Globalization and Health The regional response

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1 Zsuzsanna Jakab Director European Centre for Disease Prevention and Control (ECDC) IBA Annual Meeting Anthrax, SARS and Bioweaponry Is Globalisation Bad for Your Health? 28 September 2005, Prague

2 Globalization - inevitable fact of life in the 21st century Globalization has several faces Positive face Brings advantages, benefits in trade, access, prosperity, travel, freedom (for society and individuals) Improved quality of life Improved health indicators A face with new challenges Not accessible to everyone (economic and social problems) Drives emerging and reemerging infections, climate change, pollution, bioterrorism NEW RESPONSES NEEDED

3 Diseases travel across the globe much faster e.g. spread of SARS from the Metropole Hotel in Hong Kong in 2003

4 The Metropole Hotel Hong Kong

5 Hotel M Floor Diagram 938 Lift for Disabled Persons Flat Roof Lift Hall Service room Lift Hall index cases Previously known cases Source case Study case

6

7 Global challenges call for global solutions and context (1.) Global public health goals are needed (ownership/commitment) Collaboration and partnership for implementation between global, regional, national level Examples: FCTC, IHR, Global Fund for AIDS, Malaria, TBC, UNAIDS etc

8 Global challenges call for global solutions and context (2.) Define regional and national public health goals within global context During implementation reach out globally

9 Global challenges call for global solutions and context (3.) Knowledge-base, science/research, technology never been as developed as today Modern information and communication technology is an asset Need for trustworthy places that citizens can rely on

10 How does it apply to the new European Centre for Disease Prevention and Control (ECDC) a new player on the European and global arena Constituency: EU + EEA/EFTA countries + new accessing countries Reach out to neighbouring countries of EU (WHO, CDCs around the world) as partners build strategic partnership Make links to learned societies

11 ECDC Spider or polyp in strategic partnerships Commission EP MS Networks WHO ECDC Research community Council EU agencies US CDC

12 Why a new Centre in Europe? (1.) Expanded Europe Expanded Risk The Fifth Freedom Free movement of people Free movement of Services Free movement of Goods Free movement of Capital Free movement of micro-organisms

13

14 Why a new Centre in Europe? (2.) Globalization, interconnectivity is a drive to emerging and re-emerging infections and possible bioterrorism EU institutions want to protect European citizens further strengthen defences against communicable diseases Pre - ECDC: a lot has been done (e.g. disease-specific surveillance networks; EWRS, health security etc) SARS revealed: more co-ordinated and integrated approach is needed in surveillance, detection, preparedness, prevention, control for more uniform response

15 ECDC Mandate Founding Regulation 851/2004/EC Relatively broad public health mandate in close collaboration with Member States and EU Institutions Surveillance, detection new strategy; consolidated and integrated support and uniform methodology Risk monitoring, identification, assessment (core function continuous) Preparedness planning European and national level Response to health threats and events procedure in place Prevention of diseases (HIV/AIDS) Training training strategy Communication including risk communication - strategy Scientific, technical evidence, opinions, guidelines (core function, continuous)

16 ECDC and global health European targets with a view to global public health goals During implementation consider all public health institutions as partners reach out Knowledge-base and R&D: map knowledge and link-up to learned society Develop ECDC into a trustworthy institution for all stakeholders including general public Promote public health diplomacy

17 ECDC priorities for 2005 Build up capacity in all areas of communicable diseases and bioterrorism in In the meantime put emphasis on: Influenza related issues HIV/AIDS and STIs Antimicrobial resistance Zoonoses (burden and potential burden of diseases high)

18 Influenza activities of ECDC (1.) (as an example) Make a distinction between Seasonal influenza Highly pathogenic avian or animal influenza Pandemic Human Influenza (close link between them confused: normally pandemic virus comes from animal virus which adapts to human host or mutates with seasonal influenza virus) Assess the risk of the threat of the HPAI Considerable concern among public health people (domestic birds in close contact with humans) A/H5N1 made 2 steps out of 3 to become a human pandemic virus» Infected humans» Reproduced in them (50% fatality)

19 Influenza activities of ECDC (2.) A/H5N1 not yet made the third step of adaption to become capable of effective human transmission Pandemic alert phase 3 (last phase before human to human transmission) Should there be an AI outbreak in poultry in EU, two threats to human health: Humans working with poultry / controlling outbreaks Virus mutates / recombines with a human seasonal strain to produce a pandemic strain Public health emergency: potential outbreak follow outbreak control procedures

20 Influenza activities of ECDC (3.) Do regular risk monitoring and risk assessment with all partners Follow all formal and informal sources of evidence Analyse EWRS messages EISS network mandate expanded towards AI and pandemic (including network of European Reference Laboratories) Reviewed existing guidelines to protect humans dealing with AI (Canadian, Irish, Dutch) - develop European guidelines Pandemic preparedness project: to strengthen European and pandemic preparedness project

21 Component Phase/sub component Lead Unit 1. Risk monitoring and assessment 2. Preparedness 3. Surveillance 4. Communication Pre-pandemic Country preparedness EU preparedness ECDC and EISS Preparedness Global preparedness Pre-pandemic Epizootic PRU SCU PRU PRU SAU SCU PRU PRJ SCU SCU PRU Pandemic SCU 3.3 As 2.3 Pre-pandemic Crisis situation (epizootic/pandemic) COM COM Activity Output Timeline (completion) 1.1Daily monitoring of epidemic intelligence, media and partner information 1.2 Weekly review of surveillance and laboratory data by EISS 2.1 Assessment of country preparedness 2.2 support to EC on review of EU preparedness plan 2.3 Workshop with EISS on joint activities on influenza including what would be priority during a pandemic 2.4 Completion of internal public health event operation plan 2.5 Contribute to EU simulation exercise in November 3.1 Review with EISS activities in seasonal influenza 3.2 Formalise partnerships with EFSA, the Commission OIE, FAO, WHO 4.1 Develop ECDC communication plan Develop crisis communication plan daily epidemic intelligence briefing notes and weekly risk monitoring on ECDC web-site. Contribution to weekly output, Eurosurveillance Assessment tool Country visits x 6 Assessment report Revised EU plan Agreement on actions and resources needed in pandemic report to Director Agreed internal plan Evaluation of ECDC contribution to simulation exercise Agreement with EISS Weekly Teleconference Access to epizootic surveillance intelligence and data Pandemic influenza surveillance Report format Develop ad hoc Communication Plan Communication plan presented to AF Develop ad hoc Communication Plan Crisis communication plan presented to AF On-going On-going End October Mid December End September Mid September Mid December Mid October Mid October End September End October December End October December

22 5. Scientific watch Depository of scientific articles SAU Weekly digest of advances in science (including influenza) Provide scientific advice Implement a respiratory diseases panel (generic) Raise scientific concerns SAU SAU SAU SAU 5.1Regular screening of scientific papers on seasonal/pandemic influenza by EISS 5.2 Summary of published papers on seasonal/pandemic/avian influenza 5.3 Develop SOP for providing scientific advice 5.4 Identify panel members and develop SOP 5.5 Proactive approach of partners on scientific concerns identified Articles available on Intranet Data base of references Weekly summary disseminated SOP developed and presented to AF - Completed SOP finalized, panel operational Scientific concerns documented and communicated to partners done one October October September December When needed Publication ALL 6.1 Contribute to writing papers Published papers On-going 6. Advocacy Represent ECDC in scientific 6.2 Identification of significant event Conferences attended, session ALL conferences and proactive approach of organisers chaired, speech delivered On-going Investigate and respond to Avian 7.1Review existing guidelines and SAU Influenza outbreak adapt to EU context Initial Guidelines Drafted End October 7.2 Review existing guidelines and adapt to EU context Generic Guidelines Mid December 7. Tools and guidelines 8. Response Assess country preparedness PRU 7.3 Develop assessment tool Algorithm for human H5N1 event detection returning travellers Vaccine adverse event monitoring Vaccine coverage monitoring Pandemic vaccine efficacy monitoring Monitoring antiviral resistance Assessment tool on the ECDC Web site December SAU 7.4 Review existing algorithms Guideline Mid October SAU SAU SAU SAU SAU SAU 8.1 Develop protocol for monitoring of pandemic vaccine AEFI with EMEA 8.2 Identify countries that can investigate AEFI scientific 8.3 Develop procedures for seasonal and pandemic vaccine coverage 8.4 Develop procedure for pandemic vaccine efficacy monitoring 8.5 Identify countries that can investigate VE scientific 8.6 Develop procedure for antiviral resistance monitoring Protocol document Confidential list with EISS SOP developed, system implemented by EISS Protocol document Confidential list with EISS Protocol document Start December Start October December December October December

23 9. Support to investigation and response 10. Crisis coordination 11. Partnership Identification of outbreak assistance team members Administrative, HR and logistic issues Contribution to international teams Standard operating procedures PRU ADM PRU PRU 9.1 Develop SOP and identify potential OAT members with partners 9.2 Develop administrative tools for emergency deployment of OAT 9.3 Develop mechanism and 9.4 procedure to contribute to international teams 10.1 Develop crisis standard operating procedures SOP developed, resource database constituted Revolving fund implemented Emergency procedures developed SOP developed with WHO- EURO and HQ SOP document October November Dec 05 Mid September Crisis room management PRU 10.2 Develop crisis room Crisis room operational Mid October WHO, HQ and EURO, OIE, FAO DIR 11.1 Ensure synergy and commitment between partners Regular director level meetings Quarterly Commission (E2 & C3 and EU agencies: EFSA, EMEA MS Laboratories SAU SCU PRJ SCU 11.2 Establish contact, review activities 11.3 Establish monthly conference with MS 11.4 Review with EISS and assess influenza public health laboratories in the EU Working relationship for collaboration on pandemic influenza Agenda and notes for the record Assessment report, list of recommendations December September June 2006 List of learned societies and Learned societies SAU 11.5 Identify relevant learned societies December procedures for partnership Apportionment of task document 12. Apportionment Between ECDC and EC PRJ 12.1 Revise existing document presented to AF of tasks Weekly 20 min influenza Start Within ECDC PRJ 12.2 Whole Centre collaboration meetings to review progress September Note: DIR=Director s office, SAU=Scientific advice Unit, SCU=Surveillance and communication unit, PRU=Preparedness and response unit, ADM=Administrative and finance unit, COM=Communication officer, PRJ=Influenza project leader. Mid September

24 Role of public health agencies changed considerably since 11/9 Previously dealt with consequences of events Now in the frontline: to detect attacks, diseases (covert releases: anthrax, white powder release); work hand in hand with security Involve PHC/emergency rooms/clinicians

25 Legislative basis for public health Needs further strengthening in Europe In the meantime: collaboration/dialogue/co-ordination is needed Two legal rights in conflict with prevention and control of communicable diseases Freedom of movement Integrity of individual / privacy IHR: To hinder spread of diseases, interference with both may be necessary Major step forward minimized this interference Applies to Europe as well as to others ECDC has a role

26 Final message Globalization is a new challenge of our age needs new global solutions Beneficial for quality of life and public health if global solutions in place

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