Review of 2011, Priorities for 2012

Transcription

1 ECDC DIRECTOR S PRESENTATION Review of 2011, Priorities for 2012 ECDC Director s annual hearing with Committee on the Environment, Public Health and Food Safety (ENVI), European Parliament, Brussels 3 October 2011 Thank you Chair, for your introduction and for giving me this opportunity to talk to the Committee. It was a real pleasure to welcome Mrs Yannakoudakis, Mrs Ayuso, Mr Fjellner and yourself at ECDC at the beginning of September. This picture is from the delegation s visit to our Emergency Operations Centre. I felt our discussions were very useful, and I certainly appreciated the insights you gave me. Could I begin my remarks by thanking Marina Yannakoudakis, our contact MEP, for all the time and energy she has devoted to ECDC. I would also like to thank her, in advance, for the events she will be hosting for ECDC this autumn. At lunchtime on 22 November, Marina, along with Karin Kadenbach, will be hosting an ECDC briefing about seasonal influenza immunisation. During your debate last year on Mrs Rivasi s report on the H1N1 influenza pandemic, I promised that ECDC would give ENVI members the facts on influenza and influenza immunisation in the run up to the influenza season. So that is what our influenza coordinator, Professor Nicoll, DG SANCO and I plan to give you on 22 November. European Centre for Disease Prevention and Control, Stockholm, 2011

2 Then, on 30 November, Mrs Yannakoudakis is hosting ECDC s annual World AIDS Day seminar for MEPs. You will be receiving invitations to both these events shortly. Finally, Mrs Yannakoudakis will also be closing our scientific conference in Stockholm on 8 November, then meeting our Management Board the following day. Chairman - I would like to start by following up on issues we discussed in Stockholm when the ENVI delegation visited us. However, before I do that, I will make a declaration of my interests. Transparency about funding and financial interests Neither ECDC nor I receive any money from commercial interests. I own no shares in any bio-medical or pharmaceutical companies, and neither do any members of my management team. All ECDC s scientific advice is decided on in-house, after consultation with our Advisory Forum. The national experts of the Forum, and any other experts we consult on an ad hoc basis, have to make declarations of interests. You can find these declarations on our website. So, what I will give you over the next 20 minutes or so is expert advice independent of any commercial interests. Threats examined during ENVI visit to ECDC 1-2 September ENVI delegation participate in daily threat monitoring meeting in Emergency Operations Centre at ECDC Going back to the ENVI visit to ECDC - the delegation participated in our daily threat monitoring meeting. You can see them here at this meeting in our Emergency Operations Centre, with me and the ECDC experts. Every day of the year, ECDC monitors official alerts, official data and unofficial epidemic intelligence from around the world. Our main source of official information is the EU s Early Warning and Response System, which we operate together with DG SANCO. This is a secure messaging system linking the national and EU level health authorities. Member States use this to notify the Commission, ECDC and each other of disease outbreaks that could have EU level implications. But ECDC also gathers data and epidemiological information from its networks of disease experts in the Member States, from the World Health Organisation and other international partners for example, the US Centres for Disease Control. And then we gather less official epidemic intelligence. We screen the media across the EU and the world for signals of disease outbreaks. We also hear things unofficially from our national and international counterparts. Every working day at 11:30 we bring all this information together, and make decisions on what to do about it. On 2 September our experts, and your delegation, reviewed new information about the following three outbreaks: Firstly, a cluster of cases of Legionella among tourists at two campsites and a hotel in the village of Lazise Secondly, six cases of locally transmitted malaria in two areas of Greece; and Thirdly, a resurgence of measles in Europe, which is affecting nearly all Member States All three of these were threats about which the European Commission asked ECDC to produce risk assessments. Let me talk you through the three threats. Lazise is a beautiful village near Lake Garda in Italy. I can tell you that from personal experience I have been there a number of times. I can also tell you that most of the tourists there are from the Netherlands and Germany. Legionella is one of the diseases that Member States have committed to sharing information on with each other, and with the EU. ECDC runs a network linking the Legionella experts in the national public health institutes. They share information on the Legionella cases they diagnose rapidly, and confidentially. At the end of August, 2

3 doctors in the Netherlands, Germany and Denmark put information into our database about cases they had detected. Looking at their information together ECDC saw there were seven cases of Legionella in people who had recently been to Lazise. So, by having this EU-level view, ECDC could pinpoint the source of the outbreak. Once we saw this, we notified the Italian authorities. Regarding the malaria cases in Greece, the other Member States and, indeed the World Health Organization, want to know the significance of this. Put simply, do they need to advise tourists visiting certain areas of Greece to take precautions against malaria or would this be an overreaction? Regarding measles, the main epidemics in Europe are now so big and so enduring that the EU has become a major exporter of measles to the rest of the world. Within the Union, countries which had been measles free are now importing measles from other parts of the EU. This is an extremely contagious disease. So individual Member States, on their own, are not able to keep themselves measles free. Sustained concerted action is needed. Update on the threats examined during ENVI Chair, I would like to update you, and the Committee, on what has happened with these outbreaks. The Legionella outbreak in Lazise appears to be over. Once ECDC made them aware of the outbreak, the Italian authorities took action. They found Legionella bacteria in the water system of a campsite, and took steps to eliminate it. The Italian authorities also notified the tourists who had visited that and one nearby, that they might have been exposed to Legionella. ECDC helped them do this by producing draft letters in Dutch, German and English for these tourists. This was important. Legionella can only be treated with a specific type of antibiotic. The infection can cause severe pneumonia. If it is not properly treated, it can be deadly. The number of malaria cases reported in the outbreak in Greece has increased to 16, with cases now being seen in 5 districts. Two weeks ago, at the request of Greece, a team of our experts spent a week there assessing the situation. They reported that the cases occurred in agricultural areas, near to wetlands, and with limited tourism. Greece must continue to actively detect, and treat, new cases of malaria. But the implications of this outbreak for other EU countries are limited. We published a Rapid Risk Assessment on our website, if you would like to read more details. The development that concerns me most is the resurgence of measles. When the ENVI delegation visited us at the beginning of September, there had been just over 26,000 measles cases reported. The total now is over 28,000 and we have had 3 further deaths. This brings the total for 2011 to 9 deaths. We know that these are underestimates of the true number of cases and maybe also of the number of deaths Malaria in Greece and Legionella in Lazise are examples of the type of routine events that occur every week in the world of infectious diseases. The measles epidemics I would classify as one of the major events of this new decade. I will say more about it in a minute. This slide makes the point that Member States have an obligation under EU law to share data and alerts with the Commission and ECDC. This legislation is currently being reviewed by the Commission. 3

4 Review of 2011 Now, I would like to review what ECDC has done this year, before saying a few words about our priorities for When I appeared before you in October 2010 I identified: Cross cutting issues such as public health laboratory capacity and social determinants of health; and Organisational efficiency; as top priorities Let me say a few words about organisational efficiency. I said last year that I wanted to ensure maximum impact from every euro that Parliament gives us. Over the last 12 months we have introduced a system of activity based budgeting. Previously, we only looked at direct spending from our operational budget (so called Title 3). But this gives an incomplete picture. So for example, on this slide it looks as if we spend almost nothing on our Epidemic Intelligence activity. The reality, though, is that we invest a lot in Epidemic Intelligence. The resource this activity uses is staff time. Being able to quantify this gives us a much clearer picture of the real cost of our different activities. In February, my management team announced a reorganisation of ECDC. We reduced the number of units, and my colleague Dr Andrea Ammon became Deputy to the Director. With Andrea as my Deputy we now have gender balance at the very top of ECDC. 54% of our expert staff are women, but if we look at the middle management grades of AD8 to AD10 this fall to a bit under 40%. That said, we have just recruited for three important management posts a Deputy Head for our Resource Management and Coordination Unit, a new Head of Legal and a new Head of ICT. All three of the successful candidates were women. 4

5 But going back to the reorganisation what we tried to do was to make ECDC s priority setting more transparent, and more responsive. Most of ECDC s experts are grouped into two large units. Our seven disease programmes draw on the time of experts from the units based on priorities identified in our work programme. If priorities change for example, if there is a major epidemic such as EHEC we can reallocate the time of the experts rather easily At the same time, the structure provides stability for our actions on the key longer term threats - for example, health care associated infections, antimicrobial resistance, HIV, TB and viral Hepatitis. On all of these we work closely with the Commission and Parliament to support the EU policy agenda. Now, ECDC has been criticised by you and by the Court of Auditors for having large carry forwards in its budget. Making progress on this is one of the top priorities of Dr Ammon. It is not easy. We still have a lot to do, but we are seeing some improvements. We forecast that our carry forward for 2011 will amount to no more than 15% of our budget. This compares with a carry forward of 27% in Turning to our cross cutting priorities for 2011, we have made very good progress in our cooperation with laboratories. In May and June, I know that you were very concerned about the EHEC outbreak in Germany. There were many health policy issued raised by this outbreak. But for the public health experts investigating it, one of the key challenges was that bacteria causing the outbreak was a rare and very unusual strain of EHEC. The standard tests for EHEC used in European laboratories could not detect it. I was therefore very happy that, as part of our reorganisation I created a microbiology team at ECDC. I was even more happy that the team is being led by Professor Marc Struelens, one of Europe s most eminent laboratory experts. Professor Struelens and his team played an important role in the outbreak. Because new methods needed to be devised to test for the outbreak strain. Analysing the strain and developing the necessary testing protocols was a team effort by microbiologists across Europe. The German colleagues on the frontline of the outbreak, of course, played the biggest role. But my microbiology team, working closely with the Commission, helped coordinate the cooperation. They ensured that all the national reference laboratories had access to the correct testing protocols. This shows the value of strengthening the EU public health laboratory network a task we are working on with DG SANCO. Laboratory cooperation will continue to be a top priority in Chair, EHEC is one of the pathogens being discussed at a seminar hosted by Mrs Roth-Behrendt on 10 October on animal-to-human diseases. I will speak at this meeting, as will Mrs Geslain-Lanéelle the Executive- Director of EFSA and colleagues from DG SANCO. Social determinants and health inequalities are recurring themes in many of the infectious disease challenges Europe faces. Since becoming Director I have visited a number of the countries that ECDC serves. I want to see what is really happening at national and local level. This is where the battle against infectious diseases must be fought and won. Earlier this year, when I was visiting Romania, I went to a Roma health care centre to better understand the health challenges faced by these communities. I wanted to understand how ECDC could make a difference. There is already a lot of knowledge, and good practice, at local level on how to prevent diseases, and improve health, among the Roma. National and EU level interventions need to tap in to this knowledge. We need to link with, and support, the people working on Roma health at local level. 5

6 Young tuberculosis patients in the EU, 2011 Source: Tobias Hofsäss I also visited a tuberculosis hospital. This is a reminder that behind all our statistics on infectious diseases are real people in this case, these children. Priorities for 2012 Measles elimination theme of year Health inequalities/migrants health Reference laboratories Assessment tool for candidate countries Evidence-based medicine Contribution to AMR/HAI networks Evaluation strategy Organisational efficiency More sustainable and focused collaboration with stakeholders Strengthening of ECDC visibility Allow me to focus on our priorities for next year. If there are a large number of citizens in a Member State who are not vaccinated against a certain disease, this has implications for its EU partners too. We are seeing this with measles. The Hungarian Presidency, in the first half of this year, held an important conference on Childhood Immunisation. This led to Council Conclusions that identified measles as a key challenge for the EU. Following up on this, and with strong support from DG SANCO and our Management Board, measles elimination will next year s theme. Continued investment by the EU and by Member States in disease prevention and control is vital to address these challenges. But it is certainly not the only thing that must be done. 6

7 I mentioned earlier the huge resurgence of measles in the EU over 28,000 cases and 9 deaths so far in But if we look at the measles problem, it is not just about money. On this slide you can see that there is no East / West or North / South divide for this disease. There are some well resourced west European Member States which have not been able to achieve high rates of vaccine coverage. They are now seeing big measles epidemics. The problem is about more than just resources and access to prevention services. It is also about attitudes, priorities and leadership. Leadership in the fight against measles needs to come from Europe s health professionals particularly family doctors and paediatricians. These are the people who parents turn to for advice about vaccinating their children. There are Member States where health professionals do show this leadership. But studies suggest that is some countries a significant number of health professionals may not be doing this. Some are not rigorous in following the national vaccination calendar. A few are even hostile to the measles vaccine. We need to see leadership from the health professions in all EU countries. Public health expert and leaders of the health professions need to speak out about this. We then need politicians, such as yourselves, to back us up. EU health policy makers need to provide leadership, based on evidence and good practice. ECDC can provide you with the evidence and information you need. Let me tell you how. I am talking at a number of events in Parliament this autumn kindly hosted by you. There will also be senior disease experts from ECDC at each of these meetings. 7

8 I am making a big effort to communicate ECDC s work, including via social media. Every time ECDC assesses a threat and Chairman, you know we do this frequently we will publish a Rapid Risk Assessment on ECDC s website. These assessments should contain clear, evidence supported, public health messages that policy makers and health professionals can act on. On top of this, I am now Tweeting every day. I am following several members of this Committee on Twitter. I invite you to follow me. Chairman, to conclude, the EU already does a lot to protect its citizens from infectious diseases. But, in my view, we need to do more. The fight against infectious diseases - like measles, EHEC, and drug resistant microbes - can only be won by coordinated policy, and coordinated action at EU level. ECDC can support you, the policy makers, in devising these. Please make use of us. Thank you 8