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

1. Protecting health in Europe – the new European Centre for Disease Prevention and Control Denis Coulombier

2. 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

3. 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

4. ECDC milestones (I) • July 2003: Commission’s 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

5. ECDC milestones (II) • 2005-2006: Building up the centre • Staff • Networking • Operations • 2007: Evaluation of the possible need to extend the scope of the Centre’s mission

6. 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

7. 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

8. Organisation Director Advisers, info Management &Administration Unit for Surveillance &Communication Unit for Preparedness &Response Chief scientist --Unit for Scientific Advice

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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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 €

32. 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 Centre’s mission to other areas of public health, such as health monitoring • Timing of further reviews

33. 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