R 012119Z OCT 08
FM AMCONSUL CIUDAD JUAREZ
TO SECSTATE WASHDC 5647
INFO AMEMBASSY MEXICO 
AMCONSUL CIUDAD JUAREZ

UNCLAS CIUDAD JUAREZ 000980 
 
 
E.O. 12958: N/A 
TAGS: KFLU PGOV MX
SUBJECT: EPIDEMIC PREPAREDNESS:  COOPERATION BETWEEN CHIHUAHUA, NEW 
MEXICO, AND TEXAS 
 
¶1.  Summary: The state of Chihuahua has been working closely 
with Texas and New Mexico health departments for three years to 
coordinate preparations for a potential outbreak of a highly 
contagious influenza or similar illness.  However, New Mexico 
and Texas state officials report that their work has been 
impeded by a lack of funding.  The states have held joint 
conferences to inform local stakeholders of the status of 
emergency preparedness.  At a meeting on July 30-31, 2008, 
officials urged participants to develop emergency plans for 
their own organizations.  Based on past experience, medical 
experts from all three states and the CDC agreed that closing 
the border in the event of a flu outbreak would slow the spread 
of disease for no more than one month.  After that, a closing of 
the border would serve no medical purpose.  End Summary. 
 
¶2.  This year, more than 300 government officials from Texas, 
Chihuahua and New Mexico, along with representatives from NGOs 
and local businesses, have attended two conferences sponsored by 
New Mexico state authorities to discuss plans for responding to 
the potential outbreak of an epidemic respiratory disease.  The 
most recent meeting was in late July, and speakers admitted that 
they could not say what a highly contagious strain of avian flu 
might look like, how it would spread, and how to develop a 
vaccine for it.  A Pan American Health Organization Medical 
Officer from El Paso later described any such predictions as 
futile "soap opera." 
 
¶3.  To the extent that medical experts were willing to make 
predictions, they were based on observations about how influenza 
behaves in an unvaccinated population.  Based on this model, 
epidemiologists expected rapid transmission of the disease among 
integrated border populations.  Pointing to the limited medical 
services available in many locations along the border under 
normal circumstances, medical experts said that communities 
could not count on hospitals to mount an effective response 
against the first wave of disease, and businesses and 
individuals should prepare their own action plans. 
 
¶4.  Cooperation between Chihuahua, Texas, and New Mexican health 
authorities has so far focused on developing common protocols 
for the identification of cases, and procedures for reporting 
them to the Centers for Disease Control and Prevention.  Only 
Chihuahua has moved beyond these initial stages to run practice 
drills within its state health care system, leading U.S. 
officials to admit that, despite a late start in this tri-state 
effort, Chihuahua is now further ahead in its preparations.  New 
Mexico and Texas officials bemoan the fact that they have not 
received enough funding to conduct even limited field tests. 
The three states are just beginning to address more advanced 
planning needs, such as identifying stockpiling sites and how to 
handle a surge in hospital caseloads.  A table top exercise is 
in the planning stages, to fill the gap created by the lack of 
field testing. 
 
Utility of Closing Ports of Entry 
 
¶5.  Based on modeling of the spread of influenza in a population 
without effective vaccination, medical experts predict that if a 
new disease were to first appear in the border region, it would 
be identified almost simultaneously on both sides.  Since 
symptoms would take up to seven days to manifest themselves, 
contagion would by then be well underway and closing the border 
would do little to delay the spread of disease.  By contrast, if 
the first cases were identified elsewhere, closing ports of 
entry quickly would be more effective since border residents 
would not yet have been exposed to the same degree.  Still, the 
most that could be achieved would be to slow the rate of 
infection for a month.  After that, contagion would be 
widespread throughout the region, and keeping the border closed 
would serve no medical purpose. 
 
¶6.  Most governmental representatives at the July meeting 
believed the border would not be closed in the event of an 
epidemic because of provisions of the 2007 North American Plan 
for Avian and Pandemic Influenza.  However, a senior New Mexican 
official thought the border would be closed early because 
closure is a critical element in slowing the spread of disease. 
He added that no matter what the North American Plan might say, 
"nationalism will win out.  A country will always protect its 
own citizens first." 
 
¶7.  An official from U.S. Customs and Border Protection told a 
Consulate officer that together the Departments of Homeland 
Security, Transportation and Defense have reviewed emergency 
border crossing procedures in the event of a flu epidemic.  He 
said that the smaller ports of entry in this district would 
close first in the event of a serious threat to U.S. public 
health.  This action would channel traffic into the CDC's El 
Paso Quarantine Station.  In view of anticipated staffing 
shortfalls due to illness, El Paso and Juarez officials would 
give priority to clearing shipments of critical supplies 
northward and southward. 
 
Local and Regional Contacts 
 
 
¶8.  Key officials involved in these coordinated emergency 
preparations include: 
 
Chihuahua: 
- Dr. Luis Carlos Esquivel Ruiz, Medical Coordinator, 
Secretariat of Social Development 
- Dr. Gumaro Barrios, State Epidemiologist, Chihuahua State 
Health Services; 
- Dr. Jose Luis Mendoza, Deputy Director of Preventive Medicine, 
Chihuahua State Health Services 
 
Mexican Federal Government: 
- Dr. Gustavo Ramirez Rosales, Area Chief for Epidemiological 
Surveillance, Mexican Institute for Social Security (IMSS, which 
runs four major hospitals in Juarez) 
 
Local U.S. Government Representative: 
- Dr. Miguel Escobedo, Medical Officer, Centers for Disease 
Control and Prevention, El Paso Quarantine Station 
 
New Mexico: 
- Albert Sanchez, Border Health Emergency Health Preparedness 
Coordinator, Bureau of Emergency Management, New Mexico 
Department of Health 
- Anne Pascarelli Barraza, Pandemic Planning and Performance 
Outcomes Manager, Bureau of Health Emergency Planning, 
Department of Health 
- Paul Dulin, Director, Office of Border Health, Department of 
Health 
 
Texas: 
- Cynthia Morgan, Pandemic Influenza Program, Texas Department 
of State Health Services 
- Flor Puentes, MPH, Early Warning Infectious Disease 
Surveillance Coordinator, Department of State Health Services, 
Region 9-10, El Paso 
 
Others (not at the conferences): 
U.S.-Mexico Border Health Commission: 
- Dr. Elisa Aguilar, Regional Coordinator for Health Programs in 
Juarez 
- Amb. Eleazar Ruiz y Avila, Executive Secretary for the Mexican 
Section, Mexico City 
 
¶9.  Comment: Emergency services experts from Chihuahua, New 
Mexico, and Texas have worked closely together for three years 
to coordinate their response to the onset of an epidemic in the 
border region.  Due at least in part to a lack of funding, 
however, the three states are far from even addressing 
stockpiling of critical supplies, patient surges at hospitals, 
isolation and security requirements.  State and local medical 
officials believe they are now well-equipped at major medical 
facilities to make a fast identification of a dangerous new 
disease, but they are no further along in actually mitigating 
the potential impact. 
 
 
MCGRATH