Select Committee on Science and Technology Minutes of Evidence

Supplementary Information from Professor Angus Nicoll, PHLS

The Role of the European Union in Relation to Communicable Disease Control in the UK

Q. Why is the European Union important to communicable disease control in the UK?

A. The UK is functionally and politically part of Europe. Communicable disease events in other parts of Europe will affect the UK, and vice versa (see Table 1—Potential Major European Health Protection Emergencies). Specific real examples of acute European communicable disease emergencies" are in the accompanying article by MacLehose et al.

The increasing movement of people and goods across Europe, an element of globalisation" means that the risks from communicable diseases within Europe are rising. This will increase following the entrant of the Accession Countries", most of which have a far higher rate of various communicable disease and lower levels of disease control than other countries.

Equally concerning control of more chronic" diseases and issues (tuberculosis, HIV, anti-microbial resistance etc) many control measures need to be co-ordinated if they are to be effective across Europe as a whole.

The European Union has considerable resource available for communicable disease control in terms of EU funds and personnel in the member countries. The funding that is available through the EU dwarfs that available to WHO (Europe).

European union structures outside of the health directorates (DG-Sanco) will affect communicable disease control for example by influencing (and relaxing) controls and regulations on movements of people and goods.

Q. What has Europe achieved to date?

A. The network model for Europe has been regarded as a considerable success with a number of effective networks established for a number of diseases and functions, as detailed in the article by Van Loock (attached). The funding for this work has flowed from the Network Decision of the EU (attached). The networks include those for detection and control of specific or groups of infections. Of gastrointestinal infections (ENTERNET), detection and control of travel associated legionnaires disease (EWGLI), influenza (EISS). There are also function-related networks for training (EPIET), resource inventories (IRIDE) and information (Eurosurveillance). These networks all work on the basis of being shared across all the national surveillance/control centres but with one centre providing a server function and receiving most of their funding. This funding only provides a small amount of the support needed to deliver the function. CDSC and CPHL provides the server" element for ENTERNET and EWGLI. The central funding and administration come from the European Union Health Directorate (DG-Sanco).

Q. What weaknesses are there?

A. There are many weaknesses at national levels as not every country has a complete suite of infection control functions and quality and investment in individual components is variable. Consequently the ability to undertake surveillance and response is highly variable.

At the supra-national (European) level there are a number of structural and functional weaknesses:

— The funding for the networks are usually on an annual basis, preventing long-term planning.

— It has proved almost impossible to attract and appoint experienced senior public health staff into DG-Sanco. There have and are exceptions to this but they are just that, exceptions on short-term secondments.

— There is poor co-ordination between the Service (DG-Sanco) and Research (DG-Research). There is no effective mechanism for reviewing and strengthening the networks. Consequently almost the only mechanism for effecting improvements is moving the network server" from one country to another.

— There is no mechanism for responding to a pan-European incident or outbreak.

— The response to 11 September and bio-terrorism (Civil Protection) has not built on what was pre-existing but created a separate team and streams of work.

— There is no network for reference facilities, which are generally fragmented, disorganised with considerable duplication.

Q. What developments are proposed?

A. It is proposed that there should be a European Centre that should be active in 2005. There is a commitment to this from the Commissioner for Health and Consumer Affairs, Mr David Byrne, and this seems almost certain to go ahead (see attached transcript of a speech by Mr Byrne).

A. As yet it is unclear what is in Commissioner Byrne's mind. A list of possible functions is in Table 2 below derived from the Van Loock article and the CESE statement.

There are strong arguments for a slim (n=40-60 including out-posted staff) and effective co-ordinating centre (see MacLehose et al and Van Loock et al). However this will only work if there is a commitment to this from the stronger countries, that it works well with the central European structures and the state epidemiologists (CESE) and it can be guaranteed that it contains competent and respected senior staff. This can be achieved by placing the centre in an attractive part of Europe, close to and supporting the Commission and Parliament and with an arrangement that will allow secondments for extended periods from the strong national European centres.

Q. What are the dangers and risks?

There are a number of these:

— It could be that the UK government does not recognise the need for a European centre, not recognising the essential contribution of Europe to communicable disease control affecting the UK.

— The centre might end up following the CDC (Centres for Disease Control and Prevention—USA) model of aiming to be a large multi-purpose centre but without being a source of significant new resource for member states and effectively competes for limited European funds.

— The centre might end up being large and bureaucratic or legalistic and regulatory and not attracting the competent staff needed to make it work.

— The centre might be dealing only with communicable diseases and not the whole range of European health protection. In particular it needs to encompass the civil protection strand of work.

Angus Nicoll

Direct PHLS Communicable Disease Surveillance Centre

30 December 2002

Table 1: Potential Major European Health Protection Emergencies

1. A major community-wide outbreak of gastrointestinal disease.

2. An outbreak of an unknown illness—either biological or due to chemical or radiological exposure.

3. The appearance of a previously unrecognised pathogen in the blood supply.

4. Chemical, biological, or radiological contamination of a water supply.

5. A lost source or an accidental release of radiation affecting a number of countries.

6. An emergent or re-emergent infection abroad that could be imported to European countries.

7. International concern over the safety of a vaccine.

8. A serious imported infection affecting a number of countries.

9. The emergence of a new sexually transmitted infection (STI) or the re-emergence of a previously recognised STI.

10. The next influenza pandemic.

11. Suspected deliberate or accidental release of a serious biological agent.

12. A major international epizootic with implications for human health.

Table 2: Functions of an EU Communicable Disease Control Centre

1. Moderation and development of the EU Early Warning System.

2. Maintenance and development of a Rapid European Outbreak Response Service by co-ordinating the use and supplementation of resources in the national centres and disease specific networks in the EU.

3. Co-ordination of the rapid preparation of technical advice in emergency situations for the Commission.

4. Provision of technical briefings on policy issues for consideration by the Network Committee and the Public Health Programme.

5. Co-ordination of the structured evaluation of disease specific networks on behalf of the Network Committee.

6. Production and dissemination of authoritative information for professionals and the public (eg Eurosurveillance weekly and monthly).

7. Facilitation of a Designated EU Reference Laboratory Service" that commissions international reference services.

8. Management of the European public health training for health protection (eg the EPIET training programme) and other international training initiatives.

9. Maintenance of the inventory of resources for communicable disease prevention and control in the EU (IRIDE).

10. Advising the related research programme of DG-Research so that it supports the Public Health Programme on communicable diseases.

11. Liaison and co-ordination action with national European surveillance and response centres and Ministries of Health.

12. Liaison with other international bodies, eg WHO-Euro, WHO-GOARN, to ascertain health threats from communicable diseases outside the EU and to assist the co-ordination of international responses.

Adapted from Van Loock et al

Eurosurveillance 2002 7: 78-84

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