U.S. Government Support to Combat Avian and Pandemic Influenza -- Middle East/North Africa/Arabian Peninsula

The Middle East's first outbreak of the highly pathogenic avian influenza (HPAI) H5N1 avian influenza virus in birds occurred in January 2006 in northern Iraq. The disease has since appeared in Egypt, Iran, Israel, Jordan, Kuwait, Saudi Arabia and West Bank/Gaza. As of May 2007, 34 cases of the disease in humans, 14 of them fatal, had been reported in Egypt, and three in Iraq, with two fatalities. Millions of birds have died or have been culled, causing social and economic disruption for many members of the business community, farmers and consumers in the region.

The United States combats HPAI H5N1 in Middle Eastern nations by working with governments and regional entities, and with international organizations such as the World Health Organization (WHO), the Food and Agriculture Organization (FAO) and the World Organization for Animal Health (OIE). Through the International Partnership on Avian and Pandemic Influenza, the United States works to elevate the issue on national agendas -- and to coordinate efforts between affected nations in the Middle East and donors around the world.

To assist the Middle East in responding to avian influenza outbreaks and preparing for a possible human pandemic, the United States is supporting Middle Eastern efforts through bilateral and regional programs. The United States is providing various forms of assistance to Egypt, Iraq, Jordan, and Libya, Morocco, West Bank/Gaza and Yemen.

The U.S. Agency for International Development (USAID), the U.S. Department of Agriculture (USDA), the U.S. Department of Health and Human Services (HHS) -- including the centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) -- and the U.S. Department of State (DoS) have focused on strengthening preparedness and response planning, building Middle Eastern capacity in human and animal health, strengthening laboratory diagnostics, increasing the level of public awareness and information, and enhancing disease surveillance and detection. The U.S. Department of Defense (DoD) provides medical technical assistance and has purchased sets of personal protective equipment (PPE) for combatant command use in military-to-military and international humanitarian assistance globally. In 2006, the United States allocated $3.7 million (including $1 million for Libya) to bilateral and regional efforts. In that year:

• Nearly 57 percent of the $13.5 million science budget of the U.S. Naval Medical Research Unit laboratory (NAMRU-3) in Cairo was for seasonal, avian and pandemic influenza related activities. Approximately $350,000 has been expended for Egypt directly. Funding for NAMRU-3 is provided by HHS/CDC and DoD.
• HHS/CDC committed $2.5 million to the Eastern Mediterranean Regional Office (EMRO) of the WHO for regional influenza efforts. In addition, HHS/CDC has assigned a physician epidemiologist to the EMRO office in Cairo who works on immunizations and infectious diseases in the EMRO region.
• HHS/CDC committed $4.3 million in avian and pandemic influenza related funding towards the development of a global Disease Detection Center in Cairo, in collaboration with the Egyptian Ministry of Health and Population and NAMRU-3. A major focus of this center is improving detection and response capacity for pandemic influenza and other emerging infectious disease threats.

U.S. assistance efforts to the Middle East for preparedness and communication include:

• Assigning experts to give technical assistance to the Middle East bilaterally and through FAO (HHS);
• Delivering an epidemiology workshop in Cairo for 30 participants from 22 countries in the region (USDA);
• Supporting regional coordination, technical exchange and strategy development through an HHS/CDC-sponsored workshop for new HHS avian influenza grantees in the region held January 21-24, 2007, in Nairobi (HHS);
• Carrying out risk communications activities in Egypt and Jordan (USAID, HHS/CDC);
• Conducting training in risk communications for epidemiologists, communications specialists and laboratory personnel (HHS/CDC);
• Providing a technical expert in epidemiology and infectious diseases and funding to WHO (HHS);
• Creating and distributing avian influenza posters and pamphlets, producing three TV spots, and conducting a survey of risk behaviors in Egypt, as well as producing one TV spot in Jordan to build awareness of basic information about avian influenza and prevention methods (USAID);
• Producing an Arabic version of the Public Broadcasting System's documentary "Killer flu" for educational use (DoS);
• Providing orientation to Egyptian journalists and a Ministry of Health official in the United States (DoS);
• Carrying an avian influenza page in Arabic with news articles and other materials on the website www.usinfo.state.gov (DOS); and
• Providing orientation and briefings in the United States on infectious diseases, including pandemic influenza, to public health specialists from Egypt, Iraq and Oman (DoS).

Surveillance and Detection

To assist the Middle East in building capacity for surveillance and detection, the United States is:

• Expanding health and medical surveillance and response capacity in the Middle East through pandemic preparedness grants to Libya and Iraq, and through training (HHS/CDC, DOD/NAMRU-3);
• Training joint laboratory and epidemiology teams from WHO/EMRO countries in laboratory and surveillance methods (HHS/CDC, DOD/NAMRU-3);
• Training and supporting training for officials, veterinarians, epidemiologists and laboratory diagnosticians from seven countries in Northern Africa and the Middle East (Algeria, Egypt, Iraq, Jordan, Lebanon, Morocco and Oman) (USDA, HHS/CDC, DOD/NAMRU-3);
• Conducting an assessment of avian influenza animal surveillance/response in Egypt and providing training to veterinarians (USAID);
• Delivering rapid diagnostic testing kits (USDA, DOD/NAMRU-3); and
• Strengthening avian influenza surveillance at the central and governorate levels in Egypt, including providing commodities for HPAI H5N1 diagnosis and providing lab kits to Jordan (USAID).

• Expanding infection control capacity in the Middle East (HHS/CDC, DOD/NAMRU-3);
• Conducting integrated rapid response team training for epidemiologists, veterinarians, laboratory personnel, communications specialists and infection control specialists (HHS/CDC, DOD/NAMRU-3);
• Establishing and training rapid response teams at the central and governorate level in Egypt (USAID);
• Sending 10,000 sets of PPE, such as suits, hoods, masks and gloves, as well as laboratory kits, to Egypt, Iraq, Jordan and West Bank/Gaza for investigating outbreaks, collecting and shipping samples, responding to outbreaks and providing training in PPE use. Supporting avian influenza community training in Egypt and Jordan (USAID); and
• Providing technical assistance as needed for avian influenza containment efforts (HHS/CDC).