EU Actions in the Area of Communicable Disease Control. Ines Steffens Managing Editor Eurosurveillance

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1 EU Actions in the Area of Communicable Disease Control Ines Steffens Managing Editor Eurosurveillance

2 The Treaty Establishing the European Community Article 152 A high level of human health protection in all Community policies and activities Community action: Complementing national policies Improving public health, preventing human illness and diseases, and obviating sources of danger to human health Promoting research, health information and education Community encourages cooperation between the MS Commission takes initiatives

3 Decision 2119/98/EC Network decision Decision of the Parliament and the Council Community Network for epidemiological surveillance and control of communicable diseases : Epidemiological surveillance of diseases Early warning and response system (EWRS)

4 Decision 2119/98/EC Network decision Under coordination by the Commission decide on: List of diseases under surveillance Criteria for selection of these diseases Case definitions Nature and type of data to be collected Epidemiological and microbiological surveillance methods Guidelines on protective measures (external borders) Guidelines on information and guidance to the public

5 Decision 2000/57/EC EWRS decision Decision of Commission Events to be reported National outbreaks with a risk of spread to other MS Outbreaks outside the Community with risk of spread to MS Appearance/resurgence of communicable diseases or infectious agents wich may require timely, coordinated Community action to contain it Outbreaks involving more than 1 MS

6 Decision 2000/57/EC EWRS decision Procedures for information, consultation and cooperation Actors are the Commission and competent authorities in the MS

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8 Decision 2000/96/EC List of diseases under surveillance Decision of the Commission communicable diseases (46) and health issues (3) to be covered by epidemiological surveillance

9 Decision 2000/96/EC List of diseases under surveillance Diseases groups Diseases preventable by vaccination Sexually transmitted diseases Viral hepatitis Food- and waterborne diseases and diseases of environmental origin Transmissible spongiform encephalopathies Air-borne diseases Zoonoses (other than above) Serious imported diseases Nosocomial infections and antimicrobial resistance

10 Decision 2002/253/EC (2002/534/EC) Case definitions Decision of the Commission Detailed case definitions for all 46 diseases 3-tired system Confirmed case: verified by laboratory analysis Probable case: clear clinical picture or epidemiological link to confirmed case Possible case: indicative clinical picture without being a confirmed or probable case

11 Decision 2003/542/EC DSN decision Decision of the Commission Setting up dedicated surveillance networks for the diseases under surveillance MS designates contact points for each network Each network collects relevant surveillance data and information and and ensures coordination

12 Dedicated surveillance networks One hub with coordinator and small secretariat 1 epidemiologist + 1 microbiologist per MS Reporting of detailed diseases data Detect outbreaks and follow trends Scientific studies Rather time consuming Cofunded by Commission (60%) and MS (40%)

13 Dedicated surveillance networks ESAC antibiotic consumption (Univiersity of Antwerpen, Belgium) EARSS AMR (RIVM, Netherlands) IPSE nosocomial infections (Université Claude Bernard, France) EUCAST - Antimicrobial Susceptibility Testing EnterNet Salmonella + EHEC DIPNET Diphtheria ESSTI STI EU-IBIS invasive HI and menigococci EWGLI Legionella Euro-HIV HIV/AIDS Euro-TB TB EISS influenza EUVAC.NET VPD ENIVD hemorrhagic fevers Devine Net Norovirus

14 General infrastructural networks EPIET training field epidemiology (ECDC) IRIDE inventory of communicable disease control resources in Europe (ISS, Italy) Eurosurveillance bulletin (ECDC) EpiNorth Network for CD control in Northern Europe with bulletin, website, training courses (NPHI, Norway) EpiSouth mirror of EpiNorth

15 Health threats in Europe 21st century challenges New threats emerge SARS, pandemic flu, WNV, antimicrobial resistance Old diseases reemerge HIV/AIDS, STI, TB, food borne diseases Threat of bioterrorism EU without borders: free movements of goods and people Diseases spread within hours in a globalized and interconnected world

16 Protecting Health in Europe the new European Centre for Disease Prevention and Control

17 Tomteboda Home of ECDC

18 ECDC milestones July 2003: Commission s proposal to establish ECDC December 2003: Council decision that Sweden will host the Centre April 2004: Regulation 851 establishing the Centre December 2004: Director Zsuzsanna Jakab nominated

19 ECDC milestones May 2005: Centre operational October 2005: Move to own facilities at Tomteboda 2007: Evaluation of the possible need to extend the scope of the Centre s mission

20 Very broad mandate Founding Regulation 851/2004/EC Close cooperation with MS and EU bodies Core functions Surveillance Risk identification and risk assessment Preparedness planning Response to health threats and events Training Communication Scientific opinions and guidelines

21 Commission EP MS Networks ECDC Council EU agencies WHO Industry Research community CDCs Other countries NGOs

22 Staffing and budget (2004 cost) 2005: 60 staff 5 M 2006: 90 staff 18 M Proposal 2007: 170 staff 27 M 2008: 210 staff 36 M 2009: 270 staff 45 M : 320 staff 50 M

23 Director and Director s Cabinet Governance, External Relations, Country Cooperations, Communications Scientific Advice Surveillance Preparedness & Response Administrative Services Influenza Tuberculosis Food- & waterborne diseases Other diseases of environmental & zoonotic origin Vaccine preventable diseases & invasive bacterial infections HIV, STI & blood-borne viruses Antimicrobial resistance & nosocomial infections

24 Director s Cabinet Overall co-ordinating responsibility of all ECDC activities Governance Country cooperation External relations External communications

25 Governance Management Board Exercises disciplinary authority over the director and appoint or dismiss him/her; Ensures that the Centre carries out its mission and performs the tasks assigned to it Compiles a list of competent bodies and makes it public;

26 Governance Management Board Adopts the Centre's Work programme for the coming year plus revisable multiannual programme General report on activities for the previous year Applicable financial rules Determines by unanimity of its members the rules governing the languages of the Centre

27 Governance Advisory Forum Members from technically competent bodies in MS Supports the director in ensuring scientific excellence and independence of activities and opinions Mechanism for exchange of info + pooling of knowledge

28 Governance Advisory Forum Ensures close cooperation between ECDC and MS on: coherence of the Centre's scientific studies with MS; promoting, starting up and supervising of the European networks; where the Centre or a Member State identifies an emerging public health threat; the setting up of scientific panels by the Centre; scientific and public health priorities

29 Country Cooperation Directory of contact points MB compile and publish competent bodies Overview of health systems Detailed inventory of resources and expertise (build on IRIDE) Identification of areas for cooperation Action plan for 5 countries in 2006/2007 Country visits Country co-operation, influenza, AMR, training, HIV, TB...

30 External Communications Target groups Scientific and technical audience in MS Decision and policy makers Public and the media Means of communication Eurosurveillance Website Publications Press / Media New technical solutions

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34 Scientific Advice and Guidelines Provide sound and independent technical and scientific advice Questions, guidelines, toolkits No own research capacity Well acquainted with the front-line of research Network of experts and scientists in Europe Cooperation with laboratories European reference laboratories Roster of > 300 top experts

35 Process for scientific questions Competence in house? Competence in one of the DSNs? Competence in one of the Scientific Panels? In real life, a combination of these.

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37 Surveillance Gradually coordinate/integrate surveillance networks into ECDC Assessment and evaluation of present networks Keep the human networks Databases at ECDC Data output (website, reports, scientific journals) Some components outsourced

38 Surveillance Technical assistance to MS on surveillance issues Surveillance public health action

39 Preparedness and Response Epidemic intelligence Keep track of emerging health threats inside and outside the EU ProMed, GOARN (WHO), GPHIN (CA), GIDEON and other Community alert systems Timely advice on such threats (EC, MS, public) Operating the EWRS with a 24h/7d duty system Outbreak assistance Training (EPIET, short courses)

40 Epidemic Intelligence Framework Event-based surveillance Indicator-based surveillance EWRS MS DSN s EWGLI Enternet EISS EMEA, EFSA MedISys GPHIN WHO-OVL Promed OIE FAO Capture Filter Verify Report Assess Investigate Signal Public health threat Data Control measures Collect Analyse Interpret Disseminate DSN s Laboratory network EWRS MS Commission Other heath related EU agencies

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44 ECDC horizontal actions ( projects ) Forming partnerships Risk assessment Enhance surveillance activities Developing guidance and scientific opinions Disseminate information Assess country preparedness and capacity (country visits) Advocacy

45 Scope of ECDC from 2010 First rock solid in CDs = priority 1 Review starts in May 2007 Co-decision of Council and EP needed to extend scope Even if this happens not be before years only for CDs If extended: gradual process starting with Health monitoring, analysis and reporting?? Additional resources needed

46 How is it to work at ECDC? A lot of travels and meetings Highly political environment Exiting multicultural environment Pioneer spirit and results orientation Full EU legal framework EU Financial Regulation Heavy bureaucracy EU Staff Regulation Complicated recruitment processes Community taxes, pensions, benefits, etc Rapid growth phase in