ECDC

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ECDC a new agency for Public Health in Europe

• Karl Ekdahl
• Strategic Advisor to the Director

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How the European Union functions on health
protection

• Health care is the business of Member States
• The European Union and Parliament has no remit to
  interfere in human health care issues
• Contrasts the position for animal health
• But infection is an anomaly (the six Freedoms)

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Internal Market 4 Freedoms

• Free Movement of People
• Free Movement of Services
• Free Movement of Goods
• Free Movement of Capital

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Internal Market 5th 6th Freedom

• Free Movement of People
• Free Movement of Services
• Free Movement of Goods
• Free Movement of Capital
• Free Movement of Micro-organisms
• Free Movement of Birds

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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)
• Under coordination by the Commission decide on
• List of diseases under surveillance 49
• Criteria for selection of these diseases
• Case definitions under revision
• 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

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Daughter decisions to 2119/98/EC

• Decision 2000/57/EC EWRS decision
• Decision 2000/96 List of diseases under
  surveillance
• Decision 2002/253/EC (2002/534/EC) Case
  definitions
• Decision 2003/542/EC DSN decision

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Decision 2000/57/EC EWRS decision

• Decision of Commission
• Events to be reported
• Outbreaks involving more than 1 MS
• 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
• Procedures for informtion, consultation and
  cooperation
• Actors The Commission and competent authorities
  in the MS, lately also ECDC

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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
• Typically funded by Commission (60) and MS (40)

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Dedicated surveillance networks

• EnterNet Salmonella EHEC (HPA, UK)
• ESSTI STI (HPA, UK)
• EU-IBIS invasive HI and menigococci (HPA, UK)
• EWGLI Legionella (HPA, UK)
• Euro-HIV HIV/AIDS (InVS, France)
• Euro-TB TB (InVS, France)
• IPSE nosocomial infections (Université Claude
  Bernard, France)
• EARSS AMR (RIVM, Netherlands)
• EISS influenza (NIVEL, Netherlands)
• EUVAC.NET VPD (SSI, Denmark)
• ENIVD hemorrhagic fevers (RKI, Germany)
• ESAC antibiotic consumption (Univ. Antwerp,
  Belgium)

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General infrastructural networks

• EPIET training field epidemiology (SMI, Sweden)
• BSN minimal datasets of all diseases (SMI,
  Sverige)
• IRIDE inventory of communicable disease control
  resources in Europe (ISS, Italy)
• Eurosurveillance bulletin (HPA, UK INVS,
  France)
• EpiNorth Network for CD control in Northern
  Europe with bulletin, website, training courses
  (NPHI, Norway)
• EpiSouth mirror of EpiNorth

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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

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Limitations with old setup

• Surveillance networks uncoordinated and without
  sustained funding
• No central expert authority
• Limited resources for rapid response
• Unflexible system (bound by contracts)
• 10 new Member States
• Above evident during SARS crisis ? ECDC

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Tomteboda Home of ECDC
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ECDC milestones

• July 2003 Commissions 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
• March 2005 Director takes office (start-up
  phase)
• May 2005 Centre operational
• October 2005 Move to own facilities at Tomteboda
• 2007 Evaluation of the possible need to extend
  the scope of the Centres mission

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Very broad mandateFounding Regulation 851/2004/EC

• Close cooperation with MS and EU bodies
• Surveillance
• Risk identification and risk assessment
• Preparedness planning
• Response to health threats and events
• Training
• Communication
• Scientific opinions and guidelines

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Staffing and budget (2004 cost)

• 2005 2920 staff 5 M
• 2006 5040 staff 18 M
• Proposal
• 2007 9060 staff 27 M
• 2008 12080 staff 36 M
• 2009 150100 staff 45 M
• 2010-2013 180120 staff 50 M

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ECDC Organigramme
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Matrix organisation
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ECDC horizontal actions

• Forming partnerships
• Risk assessment
• Enhance surveillance activities
• Developing guidance and scientific opinions
• Disseminate information
• Assess country preparedness and capacity (country
  visits)
• Advocacy

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Directors Cabinet

• Overall co-ordinating responsibility of all ECDC
  activities
• Governance (AF and MB)
• Integrated information system
• Communication strategies, media relations,
  Eurosurveillance, website
• External relations

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I would like to consult Europe but I dont
know the number there
Henry Kissinger
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Commission
EP
MS
Council
ECDC
Networks
EU agencies
WHO
NGOs
Researchcommunity
Other countries
Industry
CDCs
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Framework for Country Strategy

• Directory of contact points
• MB appoint and publish competent bodies
• Overview of health systems
• Detailed inventory of resources and expertise
  (build on IRIDE)
• Identification of need for support
• Action plan for 5 countries in 2006
• Working with regional networks
• EpiNorth, EpiSouth

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Scientific Advice Unit (I)

• Provide sound and independent technical and
  scientific advice
• Questions, guidelines, toolkits
• No own research capacity
• Well acquainted with the front-line of research
  in all areas of CD control
• Actively participate in key scientific
  conferences and meetings

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Scientific Advice Unit (II)

• Network of experts and scientists in Europe
• Roster of experts
• Network of European reference laboratories
• Strong on new and emerging health threats
• Cooperation with laboratories
• Support member states in national endeavours
• Turn policies/guidelines into action if needed
• Advocacy

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Process for scientific questions

• Competence in house?
• Competence in one of the DSNs?
• Competence in one of the Scientific Panels?
• In real life, probably combination of these.

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Surveillance and Communication Unit

• Gradually coordinate/integrate surveillance
  networks into ECDC
• Consolidate surveillance with DSNs and national
  surveillance institutes
• Prepare case definitions
• Set up data-bases at ECDC
• Receive data from DSNs
• Technical assistance to MS on surveillance issues
• Surveillance ? public health action

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Output of surveillance data

• Surveillance is data for action
• Data dissemination through various means
• Eurosurveillance scientific voice of ECDC
• Public and privileged web pages
• Surveillance reports
• Articles in scientific journals
• All necessary data should be easily available
  through the ECDC web portal
• Strategic partnership with the EpiNorth network
  and bulletin

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Preparedness and Response Unit (I)

• Epidemic intelligence
• Keep track of emerging health threats inside and
  outside the EU
• ProMed, GOARN, GPHIN, GIDEON and other Community
  alert systems
• Timely advice on such threats
• Assisting the Commission by operating the Early
  Warning and Response System (EWRS) with a 24h/7d
  duty system

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Preparedness and Response Unit (II)

• Provide technical assistance in outbreak
  investigation and response
• Identify outbreak assistance teams
• Identify and mobilize lab capacity
• Training activities
• MoU with international partners (WHO)
• Inventory and development of response guidelines

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Output of epidemic intelligence data

• European Commission
• Commissioner briefing
• Member States
• Early Warning and Response System
• ECDC threat assessment weekly bulletin
• Public
• Eurosurveillance weekly
• ECDC website

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www.ecdc.eu.int
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Training activities

• Activities in 2005
• Development of a training strategy document
  (with EPIET)
• Consultation of Member States
• Participation to training on ad-hoc basis
• Planning an outbreak team leader course
• Planned Activities in 2006-2007
• Transition of EPIET
• Identify training needs and topics
• Short courses on national level
• Develop training materials and manuals (web based)

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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 before 2010
• 5 years only for CDs
• If extended - gradual process
• Starting with health monitoring, analysis and
  reporting?
• Additional resources needed

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Key message

• ECDC could only be strong if built on strong
  European networks and ideas
• ECDC will provide needed services and give a
  clear added value to the European CD control
• ECDC will channel the best available resources
  (own and others) to where they will be best needed

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How the European Union is Preparing for Influenza
- a Perspective from the ECDC
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European Union many strengths

• Well resourced compared to other global regions
• Some strong centralised health systems
• Some strong public health systems
• Enthusiasm to make EU and ECDC work
• World class laboratories
• Good vaccine manufacturing base
• Innovative approaches x 25
• European wide and international perspective

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Controlling spread of influenza?
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Influenza milestones

• March 2005 - Euro Pandemic Preparedness Workshop
  1 Luxemburg
• May 2005 ECDC became operational
• European Commission Generic and Pandemic
  Documents Launched
• October 2005 Euro Pandemic Preparedness Workshop
  2 Copenhagen
• November 2005 First Europe wide command post
  exercised (Common Ground)
• May 2006 Euro Pandemic Preparedness Workshop 3
  Uppsala

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There have also been events- mostly around
bird flu

• H5N1 approaching relentlessly from the East
• Dead gull in September 2003
• Poultry outbreaks in Romania and Turkey Autumn
  2005
• Human outbreaks on the fringes Turkey January
  2006
• Political events London, Beijing etc

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Aims of the Workshops

• Coordinated approach European Commission,
  WHO/Europe and ECDC
• 52 European countries
• Share best practice
• All European countries have pandemic plans
• Inform about developments
• Latterly maintain momentum

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Intensive ECDC activities between workshops -
examples

• Detailed influenza assessments in EU MS
• National and local
• Pandemic, seasonal and avian influenza
• Public health and microbiology
• Planning on surveillance
• Modelling
• Guidance Production

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Work on H5N1

• Essential but rather a distraction
• Huge opportunity costs for ECDC
• Kept the political momentum

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Recommendations from Uppsala Workshop, May 2006

• Complete toolkit and training packages for AI in
  humans
• Further country visits in EU and WHO region
• Sub-regional meetings to address interoperability
  and practical preparedness issues
• Further work on indicators
• Next EU / WHO plenary workshop will be July 2007

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Issues for the EU lots of these

• Interoperability issues
• Variable uptake of influenza seasonal vaccination
• Adjusting to H5N1 being either endemic or an
  occasional visitor
• A common anti-viral policy?
• Agreement on public health measures to be
  recommended
• Local preparations only starting
• Intersectoral work (Ministries of Health,
  Agriculture, Education etc working together)
• Interpreting Ferguson et al 2006 for policy
  development

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Whats going to happen with H5N1 in the bird and
the pandemic

• It is difficult to make predictions,
  .especially about the future
• Yogi Berra
• Baseball Player Sage