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Lucia A Keegan  09/25/2006 04:34:34 PM  From  DB/Inbox:  Lucia A Keegan

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UNCLAS    SENSITIVE     PARIS 06376

SIPDIS
cxparis:
    ACTION: SCI
    INFO:   POL LABO ENGO ECSO AGR UNESCO AMBO SCIO DCM AMB
            ECON ESCI

DISSEMINATION: SCIX
CHARGE: PROG

APPROVED: SCI:RDRY
DRAFTED: SCI:MHMASSING
CLEARED: CLEARED:NONE

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RR RUEHC RUEAUSA RUEHRC RUEAHLC RUEHPH RUCNMEU
RUEHZN RUEHMRE RUEHSR
DE RUEHFR #6376/01 2651642
ZNR UUUUU ZZH
R 221642Z SEP 06
FM AMEMBASSY PARIS
TO RUEHC/SECSTATE WASHDC 1614
INFO RUEAUSA/DEPARTMENT OF HHS WASHDC
RUEHRC/DEPARTMENT OF AGRICULTURE WASHDC
RUEAHLC/HOMELAND SECURITY CENTER WASHINGTON DC
RUEHPH/CDC ATLANTA GA
RUCNMEU/EU INTEREST COLLECTIVE
RUEHZN/EST COLLECTIVE
RUEHMRE/AMCONSUL MARSEILLE 1332
RUEHSR/AMCONSUL STRASBOURG 0186

UNCLAS SECTION 01 OF 03 PARIS 006376 
 
SIPDIS 
 
SENSITIVE 
 
STATE FOR OES/IHA, EUR/WE, CA, CA/OCS, G/AIAG 
HHS FOR INTERNATIONAL BUDASHEWITZ 
USDA FOR ITP/MACKE/THOMAS, CMP/DLP/WETZEL 
USDA FOR FAS PASS FSIS AND APHIS 
HOMELAND SECURITY FOR OIA 
 
E.O. 12958: N/A 
TAGS: KFLU TPHY TSPA TSPL KSCA FR
SUBJECT: AVIAN INFLUENZA FRANCE UPDATE - 09/22/06 
 
REF: Paris 520 and Subsequent 
 
NOT FOR INTERNET DISTRIBUTION 
 
¶1. (U) Summary.  France continues robust preparations for an avian 
influenza (AI) pandemic: The GOF recently updated its national plan, 
including with procedures to minimize economic disruption.  After 
focusing on technical matters such as stockpiling of medicine and 
equipment, the GOF now acknowledges the need to include an ethical 
component to the plan, addressing such issues as rationing, possible 
restriction of individual freedoms, and protection of health care 
workers.  Embassy officers attended the First National Colloquium on 
Ethics and Pandemic Flu on September 15.  Additional public 
discussions are scheduled in the coming months, partly inspired by 
North American studies.  While there has been scant AI media 
coverage in recent months, the GOF continues to take the threat of a 
pandemic very seriously.  End summary. 
 
----------------------------------- 
AI Pandemic: Ethical Considerations 
----------------------------------- 
 
¶2.  (U) On September 15, Health Minister Xavier Bertrand opened the 
first national colloquium on AI and ethics. 250-300 key 
representatives of the medical and research communities attended, as 
did government officials from a number of French agencies.  Speakers 
focused on: 
- Treatment of the animal population during a pandemic; - Role of 
the research community; 
- Role, duties, and rights of health professionals; 
- Regulating access to treatment in a context of 
  scarce resources; 
- Possible restriction of individual freedoms to avoid 
  spread of the virus (quarantine, travel 
  restrictions, compulsory vaccinations); 
- Management of information in a pandemic situation 
  (role/responsibilities of media, positive/ 
  negative role of the Internet); 
- International cooperation and the role of WHO. 
 
---------------------------------------- 
Maximizing Protection with Limited Means 
---------------------------------------- 
 
¶3.  (U) A number of health professionals stated that whatever the 
level of preparedness, in case of AI pandemic in France, medical 
supplies (anti-viral treatment, vaccines, access to intensive care 
such as mechanical ventilation) will not be sufficient to cover the 
needs of the population.  Speakers highlighted that triage 
mechanisms, both robust and transparent, would be required.  "Triage 
is not ethical," summarized Xavier Emmanualli, former President of 
"Doctors without Borders," but it will be the mission of health care 
workers and health authorities to "manage the penury" for the common 
good. 
 
-------------------- 
Who Gets Care First? 
-------------------- 
 
¶4.  (SBU) Decision-makers and health authorities debated the 
conflict between equity and efficiency but agreed on the need to set 
priorities and provide clear guidelines before the onset of any 
pandemic.  They thought that criteria for triage needed to be 
discussed with and ratified by the medical sector.  Besides public 
order criteria (priority given to people capable of ensuring safety 
and the provision of necessities), a number of prioritization 
suggestions were advanced, based on the 'save-the-most-lives' 
principle; the life-cycle allocation principle (each individual 
should have an opportunity to live through all stages of life); and 
the life investment principle (giving priority to people between 
early adolescence and middle age).  North American studies conducted 
by the Joint Center for Bioethics at the University of Toronto (an 
ethical guide for pandemic planning, based on lessons learned from 
SARS), and by CDC Atlanta ('Citizen Voices on Pandemic Flu Choices - 
Engagement Pilot Project on Pandemic Influenza, or PEPPPI) also 
served as subjects for discussion. 
 
--------------------- 
Health Workers Duties 
--------------------- 
¶5.  (SBU) The role and duties of health workers, foreseeable 
dilemmas faced by physicians, and the level of risks they could 
reasonably be expected to take generated much discussion.  Several 
participants spoke about the risk of insufficient mobilization of 
health care professionals in the event of a pandemic.  Several 
referred to the "pandemic as war" and that, in the event of an AI 
pandemic, medical staff might be forced into service.  Some speakers 
mentioned the pluses and minuses of the work of NGO's in a pandemic 
environment. 
 
--------------- 
Social Cohesion 
--------------- 
 
¶6. (U) Speakers described behaviors likely to emerge during and 
after a pandemic and the necessity to preserve confidence between 
the general population and authorities throughout such a crisis.  To 
reach this goal, speakers insisted on the need for the government to 
work with the general public in preparing a transparent ethical 
framework.  Public awareness about choices that would have to be 
made and the notion of individual responsibilities were recurring 
themes. Health Minister Bertrand, referring to his recent trip to 
the U.S., noted that in the U.S. the "logic of individual 
responsibility is more present," in contrast to France where the 
authorities had emphasized the role of the government.  In his 
remarks Bertrand said that individual responsibility is just as 
important as the role of the government. 
 
----------------------------------------- 
'Ethomics' or the Ethico-economic Dilemma 
----------------------------------------- 
 
¶7.  (U)  A number of speakers alluded to the fact that an AI 
pandemic may never occur.  They questioned whether it is justified 
to invest so much public funding to prepare for a crisis that may 
never occur.  Generally participants felt that even if a pandemic 
does not occur, efforts to prepare will not be in vain.  Other 
medical crises will sooner or later have to be faced and lessons 
learned preparing for an AI pandemic can be useful in dealing with 
those other crises. 
 
---------------------------------- 
French Stockpiles (September 2006) 
---------------------------------- 
 
¶8.  (U)  Protective masks: The GOF has stockpiled or delivered to 
medical facilities to date 240 million masks, intended primarily to 
protect health professionals (known as FFP2 masks). Another 47 
million will be available by end 2006.  France has also secured 700 
million 'anti-projection' masks.  By the end of the year, another 
300 million, for a total of one billion, will be available. 
 
¶9.  (U)  Antiviral medicine: France now possesses 14 million 
antiviral treatments, enough for about one-fourth of the French 
population. Within the next year, France will receive another 19 
million treatments, for a total of 33 million antiviral treatments. 
Furthermore, the GOF will order 10 million treatments of oseltamivir 
(non-conditioned Tamiflu) to serve as a prophylaxis for health care 
workers. Minister Bertrand noted these figures go beyond WHO 
recommendations.  He added that France is concerned to provide 
treatment to foreigners in France and to minimizing the need for 
rationing.  End note. 
 
¶10.  (U)  Vaccines: The GOF has bought and stockpiled 2.6 million 
doses of a pre-pandemic H5N1 vaccine and has "reserved" 40 million 
doses of a pandemic vaccine. They are also negotiating the 
possibility of ordering another 23 million doses. 
 
----------------------------------------- 
National Plan Incorporates Economics 
----------------------------------------- 
 
¶11.  (U)  On September 1, the Ministry of Health presented an 
updated version of France's AI plan, highlighting the need to avoid 
economic disruption.  The plan encourages private companies and 
public agencies to establish continuity plans that recognize the 
need to maintain business as usual while providing the maximum 
security for employees. 
----------------------- 
Campaign for Prevention 
----------------------- 
 
¶12.  (U)  This fall, the GOF will launch a new prevention campaign 
against risks related to infectious upper respiratory diseases in 
French schools.  This initiative, led by both the Ministries of 
Health and Education, aims to promote among the younger generation 
the development of a "risk prevention and risk management culture." 
Health professionals will be targeted next, helping them to better 
understand their role, protective measures available to them, and 
how to deal with contaminated patients. 
 
¶13.  (U)  The National Plan can be consulted on the GOF website 
dedicated to avian influenza: http://www.grippeaviaire.gouv.fr 
An English version is also available (January 2006 update). 
 
 
Stapleton