VZCZCXYZ0003
RR RUEHWEB

DE RUEHEG #2293/01 3071243
ZNR UUUUU ZZH
R 021243Z NOV 08
FM AMEMBASSY CAIRO
TO RUEHC/SECSTATE WASHDC 0770
INFO RUCNDT/USMISSION USUN NEW YORK 0228
RUEHGV/USMISSION GENEVA 0404
RUEHSUN/USUN ROME IT 0001
RUEHHI/AMEMBASSY HANOI 0037
RUEHRC/DEPT OF AGRICULTURE WASHINGTON DC
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEAHLC/DEPT OF HOMELAND SECURITY WASHINGTON DC

UNCLAS CAIRO 002293 
 
SIPDIS 
 
DEPT PLEAS PASS TO USAID M TROSTLE 
USDA FOR JOE ANELLI 
HHS FOR  DANIEL MILLER 
DEPT HS FOR WILLIAM LYERLY 
 
E.O. 12958: N/A 
TAGS: PREL TBIO KFLU EAID EAGR EG
SUBJECT: SHARM EL-SHEIKH CONFERENCE FOCUSES ON PANDEMIC THREAT, 
BRINGS TOTAL AVIAN INFLUENZA ASSISTANCE TO $3 BILLION 
 
¶1. SUMMARY:  The October 25-26 Sixth International Ministerial 
Conference on Avian and Pandemic Influenza, Sharm el-Sheikh, Egypt, 
in cooperation with the International Partnership on Avian and 
Pandemic Influenza (IPAPI), succeeded in maintaining global focus on 
the spread of avian influenza and the threat of a potentially 
devastating pandemic.  The United States, Japan, and Norway pledged 
over $350 million, bringing cumulative international pledges since 
2005 to over $3 billion.  Over 120 countries attended, including 63 
ministers -- the most since the first IPAPI meeting (Washington, 
2005), and the five IPAPI-supported meetings that followed. 
Participants addressed three main challenges: 
-- Ensuring that the world is fully prepared to mitigate the effect 
of an influenza pandemic or another unforeseen catastrophic 
epidemic; 
-- Sustaining efforts to control highly pathogenic avian influenza 
(AI), especially in poultry, and eventually to eradicate the H5N1 
virus from domestic animals in the countries that still suffer from 
it; and 
-- Initiating longer-term responses to infectious diseases that 
emerge  at the animal, human, and ecosystem interface.) 
 
¶2.  Under Secretary for Democracy and Global Affairs Paula 
Dobriansky's announcement on the first day of a U.S. pledge of $320 
million in new avian and pandemic influenza (API) assistance 
dominated media coverage and energized the conference.  Under 
Secretary Dobriansky also warned against "flu fatigue" and 
underscored the need to maintain global momentum.  Participants 
emphasized that the pandemic threat is real and necessitates another 
conference a year or more from now to maintain global momentum on 
two fronts: multi-sector pandemic preparedness, and programs 
evolving from an avian and pandemic-influenza-specific approach to 
the broader emerging infectious disease approach, or the concept of 
"One World, One Health."  Vietnam is likely to host the next 
conference in March 2010.  The IPAPI Core Group met twice on the 
margins of the conference.  END SUMMARY. 
 
¶3.   The International Ministerial Conference on Avian and Pandemic 
Influenza, October 25-26 in Sharm el-Sheikh, was the sixth and 
largest major international meeting  on  API since 2005, attracting 
some 530 delegates (63 of them ministers) from over 120 countries, 
26 international and regional organizations, and others.  The U.S. 
delegation was led by Under Secretary Dobriansky and included 
Ambassador Margaret Scobey, Special Representative on Avian and 
Pandemic Influenza John Lange, USAID Assistant Administrator Kent 
Hill, USDA Deputy Under Secretary Charles Lambert, HHS Principal 
Deputy Assistant Secretary Gerald Parker, and DHS Chief Medical 
Officer/Acting Assistant Secretary for Health Affairs, John 
Krohmer. 
 
¶4.  Egyptian Prime Minister Ahmad Nazif, Agriculture Minister Amin 
Abaza, Health Minister Hatem el-Gabaly, World Organization for 
Animal Health (OIE) Director General Bernard Vallat, World Bank Vice 
President Jeffrey Gutman, Food and Agriculture Organization Deputy 
Director General Jim Butler, World Health Organization Deputy 
Director General Anarfi Asamoa-Baah, and UN System Influenza 
Coordinator (UNSIC) David Nabarro addressed the conference. 
 
¶5.  Sessions addressed such themes as the host country's experience 
and vision for the future, analyses of best practices and challenges 
for the control of avian and pandemic influenza (API), pandemic 
preparedness and response, control of API and emerging diseases at 
the animal-human interface, community mobilization and 
communication, resource analysis, and a pledging session.   On the 
margins of the conference, there was a USG media roundtable and an 
Egyptian press conference that included a USG representative 
(reported septel). 
 
TRANSPARENCY, EDUCATION, AND PREVENTION: EGYPT'S EXAMPLE 
 
¶6.  The Egyptian hosts were eager to place the overall fight against 
API in the context of their own experience.  (Avian influenza is 
endemic in Egypt's poultry and with a total of 50 human cases, 22 of 
which were fatal, Egypt ranks among the top three endemic 
countries.)  Accordingly, Health Minister al-Gabaly set the tone of 
the conference by speaking about Egypt's own history of API (with 
the first cases in poultry in February 2006 and in humans the 
following month), and underscored that governments need to sustain 
efforts as outlined in previous international conferences to focus 
on transparency, education, and prevention, with the latter topic 
addressing both animal and human aspects of the disease.  The 
 
Egyptian presenters noted the country's establishment of appropriate 
emergency committees even before the initial outbreak, Egypt's 
poultry vaccination program, and improvements in their veterinary 
laboratories and hospitals for diagnosing AI in animals and treating 
it in human patients.  (Egypt's AI human mortality rate of 44 
percent is significantly lower than the global rate of approximately 
64 percent.)  They repeatedly drew attention to the country's 
justly-lauded pattern of complete openness to the global community 
with respect to AI -- "Transparency should be the cornerstone of an 
international strategy,"-- while citing their progress in the 
communications/education field (through, for example, using famous 
local actors and singers in TV spots and travelling presentations, 
and more than ten million visits to homes by education teams).  The 
governor of al-Qalyubiyeh Governorate, which produces 60 percent of 
the country's poultry, provided a detailed "case history" of the 
province's experience with AI. 
 
ANIMAL HEALTH 
 
¶7.  Time and again, the theme was hammered home that there can be no 
human cases without animal cases, and that "all it takes to start a 
pandemic is one dead bird."  As OIE's Vallat put it, "Good 
governance means good veterinary services."  Accordingly, qualified 
veterinary services capable of surveillance and treatment are the 
shock troops of any country's defense.  The experience of the last 
year has shown that early detection and rapid response have 
prevented the endemic establishment of AI in most countries in which 
infection has appeared, a fact that gives new impetus to the need to 
improve global veterinary services.  As USDA Deputy Under Secretary 
for Marketing and Regulatory Programs Charles Lambert put it, "The 
effort cannot be driven solely by human health concerns, for it also 
requires the health of agriculture" (i.e., the poultry industry). 
African Union program coordinator Samuel Muriuki shared the 
perspective of that continent's experience: "Investment in 
strengthening the veterinary services is the most sustainable means 
to combat API in Africa."  The Wildlife Conservation Society's 
William Karesh approached the need for qualified veterinary experts 
from the perspective of wild birds: the Global Avian Influenza 
Network Surveillance (GAINS) forum was already studying AI in wild 
birds prior to the arrival of H5N1, and thus far has recorded 103 
million wild birds in its database-a figure expected to reach 300 
million in three months.  He also emphasized the importance of 
veterinary services by observing that it is now virtually confirmed 
that it is domestic animal disease that finds its way into wildlife, 
and not, as had been suspected, the other way around. 
 
HUMAN HEALTH 
 
¶8.  WHO's Asamoah-Baah noted, in a statement quoted during the 
conference, "If a pandemic breaks out, a bail-out or rescue won't 
work.  It will attack Wall Street, Main Street, and regions where 
there are no streets."  Especially in light of the "flu fatigue" 
phenomenon, the conference's many presenters stressed the 
inevitability of a pandemic, and agreed that success in combating AI 
usually reflects such factors within each country, at the local and 
national levels, as the sustained engagement of political leaders, 
surge-capacity capability, collaborative action across government 
ministries (including health, agriculture, environment, disaster 
response, and civil defense services), the continuous engagement of 
the private sector and civil society, and transparent 
communications.  Participants emphasized the need to continue to 
support the WHO Global Influenza Surveillance Network through the 
timely sharing of viruses or specimens with WHO collaborating 
centers, and highlighted the need to increase vaccine production 
capabilities.  (Note:  The controversial issue of influenza virus 
sample and benefit sharing was not on the conference agenda because 
the issue is being dealt with by the WHO Intergovernmental Meeting 
on Pandemic Influenza Preparedness [IGM].  End Note.)  A common 
theme was the need to identify and mitigate the effects of the 
disease on vulnerable people, as well as the need to bring 
veterinary and public health systems in poorer countries up to 
global standards for disease prevention --  a staggering task 
requiring sustained, long-term international investment. 
Participants also stressed the need to develop, test, and update 
pandemic plans.  They called for the full implementation of the 
International Health Regulations (which Denis Coulombier of the 
European Center for Disease Prevention and Control called "an 
enormous achievement"), noting that low-income countries will need 
significant support to enable them to meet all requirements. Major 
emphasis was placed on significant progress on the human-health 
 
front within Europe, in contrast with major deficiencies in 
developing countries (especially Africa).  The plea of a former 
Egyptian health minister summed up the situation: "Egypt needs huge 
amounts of money.  Donors' contribution is vitally needed." 
 
LONGER-TERM ACTION: PANDEMICS AND EMERGING INFECTIOUS DISEASES OF 
ANIMAL ORIGIN 
 
¶9. The year's Sharm el-Sheikh conference broadened the focus from 
past years' gatherings from a concentration on the threat of the 
H5N1 virus to spark a pandemic to include placing the disease in the 
broader context of global health.  USAID Assistant Administrator for 
Global Health Kent Hill, for example, spoke on how API preparations 
can relate to other diseases of animal origin, and he called for 
broader transitional strategies to cope with this widening 
phenomenon. UNSIC's Nabarro placed a slightly different gloss on the 
proceedings: he reviewed advances made since the New Delhi 
conference in December 2007, using as his guide the "Fourth Global 
Progress Report" issued in October by UNSIC and the World Bank.  He 
described the international community's key goals as sustaining 
efforts to control and eventually eliminate HPAI in animals, 
preparing for a pandemic, and ensuring longer-term action: 
responding to infectious diseases that emerge at the animal, the 
animal, human and ecosystem interface.  He noted that participants 
at the New Delhi conference had recommended that the international 
community draw on experiences with HPAI to develop a medium-term 
strategy to address emerging infectious diseases, and drew attention 
to the document "Contributing to One World, One Health: A Strategic 
Framework for Reducing Risks of Infectious Diseases at the 
Animal-Human-Ecosystems Interface," developed jointly by FAO, OIE, 
WHO, UNICEF, the World Bank, and UNSIC in response to 
recommendations made in New Delhi. 
 
COMMUNITY MOBILIZATION 
 
¶10.  Participants noted that national pandemic preparedness efforts 
need to be undertaken jointly by all stakeholders--representatives 
of public-sector bodies (both local and national), private entities, 
and civil-society organization, such as the Red Cross or Red 
Crescent societies, media organizations, and faith groups-while 
international organizations should continue to monitor the global 
state of pandemic readiness and seek ways to support poorer 
countries.  A Japanese delegate noted that once a pandemic begins, 
"community mobilization is the most important problem, since it will 
be our last hope."  Special Representative Lange emphasized the need 
to plan for humanitarian needs during Phase 6 of a pandemic and for 
"community mitigation" measures, including methods to limit 
unprotected contact between infected and potentially-infected 
individuals, from those who are not infected.   EC and EU 
representatives presented evidence of European readiness. 
Participants also emphasized the need to operationalize "plans on 
paper", review lessons learned from exercises, and integrate plans 
into existing disaster management structures.  Neighbors were urged 
to engage in cross-border pandemic planning, especially in the 
context of regional organizations. 
 
PLEDGING SESSION 
 
¶10.  Under Secretary Dobriansky energized the conference early on 
the first day by announcing the U.S. contribution of $320 million, 
bringing the total U.S. pledge of assistance for efforts against API 
since 2005 to over $949 million.  At the formal pledging session on 
the second day, Japan and Norway added monies that brought the total 
for the conference to just over $350 million.  Cumulative 
international pledges of assistance since 2005 now total over $3 
billion.  Many delegates praised the U.S. contribution.  World Bank 
representative Olga Jonas noted, however, that significant funding 
gaps remain, especially for Africa ($440 million), East Asia, and 
the Pacific. 
 
"VISION FOR THE FUTURE" 
 
¶11.   UNSIC Nabarro summarized the conference in the context of the 
document, "A Vision for the Future by the Government of Egypt," that 
he, the U.S. delegation and others helped draft.  It defines future 
priorities such as addressing inequities among poorer and richer 
countries in API response capacity and pandemic preparedness; 
eradicating H5N1 in poultry; the continuing need to develop, test, 
and update pandemic plans; improve information-  and 
material-sharing and transparency; enhancing strategic communication 
 
and policy advocacy at high levels; preventing and responding to 
emerging diseases of animal  origin; and improving education, 
training, and research/development.  Nabarro alluded to inadequacies 
in long-term funding, and noted the importance of maintaining the 
sustained involvement of political leaders. 
 
MEETINGS WITH IPAPI CORE GROUP 
 
¶12.  Under Secretary Dobriansky chaired a meeting of the IPAPI Core 
Group (Australia, Canada, EU Presidency/EC, Japan, UK and U.S.) on 
October 25 to discuss virus sample/benefit-sharing.  Members agreed 
that the proper forum for negotiations on the issue was the WHO 
Intergovernmental Meeting scheduled for December 2008.  On October 
26, Special Representative Lange chaired a Core Group meeting that 
also included international organization representatives to discuss 
next steps after Sharm el-Sheikh, including suggestions for the next 
major international conference (likely to take place in Vietnam in 
February-March 2010).  Canada described its plans for a conference 
in Winnipeg in February-March 2009 to discuss the concept of One 
World One Health with interested stakeholders. 
 
SCOBEY