Tweet
influenza@ecdc.europa.eu
*B Ciancio, K Fernandez de la Hoz, P Kreidl, H Needham, A Nicoll, C Varela, P Vasconcelos, J Todd Webber and A Wurz
In early 2005, the institutions and Member States of the European Union (EU), together with the other European Economic Area (EEA) countries, Iceland, Liechtenstein and Norway, started preparing in a concerted manner for the next influenza pandemic. Following a joint workshop convened in March 2005 by the European Commission (EC) and the World Health Organization?s European Region (WHO EURO) [1], all EU and EEA countries and relevant EU institutions began working from three seminal documents: an EC Communication, WHO?s 2005 pandemic preparedness planning guidance and a WHO planning checklist [2-4]. Further impetus was given in the autumn and winter of 2005/6 with the appearance of H5N1-infected birds in Europe and infected humans in neighbouring Turkey, which gave rise to concerns over the specific threat of an H5N1-based pandemic [5].
The European Centre for Disease Prevention and Control (ECDC) opened in May 2005 and, recognising influenza as a priority, rapidly developed a procedure for helping countries to assess their current readiness in the health sector, and to map out national workplans for taking them along the long roads to preparedness. The ECDC embarked on an ambitious programme of assessment visits for every one of the 30 EU and EEA countries [6]. The procedure continued to evolve to incorporate other aspects of preparedness, notably the multi-sectoral dimension and international and local aspects, moving from consisting of a short visit to countries to a procedure that ran over some months, albeit still including a central visit [6]. Momentum was maintained by three further European Pandemic Preparedness workshops (with the ECDC now as co-organiser alongside the EC and WHO EURO), culminating in the largest and most ambitious in Luxembourg in September 2007 [1,7-9].
In autumn 2006, at the request of the EU Commissioner for Health and Consumer Affairs Markos Kyprianou, the ECDC prepared an interim report on progress [10]. In October 2007, the last of the 30 EU and EEA countries was visited by an ECDC-led team, and the ECDC has prepared a report on progress and the state of pandemic preparedness in the EU and EEA countries, in December 2007. The report has been published on the ECDC website, and consists of a concise report for policy-makers and a more complete technical report [11,12]. A commissioned journalistic report on the many examples of innovations and good practice demonstrated in a special session at the Luxembourg workshop will be available online shortly.
What do these reports say? In one short phrase: ?Much done? but much more still needs to be done.? The health sectors in all countries have developed preparedness plans and, at national level, much is now being done to make these plans operational. Through close liaison, the ECDC has prepared extensive guidance, taking care not to duplicate what WHO has already provided and, as far as possible, devising guidance that also applies for seasonal influenza [13,14]. There has been notable investment in European research, work by the European Food Safety Agency (on avian influenza) and progress by industry, academics and the European Medicines Agency in developing new vaccines and reducing the time that it will take to produce pandemic-specific vaccines [15]. The Commission itself has been very active [16], including running one of the largest ever pandemic exercises (Exercise ?Common Ground?) [17]. At the same time, many Member States have organised their own national and cross-border exercises and several are developing more multi-sectoral plans to either encompass or accompany their health sector plans.
What remains to be done? The ECDC estimates that even if a developed European country works hard and commits considerable additional resources, it will take a minimum of five years to develop adequate pandemic preparedness. Hence, we estimate that it will take Europe another two to three years of hard work and investment. Independent evidence for this comes from the ECDC?s pandemic preparedness indicators, a similar conclusion of the recently published global UNSIC/World Bank Report [18] and the long list of activities still to be undertaken reported by Member States themselves after undertaking self-assessments in 2007. However, some countries have further to go or face special problems from their structure of administration (the more federal structures or where health services are privately provided).
The WHO is confident that there has been no reduction in the threat of a pandemic and that, although unpredictable, they can be considered as inevitable [19]. Citizens might mistakenly expect to be well protected by now. Policy-makers might also feel that enough time, effort and resources have been committed. Why does so much remain unfinished after two and a half years of effort? Equally, why does it take so long to prepare complex countries for a pandemic? This is partly because Europe has never been more vulnerable to a pandemic (Table 1). Equally, the armoury of countermeasures has never been greater (Table 2). In the 1918-19 ?Spanish Flu?, as many Europeans died as during some of the battles of the 1914-18 war [20]. Now there are the countermeasures, antivirals, human H5N1 vaccines, evidence-based public health measures and modern business continuity planning (Table 2). These will deliver mitigation and reduce suffering and death in the next pandemic, but each countermeasure needs careful planning and organisation. Consider antivirals, for example: most EU Member States have limited stockpiles of varying sizes, according to their individual strategies [21]. However, developing healthcare systems that can deliver antivirals in the midst of a pandemic to most citizens that need them, when and where they need them (within 48 hours of symptoms developing) is proving challenging for all European countries.
What can be expected in 2008? Essentially, another busy year on pandemic preparedness. The WHO is revisiting its guidance for pandemic planning, the evidence base for control measures and, perhaps most difficult of all, surveillance in a pandemic [22]. Major change is not expected, but inevitably there will be some alterations needed in EU/EEA procedures; for example, what will need to be reported to the WHO in a pandemic. There will be the next United Nations (UNSIC) meeting in Egypt, probably in October. The EU Health Security Committee?s new Influenza Section will become more active, providing a forum for common discussion on issues among policy-makers in order to increase collaboration and exchange of plans and common exercises between countries. It seems likely that the French presidency of the EU will make pandemic preparedness one of its priorities, although working on pandemic preparedness has been and will need to be a feature under every EU presidency until at least 2010. The ECDC will be working closely with the Commission and the WHO (both the European Region in Copenhagen and Headquarters in Geneva) to support all these initiatives, help develop joint thinking on the public health measures, develop guidance on antivirals and undertake work with Member States in regional workshops to help them review how well they have progressed since their initial visits by the ECDC.
References:
*B Ciancio, K Fernandez de la Hoz, P Kreidl, H Needham, A Nicoll, C Varela, P Vasconcelos, J Todd Webber and A Wurz
In early 2005, the institutions and Member States of the European Union (EU), together with the other European Economic Area (EEA) countries, Iceland, Liechtenstein and Norway, started preparing in a concerted manner for the next influenza pandemic. Following a joint workshop convened in March 2005 by the European Commission (EC) and the World Health Organization?s European Region (WHO EURO) [1], all EU and EEA countries and relevant EU institutions began working from three seminal documents: an EC Communication, WHO?s 2005 pandemic preparedness planning guidance and a WHO planning checklist [2-4]. Further impetus was given in the autumn and winter of 2005/6 with the appearance of H5N1-infected birds in Europe and infected humans in neighbouring Turkey, which gave rise to concerns over the specific threat of an H5N1-based pandemic [5].
The European Centre for Disease Prevention and Control (ECDC) opened in May 2005 and, recognising influenza as a priority, rapidly developed a procedure for helping countries to assess their current readiness in the health sector, and to map out national workplans for taking them along the long roads to preparedness. The ECDC embarked on an ambitious programme of assessment visits for every one of the 30 EU and EEA countries [6]. The procedure continued to evolve to incorporate other aspects of preparedness, notably the multi-sectoral dimension and international and local aspects, moving from consisting of a short visit to countries to a procedure that ran over some months, albeit still including a central visit [6]. Momentum was maintained by three further European Pandemic Preparedness workshops (with the ECDC now as co-organiser alongside the EC and WHO EURO), culminating in the largest and most ambitious in Luxembourg in September 2007 [1,7-9].
In autumn 2006, at the request of the EU Commissioner for Health and Consumer Affairs Markos Kyprianou, the ECDC prepared an interim report on progress [10]. In October 2007, the last of the 30 EU and EEA countries was visited by an ECDC-led team, and the ECDC has prepared a report on progress and the state of pandemic preparedness in the EU and EEA countries, in December 2007. The report has been published on the ECDC website, and consists of a concise report for policy-makers and a more complete technical report [11,12]. A commissioned journalistic report on the many examples of innovations and good practice demonstrated in a special session at the Luxembourg workshop will be available online shortly.
What do these reports say? In one short phrase: ?Much done? but much more still needs to be done.? The health sectors in all countries have developed preparedness plans and, at national level, much is now being done to make these plans operational. Through close liaison, the ECDC has prepared extensive guidance, taking care not to duplicate what WHO has already provided and, as far as possible, devising guidance that also applies for seasonal influenza [13,14]. There has been notable investment in European research, work by the European Food Safety Agency (on avian influenza) and progress by industry, academics and the European Medicines Agency in developing new vaccines and reducing the time that it will take to produce pandemic-specific vaccines [15]. The Commission itself has been very active [16], including running one of the largest ever pandemic exercises (Exercise ?Common Ground?) [17]. At the same time, many Member States have organised their own national and cross-border exercises and several are developing more multi-sectoral plans to either encompass or accompany their health sector plans.
What remains to be done? The ECDC estimates that even if a developed European country works hard and commits considerable additional resources, it will take a minimum of five years to develop adequate pandemic preparedness. Hence, we estimate that it will take Europe another two to three years of hard work and investment. Independent evidence for this comes from the ECDC?s pandemic preparedness indicators, a similar conclusion of the recently published global UNSIC/World Bank Report [18] and the long list of activities still to be undertaken reported by Member States themselves after undertaking self-assessments in 2007. However, some countries have further to go or face special problems from their structure of administration (the more federal structures or where health services are privately provided).
The WHO is confident that there has been no reduction in the threat of a pandemic and that, although unpredictable, they can be considered as inevitable [19]. Citizens might mistakenly expect to be well protected by now. Policy-makers might also feel that enough time, effort and resources have been committed. Why does so much remain unfinished after two and a half years of effort? Equally, why does it take so long to prepare complex countries for a pandemic? This is partly because Europe has never been more vulnerable to a pandemic (Table 1). Equally, the armoury of countermeasures has never been greater (Table 2). In the 1918-19 ?Spanish Flu?, as many Europeans died as during some of the battles of the 1914-18 war [20]. Now there are the countermeasures, antivirals, human H5N1 vaccines, evidence-based public health measures and modern business continuity planning (Table 2). These will deliver mitigation and reduce suffering and death in the next pandemic, but each countermeasure needs careful planning and organisation. Consider antivirals, for example: most EU Member States have limited stockpiles of varying sizes, according to their individual strategies [21]. However, developing healthcare systems that can deliver antivirals in the midst of a pandemic to most citizens that need them, when and where they need them (within 48 hours of symptoms developing) is proving challenging for all European countries.
What can be expected in 2008? Essentially, another busy year on pandemic preparedness. The WHO is revisiting its guidance for pandemic planning, the evidence base for control measures and, perhaps most difficult of all, surveillance in a pandemic [22]. Major change is not expected, but inevitably there will be some alterations needed in EU/EEA procedures; for example, what will need to be reported to the WHO in a pandemic. There will be the next United Nations (UNSIC) meeting in Egypt, probably in October. The EU Health Security Committee?s new Influenza Section will become more active, providing a forum for common discussion on issues among policy-makers in order to increase collaboration and exchange of plans and common exercises between countries. It seems likely that the French presidency of the EU will make pandemic preparedness one of its priorities, although working on pandemic preparedness has been and will need to be a feature under every EU presidency until at least 2010. The ECDC will be working closely with the Commission and the WHO (both the European Region in Copenhagen and Headquarters in Geneva) to support all these initiatives, help develop joint thinking on the public health measures, develop guidance on antivirals and undertake work with Member States in regional workshops to help them review how well they have progressed since their initial visits by the ECDC.
References:
- European Commission and WHO European Region. First European Pandemic Preparedness Planning Workshop, Luxembourg March 2005. Available from: http://www.ecdc.eu.int/Health_topics...eparedness.pdf
- European Commission. Communication from the Commission to the Council, the European Parliament, the European Economic and Social Committee and the Committee of the Regions. Communication on pandemic influenza preparedness and response planning in the European Community. Brussels 28.11.2005 Comm 2005 (607). Available from: http://eur-lex.europa.eu/LexUriServ/...5_0607en01.pdf
- World Health Organization. WHO Global Influenza Preparedness Plan. Geneva 2005. Available from: http://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_GIP_2005_5.pdf
- WHO checklist for influenza pandemic preparedness planning WHO Geneva 2005. Available from: http://www.who.int/csr/resources/pub...uCheck6web.pdf
- Eurosurveillance editorial team, Meijer A. fatal human infections with avian influenza H5, Turkey, January 2006. Available from: http://www.eurosurveillance.org/ew/2006/060106.asp
- ECDC Pandemic Preparedness Assessment tool Version March 2007. Available from: http://www.ecdc.europa.eu/pdf/Assessment%20tool.pdf
- WHO European Region, European Commission, ECDC. Pandemic Preparedness Planning 2nd European Workshop, Copenhagen October 2005. http://ec.europa.eu/health/ph_threats/com/Influenza/second_workshop.pdf
- ECDC, WHO European Region, European Commission. Third joint European Pandemic Preparedness Workshop. Uppsala May 2006. Available from: http://www.ecdc.eu.int/pdf/Pandemic_workshop.pdf
- IVth Joint EC/ECDC/WHO Workshop on Pandemic Influenza Preparedness, Luxembourg, 25-27 September 2007. Available from: http://ec.europa.eu/health/ph_threat...0070925_en.htm
- ECDC Influenza Team. Pandemic preparedness in the European Union ? multi-sectoral planning needed. Eurosurveillance 2007: 12: 2 February 22nd 2007. Available from: http://www.eurosurveillance.org/ew/2007/070222.asp#1
- European Centre for Disease Prevention and Control. Policymakers report. Pandemic preparedness in the European Union Autumn 2007. Available from: http://ecdc.europa.eu/pdf/2007_12_05_Pandemic%20preparedness%20for%20policym akers.pdf
- European Centre for Disease Prevention and Control. Technical report. Pandemic preparedness in the European Union Autumn 2007. Available from: http://www.ecdc.europa.eu/Health_top...%20web%201.pdf
- ECDC Pandemic Preparedness, Scientific and Technical Guidance. Available from: http://www.ecdc.eu.int/Health_topics.../Guidance.html
- ECDC Seasonal Influenza, Scientific and Technical Guidance. Available from: http://www.ecdc.eu.int/Health_topics.../Guidance.html
- European Commission DG Research Influenza Research EU Funded Projects 2001-2007 May 2007. Available from: http://ec.europa.eu/research/health/...esearch_en.pdf
- European Commission Influenza pandemic preparedness planning : a priority for the European Commission. Available from: http://ec.europa.eu/health/ph_threats/com/Influenza/influhome/influenza_level_en.htm
- European Commission. Report of a pandemic exercise for the European Union March 2006. Available from: http://ec.europa.eu/health/ph_threats/com/common.pdf
- UNSIC/World Bank Third report on third global progress report on responses to avian influenza and the state of pandemic readiness, December 2007. Full version available from: http://www.undg.org/docs/8097/UN-WB%...al%20PRINT.pdf
- WHO The world health report 2007 - A safer future: global public health security in the 21st century. The Global Health Report 2007 WHO, Geneva. Full report available from: http://www.who.int/whr/2007/whr07_en.pdf
- Murray CJL Lopez AD, Chin B, Feehan D, Hill KH Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918-20 pandemic: a quantitative analysis Lancet (2006); 368: 2211-2218.
- Trakatellis A. Pandemic Influenza in Europe. Are we sufficiently prepard? Report of a high level policy debate, June 2007. Available from: http://www.atrakatellis.gr/Events/19/Final%20report%20(3).pdf
- European Centre for Disease Prevention and Control. Influenza Pandemics and Severe Influenza Epidemics Interim Guide to Public Health Measures to Reduce the Impact of Influenza Pandemics During Phase 6 - ?The ECDC Menu? ECDC October 2007. Available from: http://www.ecdc.eu.int/Health_topics...za/phm%20.html