VZCZCXRO6645
RR RUEHAG RUEHDF RUEHIK RUEHLZ RUEHROV RUEHSL RUEHSR
DE RUEHTL #0302/01 2720757
ZNR UUUUU ZZH
R 290756Z SEP 09
FM AMEMBASSY TALLINN
TO RUEHC/SECSTATE WASHDC 0134
INFO EU MEMBER STATES COLLECTIVE
RHMFIUU/DEPT OF HOMELAND SECURITY WASHINGTON DC
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHPH/CDC ATLANTA GA

UNCLAS SECTION 01 OF 02 TALLINN 000302 
 
SENSITIVE 
SIPDIS 
CA/OCS FOR RICK DOWELL 
 
E.O. 12958: N/A 
TAGS: TBIO KFLU CASC AMED SOCI EN
SUBJECT: H1N1: ESTONIAN VACCINATION PLAN REMAINS UNCERTAIN 
 
REF: REF A: 09 TALLINN 169; REF B: 09 SECSTATE 99088 
 
1)  (SBU)  Summary.  Despite otherwise solid pandemic planning, 
Estonian health authorities have not placed an advance order for 
H1N1 vaccine, and continue to work out the details on a national 
campaign to vaccinate high risk groups for the H1N1 influenza virus 
this fall.  Preliminary plans propose a modest vaccination campaign 
covering 2 - 5% of the population, focusing on high-risk groups. 
However, authorities are scrambling to find sources of the vaccine, 
seeking assistance from the EU.  Some believe that there will be no 
H1N1 vaccine available at all in Estonia this winter.  Estonian 
health authorities also have determined not to increase the 
country's modest Tamiflu stockpile.  Health authorities point to 
science as the basis for their pandemic planning decisions, rather 
than budget limitations.  Post will continue to provide information 
to the private American citizen community on the current H1N1 
situation in Estonia, allowing them to consider appropriate 
measures for their families.  End Summary. 
 
General Planning 
----------------------- 
 
2)  (U) The Estonian health authorities (Ministry of Social 
Affairs, Health Care Board and Health Protection Inspectorate) have 
taken a number of steps in recent years to prepare for a possible 
pandemic.  For example, the government has purchased additional 
ventilators and expanded hospital's ICU capacity by one-third.  In 
addition, the Health Protection Inspectorate has engaged in 
outreach on the pandemic, issuing guidelines to primary care 
providers and ambulance workers on appropriate steps to be taken 
for persons suspected of H1N1 infection.  Guidelines have also been 
issued to schools, and informational posters have been displayed at 
ports of entry and places where large numbers of people congregate 
(such as local festivals).  A crisis management team, comprised of 
representatives of various interested agencies, meets weekly. 
 
3)  (U) Recent legislation has granted greater powers to the 
Estonian Health Care Board that can be invoked in the event of a 
medical emergency, such as the ability to issue binding obligations 
on medical providers.  Already, the Health Care Board has issued a 
guideline mandating that all hospitals treat H1N1 patients, if 
needed (although specific hospitals have been designated to treat 
such patients at this time). 
 
H1N1 Vaccine 
-------------------- 
 
4)  (SBU) The Estonian government has not placed any advance order 
for H1N1 vaccine.  Realizing that they are now at the back of the 
line to get vaccine, the Estonian government is working with the EU 
on a "joint procurement process," and is maintaining contact with 
local representatives of vaccine manufacturers.  One officer of the 
Health Inspectorate speculated that some vaccine might become 
available as countries move from a two-dose to a one-dose strategy 
for adults, freeing up supply.  When asked, health authorities are 
reluctant to comment on the role of resources (in a time of 
cascading budget cuts across all agencies of the Estonian 
government).  Conoff separately spoke with a prominent private 
doctor in Tallinn who said that she expects no H1N1 vaccine to be 
available in Estonia this winter on the private market as 
manufacturers are fulfilling only orders from governments and 
health organizations. 
 
5)  (SBU) Despite uncertainties on Estonia's ability to obtain 
vaccine, the health authorities continue to work on a vaccination 
campaign for the upcoming flu season which it hopes to be ready "on 
paper" by the end of October.  Public health officials have 
"mapped" the financial resources needed to implement the program, 
but have not commented on the likelihood of resources becoming 
available.  The proposed campaign would cover 2 - 5% of the 
population, focusing on key risk groups, such as health care 
workers, pregnant women and persons with chronic illnesses. 
Initially, authorities indicated that they would use the national 
health plan (Haigekassa) register to determine who would fall into 
these categories (e.g., pregnant women or those with chronic 
illnesses), but Conoff received assurances from the chairman of the 
Estonian Health Board that resident American citizens (and other 
foreigners) who are not covered under the Estonian national health 
plan, but who are members of these high-risk groups, would be 
eligible as well. 
 
Anti-Virals 
-------------- 
 
TALLINN 00000302  002 OF 002 
 
 
6)  (SBU) Earlier in the year, Estonian health authorizes 
established a stockpile of 3,000 courses of Tamiflu, enough to 
treat less than 0.3% of the population.  Despite working under an 
ECDC-approved "worst-case" scenario under which the 25% of the 
country would be infected during an 8-week wave, with 5,000 
"severe" cases, the authorities have determined not to increase the 
size of the stockpile at this time.  Again, authorities indicate 
that the size of the stockpile is not determined by resources, but 
rather by experts estimating expected demand for anti-virals.  In 
addition to the government reserve, Tamiflu remains widely 
available on the public market in Estonia.  Post regularly uses a 
local internet site (www.raviminfo.ee) to track the number of 
pharmacies offering Tamiflu, in order to gauge changes in demand. 
 
The Current H1N1 Situation 
-------------------------------------- 
 
7)  (U) There have been 68 confirmed cases of H1N1 infection in 
Estonia, including some American citizens (see Ref A) and one 
member of the Embassy community.  All have showed mild symptoms and 
quickly recovered.  Only a small number of patients have been 
hospitalized, solely for isolation purposes.  Health authorities 
have confirmed that currently there is no sustained human-to-human 
transmission of the H1N1 virus in Estonia, and so are applying a 
containment strategy.  Should sustained human-to-human transmission 
occur, authorities will switch to a mitigation strategy, in 
accordance with guidelines from the European Center for Disease 
Control and Prevention (ECDC).  Health authorities have promised 
transparency should this change occur.  (One of Post EAP's pandemic 
influenza tripwires is triggered upon the commencement of sustained 
human-to-human transmission in Estonia.) 
 
Communicating with the American Community 
--------------------------------------------- ------------------- 
 
8)  (U) The Embassy maintains CA-approved language on its website 
regarding general pandemic preparedness, accompanied by information 
specific to Estonia, such as links to the Estonian Health 
Inspection Protectorate's website and links to local pharmacy 
information.  In the event that Estonia successfully launches an 
H1N1 vaccination program for high-risk groups, Post will reach out 
to the American community to ensure that American citizens not 
enrolled in the national health plan will be able to request the 
vaccine.  In addition, Post will ensure transparency with respect 
to internal actions and recommendations made pursuant to Department 
guidance on pandemic preparedness (Ref B). 
 
Comment 
-------------- 
 
9)  (SBU) Estonian health authorities continue to go through the 
motions to move forward with pandemic influenza planning, refusing 
to acknowledge that a lack of resources has limited their options. 
Taking advantage of complacency from the Estonian public due to the 
mild nature of the H1N1 pandemic so far, health authorities appear 
to be crossing their fingers that the country will avoid a severe 
wave of H1N1 infections during the fall/winter flu season.  Perhaps 
conscious of criticism aimed at other EU countries that have 
dedicated significant resources to obtain large quantities of 
vaccine and anti-virals, Estonian health authorities' approach may 
look wise in retrospect if the pandemic's worst-case scenarios do 
not materialize and other countries appear to have overreacted. 
 
10) (U)  Meanwhile, Embassy continues to move forward with its own 
pandemic influenza planning for the Mission community.  Post formed 
a Pandemic Influenza Working Group in April 2009, which provided 
recommendations to the EAC for revisions to the EAP's pandemic 
influenza tripwires and required actions.  In addition, at the 
request of the Working Group, Post has inventoried anti-virals and 
personal protective equipment (PPE), while distributing additional 
hand disinfectant throughout the chancery.  Post's own procedures 
were tested when a Mission employee became symptomatic with H1N1 
influenza shortly after returning from the UK.  Working with 
Embassy nurse and the Estonian hospital designated to perform H1N1 
testing, the employee and his family (including children who attend 
the International School of Estonia) were isolated and he quickly 
recovered.  Post has shared information with the International 
School of Estonia about pandemic planning.  Post anticipates the 
receipt of H1N1 vaccine from MED in order to implement its own 
vaccination program this fall.  End Comment. 
DECKER