Health Security Workshop:
How to benefit from European projects?
13-14 November 2014 – Brussels
SHIPSAN ACT – Joint Action
The impact on maritime transport
of health threats due to biological,
chemical & radiological agents,
including communicable diseases.
Professor Gordon Nichols
Consultant Epidemiologist, Gastrointestinal
Emerging and Zoonotic Infections, Centre for
Infectious Disease Surveillance and Control, Public
Health England
DG HEALTH & CONSUMERS PUBLIC HEALTH PROGRAMME 2008-2013 Contract No: 2012 2103
Diseases on ships: A historical perspective
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Plague in ships sailing from Asia to the Crimea, 1348
Smallpox, measles, influenza, and typhus introduced to the New World in 1492
Influenza on the 2nd Colombian expedition in 1493
Smallpox in a ship sailing from Mauritius to France, 1792
Yellow fever in a ship sailing from Cuba to Wales, 1865
Cholera transmission initiating pandemics – 19th century
EU SHIPSAN ACT Joint Action
Three SHIPSAN projects
Shipsan - Situation analysis and needs assessment
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Addressing passenger ships
State of the art: Communicable diseases & outbreaks from 1970 to 2006 2006 - 2008
Study: 32 countries and 176 authorities
Needs, gaps, legislation - EU MS categorised in 4 groups according to their capacity
Use experience of existing programmes
Manual for health and hygiene - outline
Shipsan Trainet - Developing materials and a training network
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2008 - 2011 •
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Manual for health and hygiene
Training network and pool of experts
Training material
Training modules for PHO & seafarers
EU SHIPSAN Integrated Program/pilot inspections
Web-based Communication Network
Shipsan Act - Joint Action for all types of threats in maritime transport
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Cargo ships
Inland navigation vessels
Fishing vessels
Passenger ships
EU SHIPSAN ACT Joint Action
2013 - 2016
The partnership
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institutions from
countries
were designated by their Ministries
of Health
Austria
Belgium
Bulgaria
Croatia
Cyprus
Denmark
Estonia
France
Germany
Greece
Iceland
Ireland
Italy
Lithuania
Malta
Netherlands
Norway
Poland
Portugal
Romania
Slovakia
Slovenia
Spain
United Kingdom
EU SHIPSAN ACT Joint Action
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DG SANCO
DG MOVE
ECDC
EMSA
EU-OSHA
ECHA
VSP CDC
WHO
Synergies
European Centre for Diseases Prevention and Control (ECDC)
European Agency for Safety and Health at Work (EU-OSHA)
Advanced National Networks for Administrations (AnNa) project
EU AIRSAN project
European Chemical Emergency Network project
Mediterranean Programme for Intervention Epidemiology Training
(MediPIET)
World Health Organisation
Collaboration with Chinese authorities (training/manual)
Brazilian Health Surveillance Agency (ANVISA)
EUROMED countries
Cruise Line Industry Association
EU SHIPSAN ACT Joint Action
Shipsan Act Joint Action: Objectives
To strengthen an integrated strategy and sustainable mechanisms at EU
level for safeguarding the health of travelers and crew of passenger and
cargo ships and preventing the cross-border spread of diseases.
Prevention, identification, assessment & link with existing mechanisms for response
coordination to serious cross border threats to health caused by communicable
diseases, chemical, biological and radiological agents.
Facilitate the implementation of the EU legislation:
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Decision No 1082/2013/EU of the European Parliament and of the council on serious
cross-border threats to health
Directive 2010/65/EU on reporting formalities for ships arriving in and/or departing
from ports of the Member States by supporting EMSA to implement MDH
Directive 2009/13/EC based on ILO convention on occupational health by developing an
outline of a risk assessment tool for occupational health on ships – OSHA-OiRa tool
Facilitate implementation of IHR by supporting core capacities Annex 1b by
training, inspections, contingency planning guidance and IHR provisions for
conveyances and conveyance operators including SSC
EU SHIPSAN ACT Joint Action
Duration: 39 Months (January 2013 -
April 2016)
Improving planning, preparedness and
response at ports
Guidelines under development for competent authorities in
support to their risk assessment and response to chemical and
radiological incidents on ships while the ship is at port.
• Two Simulation exercises to be conducted
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1st Simulation exercise:
– test a multi agency working in response to chemical and radiological incident
– practice procedures for the alerting and notification of significant cross border
health threats
– enable organizations to develop appropriate systems if gaps are identified
2nd Simulation exercise:
– Table top & operational exercises for the EU SHIPSAN ACT Information System (SIS)
• European Manual for Hygiene Standards and Communicable
Disease surveillance
• Guidelines for the prevention and control of influenza
• Prevention and control of gastroenteritis on passenger ships
• Guidelines for the prevention and control of legionellosis
EU SHIPSAN ACT Joint Action
Improvement
of preparedness
and response
at ports
Event
detection
and
response
Strengthening capacities for event detection and response on ships for
all types of health threats (biological, chemical, radiological)
Sharing of information and avoiding duplication of efforts and
repetition of actions in event management
Facilitation of communication in real
time within and outside countries
– 19 public health events on ships
followed up using the web-based
Communication Network
http://www.shipsan.eu/comnet/
Planning a European database for storing
the Maritime Declaration of Health
submitted in the National Single Window
(Directive 2010/65/EU)
– functions for analysing data to the
competent health authorities
– facilitate risk assessment
EU SHIPSAN ACT Joint Action
Improvementinspections
of preparednessusing
and response
at ports
Conducting
common
standards
of WHO and EU legislation
– Maintaining an information system for recording and issuing Ship Sanitation
Certificates (IHR 2005) for all types of ships based on WHO guidelines.
http://ssc.shipsan.eu/
• 172 registered inspectors from 10 European countries
• A total of 5062 SSCs have been issued and recorded in the SHIPSAN
information system based on the WHO Handbook for inspection of ship
and issuance of SSCs
– Coordinated passenger ship inspection programme and database of
inspection results based on the “European Manual for Hygiene Standards
and Communicable Diseases Surveillance on Passenger Ships”
2013:
2014 (ongoing):
2015:
50 inspections conducted
48 passenger ships in 22 ports
13 EUMS based on EU standards
By trained inspectors
51 inspections
scheduled
Unannounced inspections by trained port
health officers / Non voluntary participation
of passenger shipping companies
– Sharing results
EU SHIPSAN ACT Joint Action
Improvement
of preparedness
and response
at ports
Support
training
of port health
officers
in risk
assessment, response and ship inspections
Training courses
• Face to face courses focused on IHR(2005) and the issuance of SSCs and on European
manual and SIS:
• 4 at European Level (3 completed, 1 scheduled: June 2015)
• 6 at National Level (Ireland, Bulgaria, Greece, Italy, Spain, Croatia)
• E-learning: 325 registered users
Pool of Trainers
• 83 trainers from 20 countries
EU SHIPSAN ACT Joint Action
Trainees
• 101 port health officers trained in 3 face to face
training courses
• 104 inspectors in training/on the job training
Providing
expert
public health
advice
for
Improvement
of preparedness
and response
at ports
biological, chemical and radiological events
including communicable diseases events
• Ad hoc working group for Ebola
• Inquiry on potable water for human consumption from sea
water in Japan through reverse osmosis and evaporator
• Consultation on 2 outbreaks
• Developed Water Safety Plans for 2 ships upon request
• Request to monitor and participate in a research protocol
• Analysis of a cruise companies' data for Gastrointestinal Illness
• Analysis of data for meningitis outbreak
• Outbreak investigation on cruise ship accommodating
earthquake victims
• Advice on water microbiological testing
EU SHIPSAN ACT Joint Action
EU SHIPSAN
ACT JA activities
focused on seafarers
Activities
focussed
on Seafarers
• EU SHIPSAN ACT JA further protects health of crew
working on ships, by providing training on ILO MLC
health related issue:
– 96 seafarers were trained in 3 face to face training
courses
• Develops a web-based risk assessment tool for
occupational health risks per cargo ship type by using the
European Agency for Safety and Health at Work (EUOSHA) Online Interactive Risk Assessment (OiRA) tool
http://www.oiraproject.eu/
• Survey on the current status of implementation of ILO
Maritime Labour Convention, 2006.
EU SHIPSAN ACT Joint Action
Identification of gaps and needs - Survey on training training needs related to
core capacities at points of entry-ports
• Different policies at designated and authorized ports for issuing Ship
Sanitation Certificates.
• Different inspection practices.
• Contingency plans not available for all the countries (67%)
• Most countries have specific personnel to inspect ships but not for outbreaks
management.
• There is a lack of training.
• Lack of coordination of outbreak investigation, inspection and control
• Lack of guidance
- Recent example Fukushima, Japan = impacted ship travel challenging
authorities due to lack of guidance
• Lack of communication and differences in IHR implementation
• Diversity of inspectors’ knowledge, qualifications, training practices,
heterogeneity in MS occupational health policies, seafarers medical
certification/ infectious disease reporting
EU SHIPSAN ACT Joint Action
Identification of gaps and needs - Survey on hygiene inspection
practices on fishing vessels:
• Almost half of the countries don’t have specific legislation for the
inspection on fishing vessels.
• Most of the countries do not perform regular inspections.
• Most of the countries there is no evidence for the issuance of Ship
Sanitation Certificates.
• 7/12 countries require to report health events.
• 5/7 use the Maritime Declaration of Health.
Identification of gaps and needs - Survey on chemical and radiological
incidents in maritime transport:
• Legislation and contingency plans are not specific for ships or at ports.
• Responsible authorities for radiological events easier to identify than
for chemical events.
• Competent authorities are not usually health authorities & are mainly
national authorities.
• There is lack of training.
EU SHIPSAN ACT Joint Action
Sustainability Survey – results from associate partners, collaborative partners
and port health officers participating in SHIPSAN inspections
In your opinion, should this activity be part of the long-term strategy and be
implemented sustainably in the EU countries?
Activities
Yes
Activity 1 - Training programme
51/52
(98.1%)
Activity 2 - Maintaining an information system for recording and
issuing Ship Sanitation Certificates
Activity 3 - Coordinated passenger ship inspection programme and
database and manual
50/52
(96.2%)
52/52
(100%)
Activity 4 - Maintaining a European database for storing the
39/52
Maritime Declaration of Health
(75%)
Activity 5 - Maintaining a communication network platform of
competent authorities for ports in EU Member States
50/52
Activity 6 - Providing expert public health advice on responding to
biological, chemical and radiological events
Activity 7- Supporting and developing a risk assessment tool for
EU SHIPSAN ACT Joint Action
occupational and public health risks on cargo ships
(96.2%)
43/52
(82.7%)
37/51
(72.5%)
Sustainability – 1st General Assembly Meeting – Results 17th October 2014,
Luxembourg
• Any outcome of the Joint Action in regards to the legal framework should
be supplementary to the current legislation
– IHR 2005
– Decision No 1082/2013/EU for cross border health threats
– Directive 2010/65/EU for the NSW.
• The EU SHIPSAN ACT General Assembly members decided to proceed with
a consensus document that will be sent to the European Commission
services, the Health Security Committee and other competent bodies to
be considered for a future Recommendation
– it will address elements not currently covered by existing legislation.
EU SHIPSAN ACT Joint Action
Sustainability – Funding options considered by the partnership
– Transport and Health Joint Action (SHIPSAN, AIRSAN, LANDSAN)
OR Maritime transport Joint Action OR Joint Action involving
EUROMED countries DEVCO OR/AND Operating grant
– Fees:
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Inspection
Training
Consultation
New build ships
– Funding specific activities (training etc.)
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DG DEVCO
IMO
WHO
MONALISA project
AnNa project
MediPIET
Other projects
EU SHIPSAN ACT Joint Action
Shipsan Act Joint Action: Conclusions
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Protecting the EU population against health threats by improving health security.
– Helps country preparedness planning, responding to events in a coordinated
manner by developing contingency plans and IHR core capacities.
Protects the health of passengers travelling on ships in the EU by:
– strengthening compliance of ships with MS/and EU legislation, standards and
guidelines related to hygiene, CBRN events management and ;
– implementing an integrated strategy for epidemiological investigation;
Protects health of crew working on ships, by:
– providing training on ILO MLC health related issues.
Strengthens the EU’s capacity to monitor and respond to health threats by:
– developing EUMS cooperation
– facilitating rapid ship-to-port and port-to-port information exchange using
web-based tools.
Provides risk assessment data and implementation of response measures at the
port level to existing monitoring and early warning mechanisms at local, national
and EU levels.
EU SHIPSAN ACT Joint Action
Thank you for listening.
For further information:
www.shipsan.eu
EU SHIPSAN ACT Joint Action
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