SOUTH KOREA: PANDEMIC INFLUENZA PREPAREDNESS PLAN

RT @mbcpdcho: 미국대사관에 정보제공하는데 protect해주는 사람이 또 있군요. http://bit.ly/qxzpbM 질병관리본부 이센터장. 유시민장관이 타미플루의 국내생산을 추진하도록 했다고 일러바칩니다.

06SEOUL3794

2006-11-03 04:53

06SEOUL3794

2006-11-03 04:53

C O N F I D E N T I A L SEOUL 003794
2006-11-03 04:53

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SUMMARY
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1. (U) In preparation for a possible influenza pandemic, the
Korea Center for Disease Control and Prevention (KCDC) has
unveiled its National Preparedness and Response Plan for
Pandemic Influenza. Officials at KCDC said the plan, drawn
up by medical experts at Korea University Medical School,
closely hews to World Health Organization (WHO)
recommendations. The plan has been endorsed by the Minister
of Health and Welfare. The Korean-language version of the
plan has been posted on the KCDC website
(http//www.cdc.go.kr), and KCDC expects to complete an
English summary of the plan before the end of November.

2. (C) The plan leaves for future resolution the question of
adding to Korea's stockpile of antiviral medications.
Current contracts will bring Korea's stockpile of Tamiflu to
980,000 courses within the next few weeks, and officials
expect to procure an additional 20,000 courses, to make a
round 1 million, before the end of 2006. KCDC officials told
ESTHoff on October 27 that a committee of influenza experts
had recommended that Korea plan a stockpile of 10 million
courses, but that the Minister of Health and Welfare is
opposed to additional stockpiling. End summary.

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KOREAN PANDEMIC PLAN
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3. (U) The draft pandemic plan is a hefty 　document at more
than 240 pages. It is based on a pandemic simulation model
(FluAid 2.0) that assumes that, over the first six weeks of
an outbreak, more than 8.8 million Koreans would fall ill,
more than 235,000 would require hospitalization, and more
than 54,000 would die.

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MINISTER OPPOSES STOCKPILING OF TAMIFLU
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4. (U) A key, but still undefined, element in the plan is
the possible acquisition of additional stocks of antiviral
drugs such as Tamiflu. Korea expects to have 1 million
courses (of 10 capsules each) of Tamiflu by the end of 2006.
Current contracts will bring the figure to 980,000 courses
over the next several weeks, and KCDC plans to let contracts
for an additional 20,000 courses to be secured by the end of
the year. The plan states that the stockpiled Tamiflu should
be stored under the custody of the central government and
administered within 48 hours of the onset of symptoms through
public healthcare centers and designated hospitals throughout
the country.

5. (U) Following WHO recommendations, Korea has prioritized
the allocation of available Tamiflu as shown in table 1 below:

Table 1: Estimates of Required Amount of Tamiflu in Phase 6
of Pandemic Period
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Cumulative
Estimated number required amount

Priority/Category of persons(1,000) Tamiflu(1,000 cap)



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For treatment and/or prophylaxis:
1/High-risk inpatients 236 2,121
2/Essential healthcare personnel 148 3,450
3/High-risk outpatients 1,150 13,794
4/Essential service workers 471 17,208
5/Outpatients over age 65 1,249 28,488
6/Other low-risk outpatients 5,915 81,685

For prophylaxis:
7/Other healthcare workers 301 90,727
8/Other essential service workers 916 100,700
9/High-risk medical group 4,253 233,742
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Note: For treatment, one capsule (75mg) twice a day for five
days; for prophylaxis, one capsule per day for a maximum of
42 days. The figures for the cumulative amounts appear to
assume that fewer capsules will actually be needed due to
deaths, immunity due to survival of the disease, absenteeism,
and other factors. End note.

6. (U) These figures suggest a potential need for 57 million
courses of antivirals to treat or protect nearly 15 million
vulnerable persons.

7. (C) The plan calls for the convening of a "National
Pandemic Experts Committee" to review the assessment of risk
and to recommend the amount and the timing of future
stockpiling of antiviral drugs. Lee Duk-hyoung, the Director
General of the Communicable Diseases Surveillance and
Response Center at KCDC, told ESTHoff on October 27 that in
fact the committee had already met and recommended that Korea
create a stockpile of 10 million courses. KCDC proposed to
add 2 million courses each year during the period 2007-2008,
to have a total of 5 million courses by 2009. However, Lee
(please protect) said, Rhyu Si-min, the Minister of Health
and Welfare, opposes any additional stockpiling. He observed
that Rhyu is close to former Prime Minister Lee Hae-chan, and
noted that the former Prime Minister was also opposed to
stockpiling.

8. (C) According to Lee, Minister Rhyu is instead interested
in examining ways that Korea could obtain the capability to
produce Tamiflu. Asked whether Rhyu was considering invoking
compulsory licensing authority under WTO rules to break the
patent (as suggested in the press last year -- see reftel),
Lee avoided a direct response. He asserted that the maker of
Tamiflu, Roche, has 16 subcontractors in 10 countries,
including Yuhan Pharmaceuticals in Korea, but that each of
the subcontractors handles just one of 10 critical processes
in the production of the drug. He further stated that Roche
has licensed two companies in China and one in India to make
the drug, and has shared its technology with South Africa for
use in Africa, but said that Roche had determined that Korea,
as a developed country, was not eligible for such
arrangements.

9. (C) Earlier in the week of October 23, KCDC had undergone
its annual "inspection" by the National Assembly. ESTHoff
asked Lee whether National Assembly committee questions had
demonstrated concern about the state of Korea's preparations
to confront a pandemic, including the size of its Tamiflu
stockpile. Lee responded that, to his disappointment, the
answer was, "not much."


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HESITATION REGARDING SOCIAL DISTANCING MEASURES CONTINUES
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10. (C) The Korean pandemic plan describes public health
measures that may be taken during a pandemic, including
social distancing measures such as the closure of educational
institutions and day-care facilities, limitations on or
prohibition of mass gatherings, contact tracing, and
confinement and quarantine. Especially if suspected patients
are reported or confirmed arriving from other countries
during phase 4 and 5 of the pandemic alert period, the plan
foresees that Korea would step up quarantine efforts at ports
of entry, and could take action to restrict overseas travel
from Korea. However, in the conversation with ESTHoff, Lee
continued to stress (cf reftel) that as a senior public
health advisor to the government, he would strongly hesitate
to advise social distancing measures in case of a pandemic,
citing the social and economic disruption such measures would
cause.

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SHORTAGE OF EMERGENCY MEDICAL FACILITIES
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11. (U) According to government data, as of June 2006 there
are a total of 382,000 hospital/clinic beds, 12,800 beds in
intensive care units (ICUs), and 5,900 artificial respiratory
apparatuses in Korea, with its population of 48 million.
There are 519 beds in isolation wards at 38 hospitals
nationwide. These facilities fall far short of what would be
needed to handle the estimated number of patients in case of
a pandemic. Although the Ministry of Health and Welfare
(MOHW) plans to increase the number of fully-equipped
isolation wards, the vast majority of victims of a pandemic
would have to be treated at home.

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COMMENT
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12. (C) To date, the risks of a pandemic have not achieved
the kind of visibility and broad political engagement that
have characterized the U.S. response. After a flurry of
press attention in the fall of 2005, the issue has dropped
from view. There was little or no reporting, for example, on
the nation-wide table top pandemic exercise held in
mid-October. The Blue House, swamped with hot-button issues
such as OPCON and the North Korean nuclear test, has remained
mute on the need to prepare for a pandemic, and now it
emerges that even the Health Minister is unpersuaded, at
least with regard to stockpiling of Tamiflu. Current stocks
would be inadequate for even the highest-priority uses in
case of a pandemic. It may be that it will take another
outbreak of H5N1 avian influenza in Korea, such as occurred
in 2003-2004, to refocus the politicians' minds on what needs
to be done. End comment.

VERSHBOW