INTERNATIONAL CONFERENCE ?STRENGTHENING COOPERATION IN THE EUROPEAN UNION AGAINST INFECTIOUS DISEASES? - WARSAW, 25 JUNE 2009 (ECDC, edited)

[Giuseppe]

INTERNATIONAL CONFERENCE ?STRENGTHENING COOPERATION IN THE EUROPEAN UNION AGAINST INFECTIOUS DISEASES? - WARSAW, 25 JUNE 2009 (ECDC, edited)

ZSUZSANNA JAKAB, DIRECTOR

INTERNATIONAL CONFERENCE ?STRENGTHENING COOPERATION IN THE EUROPEAN UNION AGAINST INFECTIOUS DISEASES? - WARSAW, 25 JUNE 2009

SPEAKING NOTE

[Original Document: LINK. EDITED.]


Strengthening Europe?s defences against influenza and other infectious diseases

Introduction

• Ministers, distinguished guests, ladies and gentlemen, it is a pleasure and an honour to be addressing you here in Warsaw today.

• Twenty years ago Poland led the way in getting rid of the old order in Central Europe. As a Hungarian I am happy to acknowledge ? and to celebrate ? the important contribution Poland made to restoring democracy in this part of Europe.
• Today, I know that Poland is determined to play an equally important role in improving and protecting public health within the European Union, as we continue to develop the new Europe together.

• Chairman, I see today?s conference as a manifestation of that determination.
• I congratulate the Polish government for the leadership and vision you have shown in organising this event.

• Added value of European cooperation against infectious diseases

• The added value of European countries working together in the fight against infectious diseases is obvious.
• People, food and farm animals circulate freely in the European Union. Sometimes, when they travel across our open borders they take infectious diseases with them.
• A significant disease outbreak in a Member State is therefore usually a matter of interest to its European partners.
• The very first EU cooperation against infectious diseases started already in the 1980?s, when the European Commission funded two WHO networks to collect Europe-wide surveillance data on TB and HIV/AIDS.

• Cooperation developed further in the following decades, with the Commission funding surveillance networks against several more diseases, including influenza.
• By 2005, when ECDC became operational, the Commission was supporting a total of 17 networks, each looking at a different disease or groups of diseases. You can see them on this slide.
• Each network had its own database, its own website and its own way of collecting data.
• One of the things ECDC has been doing since 2005 is tidying up this system. All of the surveillance data is now being reported into a single database at ECDC.
• And ECDC?s website now gives health policy makers a one-stop-shop for data on infectious diseases.
• But it was developments in another of our key areas of work ? responding to health threats that precipitated the creation of ECDC.
• In 1998 the European Parliament and Council adopted Decision 2119. This obliges Member States to formally alert each other of significant
• Nonetheless, the SARS outbreak in 2003 inspired EU countries to go one step further, and create a European CDC.

• ECDC ? a networked public health institute
• What EU health ministers and the European Parliament agreed to when they passed the law creating ECDC was a new model of health cooperation.
• Though we have a similar name to our US counterpart, the Atlanta based CDC, ECDC operates in a rather different way.
• We are what I would call a networked public health institute.
• ECDC works by pooling the knowledge and resources in the national disease prevention and control institutes across Europe.
• So, for example, rather than building our own laboratories in Stockholm, we network the many excellent laboratories that already exist in the Member States.
• We have an excellent team of epidemiologists and disease experts based at ECDC in Stockholm, but we also draw on the knowledge and expertise of officials in national institutes.
• In 2007 there was a formalisation of this partnership between ECDC and the national public health institutes. Our Management Board approved a list of some 90 Competent Bodies in EU countries to be ECDC?s official interlocutors. We have seven such partners in Poland, including the National Institute of Public Health, the National Institute of Hygiene and the Chief Sanitary Inspectorate.
• Being an ECDC Competent Body brings many advantages for our national partners, but it also creates some work. We get a lot of support from them.
• So although the ECDC is small in comparison to the US CDC, our partnership with the Member States means we can achieve a lot.

• Providing evidence and advice for health policy makers
• What is it, then, that ECDC tries to achieve?
• Put simply, our mandate is to provide health policy makers with the best possible scientific evidence and analyses on which to base their decisions.
• This evidence can take many forms, such as:
  • - analysis of the trends in various infectious diseases
  • - analysis of the causes of those trends
  • - scientific guidance on control or prevention
  • - identification of good practice; and
  • - alerts on disease outbreaks
• Whatever the disease, our task is to make sure the scientific evidence we provide to policy makers is timely and accurate, and that we have drawn on the best expertise in Europe.
• Once health policy makers in the European Commission or Member States have decided to on a course of action, we can provide further technical support, if needed.
• For example, we can help coordinate multi-country outbreak investigations, if asked to do so.
• We can act as a communication hub from our state of the art Emergency Operations Centre. We can provide intelligence and daily updates to support policy makers in their response to events
• However ? and this is of central importance ? what we cannot do is to take risk management decisions.
• Public health remains primarily a national responsibility within the EU.
• ECDC can advise Member States on different policy options for preventing or controlling diseases. But we cannot - and do not ? dictate what countries should do.
• You will see the importance of this point when I talk about pandemic influenza.
• Of course, in some situations a coordinated EU-wide approach to risk management is desirable. But in these situations, when coordinated measures are under consideration, it is the European Commission ? rather than ECDC ? that leads the debate.

• ECDC?s role in strengthening Europe?s defences against influenza
• I would like to say a few words about ECDC?s role in strengthening Europe?s defences against influenza.
• This will allow me to give some practical examples of how ECDC operates. It will also enable me to illustrate the real and substantial added value of EU cooperation against infectious diseases.
• ECDC has been working intensively on influenza since 2005, when our institute first became operational.
• You may recall that in the summer and autumn of 2005 H5N1 avian influenza spread from the poultry population of East Asia, to birds in Central Asia and then to Europe.
• A perception developed that the spread of the disease in the bird population could be a precursor to H5N1 ?jumping species? and causing a human influenza pandemic. This focused a great deal of media and political attention onto influenza.
• Myself and my colleagues spent a lot of time during the autumn and winter of that year explaining that the immediate threat to public health from H5N1 was low.
• Nonetheless, we also consistently stated that an influenza pandemic was inevitable at some point in the 21st century. We just could not predict when it would happen or which virus would cause it.
• In hindsight, H5N1 served as a useful wake up call.

• Markos Kyprianou, who was then the European Commissioner for Health, asked ECDC to review the national preparedness plans of the EU Member States
• This was a major undertaking for ECDC, the experts in the European Commission and WHO Europe who assisted us, and for the Member States themselves. It has, however, proved to be a wise investment.
• Each of the reviews was undertaken jointly with the Member State concerned. Effectively this was a self-assessment by the country, working to a common template.
• The self-assessment process took up to six months with an ECDC-led team of experts, whenever possible including colleagues from the Commission and WHO, spending a week in the country working with those involved in pandemic preparedness.
• A written report would then be produced by ECDC with national officials before being submitted to the Ministry of Health.
• The value of these reviews was that they helped countries think about the practical details of their pandemic preparedness. This process of critical and constructive engagement was at least as important as the written report in helping countries strengthen their preparedness.
• Between the summer of 2005 and the end of 2007 these joint assessment visits took place in 29 European countries: all 27 EU Member States plus Iceland and Norway.
• As I have said, this was a huge investment in terms of the amount of staff time devoted to it. But it has led to the EU being much better prepared for a pandemic now than in 2005.

• Responding to the H1N1 pandemic
• So how has ECDC been responding to the pandemic now that it has actually arrived?
• Since the week beginning Monday 27 April my institute has been producing daily updates on the epidemiological situation in Europe and worldwide.
• This has meant that health policy makers have had timely, authoritative information on how the virus is spreading in Europe, and around the world. I know that this has been appreciated by policy makers, as well as colleagues in public health institutes.
• ECDC has been in daily contact with influenza experts and frontline disease control professionals in Europe, WHO and around the world. This has meant that we can rapidly inform colleagues in national public health authorities about any major scientific development.
• ECDC is also producing many scientific and technical documents to support the public health response to the new H1N1 virus. These include:
  • - documents to support a common EU reporting system for cases of the disease; and
  • - an updated menu of measures that can be used to prevent or delay the spread of the virus and to reduce the impact. This menu includes an analysis of the measures costs and their likely effectiveness;
• ECDC?s guidance is based on existing scientific evidence. For some measures, such as regular hand washing, this evidence is strong and uncontroversial.
• In other areas there is clearly scope for debate and differing judgements. There are tough policy decisions that need to be made about how far to disrupt people?s daily lives in the name of disease control.
• Decisions on what type of preventive care, and what type of medical treatment, countries offer have major financial implications. I know this from my time as State Secretary at the Ministry of Health in Hungary.
• More than this, the politics of who receives the vaccine ? and who does not ? could be very delicate. At a later stage in the pandemic, it is likely that Europe and the world will have a limited supply of vaccine against the new H1N1 influenza virus.
• Contrary to some media reports, this is more likely to be early next year rather than this autumn. But whenever it happens, balancing competing claims on the vaccine within nations and between nations is high politics indeed.
• ECDC will provide scientific advice and technical support on all issues relating to the pandemic. But we will stay out of the high politics.
• I think this is a good point at which to hand over the floor to our panel of distinguished speakers from the Member States and the European Commission

ENDS

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