ecdc.europa.eu Where are we now and what needs to be done – pandemic preparedness in Europe Professor Angus Nicoll CBE, Influenza Coordinator European Centre for Disease Prevention and Control (ECDC) French Presidency Vilamoura, 16 September 2008

ecdc.europa.eu We know everything we need to know For preparing for the next pandemic … … apart from a few details

ecdc.europa.eu Known unknowns When Where will start The severity The viral type The antiviral resistance pattern The target groups for prevention Clinical details

ecdc.europa.eu Introduction – The Vulnerability of Europe

ecdc.europa.eu 1.Free movement of people * 2.Free movement of services * 3.Free movement of goods * 4.Free movement of monies * * Adapted from Summary of Legislation - Internal Market. Availbale from Expanded Europe – the four freedoms

ecdc.europa.eu 1.Free movement of people * 2.Free movement of services * 3.Free movement of goods 4.Free movement of monies * 5.Free Movement of Influenza * Adapted from Summary of Legislation - Internal Market Expanded Europe – the fifth freedom

ecdc.europa.eu Diverse, not centrally controlled but highly interdependent

ecdc.europa.eu …but effective countermeasures Unprecedented effort by Member States and the EU since 2005, counteracting a threat to health and assuring well-being Modern approaches: –public health and personal measures; –medical care (antibiotics, antivirals); –influenza vaccines.

ecdc.europa.eu History since 2005 – EU level WHO Plan and Check-List Commission Communication in 2005 Major political initiatives Four joint Commission-ECDC-WHO workshops with all Member States to sustain momentum

ecdc.europa.eu ‘Bird Flu’ was both a stimulus and a distraction

ecdc.europa.eu Highly pathogenic avian influenza in wild birds in Europe (Autumn 2005 to 2 August 2006) Source: European Commission D1

ecdc.europa.eu ECDC’s role Technical guidance and information – as can be seen every week in Influenza News Preparing for surveillance in a pandemic with EISS and WHO. Helping Member States prepare their influenza communications. Regular EU/EEA surveys of pandemic preparedness 2006, 2007, and to come Collecting and disseminating innovations and developments from the MS and abroad. Developing and enacting a methodology for pandemic preparedness self-assessments in all thirty EU/EEA member states – done jointly with WHO Regional Office for Europe and the European Commission The recent reports all published by the countries: Ireland, Finland, Netherlands, Norway & Sweden

ecdc.europa.eu Methodology of Joint ECDC, WHO, European Commission Country Self Assessments Standardised published protocol Six month process Four to Five day Visit Initial report draft report –Description – Turkey authorities –Comments and Recommendations agreed with Turkey Authorities First draft comments and recommendations – First draft text sent to Turkey November Final report agreed with and sent to Turkey Authorities before December ? Published

ecdc.europa.eu So where are we now on pandemic preparedness?

ecdc.europa.eu Practice NationalLocal and front line Prepared- ness ECDC model for national pandemic preparedness Plans multi- sectoral unprepared adequately prepared health only 1

ecdc.europa.eu Practice NationalLocal and front line Prepared- ness ECDC model for national pandemic preparedness Plans multi- sectoral unprepared adequately prepared health only 2

ecdc.europa.eu Practice NationalLocal and front line Prepared- ness ECDC model for national pandemic preparedness Plans multi- sectoral unprepared adequately prepared health only 3

ecdc.europa.eu Practice NationalLocal and front line Prepared- ness ECDC model for national pandemic preparedness Plans multi- sectoral unprepared adequately prepared health only 4

ecdc.europa.eu So where are we now on pandemic preparedness?

ecdc.europa.eu Practice NationalLocal and front line Prepared- ness ECDC model for national pandemic preparedness Where we are now Plans multi- sectoral unprepared adequately prepared health only 3

ecdc.europa.eu Not just national Interoperability

ecdc.europa.eu European interoperability and pandemics. What does it mean? Negative Interoperability 1.I do something in my state that impacts on a neighbouring state, e.g. closing borders and stopping daily commutes to work 2.I do something in my state that causes questions or disquiet in a neighbouring state – especially if it is done without warning e.g. closing schools

ecdc.europa.eu Good news – MS Level There has been massive progress since Every Member State has a plan and many have advanced further. Many innovations and developments at the MS and EU level. novations.aspx Some states are working at all levels, down to the local level. Multi-sectoral approaches.

ecdc.europa.eu Bad news: Major gaps remain and there is some loss of momentum ‘Flu fatigue’. Policies are not yet alligned Only 12 of 29 Member States had a national contingency plan for maintaining essential services. One third of countries were yet to do work with neighbouring countries. Antiviral stockpiles do not seem to have underpinning strategies, are difficult to manage and distribute and now need to encompass antiviral resistance.

ecdc.europa.eu The five major gaps Local preparedness Intersectoral work Interoperability Research that is more targeted Improving use of seasonal vaccine and developing pandemic vaccine capacity

ecdc.europa.eu Local preparedness: most countries fail most of ECDC’s local ‘acid tests’ Are you convinced that you can –deliver and manage your stocks of antivirals in the 24–48 hour window, manage the stocks and not run out? –distribute specific pandemic vaccines efficiently and equitably when they start to become available? –maintain local essential services?

ecdc.europa.eu Intersectoral work – “The Whole Society Approach” Explicit policy options

ecdc.europa.eu between Member States, between Member States and neighbouring states, between regions and areas inside states. Interoperability

ecdc.europa.eu More targeted research A lot done Much by the European Union but Tended to be research-led, not driven by what questions need answering Need to answer specific questions, e.g. how influenza is transmitted See call for research on public health measures ECDC Influenza transmission research needs for informing infection control policies and practice Eurosurveillance 12, Issue 19, 10 May 2007

ecdc.europa.eu How to Find the Call? Deadline December 3rd eaction=UserSite.FP7DetailsCallPage&call_ id=140#infopack or Influenza News on ECDC Site news_archive.aspx September 4th news_archive.aspx

ecdc.europa.eu Seasonal vaccine use and availability of pandemic vaccine

ecdc.europa.eu Data from VENICE Survey and other sources 2008, Version 18 March 2008 From pandemic preparedness report (2007) Vaccination coverage estimated through telephone surveys (University of Zurich) Recommended WHO target for 2010 Data not available for: Bulgaria,Cyprus, Estonia, Greece, Iceland, Latvia, Malta Vaccination coverage for seasonal influenza vaccine in the elderly (65 years and older) in EU and EEA countries Latest seasonal data available in spring 2008

ecdc.europa.eu Connection between seasonal influenza and pandemic vaccines?

Influenza vaccine, worldwide production in 2003* ROW (5 %) North America Canada Japan Australia (25 %) 90 million doses distributed in Europe 100 million doses Distributed outside Europe (97 % of doses for the Americas, Eastern Europe, Middle East, Africa, Asia) Worldwide production 2003: 292 million doses (9 countries, excluding purely local production) EU production: 190 Million doses (65%) * MIV. Vaccine 2005;23:

ecdc.europa.eu Desirable Features of pandemic preparedness Measures must be centrally applied and detailed Actions should be uniform Precise priorities for prophylactic drugs Decide if and when schools should close Evidence based approach to personal measures (masks, hand washing etc) Scientific evidence for the public health measures Anderson R. Plagues & People: Preparing for Pandemics ESWI Lecture 2008

ecdc.europa.eu Conclusions A lot done, but not yet ready and there is a lot more to do. Europe is not yet prepared At least three years more hard work needed in five areas: –making plans operational at the local level; –the Whole Society approach - integrated planning across governments using explicit policy options ; –interoperability at the national level; –making influenza research more targeted; –stepping up prevention efforts against seasonal influenza; and improving vaccine capacity for a pandemic.

37 Thank you for your attention!