VZCZCXRO3999
RR RUEHCHI RUEHCN RUEHDT RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD
DE RUEHHI #2041/01 3391029
ZNR UUUUU ZZH
R 051029Z DEC 07
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 6828
INFO RUEHHM/AMCONSUL HO CHI MINH 4019
RUEHZS/ASEAN REGIONAL FORUM COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHUL/AMEMBASSY SEOUL 3209
RUEHKO/AMEMBASSY TOKYO 5783
RUEHHK/AMCONSUL HONG KONG 1299
RUEHGZ/AMCONSUL GUANGZHOU 0832
RUEHCN/AMCONSUL CHENGDU 0329
RUEHIN/AIT TAIPEI 1537
RUEAIIA/CIA WASHINGTON DC
RUEHPH/CDC ATLANTA GA
RUEHRC/DEPT OF AGRICULTURE WASHINGTON DC
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEKJCS/SECDEF WASHINGTON DC//USDP/ISA/AP//
RHMFISS/CJCS WASHINGTON DC//J2/J3/J5//
RHEFDIA/DIA WASHINGTON DC//DHO-3//
RHMFIUU/CDR USPACOM HONOLULU HI//J00/J2/J3/J5//
RHEFAFM/DIRAFMIC FT DETRICK MD//MA-1A//
RUEHSUN/USUN ROME IT

UNCLAS SECTION 01 OF 04 HANOI 002041 
 
SIPDIS 
 
SENSITIVE 
SIPDIS 
 
STATE FOR EAP/MLS, EAP/EP, INR, OES/STC, OES/IHA, MED 
STATE PASS TO USAID FOR ANE AND GH 
HHS/OSSI/DSI PASS TO OGHA (WSTIEGER/LVALDEZ/DMILLER/CHICKEY) AND 
FIC/NIH (RGLASS) 
CDC FOR OGHA (SBLOUT/KMCCALL) AND DIV-FLU (NCOX/AMOHEN) 
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (STERN) 
USDA PASS TO APHIS, FAS (OSTA AND OCRA), FSIS 
BANGKOK FOR RMO, CDC (MALISON), USAID (CBOWES/JMACARTHUR/MBRADY), 
APHIS (NCARDENAS), REO(JWALLER) 
BEIJING FOR HHS HEALTH ATTACHE (BROSS) 
PHNOM PENH FOR CDC INFLUENZA COORDINATOR(WBRADY) 
ROME FOR FAO 
VIENTIANE FOR CDC INFLUENZA COORDINATOR (ACORWIN) 
 
E.O. 12958: N/A 
TAGS: TBIO AMED AMGT CASC EAGR PINR KFLU VM
SUBJECT: A REVIEW OF VIETNAM'S AVIAN INFLUENZA POULTRY VACCINATION 
PROGRAM 
 
REF: A. 2005 HANOI 3055 B. 2005 HANOI 1791 
 
HANOI 00002041  001.2 OF 004 
 
 
¶1. (SBU) Summary.  Four years into its efforts to counter pandemic 
influenza, the Government of Vietnam (GVN) has placed ongoing 
emphasis on a vaccination program to limit the possible spread of 
avian influenza (AI) caused by the highly pathogenic influenza A 
H5N1 virus.  The nationwide program focuses on high-risk poultry 
populations, especially hatchling ducks and chickens, primarily 
through a subsidized vaccine campaign.  Despite the imperfect 
balance between effectiveness and cost of vaccinations, the GVN 
believes the program is an important short-term control measure that 
has reduced (but not eliminated) the threat to Vietnamese poultry 
and to the human population.  End Summary. 
 
Role of Vaccination Program 
--------------------------- 
 
¶2. (SBU) The GVN recognizes that AI has now become endemic in 
animals (i.e., enzootic) in Vietnam.  Per Dr. Do Huu Dung, a 
veterinary epidemiologist at the Department of Animal Health (DAH) 
within the Ministry of Agriculture and Rural Development (MARD), the 
GVN focuses on identifying and mitigating the most risky points in 
the poultry market chain to protect animal health and prevent 
possible transmission to humans.  To minimize the risk of a human 
epidemic (i.e., reduce the probability that the virus mutates into a 
form that is transmissible from humans to humans), the GVN aims to 
lower the viral load circulating among pultry and has selected an 
aggressive vaccination program as a contributory means to accomplish 
this goal. Dr. Hoang Van Nam, deputy Director of DAH,recently stated 
that the GVN will continue the animal vaccination program for the 
next five years, combined with other interventions including 
measures to improve backyard poultry raising techniques and better 
hygiene in poultry trade and slaughtering. The GVN views vaccination 
as a necessary short- to medium-term activity until it can implement 
longer-term measures, including strengthened surveillance and 
laboratory capacity, increased biosecurity, and more complete 
poultry industry restructuring to better monitor and reduce risk. 
Dung noted that while Vietnam's vaccination program is designed to 
prevent a widespread animal epidemic (i.e., epizootic), it cannot 
eliminate scattered outbreaks, particularly among flocks of 
unvaccinated and unregistered ducks far from commercial and urban 
centers. Current vaccines prevent disease and reduce spread, but may 
not curb shedding sufficiently to eliminate secondary AI infections 
among susceptible animals. 
 
Possible Impact of a Vaccination Program 
---------------------------------------- 
 
¶3. (SBU) According to a presentation prepared by Dr. Nam, the GVN 
believes that the vaccination program has played an important role 
in limiting the spread of AI, though it acknowledges that it cannot 
separate out the effects of the vaccine program from other measures. 
 .At the same time, a UN Food and Agricultural Organization 
(FAO)-led evaluation of the 2005 vaccination campaign found that 54 
percent of poultry flocks were effectively protected at one to two 
months and 45 percent protected at three to four months post 
vaccination[0]. 2006 results showed 56 percent protection at one to 
 
HANOI 00002041  002.2 OF 004 
 
 
two months and 33 percent protection at three to four months. 
Initial results from the first 2007 campaing show 60 percent at 
protection at one month.  The absence of reports of disease in fully 
vaccinated poultry, supports, but does not prove, vaccine efficacy. 
The GVN maintains that vaccination has reduced the susceptibility of 
a substantial part of the poultry population. 
 
Constraints 
----------- 
 
¶4. (SBU) DAH acknowledged several short-term and long-term 
constraints on its vaccination program.  The need to import vaccines 
from abroad puts Vietnam at a disadvantage.  While prices have 
dropped over the past few years and remain low, Vietnam faces the 
risks of future price hikes.  Once vaccines arrive in Vietnam, the 
GVN must satisfy several logistical requirements to get the vaccines 
to the field, including maintaining cold chains, training and paying 
vaccinators, shipping vaccines to isolated areas, and maintaining 
lab and field capacity to perform surveillance and monitor the 
effectiveness of the program.  During periods without outbreaks, the 
DAH struggles to maintain farmer cooperation in the program, raising 
concerns about continued sustainability.  Further threatening 
sustainability, the mass vaccination campaigns overtax the resoucres 
of local DAH staff.  Finally, the GVN cannot ensure that free 
ranging ducks receive both vaccine doses needed for full protection, 
as they move within and among provinces throughout their lifetimes. 
If infected, these adult ducks can become a resevoir for the 
disease, spreading AI to new generations of farm raised poulty with 
which they come into contact. 
 
History of Vaccination Program 
------------------------------ 
 
¶5. (SBU) Beginning in late 2003 and lasting until mid-2005, 
Vietnam's initial response focused on surveillance, rapid 
destruction of birds at infected farms and at-risk farms, rapid 
movement control and disinfection of infected premises, periodic 
bans on hatching of water fowls, closures of live bird markets in 
urban areas, and better communication (ref A). Though the bans and 
closures were not completely enforced, these efforts, combined with 
public education campaigns reduced consumer demand for poultry.  In 
August 2005, Vietnam added vaccination as a supplementary measure as 
it could not contain outbreaks by other response measures such as 
culling and disinfection (ref B). Initially implemented in provinces 
covering most of the high risk populations of poultry, particularly 
villages at which human infections had occurred, the GVN used 
vaccines where it could not modify high-risk poultry rearing and 
consumption behaviors. 
 
Current Program 
--------------- 
 
¶6. (SBU) Currently, the GVN implements three vaccine programs; 
campaign, commercial, and hatchling, each designed to help limit the 
spread of AI through the poultry population.  Funding for the 
program, including strategy development and post-vaccination 
surveillance, comes from the government (estimated at USD 10 million 
 
HANOI 00002041  003.2 OF 004 
 
 
per round), as well as USAID, World Bank, and the UN Joint Program. 
At this time, a state-owned company imports and distributes all 
vaccines.  According to DAH, Vietnam has considered domestic 
production, but has hesitated to do so due to concerns about 
long-term sustainability.  If global efforts succeeded in 
controlling AI, the GVN worries what it would do with this new and 
expensive vaccine production facility.  As the GVN imports such 
large volumes, vaccine costs have moved steadily downward over time. 
 The GVN now is considering importing vaccines in bulk and then 
bottling itself, which would limit concerns about shipment schedules 
and allow Vietnam to stockpile resources.  Dung stated that Vietnam 
had not encountered any difficulties with counterfeit vaccines, 
though the FAO has recommended that it begin quality assurance on 
imported vaccines. Through the sharing of animal isolates, the 
Centers for Disease Control and Prevention and the Department of 
Agriculture) are providing technical assistance to help MARD with 
molecular sequencing and evaluation of current vaccines in animal 
models. 
 
National Vaccination Campaign 
----------------------------- 
 
¶7. (SBU) The GVN subsidized AI animal vaccination mass campaigns 
take place twice per year (March/April and 
September/October/November) with supplemental vaccinations at other 
times. If farmers or commercial poultry raisers want to obtain 
vaccines outside the normal campaign cycle, they can do so, but need 
to pay for the vaccines.  The program continues to grow rapidly and 
now focuses on 33 provinces in high risk areas (Red River and Mekong 
River deltas) with vaccination of all long-lived poultry and all 
poultry in villages.  The program also vaccinates high risk poultry 
in other provinces, i.e. those in border, urban or previously 
infected areas.  In 2005, some 166.3 million doses were given to 
chickens and 78.1 million doses to ducks, for 81 percent coverage. 
As the program expanded to two campaigns in 2006, the GVN provided 
368 million doses to chickens and ducks combined, for 89 percent 
coverage.  The first 2007 vaccination campaign started in mid-March 
and vaccinated 131.7 million birds by mid-May.  The second campaign 
began in September and has provided over 124.29 million doses. 
 
¶8. (SBU) Though FAO provides technical assistance to the annual GVN 
review of its vaccination strategy, the GVN determined that lack of 
social mobilization prevented it from implementing FAO's suggestion 
that it move to one mass vaccination campaign.  Instead, on November 
12, the MARD Minister approved the 2008 vaccination plan, which 
envisions two mass campaigns and supplemental vaccinations covering 
all chickens and ducks in 33 provinces.  In other provinces, the GVN 
will make vaccination compulsory for all ducks, all commercial and 
semi-commercial chicken farms, and will recommend vaccinations for 
all backyard farms.  Citing concerns regarding the sustainability of 
mass vaccination and reduced protection for poultry vaccinated at 
improper ages, FAO had recommended the GVN focus on age-appropriate 
vaccination available year round, with one mass campaign in November 
to provide protection through the high-risk winter/Tet season[0]. 
Under this plan, provinces would pay for a second round, if deemed 
necessary, with farmers increasingly bearing financial 
responsibility for additional vaccinations. 
 
HANOI 00002041  004.2 OF 004 
 
 
 
¶9. (SBU) For its nationwide campaign, the GVN imports the vaccine 
from China and in 2007 brought in 1.14 billion doses. According to 
Dung, the campaign utilizes H5N1 inactivated virus from Harbin 
Veterinary Research Institute sold commercially by Weike 
Biotechnology Development Company to vaccinate chickens and ducks at 
a cost of about 280 dong (approximately 0.017 USD) per dose.  In the 
past, DAH used H5N2 vaccine for chickens and H5N1 vaccine for ducks. 
 DAH recently also halted separate H5N9 (serum based) vaccines for 
Muscovy ducks (though it had already imported 19 million doses in 
2007), as the bottles were too unwieldy and the vaccine provided too 
short an immunity duration.  Chickens require one injection of the 
H5N1 inactivated virus.  Ducks require two injections, 28 days 
apart.  Chickens need to be over 8 days old, ducks over 14 days old. 
 DAH would prefer vaccines for newly hatched ducks, but this is not 
yet available on the market.  The campaign vaccine provides six 
month immunity in chickens, five months in ducks -- more than the 
normal life cycle for chickens and ducks raised for meat.  DAH 
believes that based on empirical criteria, the Chinese vaccines 
produced "acceptable" levels of immunity one month post-vaccination. 
 According to virus sequencing work, minor changes in the structure 
of avian influenza have not affected immunity. 
 
Commercial and Hatchling Vaccine 
-------------------------------- 
 
¶10. (SBU) The GVN provides an unsubsidized commercial vaccine, 
usually to large farms, of which it imported 105 million doses in 
¶2007.  The H5N2 vaccine, under the trade name Nobilis from the 
Intervet Company in the Netherlands, is used only for chickens at an 
estimated cost of 650 dong (approximately USD 0.04) per dose.  For 
chicken hatchlings, the GVN imports H5N8 recombinant Trovax vaccine 
from Merial Company. 
 
Donor Analysis of Vietnamese Vaccination Program 
--------------------------------------------- --- 
 
 
¶11. (SBU) International experts generally approve of the Vietnamese 
vaccination program and note that Vietnam's over-all strategy to 
combat AI may have played a substantial role in the large decrease 
in animal and human AI cases over the past four years.  Poultry 
vaccination not only helps prevent disease but also reduces the 
viral burden and the amount and duration of viral shed.  Given 
Vietnam's limited biosafety capacity, the FAO believes Vietnam's 
focus on vaccinations to be technically appropriate, and public 
health practitioners have described it as a model for other 
developing countries to follow.  At the same time, donors agree that 
additional studies must be performed to evaluate the program.  To 
that end, USAID will fund an FAO study on the effectiveness of 
various vaccination strategies.  Meaningful annual reviews designed 
to improve efficiency and develop sustainability are a crucial 
component of the program and USAID and FAO agree that the GVN needs 
to develop an eventual exit strategy. 
 
MICHALAK