were sufficient, but there has been little 
dissemination of information in rural areas.  As a result, 
some recurring training in several areas of the country 
could be beneficial in stemming any animal outbreaks.  Post 
could draw effectively on farmers unions, poultry 
associations and Ministry contacts to disseminate 
information and organize this effort.  Currently, many 
countries are sending random speakers to the country.  Post 
therefore emphasizes the need for recurring efforts.  This 
would hopefully encourage the development of a mechanism to 
address any future outbreaks of AI or other diseases.  Post 
also believes strongly that in-country training would be 
much more effective in reaching a larger portion of the 
population. 
 
¶12.  Second, there is a strong need for the creation of a 
public education program.  Although, only 9000 birds had to 
be culled as a result of the one outbreak, poultry 
consumption decreased by 90 percent following the outbreak 
and is currently only 50 percent of normal.  In addition, 
small and subsistence farmers need to be educated on the 
need for reporting and the proper steps that should be taken 
in case of any bird deaths.  One possibility in addressing 
this issue would be to draw on information used worldwide on 
the outbreak, which could be tailored to the Turkish needs. 
The information could be disseminated through various 
organizations. 
 
¶13.  The media has been the chief vehicle for providing 
information about the animal outbreak.  Information from the 
GOT has been better than expected, but still woefully short, 
leaving the media to generate and provide most information. 
The World Bank has suggested the creation of a spokesperson 
position at the supra-ministerial level to provide a central 
contact to disseminate information. 
 
Response/Containment 
-------------------- 
 
¶14.  The GOT responded quickly to the Balikesir outbreak, 
establishing a 3 km quarantine zone and culling about 9000 
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 MARA emergency contingency plan has 
guidelines for quarantine, culling, disinfection of 
facilities, and disposal.  MARA is aiming to increase pre- 
positioning of personal protective gear, but has not 
achieved full coverage.  The GOT has not employed wide 
animal vaccination as a containment measure, relying instead 
on surveillance. 
 
¶15.  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.  The plan calls for imposing quarantines and 
social distancing measures; in the event of a pandemic 
crisis, the Prime Ministry national crisis center would have 
authority and willingness to close schools, public 
gatherings, and mass transit.  The military would likely be 
available to enforce quarantines. 
 
¶16.  Turkey could serve as a model for transparent response 
for other countries in the region.  Combined efforts of 
public, private, and international officials contributed to 
the good response to the outbreak.  The relationship between 
public and private agriculture (i.e. poultry sector) has 
improved as a result of this crisis.  The private commercial 
poultry sector has been providing training and some 
surveillance of farms, at least in those regions in close 
proximity to commercial areas. 
MCELDOWNEY