VZCZCXYZ0000
PP RUEHWEB

DE RUEHGO #0920/01 3380736
ZNR UUUUU ZZH
P 030736Z DEC 08
FM AMEMBASSY RANGOON
TO RUEHC/SECSTATE WASHDC PRIORITY 8445
INFO RUEHBK/AMEMBASSY BANGKOK 2751
RUEHBY/AMEMBASSY CANBERRA 1657
RUEHLO/AMEMBASSY LONDON 2053
RUEHGV/USMISSION GENEVA 4152
RHEHNSC/NSC WASHDC
RUEHBS/USEU BRUSSELS

UNCLAS RANGOON 000920 
 
SENSITIVE 
SIPDIS 
 
STATE FOR EAP/MLS, G, S/OGAC, OES 
BANGKOK FOR USAID HEALTH OFFICE 
DEPARTMENT PLEASE PASS TO USAID/AME 
 
E.O. 12958: N/A 
TAGS: SOCI EAID PHUM KHIV PGOV SENV BM
SUBJECT: BURMA MEETING ON TB DRUGS; BIG PUSH FOR GLOBAL FUND 
 
REF: A. RANGOON 842 
     ¶B. RANGOON 879 
     ¶C. STATE 115494 
     ¶D. STATE 105179 
 
Summary 
------- 
 
¶1. (SBU)  Pledged donor funding for anti-tuberculosis drugs 
in Burma will decline in 2009 and fall off sharply 
thereafter.  At a GOB-convened meeting December 1 to address 
this gap, the Health Minister committed to increase 
government funding for anti-TB drugs to 3 percent of the 2010 
requirement, a still-paltry sum of about USD 100,000.  Most 
donors at the meeting argued for the return of the Global 
Fund (GF) -- though it appears the Health Minister may be 
reconsidering a GF application in light of perceived U.S. 
opposition.  Charge attended the TB meeting and reiterated 
U.S. views on the need for Burma to address in any 
application the problems that led to the GF's withdrawal in 
¶2005.  Several donor reps approached Charge afterwards and 
urged U.S. support for the GF, citing the humanitarian need 
and the GOB's generally positive record in cooperating with 
the 3 Diseases Fund (3DF) and combating TB.  In doing so, the 
UK Ambassador asked specifically whether the U.S. has any 
flexibility on GF site access requirements, noting that the 
3DF gains access to sites in "nearly all" cases, which the UK 
considers acceptable.  Embassy Rangoon requests guidance in 
responding to the UK and other donors (see para 10).  End 
summary. 
 
GDF winding up TB drug funding; Global Fund in the wings? 
--------------------------------------------- ------------ 
 
¶2. (U)  The GOB convened a meeting on December 1 in Nay Pyi 
Taw with bilateral and NGO donors, UN entities, and others to 
discuss how best to address a looming gap in funding for 
anti-TB drugs.  The Global TB Drug Facility (GDF), based in 
Geneva, has provided the drugs for the past six years, the 
usual maximum duration, and agreed to provide funding help on 
an "exceptional" basis for 2009 at a cost of approximately 
USD 2.5 million, leaving a gap for the coming year of USD 
1.15 million.  From 2010 on there is very little funding for 
anti-TB drugs in the pipeline.  GDF sees a 2010 need of USD 
8.2 million (half for that year's use; half to create a 
buffer stock), and intends to cover only pediatric drugs, a 
small portion of the total.  Possible 2010 funding sources 
are the UN, the 3DF, bilateral aid, international NGOs, and 
GDF.  GDF informed the meeting that the only obvious sources 
for 2011 and beyond are the GOB, itself, and/or the GF, which 
often provides funds to GDF to purchase and provide TB drugs. 
 
 
GDF assessment generally positive; emphasizes funding need 
--------------------------------------------- ------------- 
 
¶3. (U)  The GDF presented findings from a week-long 
monitoring mission November 24-29 that generally observed a 
successful anti-TB program in Burma.  The assessment saw a 
continued increase in detection of new cases, the maintenance 
of high treatment success rates, and an uninterrupted supply 
of anti-TB drugs and laboratory supplies over the past two 
years, with "excellent" drug management practices at all 
levels, and "highly competent and dedicated" staff.  Prisons, 
military, police, and others follow treatment guidelines and 
"refer patients where and when possible and have access to 
services and products."  The study noted challenges, 
including the funding gap, unfilled health positions, and 
irregular supervision due to lack of resources.  The study 
recommended increased GOB funding and sustainable multi-year 
support from donors, including the GF. 
 
GOB to increase funding (from low base); most donors favor GF 
--------------------------------------------- -------------- 
 
¶4. (U)  Health Minister Kyaw Myint informed the meeting that 
his ministry is prepared to commit "no less than 3 percent" 
of the expected drug cost for 2010, about USD 100,000, with 
an intention to augment that amount by no less than 1 percent 
per year in the future.  UN agency reps, GDF's General 
Manager Dr. Robert Matiru (Geneva), and Dr. Mario Raviglione, 
Director Stop TB Department (WHO Geneva), all argued that 
Global Fund is the obvious long-term answer and that the GOB 
should make every effort to apply in 2009 for Round 9. 
Matiru said GF is a "realistic and viable" option for Burma. 
He urged the GOB to look at the past and see how a future 
program can be made to work.  Raviglione said of all the 
high-burden TB countries, Burma is the only non-participant 
in the GF.  He said WHO strongly recommends an application 
and is keen to provide technical assistance.  Per previous 
reporting, the British and Australians are also urging a 
Burmese Global Fund application, given what they see as 
generally positive GOB behavior during the past two years in 
implementing the 3DF (see Ref A). 
 
USG views on the table 
---------------------- 
 
¶5. (U)  The Charge represented the USG at the meeting.  Dr. 
John MacArthur, USAID RDMA Bangkok's infectious disease team 
leader, was unable to accompany due to the closure of the 
Bangkok airports.  In an intervention, the Charge noted a 
recent large USG contribution to the Stop TB Partnership 
(which includes the GDF), and a recent USD 1 million USG 
contribution to WHO and PSI anti-TB efforts in Burma.  As 
advised by Dr. MacArthur, Charge said RDMA is looking to see 
if it can find available funding to help cover the 2009 drug 
gap.  Charge noted the ongoing USG dialogue with the GOB 
regarding the GF (refs B and C) including the marker that any 
Burma application needs to address up front and 
satisfactorily the past problems that brought GF withdrawal 
from Burma in 2005.  Charge joined other donors in urging the 
GOB to increase its own contribution to the drug budget. 
 
Minister asks USG support for GF application 
-------------------------------------------- 
 
¶6. (U)  In response Health Minister Kyaw Myint said he badly 
wants to keep up momentum in the GOB's effort against TB.  He 
said he would "crawl on his knees" if necessary to GOB 
decision makers (the senior generals) to try to increase GOB 
TB-drug funding.  The Minister asked for Charge's "blessing" 
for USG support of a GOB GF application. 
 
Pretty unambiguous signal: no GF application? 
--------------------------------------------- 
 
¶7. (SBU)  The UK and Australian Ambassadors were invited to a 
short chat with Kyaw Myint prior to the donor meeting.  After 
the meeting, the Ambassadors informed Charge that the 
Minister had left a "pretty unambiguous" impression that he 
does not intend to apply for GF Round 9.  The Minister said 
he "doesn't want to be humiliated again" and will "err on the 
side of caution."  The Minister seemed convinced the USG 
intends, in the end, to block an application. 
 
UK believes USG should support GF for Burma 
------------------------------------------- 
 
¶8. (SBU)  Per refs B and C, Charge in recent weeks provided 
as clearly as possible USG views on the GF to the Health 
Minister and one of the two Deputy Health Ministers, noting 
U.S. understanding of Burma's health needs, but also 
explaining the USG belief that the GOB must satisfactorily 
address in its GF application several important problems from 
the past:  the need for full access to GF program sites; a 
market-rate currency exchange mechanism; appropriate tax 
exemptions; and assurance no funds would flow through the GOB 
or its proxies.  The UK Ambassador emphasized to us later his 
government's agreement that the USG issues are important; but 
the UK also believes the GOB in its work with 3DF (the 
European/ Australian funding mechanism for Burma in the 
absence of GF) is demonstrating its willingness to meet GF 
requirements satisfactorily.  The UK Ambassador, who chairs 
the 3DF process, said "access" is the one question mark.  The 
GOB has provided nearly all the access 3DF has requested; not 
always immediately and in a couple of cases not at all, but 
nearly always, he stressed.  The UK sees that "not black and 
white but only a little gray" situation as acceptable, given 
the life and death TB issues at stake.  Charge promised to 
convey, again, that view to Washington and seek any further 
guidance, particularly on whether the USG can envision any 
flexibility at all on the access issue. 
Lack of message in Geneva...a worry 
----------------------------------- 
 
¶9. (SBU)  On the margins of a post-meeting luncheon, Stop 
TB's Dr. Raviglione approached Charge to argue that the USG's 
issues regarding a GF application should be addressed in 
technical discussion down the road, not in the application 
itself.  Charge referred to Ref D instruction in which 
Washington made clear it does not agree with that approach, 
believing the GF's own rules for a Burma application require 
addressing problem areas in the application.  Raviglione 
expressed puzzlement why the USG has not made its variety of 
points to GF in Geneva.  When Charge said he is quite sure 
U.S. Mission Geneva has delivered the points, Raviglione said 
the U.S. raised no such points at a GF Board discussion of 
Burma in Geneva in early November. 
 
Comment and action request 
-------------------------- 
 
¶10. (SBU)  Given the GF previous withdrawal from Burma, the 
USG has appropriately raised the issues that need addressing 
in any new application process.  The other participants at 
this week's meeting seemed united in believing that the GOB's 
overall positive record with the 3DF and its generally very 
helpful approach in combating TB argue persuasively for a 
return of the GF.  A critical factor in that analysis is the 
undoubted reality that a funding failure would, in this "high 
burden" country, lead to the loss of many thousands of lives 
and a significant public-health threat to the rest of the 
Southeast Asia region.  Factors weighing against include the 
risk that the GOB will not satisfactorily meet or sustain 
necessary GF commitments, and the paltry sums Burma's senior 
generals are prepared to spend on health, compared to huge 
amounts spent on major construction projects.  At present, 
most other donors perceive the USG stance on GF for Burma as 
overly rigid, not acknowledging that useful work can be done 
in the health sector with what most others perceive to be 
adequate safeguards.  We continue to urge Washington and GF 
Geneva to engage in discussion regarding Burma.  In the 
meantime, we request guidance for responding to the UK 
Ambassador on whether the USG is willing to accept some 
"degree of gray" -- i.e., show some amount of flexibility -- 
in our view of how much access to GF sites in the future is 
essential here.  Please advise. 
DINGER