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ECDC

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Health care is the business of Member States ... Dead gull in September 2003. Poultry outbreaks in Romania and Turkey Autumn 2005 ... – PowerPoint PPT presentation

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Title: ECDC


1
ECDC a new agency for Public Health in Europe
  • Karl Ekdahl
  • Strategic Advisor to the Director

2
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)

3
Internal Market 4 Freedoms
  • Free Movement of People
  • Free Movement of Services
  • Free Movement of Goods
  • Free Movement of Capital

4
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

5
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6
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

7
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

8
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

9
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)

10
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)

11
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

12
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

13
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

14
Tomteboda Home of ECDC
15
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

16
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

17
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

18
ECDC Organigramme
19
Matrix organisation
20
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

21
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

22
I would like to consult Europe but I dont
know the number there
Henry Kissinger
23
Commission
EP
MS
Council
ECDC
Networks
EU agencies
WHO
NGOs
Researchcommunity
Other countries
Industry
CDCs
24
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

25
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

26
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

27
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.

28
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

29
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

30
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

31
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

32
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33
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34
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

35
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36
www.ecdc.eu.int
37
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)

38
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

39
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

40
How the European Union is Preparing for Influenza
- a Perspective from the ECDC
41
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

42
Controlling spread of influenza?
43
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

44
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

45
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

46
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

47
Work on H5N1
  • Essential but rather a distraction
  • Huge opportunity costs for ECDC
  • Kept the political momentum

48
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

49
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

50
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
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