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Strengthening Europe’s defences against infectious disease

Zsuzsanna Jakab
European Centre for Disease Prevention and Control

We saw it in 2003 with SARS, and we have seen it again this year with H5N1 avian influenza. Infectious diseases can  spread internationally at alarming speed – and they do not  respect borders. In the 21st century, effective  international cooperation is essential if we are to protect  public health against such threats.

This was recognised by the European Parliament and the EU’s Council of Ministers in 2004 when they passed legislation to create the European Centre for Disease Prevention and Control (ECDC). The need for public health cooperation is particularly acute in the EU, where economic integration and open frontiers mean millions of people cross national borders every day. Indeed, such cooperation has been taking place between EU countries since the 1990s with countries alerting each other to disease outbreaks that might spread across borders via the EU’s Early Warning and Response System (EWRS), and various joint projects on disease surveillance. The creation of the ECDC marks a step change in this cooperation. Europe now has a centre dedicated to developing and strengthening its continent-wide defences against infectious disease.

Identify, assess and communicate
I took up my post as director of the ECDC in March 2005. In  the early months my focus had to be on the basics of recruiting staff, finding premises and getting the telephones connected. These things are important, and as director I have had to devote time to them. But our mandate  to “identify, assess and communicate current and emerging  threats to human health from communicable diseases” obliged us to start producing the product while we are still  building the factory!

By late May 2005 the ECDC had a core staff in place and  become operational, in the sense that it began monitoring  the EU’s disease outbreak EWRS 24 hours a day, seven days a week. EWRS is still run by the European Commission, but the ECDC has become an increasingly significant player in this network. By the autumn of 2005, the ECDC’s senior management team was in place and we moved to permanent headquarters, the Tomteboda building, on the campus of the Karolinska Institute, Sweden (see Figure 1). Finding a permanent base was of major operational importance in giving our staff and our IT systems long-term stability.

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Straight into action
The sense of urgency in making the ECDC operational quickly was well placed – autumn 2005 saw H5N1 avian influenza arrive in the EU. The ECDC was called on to work with public health authorities across Europe to develop EU guidelines on the protection of people who might be exposed to infected poultry and an assessment of the risk H5N1 avian influenza posed to human health in Europe. We were able to produce these documents rapidly thanks to the dedication and hard work of its management team and key scientific staff.

The start of 2006 saw human cases of avian influenza in  Turkey and then in Iraq. In both cases ECDC epidemiologists played a key role in the international teams sent to assist  these countries. From mid-February onwards, H5N1 avian  influenza started appearing in wild birds in the EU. The  ECDC issued further advice to Member States on populations in the EU that could be at risk – in particular, people who keep “backyard” poultry flocks – and suggested messages they could give out.

Public concern over H5N1 avian influenza has focused  political attention on the wider issue of preparedness  against a human influenza pandemic. The ECDC has been active in this field with a programme of visits to assist European countries in reviewing and strengthening their preparedness. In May, the ECDC hosted an EU/WHO workshop entitled “Pandemic Preparedness”, which followed up on similar workshops in 2005.  

Integrated surveillance cooperation
This year is regarded as a preparatory year for the ECDC’s  surveillance activities. From 2007 we will start taking over  responsibility for producing European level surveillance  data on the 46 diseases and disease groups that are  notifiable at EU level. In October 2005 the Centre’s  Management Board approved a strategy on the future of  European disease surveillance. This sets out the principles  and objectives that will guide the transition from the  current situation, where there are just under 20 dedicated  surveillance networks (DSNs) run as individual EU funded  projects, towards a more integrated approach to surveillance  cooperation. A first meeting between the ECDC and the DSN  teams took place in November and a process of reviewing the  work of the DSN – and the needs of the ECDC for external  support in disease surveillance – will get underway this  year.

In the autumn of 2005 the ECDC published an open call for  nominations aimed at scientists wishing to be considered as  members of its expert scientific panels. The ECDC is  planning to create ad hoc panels as the need for external  scientific advice evolves. This will be especially necessary  during the first years of existence, when the number of  staff will still be quite small. However, we have already  started producing science. Notably, we have devised a risk  assessment on the human health implications of the arrival  of H5N1 avian influenza in Europe and guidelines on the  protection of persons who may be exposed to infected birds.  These documents were produced after intensive consultation  with the ECDC’s Advisory Forum, which brings together the  public health institutes of the Member States.

The ECDC’s provisional budget for 2006 is €17.2 million, and  its head count is set to rise to 50 officials (from 29  presently), with staff on detachment to us from national  public health authorities providing an additional resource.  My ambition is that by the end of 2006 ECDC will have  experts in place to cover all of the key infectious diseases  within our mandate.

Much attention has been focused in recent months on avian  influenza. However, there are other diseases – some old,  some new, all potentially lethal – that we must also focus  on. These include HIV/AIDS, tuberculosis and emerging  diseases such as drug-resistant 027 Clostridium difficile.