ONLINE DISCUSSION: EU as crisis manager: How does it respond to a pandemic?

logo-GAHP-lowres-neg_2The Geneva Health Forum at the Geneva University Hospitals and Global Health Europe would like to invite you to join an online discussion on: EU as crisis manager: How does it respond to a pandemic?

This discussion held on the Global Access to Health Platform from 11 to 29 January 2010 intends to discuss EU ambitions to become a capable, active and coherent actor in global crisis management. Taking the current H1N1 pandemic as a starting point, we would like to hear your expectations for EU health policy and agencies at regional and national levels and in relation to other international institutions when preparing for and responding to pandemics

To join the discussion visit the Global Access to Health Platform and join the group ghg (global health governance) or click here for more details instructions

Discussion Introduction

International cooperation for health is led by the United Nations' World Health Organization, but regional bodies developed to support the mutual interests of states in trade, such as the EU, are increasingly important global health actors. A cornerstone of the EU's regional policy framework is the concept of multi-level governance, i.e. a system of continuous negotiation among governments and statutory authorities at different territorial levels, including national and sub-national regional or local levels. Another characteristic of this multi-level governance system is the participation of non-state actors that are mobilized in policy-making and implementation. This complex form of cooperation and cohesive policy-making raises new and important questions about the power of international, national and regional governments and agencies and their ability to balance national interests with the need for regional and international cohesion and concerted action.

The EU seeks to maintain a coordinated approach in public health by taking joint positions in international fora such as the World Health Assembly and adopting common standards in areas such as food and nutrition labeling, the safety of medical equipment, blood products and organs, or the quality of air and water. In the case of infectious diseases, the EU has developed common action plans to help Member States respond to cross-border public health emergencies including the current influenza pandemic. In addition to these policy instruments, a new European Centre for Disease Prevention and Control, was established in 2005, which pools and shares knowledge on current and emerging threats, and works with its national counterparts to develop Europe-wide disease surveillance and early warning systems.

The pandemic of H1N1 hit all EU Member States and neighboring countries many of which are within the WHO European Region. Levels of infection vary across Europe, while the majority of deaths have occurred in Western Europe the pandemic seems to be coming under control there. Currently the disease seems to be worsening in Central and Eastern Europe and from the Baltic countries, down to Greece. In an attempt to limit the health and other impacts of the pandemic, EU countries moved from a containment strategy (trying to stop influenza spread beyond initial outbreaks), to a mitigation and treatment strategy, making antivirals and vaccines available for all who need them, within the limits of national resources and capacities. They have also supported joint efforts to work with other States and international agencies.

This pandemic constitutes a real field-test for European health governance and institutions. The regional response to raises several (unanticipated, unacknowledged, and unaddressed) issues around where and when national responses stop and mechanisms for regional collective action begin. Good Governance beginning at home, EU ambitions to become a capable, active and coherent actor in global crisis management are currently being tested.

In the upcoming online discussion we would like to discuss:

How should the EU respond to a pandemic?

  • What were your expectations for EU health policy and agencies at regional and national levels and in relation to other international institutions when preparing for and responding to pandemics? How did this compare with your experience in the case of H1N1?
  • In which phases of the H1N1 pandemic did the EU assist your efforts and in which do you expect improvement (e.g. information sharing, technical assistance for drafting, financial support)?
  • What have been the main challenges in dealing with the current H1N1 crisis?
  • To what extent has EU institutional arrangements helped or hindered in coping with the crisis?

Background to EU's Current Approach to Communicable Disease

The EU's current approach to communicable disease surveillance and control is guided by a complex set of legal rules, procedural norms, and organizational bodies. The following background is from European Cooperation on Future Crises: Toward a Public Good? Mark Rhinard, Swedish Institute of International Affair, 2009.

"Legal Framework
The legal framework governing communicable disease cooperation in Europe is divided between the international and EU regulatory levels.
At the international level

  • All EU members are party to the International Health Regulations (IHR) of the WHO. The scope of IHR covers any event "posing a serious and direct threat to the health of human populations." This imposes an obligation that members report new disease outbreaks such as SARS. The IHR set out:

Rules for the surveillance, notification, and control of infectious diseases. States are required to develop and maintain surveillance capacity and "respond effectively to public health risks and events potentially constituting . . . public health emergencies of international concern" (Fidler, 2004)

There is a provision for the WHO to take account of informal sources of information and not just information provided by official sources.

The WHO is authorized to determine, independently of its member states, whether an event constitutes a public health emergency.

The WHO is authorized to take additional steps such as recommendations on travel bans and trade restrictions (Barrett, 2007).

At the European level

A more complex but ultimately less binding set of EU arrangements tie national authorities together.


1. Those managed by the EU institutions in general: In 1992, Article 219 of the Maastricht Treaty gave the European Commission a degree of legal competence in the area of public health protection. This competence extended only to education campaigns and research programs, however. Not until the late 1990s, in the aftermath of the mad cow incident, were firm measures put in place. One such measure, agreed upon by member states, was a binding obligation to take part in increased cooperation "for epidemiological surveillance and control of communicable diseases" in 1998 (Parliament and Council, 1998). The Communicable Disease Network is the legal basis of EU efforts and requires coordination to build surveillance capacities, share information on emerging threats, and notify one another of any control measures taken.


Three central initiatives have been agreed under this legal framework:

1. First, member states have entrusted the EU institutions to build an EU-wide surveillance system linking national health authorities together, intended to monitor and track developments in a cooperative fashion.


2. Second, the EU is authorized to place certain communicable diseases on a watch list for monitoring and tracking (Commission, 2007). This list is updated when deemed necessary by the Commission, thus obligating member states to increase surveillance and reporting capacity regularly. The list is coordinated closely with the WHO but in fact contains a higher number of communicable diseases to be monitored than IHR. The addition of new diseases to the watch list has led to disease-specific networks (approximately 17) that further bind national health authorities together. Perhaps the most prominent of these networks is the European Influenza Surveillance Scheme that draws data from member state sources to create a weekly influenza report.


3. Third, an early warning and response network has been put in place to notify national authorities and to recommend control measures when an outbreak requiring coordination occurs (Commission, 1999). The Early Warning Response System is based on specific case definitions that lay down requirements for reporting diseases to the network (Commission, 2002).


2. Those associated with the ECDC: The final element of the EU's legal framework on communicable disease is the ECDC. In response to concerns that member states were not adequately prepared for communicable diseases, this EU agency was founded in 2004 in Stockholm, Sweden. The mission of the agency is to "identify, assess, and communicate current and emerging threats to human health from communicable diseases" (Parliament and Council, 2004). The ECDC is, in other words, intended to consolidate the surveillance and early warning responsibilities that have been delegated to the European level. One rationale for the construction of a quasi-independent agency is its "bird's-eye" perspective, capable of detecting outbreaks that may not be spotted or communicated to other member states. The ECDC is also intended to act as a repository of scientific knowledge that can be deployed across Europe and as a source of "best practice" for countries that may not have sufficient capacity.

In short, the EU's legal framework of communicable diseases is one that requires communication and information sharing through networks and one that provides for independent capacity through the ECDC to conduct investigations. On the first count, there are few legal obligations beyond participation in the networks. On the second count, the ECDC's investigation authority extends only to disease outbreaks and not to the sufficiency of efforts being made at national levels. That role is pursued through sharing of best practice and ongoing seminars."

 

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