Preparing for an influenza pandemic and other health threats
The European Commission has adopted two action plans aimed at helping the Community and the Member States cope with cross-border public health emergencies and a possible influenza pandemic.
Commission Communication of 28 November 2005 on strengthening coordination on generic preparedness planning for public health emergencies at EU level [COM(2005) 605 final - Not published in the Official Journal].
Commission Communication of 28 November 2005 on pandemic influenza preparedness and response planning in the European Community [COM(2005) 607 final - Not published in the Official Journal].
PREPARING FOR PUBLIC HEALTH EMERGENCIES AT EU LEVEL
Purpose and scope
The general objective of the Commission communication on European coordination in the event of health emergencies is to help the Member States to draw up generic plans for all sorts of public health emergencies with the European dimension in mind. The communication and technical guidance document give the Member States a basis for devising their own general or specific plans and outline the main elements to be taken into consideration in preparing for public health emergencies.
With a view to formulating national emergency plans in the public health sphere, the Commission describes the measures which should be incorporated or taken into account in the plans for each of the following essential elements: information management, communication, scientific advice, liaison and command and control structures, preparedness of the health sector and inter-sectoral preparedness.
Information management entails the gathering, processing, use and dissemination of
- information relating to an emergency, in order to identify the hazards and risks, monitor the
- evolution of the emergency and determine the assets and resources available.
It is necessary to organise appropriate health surveillance at Member State level before an event occurs. To this end, surveillance standards in the different areas must be comprehensive and rigorously applied. Moreover, it is important to have collaboration with and between various sources of information (both within the public health sector and outside it, including the media, veterinary services and security services).
Information management entails the distribution of accurate and timely information. The infrastructure that is put in place must therefore be as robust as possible, so as to preserve communication channels even in emergencies when some forms of communication may be incapacitated.
Public authorities should communicate effectively with the public and the media in anticipation of events that may lead to public health emergencies, establishing themselves as the leading, if not the only, source of authoritative information about the event and its consequences.
Coordination is paramount for the transmission of accurate and coherent messages to the public. The Member States, the Commission and the competent EU agencies must strive to coordinate their crisis communications in the best possible way.
Management of an emergency necessarily involves the preparation and delivery of scientific advice, covering two elements:
- the creation, at all levels and in all areas, of structures such as expert groups or committees;
- rapid consultation on the scientific and technical basis for assessing and examining risks so as to make clear the options for response.
At Community level, mechanisms and structures for providing scientific advice have been set up in different sectors:
- the European Centre for Disease Control (ECDC);
- the European Medicines Evaluation Agency (EMEA);
- the Joint research Centre (JRC);
- the European Food Safety Authority (EFSA);
- the European Environment Agency (EEA);
- the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA);
- the European Agency for Occupational Safety and Health (OSHA).
In the area of communicable diseases, a coordinated real-time forecast modelling capability is being set up at EU level. This will help to identify the most appropriate ways of countering the spread of disease and agents, and to assist authorities by informing public health policy and forward planning.
Liaison and command and control structures
Command and control encompasses all planning and response functions and operations. In particular, command and control structures are required to arrest the spread of disease or contamination among the population and in the environment.
The requirements for effective command and control include:
- knowledge of the situation in terms of casualties and resources;
- response and communications coordination;
- information analysis and management.
Command and control structures help those in charge to operate effectively, despite the complexity of the situation (uncertainty, conflicting or incomplete information, etc.). In this connection, simulation can provide a valuable tool for tackling the complexity and anticipating the outcome.
Command and control centres in the Member States need to have good systems for liasing with other Member States, the Commission, Community agencies and international organisations, in particular the World Health Organisation (WHO). The Community has many liaison systems, most of which are geared to early warning and rapid alert. Notification of a health threat through the early warning and response system or the Community rapid alert system for biological, chemical and radio-nuclear attacks and threats may lead to the recognition of a public health emergency and to the activation of appropriate liaison and coordination structures at EU level and within the Commission. Furthermore, the Commission has set up the ARGUS system, which interlinks all the Community rapid alert systems, and a crisis centre with appropriate coordinating structures.
Preparedness of the health sector
Health sector preparedness covers several aspects:
- exchange of information between Member States on the national planning principles (including sharing of information on planned activities and assistance);
- pooling of resources for epidemiological and laboratory investigations;
- strengthening of procedures for transferring patients from one Member State to another;
- introduction of isolation procedures;
- development of new medicinal products and medical services. In this area, an EU-wide effort is needed to guarantee equitable access to essential medicinal products and to ensure the provision of adequate reserve supplies. A Community strategy for the development and production of priority medicinal products to counter the main health threats is also necessary. The Community has already taken a series of initiatives to ensure the availability of antivirals and vaccines in the event of an influenza pandemic.
Preparedness in other sectors and inter-sectorally
The mechanisms required to deal with public health emergencies beyond the health sector work in two ways, serving to:
- assist the public health authorities in medical interventions;
- perform activities which fall mainly within the responsibility of sectors other than public health (logistics, decontamination, transport, telecommunications, civil protection and civil defence operations, maintenance of public order, etc.).
The application of certain measures will require the intervention of authorities other than health services and will therefore entail coordination between them.
The preparedness of third countries is also crucial for protecting the European Union against health risks that may arise in those countries. Thought therefore needs to be given to a coordinated approach within and outside the EU in order to protect citizens from known or unforeseen health risks.
EU PREPAREDNESS AND RESPONSE PLANNING FOR AN INFLUENZA PANDEMIC
In March 2004, the European Commission adopted the first Community influenza pandemic preparedness plan (COM(2004) 201 final). This strategy establishes the respective roles of the Commission and the Member States in preparing for a pandemic, and outlines the key measures to be taken at certain pre-defined stages and levels, primarily concerned with management and coordination, surveillance, prevention, alleviation and response, communication, civil protection and research. This strategy is constructed mainly around the recommendations of the World Health Organisation (WHO).
The communication of 28 November 2005 on pandemic influenza preparedness seeks to review this strategy in the light of new developments in the field, namely:
- the publication of revised WHO recommendations concerning pandemic influenza;
- the setting up of the European Centre for Disease Prevention and Control (ECDC).
The six phases of an influenza pandemic
The action plan sets out an EU response proposal for each of the six phases of an influenza pandemic as defined by the WHO:
- Phase 1 - inter-pandemic period: no new influenza virus subtypes detected in humans;
- Phase 2 - inter-pandemic period: no new influenza virus subtypes detected in humans, but a circulating animal influenza virus poses a heightened risk of human disease;
- Phase 3 - pandemic alert period: human infection with a new subtype, but no human-to-human spread;
- Phase 4 - pandemic alert period: small cluster(s) with limited human-to-human transmission but spread is highly localised, suggesting that the virus is not well adapted to humans;
- Phase 5 - pandemic alert period: larger cluster(s) but human-to-human spread still localised, suggesting that the virus is increasingly becoming adapted to humans, although not yet fully transmissible (substantial pandemic risk);
- Phase 6 - pandemic period: increased and sustained transmission in the general population. Several outbreaks in at least one country outside the EU with human-to-human transmission and spread to other countries.
Determining responsibilities at Community and national levels
For each phase of the pandemic, the action plan sets out in detail the respective responsibilities of the Member States, the Commission and the ECDC. At the operational level, the measures to be taken are presented in terms of:
- planning and coordination;
- assessment and monitoring;
- prevention and containment;
- health system response;
- communication between Member States and the EU, and to the public.
The terrorist attacks that occurred in the United States in September 2001 demonstrated the need for stronger public health policies, contingency plans and resources geared to preventing this type of attack and limiting the effects.
The SARS epidemic of 2003, constituting another major event in the public health field, resulted in a major re-think of defences against communicable diseases. It provided a test of the usefulness of the EU's coordination activity based on the early warning and response system. Thanks to this system, the Member States were kept informed of the situation and were able to make preparations to halt any spread of the disease.
The twentieth century has also experienced three influenza pandemics. Recently, the risk of a new global influenza pandemic had to be re-assessed following the appearance of avian influenza in Asia and its spread in the world. Although there is no way of forecasting when the next pandemic might start, the repercussions of such an event would be considerable, not only in terms of mobilising the health and social services but also in terms of social and economic upheaval. Methodical preparedness planning and action at EU and Member State level can help to attenuate the extent and consequences of a pandemic.
The Commission has accordingly adopted two action plans designed to prepare the Community and the Member States for confronting public health threats at European level. One plan aims to enhance European coordination in the event of public health emergencies by providing for a general strategy applicable to different types of health threat, whether they are anticipated (like pandemic influenza) or unforeseen (like an epidemic similar to SARS). The other is concerned more specifically with preparing for and responding to an influenza pandemic.
- Further information can be found on the European Commission's Public Health website