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 ROME 004113 
 
SIPDIS 
 
SENSITIVE 
 
DEPT FOR OES/IHA (DR. DSINGER/RSDALEY), DHHS FOR OGHA (STEIGER) 
 
E.O. 12958:  N/A 
TAGS: TBIO SENV ECON EAGR EAID PREL IT FAO
SUBJECT:  ITALIAN PREPAREDNESS FOR AVIAN/PANDEMIC INFLUENZA 
 
REFTEL:   STATE 209622 
 
SENSITIVE BUT UNCLASSIFIED - PROTECT ACCORDINGLY 
 
¶1.  (U) Information on avian/pandemic influenza preparedness in 
Italy is keyed to categories and questions in reftel. 
 
A) PREPAREDNESS/COMMUNICATION 
----------------------------- 
 
¶2.  (SBU) Does the government of Italy have a preparedness 
plan/strategy for preventing avian flu (AI) from becoming a 
pandemic and containing a pandemic once it occurs?  If the 
country has a strategy, how capable is it of implementing it? 
 
--  (SBU) The GOI has established a Task Force for AI. 
Membership includes:  the Ministry of Health, the Civil 
Protection Agency, medical experts, the Higher Institute of 
Health, selected university representatives, and the Italian Drug 
Agency - FDA equivalent.  The GOI has a draft strategy dated 
November 30, a copy of which was furnished in confidence to the 
Embassy.  After all of Italy's twenty regions approve the draft, 
it will be made public on the Ministry of Health's Internet 
website. 
 
¶3.  (U)  How truthful will the government be in reporting the 
scope of any disease outbreak among people?  Among animals? 
 
--  (U) Recent experience with AI has contributed to the GOI's 
open attitude on AI.  Italy, like many poultry-producing 
countries, has had experience with avian influenza.  A major 
outbreak of high-path AI occurred in Italy between 1999-2000, and 
this experience led the Ministry of Health to make a substantial 
investment in the Istituto Zooprofilattico Sperimentale delle 
Venezie (IZSVe - Experimental Zooprophilactic Institute of the 
Veneto).  IZSVe is a reference laboratory for AI for the World 
Animal Health Organization (OIE).  An outbreak of low-path AI 
occurred on turkey farms in the region of Lombardy in April, 
¶2005.  Neither of these incidents involved H5N1, but both were 
reported in a timely manner and are listed on IZSVe's Internet 
website.  When one of the over one thousand recent tests on 
avians tested positive for low-path AI in a wild duck, the 
Ministry of Health immediately issued a press release (on 
November 9); and the Minister of Health mentioned the finding to 
the U.S. Ambassador that same day during the Ambassador's 
introductory call.  Further, the GOI is a member of the 
International Partnership on Avian and Pandemic Influenza 
(IPAPI), which includes core principles (number three) of 
"transparency in reporting influenza cases in humans and animals 
caused by strains that have pandemic potential" and (number four) 
"immediate sharing of epidemiological data and samples with the 
World Health Organization (WHO) and the international 
community...".  The GOI works closely with the UN Food and 
Agriculture Agencies (FAO), whose headquarters are in Rome.  The 
GOI supplies national virological data weekly to WHO 
(www.who.int/GlobalAtlas/home.asp, www.eiss.org).  The GOI 
preparedness plan calls for daily dissemination of data in case 
of a pandemic. 
 
¶4.  (U) 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 for USG officials? 
 
--  (U) The GOI considers AI a top priority.  Italy became a 
member of IPAPI, and is also a member of the Global Health 
Security Action Group.  Italian counterparts recently hosted the 
visit of Animal Plant and Health Inspection Service (APHIS) 
Administrator Dr. Ron De Haven.  The "go-to" person for animal AI 
issues is Dr. Romano Marabelli, Chief Veterinary Officer for 
Italy (within the Ministry of Health) and the Italian delegate to 
OIE.  The chief "go-to" person for human AI issues is Dr. Donato 
Greco, Director of Italy's Centers for Disease Control-equivalent 
within the Ministry of Health. 
 
¶5.  (U) 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? 
 
--  (U) The GOI has reviewed laws and has issued two law decrees 
and four ordinances to enhance AI detection, containment and 
response.  The legislation of August 26, and October 10, 18 and 
22 mandate the following: 
- Registration of all national poultry farms and processing plans 
on ad hoc register (August 26); 
- Mandatory country of origin labeling on all domestic and 
imported poultry products for human consumption (August 26 - 
approved by the government on December 1); 
- Minimum standards for plants, including equipment and sanitary 
standards, such as cleaning procedures, disposal of dead animals, 
and waste management (October 10); 
- Measures for preventing contamination from wild birds (nets to 
avoid them flying into commercial flocks) and from other flocks 
(prohibition of live poultry shows or other gatherings (October 
22); 
- Ad hoc National Surveillance Plans on wild birds and commercial 
flocks to be carried on by regional governments by January 2006 
(October 22); 
- Creation of a national register of commercial hatcheries 
(October 18); 
- Creation of a Department of Public Veterinary Health at the 
Ministry of Health (August 26); 
- Creation of a specialized "Center for the Coordination of the 
Response to Animal Disease" under the new Ministry of Health 
Department -- in accordance with FAO recommendations, (August 
26); 
- Mandated direct hiring of up to 110 new veterinarians and up to 
96 veterinary police (Ministry of Health branch of the national 
"Carabinieri") (August 26); 
- Allows the Ministry of Agriculture to withdraw from the 
domestic market up to 17,000 tons of poultry meat in the event of 
an "AI scare;" 
- Suspends social security payments and loan repayments for 
poultry farms for a value of up to 8 million euros; and 
- Authorizes the Ministry of Health and regional governments to 
obtain stocks of vaccines in case WHO declares a pandemic. 
 
¶6.  (U) Is Italy already working with international organizations 
or other countries on the avian flu issue?  Are GOI officials 
likely to ask for assistance from the U.S. or other countries? 
Would GOI leaders be receptive to messages from U.S. leaders 
through a bilateral approach or via multilateral fora such as WHO 
or FAO?  What would Italy want from the U.S. in return for its 
efforts? 
 
--  (U) Italy works closely with international organizations. 
Italian Chief Veterinary Office Dr. Romano Marabelli has been for 
many years the Vice President and President of the OIE.  The FAO, 
with which OIE has been at the forefront of international efforts 
to combat AI in the agricultural context, is headquartered in 
Rome.  The GOI, a member of the G-8, has joined IPAPI and is a 
member of the Global Health Security Action Group.  The GOI also 
works closely with the WHO.  The IZSVe laboratory in Padua works 
with many other countries and with the OIE and FAO. 
 
-- (U) Post cannot predict at this time what Italy might want 
from the U.S. in return for its efforts. 
 
¶7.  (U) Does Italy currently administer annual flu shots?  What 
is the production capability? 
 
-- (U) The GOI administers free annual flu shots for health care 
and primary public assistance (police, firemen) personnel, as 
well as to citizens over 65 years old and those suffering from 
chronic diseases.  The draft AI preparedness plan envisions a 
register of persons over 65 and/or with chronic health problems 
in order to have a precise list on hand in case of a pandemic. 
In 2004, 17.5% of the Italian population received flu 
vaccinations.  As of October 7, 2005, 17.7% of the population has 
already been vaccinated, an indication of higher public awareness 
of influenza. 
 
--  (SBU) Post has been told that the GOI has contracted to 
produce vaccines with the companies CHIRON, SANOFI-PASTEUR, and 
SOLVAY. 
 
-- (U) The IZSVe is in the process of developing an animal 
vaccination strategy, but for the N7H1 strain.  Lab personnel 
indicated they are having success using an American vaccine. 
 
¶8.  (U) 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 and how effective are these 
measures? 
--  (U) The GOI has started an influenza outreach campaign on 
television and in the newspapers.  The Ministry of Health has 
published brochures, the text of which is posted on the 
Ministry's Internet website. 
 
--  (U) Italy's media are very capable of providing information 
in both urban and rural areas. 
B)SURVEILLANCE/DETECTION 
------------------------ 
 
¶9.  (U) How capable are the medical and agriculture sectors of 
detecting a new strain of influenza among people or animals?  Can 
influenza viruses be subtyped in Italy, if so by whom? 
 
--  (U) The Italian agriculture sector is very capable.  The 
IZSVe was designated the National Reference Center for Newcastle 
disease and AI in October, 1999.  In June 2001, it became a World 
Animal Health Organization (OIE) reference laboratory for those 
diseases.  In 2005, it was designated an FAO Collaboration 
Center.  Italy has other top-flight labs in addition to the 
IZSVe. 
 
-- (U) The Italian medical sector is equally capable.  The 
National Influenza Center of the Higher Institute of Health is 
responsible for human virologic surveillance for the WHO world 
net.  Surveillance is comprised of thirteen peripheral labs 
(first level), two central labs (second level), the National 
Influenza Center, and the Inter-University Research Center for 
Influenza and Other Viral Infections (CIRI-IV) at the University 
of Genoa.  Post can furnish a list of the first level labs, if 
requested. 
 
¶10.  (U) What are the critical gaps that need to be filled in 
order to enhance Italy's disease detection and outbreak response 
capabilities?  What is Italy's greatest need from the U.S. or 
international organizations? 
 
-- (SBU) The Director of IZSVe noted at least one instance in an 
AI-affected country where scientific data critical to producing a 
human vaccine were not shared openly, possibly because of the 
"profit motive."  The data related in particular to the exchange 
of viral sequences and isolates. 
 
C)  RESPONSE/CONTAINMENT 
------------------------ 
 
¶11.  (U) Does Italy have a stockpile of medications, particularly 
antivirals, and if so, how much?  How much has been ordered and 
when is it expected? 
 
-- (U) The GOI preparedness plan calls for immediate contracts to 
purchase 36 million doses of pandemic vaccine (when available) to 
cover 63 pct of the population.  The GOI will later contract with 
other producers for a further ten million doses to eventually 
cover 80 pct of the population.  Some 5.4 million euros have been 
allocated for vaccines. 
 
--  (U) The GOI would stockpile 155,000 doses, eventually 
possibly rising to one million doses, of the human H5N1 vaccine 
for use primarily among poultry workers in the containment 
response to a human pandemic. 
 
-- (U) The Ministry of Health has stockpiled 150,000 cycles of 
antiviral medications and is in the process of acquiring four or 
five million additional cycles within the next twelve months 
(NOTE:  the draft plan lists four million in one place and five 
million in another). 
 
¶12.  (U) Does Italy have a stockpile of pre-positioned personal 
protective gear? 
 
--  (U) Post does not have information on PPE stockpile amount. 
After the SARS outbreak, each hospital and each region should 
have had its own stockpile, but there is not a national registry 
for PPE stockpiles. 
¶13.  (U) What is the rapid response capacity for animal and human 
outbreaks?  Are guidelines in place for the culling and 
vaccination of birds, disinfection of facilities, and limitations 
on animal movement? 
 
--  (U) To fulfill EU Directive 2005/464/CE, the GOI must issue 
ad hoc National Surveillance Plans for wild birds and commercial 
flocks, to be carried out by regional governments, by January 
¶2006.  Guidelines for culling, vaccination, and limiting 
movements are noted in Part A in paragraph five (5) on reviewing 
national laws. 
 
¶14.  (U) How willing and capable is the GOI of imposing 
quarantines and social-distancing measures (closing schools, 
etc.)?  Would its military enforce quarantines? 
 
--  (U) For animals, the GOI is capable and willing to impose 
measures such as quarantines and restriction of movement.  In the 
regions of Lombardy and Veneto, where the concentration of 
poultry stock is the highest, veterinary authorities have access 
to technology tools based on the Geographic Identification System 
(GIS) to locate concentrations of animals and define quarantine 
areas.  The GOI can also deploy measures for preventing 
contamination from wild birds (nets), and from other flocks 
(prohibition of live poultry markets or shows). 
 
--  (U) For humans, the GOI's preparedness plan describes 
surveillance, isolation, and quarantine measures within Italy, at 
borders, and at the international airports of Fiumicino (Rome) 
and Malpensa (Milan). 
SPOGLI