Cablegate: Sharm El-Sheikh Conference Focuses On Pandemic Threat,

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DE RUEHEG #2293/01 3071243
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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

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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

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