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

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

• Denis Coulombier

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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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Pre-ECDC capacity

• EU funded surveillance networks since 1999
  (2119/98/EC)
• Well functioning within their remits, but
• uncoordinated
• do not cover all diseases under 2119/98
• funding not sustainable
• Weak response capacity
• SARS, anthrax threats, pandemic flu
• 10 new member states

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ECDC milestones (I)

• July 2003 Commissions proposal to establish the
  Centre
• December 2003 Council decision that Sweden will
  host the Centre
• April 2004 Regulation 851 establishing the
  Centre
• September 2004 1st meeting of Management Board
  with international launch
• December 2004 Director Zsuzsanna Jakab nominated
• March 2005 Director takes office (start-up
  phase)
• May 2005 Centre operational

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ECDC milestones (II)

• 2005-2006 Building up the centre
• Staff
• Networking
• Operations
• 2007 Evaluation of the possible need to extend
  the scope of the Centres mission

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What kind of ECDC

• Small but very well-connected
• Spider in the web
• An expert institution that makes a difference
• A one-stop-shop for CD information and advice
• An important player on the global arena
• Moving fast
• even faster than ambitious Work Programme

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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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Organisation
Director
Advisers, info
Unit for Surveillance Communication
Management Administration
Unit for Preparedness Response
Chief scientist --Unit for Scientific Advice
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Matrix organisation

• Horizontal, matrix type of projects in priority
  areas
• Influenza
• Antimicrobial resistance
• HIV/AIDS and STI
• Zoonoses

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Horizontal projects (I)

• Pandemic and avian influenza
• Monitoring and assessing the threat day-by-day
• Strengthening European and country
  preparedness(assessment tool country visits)
• Developing surveillance of seasonal, epizootic
  and pandemic influenza
• Teleconferences with all stakeholders
• Monitoring scientific development, providing
  scientific opinion and promoting scientific
  issues
• Advocating for pandemic influenza preparedness
• Developing tools and guidelines
• Supporting MS for investigation and response
• Coordinating risk assessment activities in the
  event of a pandemic influenza or an avian
  influenza public health crisis
• Developing partnership

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Horizontal projects (II)

• Antimicrobial resistance
• Coordinate and support various ongoing activities
• Add resistance components in all relevant
  surveillance networks (TB, HIV, enteric
  infections, etc)
• Harmonisation and QA of surveillance data
• Combine data on resistance and consumption
• Inventory of actions in MS
• Evaluate the costs of AMR
• Evaluate the scientific basis for intervention
• Develop tools and guidelines

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Unit for Scientific Advice (I)

• Provide sound and independent technical and
  scientific advice
• Well acquainted with the front-line of research
  in all areas of CD control
• Actively participate in all key scientific
  conferences and meetings
• Network of experts and scientists in Europe
• Inventory of resources
• Build on the scientific competence and experience
  within the NSI and DSNs

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Unit for Scientific Advice (II)

• Set up independent advisory panels and initiate
  studies
• Cover all categories of CDs listed in Decision
  2119/98/EC and develop guidelines and other tools
• Be strong on new and emerging health threats
  including antimicrobial resistance
• Support member states in national endeavours

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Unit for Scientific Advice Work Plan 2005 (I)

• Operating procedures and ToRs in place
• Rules for answering scientific questions
• ToR for Scientific Panels
• Scientific Panels operational
• Six panels with 11 members each agreed on
• Support staff for panels
• First meeting of Panels
• Collaboration with laboratories
• Clear guidelines for how ECDC will cooperate with
  EU labs

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Unit for Scientific Advice Work Plan 2005 (II)

• Collaboration with learned societies to secure
  scientific input
• OP for cooperation with learned societies
• ECDC guidelines on specific diseases/issues
• Priority list
• OP for producing guidelines
• Sample guideline
• Internal weekly summaries of new scientific
  findings

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ECDC with no laboratories

• Build on what already exists in Member States to
  avoid duplication
• Support MS response capacity by always knowing
  where appropriate lab. capacity is located
• Ensuring microbiological expertise through
  secondments and short-term positions
• Build up a system of reference labs

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Unit for Surveillance and Communication (I)

• Gradually coordinate/integrate surveillance
  networks into ECDC
• Incorporate technical aspects of surveillance
  components of DSN into the Centre
• Promote an increase in coverage and effectiveness
  of the surveillance networks as well as quality
  control
• Technical assistance to MS on surveillance issues

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Unit for Surveillance and Communication (II)

• Avoid all duplicate reporting
• Data standardisation and comparability
• Denominators
• Harmonisation of laboratory methods
• Further integration of sub-typing data
• Surveillance ? public health action
• Surveillance ?? Research
• Alternative surveillance systems

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Unit for Surveillance and Communication (III)

• Public and privileged web pages
• Surveillance reports
• Weekly (electronic) epidemiological report
• Annual epidemiological report
• Articles in scientific journals
• Risk communication strategy for target groups

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Road map for future surveillance

• 2005
• Agreements on data access
• Consultation process
• Technical systems for storing/accessing data
• Strategy document (several steps)
• 2006
• Build close links to the BSN
• Detailed evaluation of networks (SURVEVAL)
• 2007/2008 (as present network contracts ends)
• Full coordination of all surveillance activities

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Surveillance and Communication Work Plan 2005 (I)

• Development of a surveillance strategy
• Site visits in 10 MS Commission
• Web based questionnaires to all MS and learned
  societies
• Strategy document presented to MB
• Integrated operations of networks
• Inventory of set-ups of networks
• Re-establishment of the Network Forum
• Agreements for database access and database
  transfers

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Surveillance and Communication Work Plan 2005 (II)

• Surveillance data bases at ECDC
• Contract with IT company to develop specification
  for integrated/combined data bases
• Liaise with IT persons of surveillance networks
  regarding characteristics of network databases
• Acquisition of hardware/software for databases

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Surveillance and Communication Work Plan 2005
(III)

• Preparations for evaluations of networks
• General protocol for evaluation with
  disease-specific aspects
• Zoonoses report
• Data base of BSN adjusted to fit zoonoses report
  (human data)
• Data flow from MS tested in a dummy run in
  preparation of zoonoses report in 2006

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Unit for Preparedness and Response (I)

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

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Unit for Preparedness and Response (II)

• Provide technical assistance in outbreak
  investigation and response
• Identify outbreak assistance teams (OAT)
• Identify and mobilize lab capacity
• Training activities (follow-up of EPIET)
• Memorandum of understanding with international
  partners (WHO)
• Inventory and development of response guidelines

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Unit for Preparedness and Response Work Plan
2005 (I)

• Improved preparedness to tackle PH crises
• Pandemic preparedness assessment tool
• Outbreak assistance teams mechanisms in place
• Training module on Outbreak Assistance Team
  coordination
• Intervention kits for outbreak assistance teams

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Unit for Preparedness and Response Work Plan
2005 (II)

• Improved detection of emerging threats in Europe
• Threat tracking tool (3T)
• Weekly threat monitoring bulletin
• Annual report on emerging threats
• EWRS operated by ECDC
• Meeting with MS on epidemic intelligence

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Unit for Preparedness and Response Work Plan
2005 (III)

• Improved coordination of risk assessment and
  support during PH crisis
• Crisis room operational
• Internal public health crisis operation plan
• External public health crisis operation plan
• Improved country capacity for CD surveillance and
  response
• Capacity strengthening policy developed

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ECDC role in outbreaks

• Outbreak in 1 MS
• ECDC may be invited by MS to assist
• Co-ordinate EU risk assessment and response (if
  EU threat)
• Outbreak affecting more than 1 MS
• Coordinated approach to investigation and
  response
• Cooperate closely with other EU agencies
• Ensure proper communication through the network,
  with the Commission and the public
• Offer assistance

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Outbreaks outside the EU

• Risk assessment
• Potential to spread to MS
• Need for co-ordinated preparedness and response
• Recommendations to MS and Commission
• Support to response upon request from
• WHO-HQ, through GOARN, by mobilizing EU expertise
• WHO-EURO for non-EU European countries
• Countries if perceived added value for EU

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ECDC Staffing and budget

• 2005 29 staff 5 M
• 2006 50 staff 16 M 3 M
• Proposal
• 2007 70 staff 41 M
• 2008 120 staff 80 M
• 2009 170 staff 80 M
• 2010 220 staff 90 M
• 2011 270 staff 90 M
• 2012-13 300 staff 90 M

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Scope of ECDC

• ECDC will commission independent external
  evaluation in May 2007 of its achievements
• The evaluation will also assess
• The possible need to extend the scope of the
  Centres mission to other areas of public health,
  such as health monitoring
• Timing of further reviews

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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