VZCZCXYZ0000
RR RUEHWEB

DE RUEHEG #1524/01 1991319
ZNR UUUUU ZZH
R 171319Z JUL 08
FM AMEMBASSY CAIRO
TO SECSTATE WASHDC 9870

UNCLAS CAIRO 001524 
 
SENSITIVE 
 
SIPDIS 
 
STATE FOR NEA/ELA 
STATE FOR AIWG (WINN) 
USAID FOR ME/MEA/MCCLOUD 
 
E.O. 12958:  N/A 
TAGS: ECON EAID EAGR PGOV TBIO KIPR KSCA KFLU KWMN EG
SUBJECT: MEETING BETWEEN AMBASSADOR SCOBEY AND MINISTER OF HEALTH 
AND POPULATION HATEM EL GABALY 
 
REF: CAIRO 413 
 
¶1.  (SBU) Summary: Ambassador Scobey paid an introductory call on 
Minister of Health and Population Hatem El Gabaly on June 29. 
Discussion centered on ongoing health sector reform, graduate level 
training for ministry staff in US and by U.S. universities in Egypt, 
pharmaceutical intellectual property rights, follow up on the 
National Population Conference, October visit by Secretary of Health 
and Human Services Leavitt, and avian influenza.  Minister El Gabaly 
is a reformer and advocate of partnership with the US.  He faces 
significant challenges in tackling Egypt's woefully inadequate and 
mismanaged health care system.  The Ambassador was struck by El 
Gabaly's failure to recognize the link between education for girls 
and fertility rates, and to address this in the GOE's revived 
population program.  USAID will look for opportunities to update his 
expertise in this area.  EL Gabaly has invited Secretary Leavitt to 
Egypt in October when Egypt is hosting the International Conference 
on Avian and Pandemic Influenza; it is our understanding that 
Secretary Leavitt plans to make the trip.  End Summary. 
 
¶2.  (U) Ambassador called on Minister of Health and Population Dr. 
Hatem El Gabaly on June 29, accompanied by USAID health officer. 
Appointed in the 2006 cabinet reshuffle, El Gabaly is engaged in a 
major effort to reform the health sector. He is an advocate of 
partnership with the United States and has on many public occasions 
recognized the superiority of graduate level education at US 
universities and the global example the U.S. sets with its strong 
work ethic. 
 
HEALTH SECTOR REFORM 
-------------------- 
 
¶3.  (U) El Gabaly recognizes the need for continued GOE efforts to 
reform the health sector, despite extensive public criticism and 
negative media coverage. Given the high profile of education and 
health, he acknowledged that public resistance and criticism are 
posing a significant challenge, but that patience and continuing to 
provide accurate information about the reforms are key.  The 
minister highlighted the need for social health insurance, given 
high out of pocket expenses for healthcare. El Gabaly estimated 
10-12 million Egyptians are at risk of sinking into poverty should 
they experience a major medical condition.  He said his ministry is 
making some progress; the Ministry of Finance is doing actuarial 
studies needed to underwrite the proposed social health insurance 
from general revenues. 
 
MANAGEMENT DEFICIT 
------------------ 
 
¶4.  (U) To address what he sees as a crippling lack of management 
capacity at his ministry, El Gabaly is proposing the creation of a 
"Leadership Academy."  USAID is putting together a public-private 
partnership between the pharmaceutical industry (PhRMA) and Harvard 
University, which will provide the Egypt-based training.  El Gabaly 
is pleased with the progress of the seven ministry staffers now in 
the US in USAID-funded MBA programs, and said nine more will go this 
fall. 
 
INTELLECTUAL PROPERTY RIGHTS 
---------------------------- 
 
¶5.  (U) El Gabaly discussed the ongoing work on IPR issues. In 
response to a question on data exclusivity and length of 
registration process, he described procedural changes at the 
ministry. The minister said the 2006 ministerial decree governing 
this process had substantially reduced the timeline for product 
registration. He explained that many delays resulted from incomplete 
files and the new website will ensure transparency in the process. 
El Gabaly was surprised to hear that pharmaceutical companies are 
still concerned about unnecessary delays in the registration 
process, and said he had not heard any official complaints. 
 
¶6.  (SBU) COMMENT: El Gabaly's claim to be surprised by complaints 
about registration delays is disingenuous; he has personally 
acknowledged in the past that the ministry's new expedited approval 
process is not working as intended. However, it is possible that 
pharmaceutical companies' recent complaints have not percolated up 
through the Ministry's bureaucracy.  We will follow up with El 
Gabaly to ensure he has the latest information on our continuing 
concerns about registration delays.  End comment. 
 
¶7.  (U) With the start of production by multinationals for Egypt's 
generic market, El Gabaly expects that generics will take a larger 
market share.  He said that national expenditures on generics are 
currently USD 2.1 billion, but the figure is expected to reach USD 5 
billion by 2015.  The projected increase, he said, should result 
from higher GOE health expenditures, more awareness of treatment 
 
options, and an aging population with greater pharmaceutical 
requirements. 
 
POPULATION PRESSURES 
-------------------- 
 
¶8.  (SBU)  The Ambassador asked El Gabaly about President Mubarak's 
recent remarks at the June 9-10 National Population Conference, in 
which he called on Egyptians to have fewer children (See septel). 
El Gabaly noted that Egypt's family planning program has stagnated 
during the last five to seven years. Given the impact of a rapidly 
growing population on economic development, infrastructure, water 
use and land requirements, the GOE has decided to reinvigorate its 
campaign to promote healthy family size. According to the minister, 
the single most important factor for smaller families is addressing 
the issue of "male dominance," adding that "the mind set of the male 
must be addressed."   He dismissed the impact of girls' education on 
fertility. Comment:  We are concerned about El Gabaly's dated 
analysis of the impact of education for women on fertility rates. 
USAID will seek opportunities to update his expertise, and that of 
his ministry.  End Comment. 
 
AVIAN INFLUENZA AND THE IPAPI CONFERENCE 
---------------------------------------- 
 
¶9.  (U) El Gabaly reviewed positive results of Egypt's program to 
combat avian influenza, and acknowledged U.S. contributions.  In 
planning for the October International Conference on Avian and 
Pandemic Influenza, organized in collaboration with the 
International Partnership on Avian and Pandemic Influenza, to be 
held in Sharm el-Sheikh, El Gabaly is worried about "flu fatigue." 
To combat this, El Gabaly would like a big name speaker for the 
conference, citing, for example, Bill Gates as someone who might 
draw international attention to the continuing problem of avian 
influenza. 
 
¶10.  (SBU) Note:  The minister raised the "flu fatigue" issue with 
Ambassador Lange on June 8, repeating his request for assistance 
with identification of a high profile speaker for the conference. 
El Gabaly also discussed the conference with Health and Human 
Services Secretary Leavitt at the World Health Assembly in May.  At 
that time, El Gabaly invited Secretary Leavitt to visit Egypt.  It 
is our understanding that Secretary Leavitt plans to attend the 
conference in October, followed by visits to avian influenza-related 
sites. 
SCOBEY