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 SAN JOSE 002718 
 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: TBIO SENV EAGR EAID PREL CS
SUBJECT: COSTA RICA AND AVIAN AND PANDEMIC INFLUENZA 
 
REF: STATE 209622 
 
¶1.  The responses below key off reftel. 
 
A) PREPAREDNESS/COMMUNICATION 
 
-- DOES THE GOVERNMENT HAVE A PREPAREDNESS PLAN/STRATEGY FOR 
PREVENTING AVIAN FLU FROM BECOMING A PANDEMIC AND CONTAINING 
A PANDEMIC ONCE IT OCCURS? IF THE COUNTRY HAS A STRATEGY, HOW 
CAPABLE IS IT OF IMPLEMENTING IT? PLEASE PROVIDE A COPY OF 
THE PLAN OR THE INTERNET ADDRESS FOR THE PLAN. 
 
The GOCR is finalizing a preparedness plan establishing a 
Core Commission on avian flu seating key ministries and 
agencies like the Ministry of Agriculture, Ministry of 
Health, and the Costa Rican Fund for Social Security (Caja 
Costarricense de Seguridad Social -CCSS), which administers 
the country's public health care system.  The plan also 
establishes a Communications Council that would manage 
outreach and education activities.  The plan is modeled along 
the recommendations that emerged from the Pan American Health 
Organization/World Health Organization.  The private sector 
has not yet been consulted or incorporated into the plan.  A 
copy of the plan will be forwarded when it is issued. 
 
Capacity for implementing the strategy is low.  Much will 
rely on the good will and common sense of the Costa Rican 
public to follow what will essentially be voluntary measures. 
 The view among doctors is that emphasis of any effort should 
be on education before an outbreak as an epidemic would 
quickly overwhelm the health system. 
 
-- HOW TRUTHFUL WILL THE GOVERNMENT BE IN REPORTING THE SCOPE 
OF ANY DISEASE OUTBREAK AMONG PEOPLE?  AMONG ANIMALS?  WHAT 
INCENTIVES COULD BE OFFERED THAT WOULD LIKELY RESULT IN MORE 
TRANSPARENCY? 
 
We expect the GOCR to be truthful in reporting the scope of 
the disease in animals or humans.  Costa Rica's Ministry of 
Agriculture and Livestock has good avian disease surveillance 
capabilities and a longstanding cooperative relationship with 
USDA's Animal & Plant Health Inspection Service.  Difficulty 
in diagnosing the disease in humans and slow processing time 
of tests rather than a lack of truthfulness would be the more 
likely cause of a delay in reporting the scope of the disease 
in CR, should it be introduced.  Timely reporting could be 
bolstered by contributing to an adequate supply of 
fast-reading tests that would permit a quicker diagnosis. 
 
-- WHERE DOES PREPARING FOR AN AVIAN FLU HUMAN PANDEMIC RANK 
AMONG GOVERNMENT PRIORITIES? WHO AND WHAT WOULD MOST 
INFLUENCE THE COUNTRY TO GIVE THE ISSUE A HIGHER PRIORITY? 
WHO IS THE KEY "GO-TO" PERSON, OFFICE OR DEPARTMENT (I.E. 
MINISTER FOR HEALTH, PRIME MINISTER, ETC.) FOR USG OFFICIALS 
TO ENGAGE ON THIS ISSUE? 
 
The Ministry of Health moved quickly to organize its approach 
and develop possible strategies (The Ministry of Agriculture 
already had an AI surveillance program in place).  Avian flu 
and its implications for Costa Rica have received 
considerable public relations play.  However, avian flu 
preparation is likely to take a back seat to pressing issues 
like burgeoning dengue numbers, malaria, TB, and deficient 
infrastructure.  Key go-to people include the Minister of 
Health; Ministry of Health avian flu coordinator Dr. Salas; 
and senior officials at the CCSS. 
 
 -- HAVE NATIONAL LAWS BEEN REVIEWED TO ENSURE THAT THEY ARE 
CONSISTENT WITH THE INTERNATIONAL HEALTH REGULATIONS AND DO 
NOT POSE BARRIERS TO AVIAN INFLUENZA DETECTION, REPORTING, 
CONTAINMENT, OR RESPONSE? 
 
Answer is not known. 
 
-- IS THE HOST COUNTRY ALREADY WORKING WITH INTERNATIONAL 
ORGANIZATIONS OR OTHER COUNTRIES ON THE AVIAN FLU ISSUE?  ARE 
GOVERNMENT LEADERS LIKELY TO ASK FOR ASSISTANCE FROM THE US 
OR OTHER COUNTRIES? WOULD GOVERNMENT LEADERS BE RECEPTIVE TO 
MESSAGES FROM US LEADERS THROUGH A BILATERAL APPROACH, AT A 
MULTILATERAL FORUM SUCH AS THE UN (WHO,FAO,ETC.) OR APEC, OR 
THROUGH BILATERAL CONTACTS BY A THIRD COUNTRY?  WHAT WOULD 
THE COUNTRY WANT FROM THE US IN RETURN FOR ITS EFFORTS? 
 
GOCR is working with the Pan American Health 
Organization/World Health Organization.  GOCR is likely to 
seek U.S. assistance if an outbreak occurs.  From technical 
staff to the Minister of Health, the Ministry of Health has 
comfortable contacts with their U.S. counterparts.  GOCR 
would be open to whatever approach is likely to deliver 
assistance and cooperation soonest in the case of an 
emergency.  In the preparedness phase, GOCR is likely to look 
to the U.S. for expertise and assistance in planning and in 
underwriting development of stockpiles.  In case of an 
impending pandemic scenario, GOCR is likely to seek access 
and financing for vaccines and medicines.  Depending on the 
scale of the outbreak, GOCR might request supplies needed to 
establish makeshift isolation wards or financial assistance 
to underwrite certain deferred infrastructure improvements. 
 
-- DOES THE COUNTRY CURRENTLY ADMINISTER ANNUAL FLU SHOTS? 
IF NOT, MIGHT IT CONSIDER DOING SO?   WHAT IS THE PRODUCTION 
CAPABILITY (I.E. HOW MANY DOSES OF THE ANNUAL TRIVALENT FLU 
VACCINE CAN THE COUNTRY MAKE) FOR HUMAN INFLUENZA VACCINES IN 
THE COUNTRY? DOES THE COUNTRY PRODUCE INFLUENZA VACCINE FOR 
POULTRY AND IF SO HOW MUCH?  IF THE COUNTRY IS DEVELOPING AN 
H5N1 VACCINE, WHERE IS IT IN PRODUCTION AND TESTING? ANY 
LICENSING ISSUES? IS THERE A LIABILITY SHIELD FOR FOREIGN 
MAKERS/DONORS OF VACCINES?  IF NOT, ANY PROSPECTS OF ONE 
BEING ENACTED? 
 
Costa Rica administers annual flu shots to its most 
vulnerable population --children, the elderly, those with 
Cardiopulmonary Disease, or cardiopathology.  Costa Rica does 
not produce vaccines.  An H5N1 vaccine is not in development. 
 Post does not know whether there is a liability shield for 
donors or foreign manufacturers. 
 
--HOW WELL INFORMED IS THE POPULATION ABOUT THE AVIAN FLU 
THREAT AND ABOUT MEASURES THEY SHOULD TAKE TO MITIGATE THE 
THREAT? WHAT MECHANISMS ARE AVAILABLE FOR PROVIDING 
ADDITIONAL INFORMATION TO THE POPULATION, PARTICULARLY IN 
RURAL AREAS AND HOW EFFECTIVE ARE THESE MEASURES? 
 
Recent press coverage focused on the risks of avian flu.  The 
population is aware of the risk, but are likely not familiar 
with measures they can take to mitigate the threat.  Most of 
the population can be reached through newspapers, TV and 
radio.  The CCSS, system of hospitals and health care 
centers is within reach of most of the population.  Of 
particular concern are the aboriginal peoples of remote 
southern Costa Rica, who are the hardest for the government 
to reach and whose subsistence farming occurs near wilderness 
areas that may host migratory birds. 
 
B) SURVEILLANCE/DETECTION 
 
-- HOW CAPABLE ARE THE MEDICAL AND AGRICULTURE SECTORS OF 
DETECTING A NEW STRAIN OF INFLUENZA AMONG PEOPLE OR ANIMALS 
RESPECTIVELY? HOW LONG MIGHT IT TAKE FOR CASES TO BE PROPERLY 
DIAGNOSED, GIVEN OTHER ENDEMIC DISEASES? CAN INFLUENZA 
VIRUSES BE SUBTYPED IN THE COUNTRY, IF SO BY WHO, AND IF NOT 
WHERE ARE THEY SENT? DOES THE COUNTRY SEND SAMPLES TO A 
WHO/EU/US REFERENCE LABORATORY? 
 
We expect that detection capacity by the Health Ministry is 
good and that Agriculture's capacity is better.  However, the 
lack of quick flu tests indicates that Costa Rican tests may 
take a week or more to establish presence of the disease in 
humans - a delay inconsistent with the nature of a pandemic 
emergency. Influenza viruses are sent to CDC/Atlanta for 
subtyping. 
 
-- WHAT ARE THE CRITICAL GAPS THAT NEED TO BE FILLED IN ORDER 
TO ENHANCE THE COUNTRY'S DISEASE DETECTION AND OUTBREAK 
RESPONSE CAPABILITIES? WHAT IS THE COUNTRY'S GREATEST NEED IN 
THIS AREA FROM THE US OR INTERNATIONAL ORGANIZATIONS? 
 
Key gaps include shortage of fast flu tests for the number 
required in case of a pandemic; limited ability to isolate 
sick patients - and inadequate infrastructure for handling 
suspicious cases- waiting rooms are not separated between the 
infectious and non-infectious and many sick individuals using 
public transport to get to hospitals. 
 
GOCR could use equipment and supplies to quickly distinguish 
among types of flu. 
 
C) RESPONSE/CONTAINMENT 
 
-- DOES THE COUNTRY HAVE A STOCKPILE OF MEDICATIONS, 
PARTICULARLY OF ANTIVIRALS, AND IF SO HOW MUCH?  IF SOME HAS 
BEEN ORDERED, HOW MUCH AND WHEN IS IT EXPECTED? 
 
NO.  GOCR is considering an order for sufficient vaccines for 
50 percent of their population.  The GOCR has not decided 
whether to put itself on the waiting list for Tamiflu orders. 
 
--DOES THE COUNTRY HAVE A STOCKPILE OF PRE-POSITIONED 
PERSONAL PROTECTIVE GEAR? 
 
GOCR only has on hand a stockpile of personal gear to meet 
normal needs.  Sometimes major public Hospitals have 
shortages for normal needs due to distribution problems. 
 
--WHAT IS THE RAPID RESPONSE CAPACITY FOR ANIMAL AND HUMAN 
OUTBREAKS? ARE GUIDELINES IN PLACE FOR THE CULLING AND 
VACCINATION OF BIRDS, DISINFECTING OF FACILITIES, AND 
LIMITATIONS ON ANIMAL MOVEMENT? 
 
Good.  GOCR has worked with APHIS on tracking diseases among 
domesticated poultry and other animals. 
-- HOW WILLING AND CAPABLE IS THE GOVERNMENT OF IMPOSING 
QUARANTINES AND SOCIAL DISTANCING MEASURES (CLOSING SCHOOLS, 
PUBLIC GATHERINGS, MASS TRANSIT)? WOULD ITS MILITARY ENFORCE 
QUARANTINES? 
 
GOCR can persuade organizers to cancel many public events. 
However, its capacity for enforcing restraints on private 
behavior is limited.  With no military, civil security forces 
will bear the burden of persuading citizens to respect 
government recommendations. 
 
¶2.  COMMENT:  Costa Rica's underfunded, deteriorating health 
care system is unlikely to be able to handle a full-scale 
epidemic.  Should the first line of defense, isolation of the 
earliest cases, fail to contain the outbreak, the health care 
system will have to resort to home quarantine, rely on the 
"Honor System" for restraining public activities, and trust 
that the common sense of the citizenry will respect 
precautionary measures.  In this case, as one doctor put it 
to the Embassy nurse, "Cada uno a su santo" - Each to his 
saint.  End comment. 
LANGDALE