1. EUNID meeting-Rome,27-28 May 2005
Highly infectious diseases: prevention and control and the impact on public health in the EU
George Gouvras
European Commission
Directorate-General Health and Consumer Protection

2. Synopsis
Key events in EC involvement on diseases from highly virulent agents, requiring special conditions of care and protection
Health and Safety at Work, Research,Public Health,Humanitarian Aid measures
Impact of the anthrax attacks in the US in 2001 and the work on health security
SARS and the advent of the ECDC
The future public health programme proposals

3. Key events and moves Ebola in Congo,1995 – EC humiliation
Plague in India,1995 – EC impotence
BSE/CJD, 1996 – EC guilt
Anthrax attacks in 2001 – EU awakening
SARS, 2003 – generic plan request
Highly pathogenic AI,2004
Marburg in Angola,2005 – More of the same, but a glimmer of hope
AIDS and other CDs programme proposal
Friction with the WHO- beginning of the IHR revision effort
Community Network
Health Security Programme – Funding from Public Health and Research Programmes
ECDC, proposals for a new Public Health Programme and RTD FP7, BTWC

4. Health and safety at work
The most comprehensive set of biosafety legislation, aims at prevention
Framework Directive 391/89/EC
Biological agents Directive 1990 revised
Personal Protective Equipment Directive 1989
Workplaces directive 1989
Harmonisation directives on equipment, medical devices – European Standards
Application? Control? Enforcement?

5. EU strategy on communicable diseases and health security
November 1993:Maastricht Treaty and Article 129
First public health strategy: identified co-operation in communicable disease control as one of the Community’s priorities
Funding of surveillance networks, training in field epidemiology (EPIET) and dissemination of information (EURO-SURVEILLANCE, EPINORTH etc) through the programme on AIDS and other communicable diseases
March 1996:European Network for the epidemiological surveillance and control of communicable diseases –
(EP-Council Decision 2119/98/EC adopted on )
Epidemiological Surveillance component of the Community Network (Network of surveillance agencies)
Early Warning and Response System ( national public health authorities)
Five Commission decisions on: diseases under active surveillance, case definitions, event reporting requirements, bioterror agents, and conditions for the operation of dedicated networks
November 2001: Council Rcommendation on AMR
Amsterdam/Nice Treaties: Regulation on Centre for Disease Prevention and Control

6. Health Security Programme- objectives
Threat awareness and command and control arrangements: Mechanism for information exchange, consultation, co-ordination
Surveillance and detection: Capability for inventorying, detection and identification
Response and recovery: Medicines’ stocks and health services database and arrangements for availability of medicines, specialists, other medical goods and infrastructure, clinical guidelines for bioagents
Prevention and Protection: Interdiction of agent movement and critical infrastructure protection
Legislation, rules and guidance
co-ordination of the EU response in other policies

7. Infection control projects under the public health programme
EUNID
E-Threat
Associated
EPIET
EURONET P4
Proposed
EUTIDE
SX diagnostics

8. European Centre for Disease Prevention and Control
AIDS-STDs
Vaccine preventable
CJD and non-conv.
Anti-microbial resistance
Serious imported
Viral hepatitis
Air-borne (Legionella, TB,Meningitis)
Food, water, environmental -related
Schemes to evolve:
Evaluation
Budget issues
Timetable
EPIET Training
Eurosurveillance
European Centre for Disease Prevention and Control

9. Assistance and training
Networks
Ad hoc panels
Studies
Cion, EP, MSs
The 3 Strands
Assist by Operating EWRS
Identification of health threats
Training
Expertise and outbreak assistance
Scientific opinions
Information
Assistance and training
Operate or commission networks
Set up and maintain databases
Disseminate information
Communication to public

10. Other policies Research: Committees Expert Groups
6th Framework Programme:
diagnostics
detection
new vaccines and therapeutics
decontamination

11. Thematic priority 1: Life sciences, genomics and biotechnology for health
1.1 Advanced genomics and its application for health
(€ 1100 M)*
1.1.a Fundamental knowledge and basic tools for functional genomics in all organisms
1.1.b Applications of knowledge and technologies in the field of genomics and biotechnology for health
1.2 Combating major diseases
(€ 1155 M)
1.2.a Application oriented genomic approaches to
medical knowledge and technologies
1.2.b Combating cancer (400 M)*
1.2.c Confronting the major communicable
diseases linked to poverty
755 M*
400 M

12. Integrated actions (IAs);
Specific targeted research projects (STREPs): gain new knowledge, improve or develop new products, processes or services, prove viability of new technologies;
Networks of Excellence (NoEs): Integrating activities, coordination of partners, staff mobility and exchanges, relocation of staff, teams and equipment;
Coordination actions (CAs): Conferences, studies, exchanges of personnel;
Training (Marie Curie actions): Mobility of researchers;
Technology platforms (TPs): Stakeholders to develop long-term vision for new technologies, create coherent research strategies and plans, stimulate increased and more effective investment in RTD, accelerate innovation and eliminate barriers;
Scientific support to policies (SSP) or to actions (SSA)

13. Health, Security and Opportunities for the People of Europe
- Public health issues : epidemiology, disease prevention, rare and communicable diseases, allergies, secure blood and organ donations, non-animal testing methods
Civil protection issues (including biosecurity and protection against risks arising from terrorist attacks and crisis)
A special call on SARS published on 3rd July 2003:Research capacity and scientific support & advice, molecular epidemiology of SARS, clinical manifestations including disease transmission, infection control, risk assessment

14. Resistance to antibiotics and other drugs
1st Call
Antiviral drug resistance (Influenza, HBV, HCV) (NoE)
Lower respiratory tract infection (NoE) – not covered
Basic mechanisms of resistance (STREP or CA)
Exploitation of microbial genomics (SSA)
Hospital-infection (SSA) - not covered
3rd Call
2nd Call
Functional genomics of antibiotics producing organisms (IP)
New molecular targets for anti-bacterial drugs (IP)
Non-antimicrobial approaches to address resistance (STREP or CA)
Lower respiratory tract infection (NoE)
Mobile genetic elements and resistance genes (STREP)
Ecological factors impacting on fitness/ virulence/ resistance (STREP)
From ba sic research to clinical practice (SSA)
Microbial genome annotation (SSA)

15. Other policies
Humanitarian aid: operates through international organisations (eg WHO, Red Cross and Red Crescent, etc)
Development – the malaria, AIDS and TB programme
Civil Protection: assistance for first phase emergency actions
Prevention-control measures:
Food and water safety
Animal and plant safety, eg highly Infectious Avian Influenza
Measures concerning movement and residence

16. International Co-operation
UN and UN agencies, ECHO, OECD-DAC
Global Health Security Initiative (Nov. 2001)
Incident scale, risk management and communication
Smallpox training,vaccine conference,exercise Global Mercury to evaluate communications and plans and check inter-operability
P4 laboratory co-operation
Chemical threats
patient isolation techniques
Influenza
Co-operation with the WHO on exchange of letters, support to GOARN operations (EPIET)

17. Current priorities Health system preparedness
Development and evaluation of general preparedness and response plans and capability
Health system preparedness
Hospitals
(disaster plan and procedure, safety and hazard control and QA)
Capacity fixes : emergency and casualty, isolation, barrier nursing, intensive care)
preventive and protective measures’ plan for staff
staff numbers, training and assignment in teams
Health centres and mobile units & medical teams
Ambulance support and victim distribution
Rest of patient/victim transport and treatment capacity

18. New developments Marburg outbreak in Angola
The new public health programme proposals:
Two mobile laboratories
Ten isolation modules for transport
Associated PPE
Custody by ECDC
Training to be organised by the ECDC
Outbreak assistance teams
Deployment on request
Solidarity Fund : reimbursement of medical intervention costs