ECDC – a new agency for
Public Health in Europe
Karl Ekdahl
Strategic Advisor to the Director
How the European Union functions
on health protection
• Health care is the business of Member States
• The European Union and Parliament has no
remit to interfere in human health care issues
• Contrasts the position for animal health
• But infection is an anomaly (the six Freedoms)
Internal Market – 4 Freedoms
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Free Movement of People
Free Movement of Services
Free Movement of Goods
Free Movement of Capital
Internal Market – 5th & 6th Freedom
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Free Movement of People
Free Movement of Services
Free Movement of Goods
Free Movement of Capital
Free Movement of Micro-organisms
Free Movement of Birds
Decision 2119/98/EC
”Network decision”
• Decision of the Parliament and the Council
• Community Network for epidemiological surveillance and
control of communicable diseases :
 Epidemiological surveillance of diseases
 Early warning and response system (EWRS)
• Under coordination by the Commission decide on:
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List of diseases under surveillance = 49
Criteria for selection of these diseases
Case definitions – under revision
Nature and type of data to be collected
Epidemiological and microbiological surveillance methods
Guidelines on protective measures (external borders)
Guidelines on information and guidance to the public
”Daughter decisions” to 2119/98/EC
• Decision 2000/57/EC ”EWRS decision”
• Decision 2000/96 ”List of diseases under
surveillance”
• Decision 2002/253/EC (2002/534/EC) ”Case
definitions”
• Decision 2003/542/EC ”DSN decision”
Decision 2000/57/EC
”EWRS decision”
• Decision of Commission
• Events to be reported
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Outbreaks involving more than 1 MS
National outbreaks with a risk of spread to other MS
Outbreaks outside the Community with risk of spread to MS
Appearance/resurgence of communicable diseases or
infectious agents wich may require timely, coordinated
Community action to contain it
• Procedures for informtion, consultation and
cooperation
• Actors = The Commission and competent authorities
in the MS, lately also ECDC
Dedicated surveillance networks
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One hub with coordinator and small secretariat
1 epidemiologist + 1 microbiologist per MS
Reporting of detailed diseases data
Detect outbreaks and follow trends
Scientific studies
Typically funded by Commission (60%) and
MS (40%)
Dedicated surveillance networks
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EnterNet – Salmonella + EHEC (HPA, UK)
ESSTI – STI (HPA, UK)
EU-IBIS – invasive HI and menigococci (HPA, UK)
EWGLI – Legionella (HPA, UK)
Euro-HIV – HIV/AIDS (InVS, France)
Euro-TB – TB (InVS, France)
IPSE – nosocomial infections (Université Claude Bernard, France)
EARSS – AMR (RIVM, Netherlands)
EISS – influenza (NIVEL, Netherlands)
EUVAC.NET – VPD (SSI, Denmark)
ENIVD – hemorrhagic fevers (RKI, Germany)
ESAC – antibiotic consumption (Univ. Antwerp, Belgium)
General infrastructural networks
• EPIET – training field epidemiology (SMI, Sweden)
• BSN – minimal datasets of all diseases (SMI, Sverige)
• IRIDE – inventory of communicable disease control
resources in Europe (ISS, Italy)
• Eurosurveillance – bulletin (HPA, UK + INVS, France)
• EpiNorth – Network for CD control in Northern Europe
with bulletin, website, training courses (NPHI, Norway)
• EpiSouth – mirror of EpiNorth
Health threats in Europe –
21st century challenges
• New threats emerge
 SARS, pandemic flu, WNV, antimicrobial resistance
• Old diseases reemerge
 HIV/AIDS, STI, TB, food borne diseases
• Threat of bioterrorism
• EU without borders: free movements of goods
and people
• Diseases spread within hours in a globalized and
interconnected world
Limitations with old setup
• Surveillance networks uncoordinated and without
sustained funding
• No central expert authority
• Limited resources for rapid response
• Unflexible system (bound by contracts)
• 10 new Member States
• Above evident during SARS crisis  ECDC
Tomteboda – Home of ECDC
ECDC milestones
• July 2003: Commission’s proposal to establish ECDC
• December 2003: Council decision that Sweden will host
the Centre
• April 2004: Regulation 851 establishing the Centre
• December 2004: Director Zsuzsanna Jakab nominated
• March 2005: Director takes office (start-up phase)
• May 2005: Centre operational
• October 2005: Move to own facilities at Tomteboda
• 2007: Evaluation of the possible need to extend the scope
of the Centre’s mission
Very broad mandate
Founding Regulation 851/2004/EC
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Close cooperation with MS and EU bodies
Surveillance
Risk identification and risk assessment
Preparedness planning
Response to health threats and events
Training
Communication
Scientific opinions and guidelines
Staffing and budget (2004 cost)
• 2005:
• 2006:
Proposal
• 2007:
• 2008:
• 2009:
• 2010-2013:
29+20 staff
50+40 staff
5M€
18 M €
90+60 staff
120+80 staff
150+100 staff
180+120 staff
27 M €
36 M €
45 M €
50 M €
ECDC Organigramme
Director
Director’s Cabinet
External Relations
Country Strategies
Governance
Media & Information
Secretarial support
Scientific Advice
Scientific Panels
Guidelines
Advanced Analysis
Knowledge Base
Surveillance and
Communication
Data Management
Surveillance
Preparedness and
Response
Threat Assessment
Capacity Building
Crisis Operations
Administrative
Services
Finance & Budget
Human Resources
ICT & Logistics
Publications & Info
Matrix organisation
Director and Director’s Cabinet
Scientific
Advice
Surveillance &
Communication
Preparedness &
Response
Administrative
Services
Influenza
Antimicrobial Resistance
HIV/AIDS and other STI and bloodborne viral infections
Other horizontal Working Groups and Task Forces
ECDC horizontal actions
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Forming partnerships
Risk assessment
Enhance surveillance activities
Developing guidance and scientific opinions
Disseminate information
Assess country preparedness and capacity
(country visits)
• Advocacy
Director’s Cabinet
• Overall co-ordinating responsibility of all ECDC
activities
• Governance (AF and MB)
• Integrated information system
• Communication strategies, media relations,
Eurosurveillance, website
• External relations
“I would like to consult Europe –
but I don’t know the number there”
Henry Kissinger
Commission
EP
MS
Council
Networks
ECDC
EU agencies
WHO
Industry
Research
community
Other
countries
CDCs
NGOs
Framework for Country Strategy
• Directory of contact points
 MB appoint and publish competent bodies
• Overview of health systems
 Detailed inventory of resources and expertise
(build on IRIDE)
• Identification of need for support
 Action plan for 5 countries in 2006
• Working with regional networks
 EpiNorth, EpiSouth
Scientific Advice Unit (I)
• Provide sound and independent technical and
scientific advice
 Questions, guidelines, toolkits
 No own research capacity
• Well acquainted with the front-line of research in
all areas of CD control
 Actively participate in key scientific conferences and
meetings
Scientific Advice Unit (II)
• Network of experts and scientists in Europe
 Roster of experts
 Network of European reference laboratories
• Strong on new and emerging health threats
• Cooperation with laboratories
• Support member states in national endeavours
 Turn policies/guidelines into action if needed
 Advocacy
Process for scientific questions
• Competence in house?
• Competence in one of the DSNs?
• Competence in one of the Scientific Panels?
• In real life, probably combination of these.
Surveillance and Communication
Unit
• Gradually coordinate/integrate surveillance
networks into ECDC
• Consolidate surveillance with DSN’s and national
surveillance institutes
• Prepare case definitions
• Set up data-bases at ECDC
• Receive data from DSNs
• Technical assistance to MS on surveillance
issues
• Surveillance  public health action
Output of surveillance data
• “Surveillance is data for action”
• Data dissemination through various means
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Eurosurveillance scientific voice of ECDC
Public and privileged web pages
Surveillance reports
Articles in scientific journals
All necessary data should be easily available through
the ECDC web portal
 Strategic partnership with the EpiNorth network and
bulletin
Preparedness and Response Unit (I)
• Epidemic intelligence
 Keep track of emerging health threats inside and
outside the EU
 ProMed, GOARN, GPHIN, GIDEON and other
Community alert systems
• Timely advice on such threats
• Assisting the Commission by operating the Early
Warning and Response System (EWRS) with a
24h/7d duty system
Preparedness and Response Unit (II)
• Provide technical assistance in outbreak
investigation and response
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Identify outbreak assistance teams
Identify and mobilize lab capacity
Training activities
MoU with international partners (WHO)
Inventory and development of response guidelines
Output of epidemic intelligence data
• European Commission
 Commissioner briefing
• Member States
 Early Warning and Response System
 ECDC threat assessment weekly bulletin
• Public
 Eurosurveillance weekly
 ECDC website
www.ecdc.eu.int
Training activities
• Activities in 2005
 Development of a training strategy document
(with EPIET)
 Consultation of Member States
 Participation to training on ad-hoc basis
 Planning an outbreak team leader course
• Planned Activities in 2006-2007
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Transition of EPIET
Identify training needs and topics
Short courses on national level
Develop training materials and manuals (web based)
Scope of ECDC from 2010
• First rock solid in CDs = priority 1
• Review starts in May 2007
 Co-decision of Council and EP needed to extend scope
• Even if this happens not before 2010
 5 years only for CDs
• If extended - gradual process:
 Starting with health monitoring, analysis and reporting?
 Additional resources needed
Key message
• ECDC could only be strong if built on strong
European networks and ideas
• ECDC will provide needed services and give a
clear added value to the European CD control
• ECDC will channel the best available resources
(own and others) to where they will be best
needed
How the European Union is
Preparing for Influenza - a
Perspective from the ECDC
European Union – many strengths
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Well resourced compared to other global regions
Some strong centralised health systems
Some strong public health systems
Enthusiasm to make EU and ECDC work
World class laboratories
Good vaccine manufacturing base
Innovative approaches x 25 +
European wide and international perspective
Controlling spread of influenza?
Influenza milestones
• March 2005 - Euro Pandemic Preparedness
Workshop 1 – Luxemburg
• May 2005 – ECDC became operational
• European Commission Generic and Pandemic
Documents Launched
• October 2005 Euro Pandemic Preparedness
Workshop 2 Copenhagen
• November 2005 – First Europe wide command
post exercised (’Common Ground’)
• May 2006 Euro Pandemic Preparedness
Workshop 3 Uppsala
There have also been ’events’
- mostly around bird flu
• H5N1 approaching relentlessly from the East
• Dead gull in September 2003
• Poultry outbreaks in Romania and Turkey
Autumn 2005
• Human outbreaks on the fringes – Turkey
January 2006
• Political events – London, Beijing etc
Aims of the Workshops
• Coordinated approach European Commission,
WHO/Europe and ECDC
• 52 European countries
• Share best practice
 All European countries have pandemic plans
• Inform about developments
• Latterly maintain momentum
Intensive ECDC activities between
workshops - examples
• Detailed influenza assessments in EU MS
 National and local
 Pandemic, seasonal and avian influenza
 Public health and microbiology
• Planning on surveillance
• Modelling
• Guidance Production
Work on H5N1
• Essential but rather a distraction
• Huge opportunity costs for ECDC
• Kept the political momentum
Recommendations from Uppsala
Workshop, May 2006
• Complete toolkit and training packages for AI in
humans
• Further country visits in EU and WHO region
• Sub-regional meetings to address interoperability
and practical preparedness issues
• Further work on indicators
• Next EU / WHO plenary workshop will be July
2007
Issues for the EU – lots of these
• Interoperability issues
• Variable uptake of influenza seasonal vaccination
• Adjusting to H5N1 being either endemic or an occasional
visitor
• A common anti-viral policy?
• Agreement on public health measures to be recommended
• Local preparations only starting
• Intersectoral work (Ministries of Health, Agriculture,
Education etc working together)
• Interpreting Ferguson et al 2006 for policy development
What’s going to happen with H5N1 in
the bird and the pandemic
“It is difficult to make
predictions,
….especially about
the future”
Yogi Berra
Baseball Player & Sage