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CNS Research StoryThe EU Moves Closer to Establishing a European CDC
by Alessandro Andreoni, CNS Research Assistant January 8, 2004
Approval Process for the ECDC On July 23, 2003, the European Union Commission (the EU executive body) first adopted a proposal to create the ECDC.[2] The proposal was then forwarded to the EU Health Ministers for approval.[3] That approval, along with a few minor changes, has now been formalized in principle by the EU Health Ministers, and the proposal forwarded to the European Parliament for further agreement.[4] Early indications, combined with a general feeling of optimism, suggest that the Parliament will take up the proposed ECDC regulation as early as February 2004.[5] This means that when the European Council next meets in March 2004, the EU governments might be already in a position to confirm an agreement with the Parliament; both the Parliament and the Council must agree on identical versions of the regulation. Should they agree, the Council meeting would likely indicate early 2005 as the time set for the ECDC to become fully operational.[6] Functions of the ECDC Since the Commission's proposal on July 2003, the EU Centre for Disease Control has been envisioned as pursuing the same goals as its American counterpart based in Atlanta, Georgia.[7] However, while their general tasks may be similar, the ECDC will have very different operational and administrative structures.[8] The ECDC will work as a network rather than a centralized agency, maintaining only a small office in Sweden. The agency will likely start in 2005 with a core staff of as few as 40 people and then grow to a full force of 100 people by 2007.[9] The agency will run no independent labs nor relocate within unified headquarters the member states' institutes and disease control agencies. It will work as a coordinating entity in charge of pooling European resources and reinforcing those existing public health organizations across the European Union that are in charge of controlling communicable diseases. [10] According to the approved guidelines, the ECDC will pursue six broad core tasks.[11] The newly established EU agency will provide epidemiological surveillance and laboratory networking, by harmonizing "surveillance methodologies and increasing the comparability and compatibility of the surveillance data collected."[12] The center will also be in charge of early warning and response, taking on the technical operation of the early warning and response system (EWRS) and coordinating with other relevant EU agencies such as the European Food Safety Authority as well as international organizations such as the World Health Organization (WHO). The ECDC will provide EU member states with scientific opinions and assessments to aid national governments in developing sound health policies. The EU agency will also furnish technical assistance and upon request "send an EU team to investigate an outbreak of an unknown human disease, either in Europe or beyond."[13] Also, the ECDC will work toward increasing the Union's preparedness against health emergencies, by pooling expertise and "supporting the development of EU level preparedness planning for health crises, such as an influenza pandemic or a bioterrorist attack."[14] Finally, the newly established EU agency will communicate on health threats making objective and reliable information on the subject accessible to both the general public, the European Union, and national decisionmakers.[15] The price tag for the whole initiative is still undetermined. Some pre-announced budget figures are close to €4 million, while others indicate a gradual growth from €10 million up to €20 million over two years.[16] The estimated costs included in the Commission's proposal are consistent with both indications: a required subsidy of €4.753 million for the center's first year of operation will grow into €14.303 million for the second year, and then increase to €28.779 million for 2007.[17] The Background of the ECDC Concept With its operational debut in early 2005, the ECDC will implement an idea that is older than the 2003 Commission proposal. Most notably, it will take over the work on health security that the European Union has been undertaking under different auspices for some time now.[18] The ECDC will be integrating several activities under the same organizational umbrella. Most importantly, it will provide a systematic approach toward alerts and responses to health crises - both accidental, such as epidemic threats, and deliberate, such as bioterrorist attacks.[19] The concept of a European agency in charge of disease control is at least a couple of years old. By late 2001, EU Health Commissioner David Byrne considered the U.S. model of a center for disease control as a possibility for the European Union.[20] By then, the borderless nature of the European Union had made it imperative to take further steps in that direction.[21] However, only as recently as early 2003 did the idea of creating a European counterpart to the Atlanta-based agency become an actual Commission proposal. First the anthrax scare of 2001, then the SARS outbreak of 2003 turned the issue of health threats into a policy priority.[22] The European Union has been proactively monitoring health threats, working on alerts and preparedness for health crises - especially those deliberately caused - since as early as 2001.[23] Since 1999, the Commission has managed a Communicable Diseases Network, based on ad hoc cooperation among member states.[24] As for the threats posed by bioterrorism, the newly established ECDC will de facto take over the work on monitoring and planning against bioterrorist attacks pursued by the European Commission's Task Force on bioterrorism. That task force was established in May 2002 as part of the broader Health Security Programme for cooperation on preparedness and response to biological and chemical agent attacks co-developed by the Council and Commission on December 2001.[25] The European Union's Task Force on Bioterrorism To implement the Programme's overall objective of improving cooperation among member states in dealing with bioterrorism threats, the Commission's Task Force has been promoting a series of activities, including setting up a mechanism for information exchange on all issues related to bioterrorism. This network operates by means of electronic communications, faxes, and telephone. It has connected the EU member states over the past year and a half and its round-the-clock functioning has been routinely monitored by the Task Force. The network has also been tested by two major EU-wide exercises as well as by several real alerts about suspicious events communicated by the connected member states.[26] The fifteen-member strong task force - including nine national experts and six commission officials - has identified gaps in resources and approaches across the European Union and started projects to fill those gaps.[27] The Task Force has also been working extensively on expanding the taxonomy of possible agents used by terrorists for a biological attack in order to include additional threats such as tularemia, anthrax, Q fever, and smallpox. Moreover, it has been updating the list of authorized pharmaceuticals to be used in case of a biological attack. To that end, the Task Force has been coordinating with two other major EU initiatives. To detect new challenges in the use of agents, the Task Force collaborates in the areas of infectious disease surveillance and control with the Community Network of Communicable Diseases, which the Commission established in 1999.[28] To upgrade the list of pharmaceuticals, the Task Force has counted on the European Agency for the Evaluation of Medicinal Products (EMEA).[29] The Task Force has also engaged mathematical modelers to work on modeling crises and estimating the optimal amounts of pharmaceuticals for stockpiling.[30] Conclusion The ECDC will take over the
Task Force's work, while also enlarging its responsibilities and expertise
beyond deliberate releases of agents by terrorists. The new disease control
center will enhance the ability of the European Union and its member states to
cope with bioterrorism by taking advantage of synergistic efforts.[31] It is
generally believed that laboratory capacity to diagnose most of the potentially
threatening agents exists within the European Union as a whole. Identifying the
necessary expertise requires determining the exact kind of capabilities needed
for specific cases and targeting specific segments of public health
preparedness.[32] The ECDC will provide the common directory of experts and the
epidemiological surveillance network that represent the keys to increased
preparedness against bioterrorism. The ECDC's primary task will be
coordination.[33] According to the plans, the ECDC will coordinate prevention,
alerts, and crisis management in the event of a bioterrorist attack. In all of
these circumstances, the ECDC will rely on networking knowledge and reinforcing
the synergies between the existing national centers for disease control.[34]
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