Health

Centre for Disease Prevention and Control

EXPLANATORY STATEMENT
from John Bowis's Report on the proposal for a European Parliament and Council regulation establishing a European Centre for Disease Prevention and Control
(COM(2003) 441 – C5-0400/2003 – 2003/0174(COD))
PE 337.050

“He who has health, has hope; and he who has hope, has everything.”
-- Arabian Proverb

THREATS (AND PROMISES)

One in ten of new HIV/AIDS cases diagnosed in Europe are now drug-resistant strains. In the United States the figure is some 23% - just one menace for millions of our citizens, that demands effective surveillance and rapid coordinated response. Multi-drug resistant tuberculosis and methicillin resistant staphylococcus aureus are also on the increase. There is a growing threat of major disease epidemics throughout the world. The voluntary and forced movements of people, globalisation, wars, famines and environmental and social changes, all contribute to greater opportunities for the spread of disease. The experience of the SARS (Severe Acute Respiratory Syndrome) virus has highlighted the danger of complacency. And over us is the dark shadow of the threat of bioterrorism. Public health authorities throughout our Union know they must be prepared to respond to very real health threats, crises and emergencies.

The European Union has sought to improve co-operation and coordination between Member States in disease surveillance. Since 1999 the European Commission has managed a Communicable Diseases Network, funded through the Health Action Programme. This network comprises designated national bodies responsible for communicable diseases within Member States. In addition to this overall Network Committee, the network operates as an ad hoc 'network of networks', made up of a number of Dedicated Surveillance Networks (DSNs) undertaking epidemiological surveillance and an early warning and response system for specific diseases or groups of diseases (including HIV/AIDS, legionellosis and tuberculosis).

Over its brief lifetime it has become clear that the network urgently needs substantial reinforcement to offer a structured, swift, flexible and efficient co-ordinating role in the EU over the longer term.

DECISIONS DECISIONS

Our Treaties respect Member State subsidiarity in the provision of health services, but encourage Community action in public health and illness prevention. Disease control and surveillance is therefore an example, par excellence, where the Treaties expect the Community and Member States to work closely together in an effective and coordinated way. EU activity has focused on improving communication, co-ordination and co-operation, supported by a number of EU Decisions, the most significant of which is Decision 2119/98/EC. This established the Network for Epidemiological Surveillance and Control of Communicable Diseases in the European Community – a catchy little title for a serious mission. The categories of communicable diseases to be monitored are:

· Diseases preventable by vaccination
· Sexually-transmitted diseases
· Viral hepatitis
· Food-borne diseases
· Water-borne diseases and diseases of environmental origin
· Nosocomial infections
· Other diseases transmissible by non-conventional agents (including CJD)
· Diseases covered by international health regulations (yellow fever, cholera and plague)
· Other diseases (rabies, typhus, viral haemorrhagic fevers, malaria and any other as yet unclassified serious epidemic disease, etc.).

The full, but not final, list of diseases covered by these categories was published through Decision 96/2000/EC. Communication between Member States is supported by an electronic early warning and response system (EWRS), set up through Decision 57/2000/EC.

SO FAR SO (FAIRLY) GOOD

The current system has been an effective first step in bringing improved co-ordination between Member States. For example, the epidemiologists involved in the Network believe that it has established good coverage for a number of the most important communicable diseases.

Nevertheless its limitations are acknowledged by Commission and participants. It has become clear that the limitations of the ad hoc network will restrict the future evolution of the EU's capacity to react swiftly to epidemics. The reliance on the Public Health Action Programme does not encourage long term planning and allows for potential fragmentation in the work of different Dedicated Surveillance Networks. Co-ordination has become more and more complicated.

A key concern has been the ability of the Commission to follow up on actions identified by the network. The nature of the network and the understandable limitations on resources within the Commission has meant that while the Network has been able to react effectively, it needs a greater number of dedicated staff and specialists to review responses to outbreaks and plan for future incidents. In some outbreaks there has been duplication of effort by different teams from different Member States which should be avoided with the help of a strong co-ordinating role from the Centre.

SO WHAT TO DO?

The proposal builds upon the recommendations of the Commission's three external evaluations. It establishes a more formal co-ordinating structure within the EU to strengthen the work of the network. Given the considerable resources that many Member States can call upon within communicable disease control, the most effective role for the EU would be to establish a small centre enhancing and utilising these national resources. It is proposed that the Centre gradually increases its staff capacity and financial resource over its first two years, to be reviewed in the third year. Total annual costs in the beginning of its operation would be around 12 million Euro and after five years around 48 million Euro. It should also have an appropriate contingency budget of up to 5 million Euro. These are tiny and, probably, inadequate figures.

The tasks of the Centre include:

· Rapid action in the case of emergencies
· harmonisation of surveillance methodologies, including better comparability and compatibility of the surveillance data collected in the Member States;
· provision of epidemiological training;
· provision of independent scientific advice to the Commission, Member States and other relevant EU agencies;
· continuing operation of the Early Warning and Response System (EWRS);
· technical assistance to EU agencies and to third countries and close working with the WHO.

The Centre would operate as a visible centre of excellence and facilitate collaboration by the Commission and the Member States with other partners (e.g. third countries and international organisations, such as the World Health Organization).

WE COULD DO BETTER

We have consulted widely among national and international NGOs, academic institutions, Parliamentary colleagues, the Council, Commission and Member States. There is a general wish to see the Centre established and operational in 2005. This has of course implications for the legislative processes which need to be thorough but expeditious. To that end we have sought to incorporate as far as possible the views we have received both on the current networking system and on the Commission's proposals.

There have been two major themes in contributions we have received, notwithstanding the overwhelming support for the establishment of the Centre. The first of these is addressing the operational difficulties which have arisen during the initial phase of the Network.

It is important that the Centre does not only collect information but is also in a position to make recommendations on the basis of that information and to give technical advice to Member States, other EU agencies and third parties, without lengthy administrative delays within the Commission. In other words this must be an operational centre and not just a think-tank.

An early evaluation by the Centre will need to be an analysis of the effectiveness of existing surveillance activity and dedicated surveillance networks. A basic template for the resourcing, operation and evaluation for each network should be established. For example, to enable effective comparability of data, it would be desirable to ensure operating procedures are at least compatible and at best standardised, building upon Decision 253/2002 which set out standard reporting requirements. In the area of rapid response to emergencies, there is a need to ensure that the Centre co-ordinates effectively with civil protection structures within the EU.

The technical expert group operating within the network, the Council of European State Epidemiologists, has called for a quality evaluation of the network in addition to a technical evaluation, to see if the quality of surveillance has improved, whether it has had an impact on disease incidence and if there have been other public health benefits. An inventory of laboratory and staff resources throughout the EU could also identify where the Centre can assist in emergencies and what resources are available to call upon.

The second theme has been the developing scope of the Centre. The intention is that it should start and establish itself with communicable diseases and other major health threats and emergencies. We are sure this is right. The subsequent reviews are geared to point to appropriate areas for expanding the role of the Centre as resources and capacity permit. We believe that too is the right way forward. This makes the immediate tasks clear while leaving a degree of flexibility on future development, but future development there must be.

AND FINALLY:

a) it needs to be made clear that when the text refers to recognising competent bodies to assist in Community responses to health threats, it is likely in practice to mean identifying individuals with appropriate expertise for the task concerned, who might join a team to assist in responding to an outbreak or event;

b) there will need to be checks on what the Centre is asked to deliver if they are not to be completely overwhelmed;

c) there is an inevitable conflict of interest between those who want every Member State represented on the Management Board and those who prefer the greater focus and efficiency that comes from a small Board. Whichever is chosen there should be a better balance of membership between Council, Parliament, Commission and NGOs than originally proposed;

d) there are several disciplines that should have an input to the Centre. These include epidemiology, public health, microbiology, virology and clinical infectious diseases. A number of them have European professional bodies and it would be appropriate for them to be involved.