VZCZCXRO5089
RR RUEHAST RUEHCHI RUEHDT RUEHHM RUEHLN RUEHMA RUEHNH RUEHPB RUEHPOD
RUEHTM RUEHTRO
DE RUEHBK #0611/01 0691245
ZNR UUUUU ZZH
R 101245Z MAR 09
FM AMEMBASSY BANGKOK
TO RUEHC/SECSTATE WASHDC 6339
INFO RUEHCHI/AMCONSUL CHIANG MAI 6288
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUCNASE/ASEAN MEMBER COLLECTIVE
RUEHKT/AMEMBASSY KATHMANDU 7473
RUEHSV/AMEMBASSY SUVA 0437
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEKJCS/USCINCPACLO WASHDC
RUEHPH/CDC ATLANTA GA
RUEHRC/USDA FAS WASHDC

UNCLAS SECTION 01 OF 04 BANGKOK 000611 
 
SIPDIS 
 
DEPARTMENT FOR OES/IHB:JJONES,LMILLER 
DEPT FOR USAID/GBH 
USDA FOR FAS AND APHIS 
HHS FOR CDC 
USCINCPACLO FOR AFRIMS/WALTER REED ARMY INST. OF RESEARCH 
 
E.O. 12958: N/A 
TAGS: TBIO WHO KPAO KFLU KHIV ECON EAID TH
SUBJECT:  THAILAND HOSTS USG CUTTING EDGE DISEASE PROGRAMS 
 
REF: State 2172 
 
BANGKOK 00000611  001.2 OF 004 
 
 
¶1. SUMMARY: With over one-fifth of Mission Bangkok's staff of 
roughly 2000 working on health issues, the Embassy hosts one of the 
USG's largest efforts to fight the world's most dangerous diseases: 
malaria, TB, dengue, HIV/AIDS and avian/pandemic influenza.  USAID, 
HHS/CDC, USDA/APHIS and the Armed Forces Research Institute of 
Medical Sciences (AFRIMS) collaborate with each other and Thai 
counterparts, and are platforms for assistance and partnership 
throughout the region.  A number of important breakthroughs, such as 
in the prevention of HIV/AIDS transmission from mothers to children, 
were developed here.  The agencies supplement their Southeast Asia 
focus with collaboration in Central and South Asia as well as the 
Pacific Islands.  SE Asia is a critical locale as the birthplace of 
avian influenza and the most drug-resistant malaria strains; our 
health agencies with Thai and ASEAN counterparts do everthing from 
assuring the health of U.S.-bound Burmese refugees to developing 
malaria treatments and testing of HIV vaccines. 
 
¶2. Thailand and Mission Bangkok collaborate to make a regional 
health hub of excellence, relying on extensive Embassy management 
support, excellent infrastructure, good air connections and pro-U.S. 
attitudes.  The relative sophistication of the Thai scientific and 
medical community makes collaboration as useful to USG research as 
it is to the Thais themselves. Thailand is emerging as a donor and 
science collaborator to help other countries as far away as Africa. 
AFRIMS, CDC, USDA and USAID programs reach a wide range of people, 
from the military to migrants, refugees and farmers.  END SUMMARY. 
 
THE THREAT FROM EAST ASIA 
------------------------- 
¶3. Many of the infectious diseases that pose critical threats to the 
U.S. and world have important connections to Southeast Asia. As the 
birthplace of avian influenza (AI), and bearing the brunt of the 
outbreaks along with China, SE Asia is the logical focus for 
research in prevention and treatment.  SE Asia has been the locus 
for emerging strains of drug-resistant malaria pathogens. 
Multiple-drug resistant strains of tuberculosis (TB) have also 
emerged here.  Other prevalent diseases include HIV/AIDS, hepatitis, 
diarrheal and respiratory diseases, dengue fever, hand, foot and 
mouth disease, and Japanese encephalitis.  Climate change is also 
expected to have a particularly harmful effect on the people and 
ecosystems of SE Asia, coupled with significant mega-urbanization. 
Research and program development are vital to this region to ensure 
its economic health as rising temperatures, sea levels, 
precipitation and drought combine to increase the threats, 
especially from vector-borne diseases. Thailand is one of the most 
developed and stable nations in the midst of this infectious disease 
panorama. 
 
WHY BANGKOK IS THE HUB 
---------------------- 
¶4. With around one-fifth of the employees at the fourth-largest U.S. 
mission working on infectious disease and health issues, Bangkok is 
one of the USG's largest centers to fight the world's most dangerous 
global health threats.  The well-developed embassy management 
platform, coupled with the excellent infrastructure, air travel 
infrastructure and connections, and a generally pro-U.S. attitude 
among the Thai government and populace make Bangkok the ideal USG 
health hub for Asia. These same advantages make Bangkok the premier 
conference site in Southeast Asia, possibly in all of East Asia. 
 
¶5. In the past six months there have been major international 
conferences here on dengue, HIV/AIDS, and other diseases, and 
Thailand's transportation nexus enables agencies such as USAID to 
hold NGO and national partner conferences with dozens of 
institutional participants and representatives of 15 nations. 
Bangkok is also home to a large number of conferences on topics 
related to public health such as climate change, air pollution and 
mega-urbanization; the availability of Bangkok-based USG personnel 
to participate in these conferences helps both those disciplines and 
USG/global health partnerships (Reftel). (Note: The airport closures 
last year certainly affected the conference industry in Thailand, 
but it has now largely recovered.  End Note.) Having agencies 
grouped here has also facilitated coordination and enhanced 
cross-agency collaboration on a number of different fronts 
 
THAILAND: THE IDEAL U.S. PARTNER 
 
BANGKOK 00000611  002.2 OF 004 
 
 
-------------------------------- 
¶6. The relative sophistication of the Thai scientific and medical 
community makes the primary collaboration with the Thais as useful 
to USG research as to the Thais.  With three kinds of partners, our 
health agencies cover a range of sophisticated actors in Thailand: 
NGOs (USAID), the Royal Thai Army Medical Department (AFRIMS); the 
Ministry of Agriculture (USAID and APHRIMS) and the Ministry of 
Public Health (CDC). 
 
¶7. Aided considerably by our partnership, Thailand is emerging as a 
donor and science collaborator in its own right, helping other 
countries with their health problems.  The Royal Thai Government's 
development agency, TICA, has programs in 27 nations, for example: 
TICA sends primary health care trainers to Timor Leste and has 
recently started a multifaceted cooperation project in public health 
for Pacific Island countries. TICA conducts far flung programs for 
malaria and HIV/AIDS (Mozambique), and medicine (Cuba). TICA has 
recently proposed an AI training program, to share its successes in 
prevention and control with members of the Bay of Bengal Initiative 
for Multi-Sectoral Technical and Economic Cooperation public health 
(BIMSEC) and the Organization of Islamic Conference (Thailand is an 
observer), both of which also cooperate with Thailand on other 
public health topics.  The Thai International Postgraduate Programme 
reaches over 50 countries with annual training and degree programs; 
Thailand offers scholarships in public health in cooperation with 
other donors such as JICA and UN agencies. 
 
THE USG RESPONSE: RESEARCH, COLLABORATION AND SUCCESS 
--------------------------------------------- -------- 
¶8. The three main health agencies - USAID/RDMA, HHS/Centers for 
Disease Control (CDC) and the Armed Forces Research Institute of 
Medical Sciences (AFRIMS) -- collaborate with Thai counterparts as 
well as operate regional platforms for assistance and partnership. 
While Southeast Asia is a focal region, the three agencies support 
other USG programs in Central and South Asia as well as the Pacific 
Islands.  Activities run the gamut of research, treatment, capacity 
building and cover other diverse subjects such as health screening 
for U.S.-bound Burmese refugees (CDC); multi-country malaria 
containment programs and validation of a new TB test (USAID) to the 
testing of HIV vaccines (AFRIMS).  USDA's food safety and animal 
health programs also contribute to Mission Bangkok's human health 
efforts. 
 
¶9. The reach of these agencies from India to China and the Pacific 
Islands gives our agencies in Thailand a unique middle ground 
between the two Asian nations with the largest health problems and 
vulnerable populations, as well as important health infrastructures 
with which to partner.  Bangkok-based USG agencies also partner with 
those UN agencies that use Bangkok as their Asia hub.  For example, 
CDC's Global AIDS Program developed new technical support programs 
in Laos and Papua New Guinea, working in close partnership with 
AFRIMS, USAID, and WHO. A short synopsis of a few of the programs 
follows. 
 
USAID 
----- 
¶10.  USAID's Regional Development Mission - Asia (RDMA) supports 
with direct and indirect funding over 50 NGOs, other USG agencies, 
and both national and multinational institutions. RDMA manages 
health programs for infectious disease and chronic health problems 
in eleven countries from India to China; some programs are regional, 
some are bilateral and some are advisory to USAID missions in Asian 
countries such as Vietnam.  RDMA focuses on HIV/AIDS, malaria, TB, 
dengue and Avian Influenza in the Greater Mekong Subregion.  The 
Asian Collaborative Training Network for Malaria brings together 
National Malaria Control Programs from 11 malaria-endemic countries 
in Southeast Asia for staff training and enhancement of a regional 
information network. RDMA's new Asian Network of Excellence in 
Quality Assurance of Medicines (ANEQAM) led the effort to identify 
problematic pharmaceuticals, using Thailand and the Philippines as 
its centers of excellence and partnering with the WHO and the United 
States Pharmacopeia, the official standards-setting authority for 
all medicines sold in the U.S. that also has a regional office in 
Bangkok. 
 
¶11. The USAID Avian Influenza program develops prevention and 
control (for bird and human health) in the Mekong Region, China, 
Bangladesh, India and Nepal. HIV/AIDS prevention and care programs 
 
BANGKOK 00000611  003.2 OF 004 
 
 
target Laos and Thailand.   USAID supports key treatment facilities 
such as the Mercy Center, visited by President Bush in 2008, for 
education and home-based care to AIDS victims in low-income 
communities.  RDMA has played a key role in the USG health and other 
responses to Cyclone Nargis as well as the health problems among 
Burmese refugees, where there is a danger that AI and other diseases 
could take root.  The TB program among that group resulted in a new 
Multi-resistant TB diagnostic test. 
 
HHS/CENTERS FOR DISEASE CONTROL 
------------------------------- 
¶12. In the past ten years, the CDC Office in Thailand has nearly 
doubled in size to almost 200 employees; currently almost all of 
CDC's direct-hire staff have regional responsibilities.  CDC assures 
the quality of health screening for all U.S. -bound refugees and 
immigrants from the region. CDC conducts collaborative research with 
the Thai Ministry Public Health (MoPH) in areas like evaluating the 
efficacy of pre-exposure prophylaxis with anti-retroviral therapy to 
prevent HIV/AIDS in high risk groups such as IV drug users. With 
assistance from CDC, Thailand has become a model partner 
demonstrating the success and expandability of multiple HIV 
programmatic interventions in the quality of HIV care and prevention 
of prenatal HIV transmission, for example; the first successful drug 
therapy to prevent mothers from passing the HIV virus to their 
offspring was developed in a CDC program in Thailand.  CDC has 
documented the risks of mortality among HIV-infected TB patients in 
Thailand and demonstrated the benefits of early antiretroviral 
therapy. 
 
¶13. CDC's support for the Thai Field Epidemiology Training Program 
recently helped launch an electronic journal for regional outbreaks 
and helped sponsor "TIGER," a regional collaboration of Mekong Basin 
countries aimed at strengthening the detection and control 
outbreaks.  CDC has also been heavily involved in helping Thailand 
develop a pandemic and all-hazards preparedness plan, and in 
strengthening surveillance and diagnostic capacity for severe 
respiratory illnesses.  These successes have helped Thailand help 
other nations.  For example, CDC's Global AIDS Program, working with 
AFRIMS, USAID and WHO developed new technical support programs in 
Laos and Papua New Guinea, to complement the already existing USAID 
HIV programs in those two countries. 
 
ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES 
--------------------------------------------- ------       14. Over 
50 years ago the U.S. Army identified the Royal Thai Army Medical 
Department (RTAMD) as the ideal medical collaborator in the region 
and Thailand the ideal site for its research.  What is now the Armed 
Forces Research Institute of Medical Sciences - U.S. Army Medical 
Component (AFRIMS-USAMC) works in militarily-relevant infectious 
disease research, including conducting disease surveillance, and 
evaluating and testing new drugs, vaccines, and diagnostic 
procedures.  AFRIMS now has around 470 employees and contractors. 
Beyond its in-house research on diseases of military importance to 
directly benefit U.S. servicemen, AFRIMS conducts collaborative 
research with Thai and international partners on HIV/AIDS, malaria, 
dengue, Japanese encephalitis, scrub typhus and other rickettsioses, 
diarrheal and respiratory diseases, and HIV/AIDS.  Partner nations 
include Cambodia, Bhutan, Nepal, Philippines and Vietnam.  AFRIMS 
has had a renowned HIV research program but its most striking 
achievement is its HIV vaccine development program, started in 1991. 
AFRIMS is currently testing a new HIV vaccine in a Phase III 
efficacy trial. AFRIMS-USAMC assists the RTAMD with health 
surveillance in several Thai border regions and for the large number 
of UN peacekeeping forces that Thailand provides around the world. 
 
USDA 
---- 
¶15. The United States Department of Agriculture (USDA) contributes 
to human health in several ways, with the Foreign Agriculture 
Service (FAS) and Animal and Plant Health Inspection Service (APHIS) 
regional offices in Bangkok working in food safety.  APHIS 
veterinarians also play a key role building capacity to combat Avian 
Influenza (AI), as nearly all human AI cases have been attributed to 
direct contact with infected birds.  APHIS Bangkok oversees offices 
in Burma, Cambodia, Indonesia, and Laos, and has supported 
activities in other nations such as Vietnam and the Philippines. 
APHIS collaborates with the other USG agencies, the various host 
governments, and international organizations to provide prevention 
 
BANGKOK 00000611  004.2 OF 004 
 
 
and control activities.  Programs include: developing regulatory 
frameworks; field investigation; outbreak response; wildlife 
surveillance; epidemiology research; laboratory diagnosis; 
vaccination; compensation for producers; managing live bird markets; 
and information management.  As these capacity building activities 
apply to general animal health programs, the APHIS promotion of 
international standards for animal health activities have led to 
sustained improvement in general animal health, food security and 
economic infrastructure in addition to an important public health 
service. 
 
COMMENT 
------- 
¶16.  The number of health professionals at Mission Bangkok is no 
surprise when one considers the near-ideal environment Thailand 
provides.  Thailand is a solid ally with the infrastructure, 
capacity and attitude to make USG collaboration a plus for both 
countries, and a tremendous asset globally in the effort to fight 
infectious disease.  At the same time, Mission Bangkok's infectious 
disease collaboration is one of the best agents for creating a 
positive impression of the United States in this region of the 
world. 
 
JOHN