VZCZCXRO8520
PP RUEHBC RUEHDE RUEHHM RUEHKUK RUEHLN RUEHMA RUEHPB RUEHPOD RUEHROV
DE RUEHEG #0620/01 0661431
ZNR UUUUU ZZH
P 071431Z MAR 07
FM AMEMBASSY CAIRO
TO RUEHC/SECSTATE WASHDC PRIORITY 3886
INFO RUEHEE/ARAB LEAGUE COLLECTIVE PRIORITY
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE PRIORITY
RUEHHI/AMEMBASSY HANOI PRIORITY 0020
RUEHJA/AMEMBASSY JAKARTA PRIORITY 0100
RUEHOS/AMCONSUL LAGOS PRIORITY 0056
RUEKJCS/SECDEF WASHINGTON DC PRIORITY
RUEHPH/CDC ATLANTA GA PRIORITY
RUEHRC/DEPT OF AGRICULTURE WASHDC PRIORITY
RUEAUSA/DEPT OF HHS WASHDC PRIORITY
RUEAHLC/DEPT OF HOMELAND SECURITY WASHDC PRIORITY
RUCPDOC/DEPT OF COMMERCE WASHDC PRIORITY
RUENAAA/SECNAV WASHDC PRIORITY

UNCLAS SECTION 01 OF 04 CAIRO 000620 
 
SIPDIS 
 
SENSITIVE 
SIPDIS 
 
STATE FOR NEA/ELA, AND G/AIAG FOR LANGE AND WINN 
AMMAN FOR WHITTLESEY 
USAID FOR HILL, CLEMENTS, AND CARROLL 
HHS FOR BELL 
DHS FOR MCGINN 
USDA FOR ANNELLI 
DOD FOR MISHRIK 
 
E.O. 12958: N/A 
TAGS: KFLU KSTH TBIO ECON PREL WHO EG
SUBJECT: INTERAGENCY DELEGATION ENGAGES WITH EGYPTIAN 
OFFICIALS ON AVIAN AND PANDEMIC INFLUENZA 
 
REF: STATE 22291 
 
Sensitive but unclassified.  Not for internet distribution. 
 
¶1. (SBU)  Summary.  Special Representative on Avian and 
Pandemic Influenza John Lange and an interagency delegation 
of USG officials from DOS, USAID, HHS, USDA, DHS and DOD met 
with senior Egyptian government officials, toured laboratory 
facilities, and visited poultry farms from February 19-21. 
While Egypt is struggling to combat outbreaks of H5N1 in its 
backyard sector, a wide-ranging vaccination campaign in the 
commercial sector has controlled outbreaks on medium and 
large farms.  The interagency team was impressed with the 
overall high level of transparency and organization GOE 
officials have shown in tackling this disease.  The Embassy, 
in close consultation with Washington agencies, is working to 
identify specific areas for increased assistance to the GOE 
on both human and animal health activities.  End Summary. 
 
¶2. (U)  During the December 2006 donors, conference in 
Bamako, Mali, participants recognized Egypt as a priority 
country of concern in 2007, in addition to Indonesia and 
Nigeria.  The purpose of the interagency team,s visit was to 
assess Egypt's AI and pandemic flu preparedness, and to 
pinpoint areas for future assistance.  Members of the 
Interagency Delegation included:  Ambassador John Lange, DOS; 
Kent Hill, USAID Assistant Administrator for Global Health; 
Dr. David Bell, HHS; Dr. Joseph Annelli, USDA-APHIS; David 
Winn, DOS; Andrew Clements, USAID; Dr. Tom McGinn, DHS; 
Captain Nada Mishrik, DOD; Dennis Carroll, USAID. 
 
¶3. (SBU)  Since health officials first confirmed the H5N1 
highly pathogenic virus in Egypt in February 2006, GOE 
officials confirmed 23 human cases, 13 resulting in 
fatalities, making it the most severely affected country 
outside of Asia.  On February 27, Ministry of Health and 
Population (MOHP) officials confirmed the most recent case, a 
four-year-old girl in Daqahliya, 90 km north to Cairo.  Two 
human cases in December 2006 showed a moderate resistance to 
the antiviral drug Tamiflu.  MOHP plays a lead role in 
steering the Supreme Council on Combating Avian Influenza, a 
high-level inter-ministerial committee currently meeting on a 
weekly basis to discuss AI reaction and preparedness.  While 
there is some confusion among donors and even GOE officials 
on the status of a cohesive, national strategy on AI and 
pandemic flu, it is clear that officials at the highest 
levels of government are making a serious effort to 
coordinate activities (ref A). 
 
------------------------------------- 
MOHP LEADS COMMITMENT TO TRANSPARENCY 
------------------------------------- 
 
¶4.  (SBU)  On February 21, Minister of Health and Population 
(MOHP) Hatem El Gabaly met with the interagency team and 
Ambassador Ricciardone, outlining the ministry's program of 
active surveillance and risk communications.  Undersecretary 
Dr. Nasr El Sayed presented specific details about their 
communication program and a detailed analysis of their 
surveillance techniques.  According to the minister, 
maintaining a high level of transparency is an essential 
element of both their surveillance and communication 
strategy, though they continue to fight the public perception 
that they conceal true statistics.  During the initial 
outbreak in 2006, MOHP established a 24-hour call center, and 
has received over 450,000 inquiries during the past year. 
MOHP also launched a communication plan, including 
television, radio, and press releases designed to "build and 
maintain public trust," a largely USAID-funded campaign. 
 
¶5.  (SBU)   In addition to an organized communication plan, 
 
CAIRO 00000620  002 OF 004 
 
 
MOHP officials have a system for case surveillance and 
specimen verification, accomplished partly via a partnership 
with NAMRU-3, a WHO collaborative center in the region.  The 
MOHP Central Public Health Lab, which screens about 50 human 
samples per day, sends all positive cases to NAMRU-3 for 
confirmation and sequencing before passing on results to WHO 
and CDC.  Dr. Hassan Al-Bushra from the WHO told the 
interagency team on February 19 that Egypt is "by far the 
most advanced country in the region" in terms of human 
surveillance and verification.  Virus sequencing results 
generally appear in an on-line data base only three to four 
weeks after confirmation, fast even by international 
standards. 
 
¶6.  (SBU) Staff of the Abbassiya Chest Hospital, where 12 of 
the 23 human cases received treatment, also demonstrated 
transparency and organization during a February 20 visit. 
Hospital director Dr. Mahmoud Abdel Mageed presented an 
outline of several human cases, displaying x-rays and a 
detailed timetable summarizing the patients, conditions. 
Since October, 7, 2007, nine of the confirmed human cases 
succumbed to H5N1, and hospital officials openly discussed 
their concern for the increased speed in multi-systemic organ 
failure shown in recent patients.  Though hospital staff is 
equipped to handle the current trickle of patients, it has 
limited isolation capacity and, like nearly all hospitals in 
the world, would be overwhelmed in the event of a pandemic 
outbreak. 
 
------------------------------------------ 
MOA STRUGGLES TO VACCINATE BACKYARD SECTOR 
------------------------------------------ 
 
¶7. (SBU)  While vaccination of the 420 million birds in the 
commercial sector has reached nearly 100%, the Ministry of 
Agriculture (MOA) continues to struggle with implementing a 
free vaccination campaign in the backyard poultry sector. 
GOE officials estimate that 5 million families raise backyard 
poultry, but only 30 million of the 200 million backyard 
birds have been vaccinated.  The high mobility of people 
among Egypt's 5000 villages, most of which hug the Nile and 
form "one big village," is another challenge to disease 
containment.  Citing the fact that 21 of the 23 human cases 
come from the backyard sector, Minister of Agriculture Amin 
Abaza told the team in a candid discussion on February 20 
that, "the number one reason for vaccinating birds is to 
protect human health." 
 
¶8.  (SBU)  Dr. Mona M. Aly, director of MOA,s Central 
Laboratory for Veterinary Quality and Control of Poultry 
Production, responsible for AI screening and surveillance in 
poultry, cited the need for increased lab capacity, during 
the February 20 visit.  "We need at least two satellite labs 
to handle the sample screening."  The lab, which screens 
samples from the commercial and backyard sector as well as 
migratory birds, has identified almost 300 positive sites in 
the backyard sector, and nearly 900 in the commercial sector 
since February 2006.  She also stressed the need for enhanced 
technical training for laboratory assistants and MOA vets, 
who conduct sample collection and vaccinate all backyard 
birds.  (Note: On commercial farms, workers vaccinate birds 
under the direction of MOA veterinarians. End note.).  The 
GOE purchases most flu vaccinations from several companies 
including one in China, but on February 22, the Prime 
Minister announced a new LE 120 million allocation to produce 
and purchase vaccines locally. 
 
¶9.  (SBU)  In addition to facing significant obstacles in 
mass vaccination in the backyard sector, the MOA is also 
hindered by lack of cooperation between MOA labs and the 
General Organization for Veterinary Services (GOVS).  In 
 
CAIRO 00000620  003 OF 004 
 
 
meetings with FAO and WHO on February 19 and 20, 
representatives from both organizations agreed that the 
Egyptian veterinary service needs to be bolstered and 
intra-ministerial cooperation enhanced.  FAO is making 
attempts to rectify disparate GOVS and MOA plans for AI 
eradication.  The MOA is proposing a reorganization of the 
GOVS to provide better support for the animal health sector. 
 
¶10.  (SBU) A February 21 visit to two commercial poultry 
farms and a hatchery in Gharbiya governorate, one of the most 
severely affected governorates, interagency team members saw 
evidence of the success of the wide-scale vaccination plan. 
Biosafety and biosecurity practices on the farms were 
limited, and several recent outbreaks in commercial farms 
illustrate the need for continued vigilance.  Indefinite 
vaccination for the commercial sector, though, is not a major 
obstacle.  Farm owner Ehab Ramone noted that although he 
suffered significant financial loss during the initial 
outbreaks, he has recovered his profits and the vaccine cost, 
about 1 LE/dose, was negligible.  "The most pressing costs 
for us are the high cost of feed, imported from America," he 
noted. 
 
------------------------------------------ 
GOE OFFICIALS CONSIDER COMPENSATION REFORM 
------------------------------------------ 
 
¶11.  (SBU) The GOE is looking to revise its self-admittedly 
botched compensation scheme for backyard poultry farmers. 
Last year, the GOE spent over 120 million LE (USD 21 million) 
to compensate mostly commercial farmers.  MOA and MFA 
officials cited wide abuse by unscrupulous farmers. When 
demand for poultry fell and prices plummeted, some farmers 
were reported to have purposefully infected their birds to 
get compensation from the government.  A revised compensation 
plan, where the government would replace culled infected 
birds with vaccinated chicks, is under consideration. 
 
----------------------------------------- 
INTERNATIONAL ORGANIZATIONS OFFER SUPPORT 
----------------------------------------- 
 
¶12.  (SBU)  WHO representatives stressed in a February 19 
meeting that AI in humans is a "disease of behavior" and that 
because the deeply rooted cultural practice of living in 
close proximity to poultry will continue, an improved 
community awareness and communication campaign is the only 
solution to stopping the spread of H5N1 to humans.  WHO 
deputy regional director Mohamed Abdi Jama warned of the 
sensitivities in developing nations surrounding expeditious 
access to vaccines in the event of a pandemic flu.  In a 
February 20 meeting with FAO representatives from both Cairo 
and Rome, they presented a proposal to bolster the MOA's 
vaccination capabilities and to mend the division between the 
GOVS and the MOA's lab service.  In a February 22 meeting 
with the Minister of Agriculture, he stated his support for 
their proposal. 
 
--------------------------------------------- 
MINISTER OUTLINES SPECIFIC FUNDING PRIORITIES 
--------------------------------------------- 
 
¶13.  (SBU)  Stressing the need to stem the spread of H5N1 in 
Africa, as well as the cost-effectiveness of fighting it here 
instead of the Western Hemisphere, Minister El Gabaly 
outlined specific funding priorities for 2007: 
 
Animal Health: Total of USD 143 million 
 
Surveillance (USD 28.81 million) 
Vaccination and Vaccination Production (USD 46.82 million) 
 
CAIRO 00000620  004 OF 004 
 
 
Compensation (USD 36.38 million) 
Poultry Farm Census (USD 15,000) 
Capacity Building for Veterinary Services (USD 18 million) 
Capacity Building for the Central Laboratory (USD 3 million) 
Awareness Campaigns (USD 8.8 million) 
Quarantine Measures (USD 1.55 million) 
 
Human Health:  Total of USD 205 million 
 
Anti-Viral Drugs (USD 20.9 million) 
Personal Protective Equipment (USD 8.7 million) 
N95 Masks (USD 139.1 million) 
Disinfectants (USD 3.48 million) 
Ventilators for ICUs (USD 8.7 million) 
Strengthen Emergency Care Services (USD 8.7 million) 
Medications and Hospital Equipment (8.7 million USD) 
Two Additional Flu Labs (USD 5.2 million) 
Social Mobilization and Communication Activities (USD 1.7 
million) 
 
¶14.  (SBU) On the animal health side, Minister El Gabaly 
asked for specific USG support on bolstering their capacity 
to develop vaccines, training for veterinarians, and 
assistance in creation of MOA satellite labs.  On the human 
health side, he asked for technical expertise in making their 
pandemic plan operational, N95 masks, and assistance in human 
vaccine research and preparation. 
 
-------------------------------------- 
NEXT STEPS: DEFINING FUTURE ASSISTANCE 
-------------------------------------- 
 
¶15.  (SBU)  Embassy Cairo is currently working in close 
conjunction with Washington agencies to expand upon its 2006 
assistance on AI.  In FY 2006, USAID directed 750,000 USD to 
the MOHP's AI surveillance and response activities, as well 
as its communication campaign.  APHIS and USAID sent MOA vets 
to the US for training, and conducted a regional workshop on 
AI Veterinary Epidemiology.  NAMRU estimates it spent USD 
300,000 for testing and anti-body analysis.  FY 2007 USAID 
assistance will include up to USD 4 million more for 
technical assistance in their massive vaccination and disease 
surveillance campaign for backyard poultry, and increased 
funding for MOHP communication efforts. 
RICCIARDONE