VZCZCXRO1575
RR RUEHBZ RUEHDU RUEHJO RUEHMR RUEHRN
DE RUEHLG #0316/01 1561226
ZNR UUUUU ZZH
R 051226Z JUN 09
FM AMEMBASSY LILONGWE
TO RUEHC/SECSTATE WASHDC 0545
INFO RUCNSAD/SOUTHERN AF DEVELOPMENT COMMUNITY COLLECTIVE
RUEHLO/AMEMBASSY LONDON 0368

UNCLAS SECTION 01 OF 02 LILONGWE 000316 
 
CDC ALANTA 
MILLENNIUM CHALLENGE CORPORATION WASHINGTON DC 
 
SIPDIS 
 
LONDON FOR AF WATCHER PETER LORD 
 
E.O. 12958: N/A 
TAGS: KFLU TBIO AEMR CASC KSAF KPAO MI
SUBJECT: MALAWI SWINE FLU RESPONSE: GOOD PLANNING BUT STILL 
VULNERABLE 
 
¶1. Summary:  While experience with SARS and preparations for 
Avian Influenza (AI) have benefited Malawi by raising 
awareness and facilitating relatively advanced planning, the 
GOM would face serious challenges in managing an actual H1N1 
swine flu outbreak.  Limited human capacity and scarce 
financial resources present the greatest constraints.  End 
summary. 
 
Good Planning Puts Malawi Ahead of the Curve 
-------------------------------------------- 
 
¶2. Soon after the H1N1 swine flu outbreak in Mexico, Malawi's 
health services began developing a national response.  Malawi 
had experience in 2003 in mobilizing surveillance in response 
to the SARS outbreak and has been able to apply some of that 
experience in developing a pandemic response.  Work since 
2005 on AI has also made national health officials aware of 
the implications of pandemic influenza, provided familiarity 
with WHO phases, and has led to the development of a basic 
planning / response framework and establishment of a standing 
committee. 
 
¶3. On May 5, the GOM convened a meeting of health sector 
stakeholders from government and the donor community to work 
on a swine flu action plan.  With a draft plan and an 
associated budget in hand, officials held a follow-up meeting 
on May 15 and initiated individual task groups covering 
Surveillance, Communications, Diagnosis and Treatment. 
 
** Surveillance planning addressed airport and land border 
crossings, including an assessment of quarantine facilities 
at the airports and development of standard criteria and case 
definitions to support immigration controls. 
 
** Communications work included development of a strategy for 
disseminating information in both English and Chichewa 
through print and broadcast media.  The Communications task 
force has put out press releases and fact sheets for health 
workers. 
 
** Addressing diagnosis, the GOM activated the national 
reference laboratory in Lilongwe for proper sample 
collection, and it plans to activate a previously used 
courier service to transport samples.  The government also 
intends to secure the services of two WHO-approved 
collaborating laboratories in Kenya and South Africa to 
receive and test samples for H1N1.  The two laboratories have 
since obtained primers from CDC-Atlanta and are now ready to 
test samples. 
 
** Hospital sites in Blantyre, Mzuzu and Lilongwe are 
designated for managing H1N1 cases, including forward 
deployment of sample materials and Tamiflu.  Standard 
operating procedures, based on AI procedures, have been 
developed with the assistance of CDC and WHO.  WHO has 
brought in 19,096 doses of Tamiflu and the GOM has completed 
an expedited registry of the drug, making it legally 
available for use in Malawi. 
 
Capacity Limitations Expose Continuing Vulnerability 
--------------------------------------------- ------- 
 
¶4. Despite commendable planning, Malawi's overall 
preparedness for a major swine flu outbreak remains suspect. 
Lack of resources, both in human capacity and funding, 
presents the greatest challenge.    Although planning has 
been good for surveillance and management at the initial 
stages, there is no national response plan should Malawi be 
subject to a full blown pandemic.  The inability of the 
health sector to cope adequately with a cholera outbreak 
earlier this year also raises concern.  Finally, a high 
incidence of HIV/AIDS, poor nutrition, and inadequate health 
coverage, particularly in rural areas are examples of factors 
that could make a pandemic flu outbreak in Malawi devastating. 
 
¶5. Inadequate numbers of Personal Protection Equipment is of 
particular concern.  The MOH has made a specific request to 
the USG for 1,000 PPEs. 
 
Comment 
------- 
 
¶6. Malawi's response to the outbreak of swine flu in Mexico 
was gratifyingly swift.  It's development of communication 
materials, plans for surveillance, testing and treatment, and 
structures to channel assistance represent a significant 
 
LILONGWE 00000316  002 OF 002 
 
 
accomplishment.  Nevertheless, capacity constraints continue 
to make Malawi vulnerable to a serious outbreak in the 
country or the region.  Malawi must make continued efforts to 
strengthen its health care system at all levels before it can 
be fully prepared to face an outbreak. 
BODDE