The role and partnerships of ECDC, a new EU agency, in regional and global governance

1. The role and partnerships of ECDC, a new EU agency, in regional and global governance Zsuzsanna Jakab, Director, European Centre for Disease Prevention and Control 15 October2009

2. Road map • What is its remit? • Why was ECDC created? • ECDC’s role in the EU health protection system • ECDC’s role in regional and global health governance • How to further strengthen governance

3. Expanded Europe – the five freedoms in the EU 1. Free movement of people* Free movement of services* Free movement of goods* 4. Free movement of monies* 5. Free movement of microbes Adapted from Summary of Legislation — Internal Market http://europa.eu.int/scadplus/leg/en/s70000.htm

4. Why was ECDC created? • Europeans still die of infectious diseases. • New opportunities for microbes to emerge/re-emerge. • Bigger, more diverse EU after 2004-2007 enlargements • Epidemics still happen in our era. 20th century saw influenza pandemics in 1918, 1957, 1968.

5. SARS in 2003 spread internationally at alarming speed SARS in 2003 – “wake up call” for health policymakers • Showed microbes do not respect borders • Showed need for coordinated EU response… • ..but no EU level capacity to rapidly analyse threat and propose options to deal with it

6. Rapid creation of ECDC • Draft legislation presented by European Commission July 2003 • ECDC Founding Regulation passed by European Parliament and Council in April 2004 • EU legislative process usually takes 2 or 3 years! • ECDC operational in May 2005

7. What is ECDC ? "An independent agency, named the 'European Centre for Disease Prevention and Control'." (Regulation 851/2004) A European Union Agency that: • is a member of the European Union (EU) family; • covers EU 27, EEA/EFTA and —as of 1 January 2008 —integrates Turkey, the Former Yugoslav Republic of Macedonia, and Croatia. • Focuses on prevention and control of infectious diseases ECDC started work in 2005. It is now operational in every aspect of its mandate. Dr Hubert Hrabcik, Chair of ECDC's Management Board

8. What is the role of ECDC in the Founding Regulation? • Supporting role (risk assessment and advice) and to the EC and Member States on risk management issues. • Detection of health threats: surveillance and epidemic intelligence. • Provide evidence-based scientific opinions/advice. • Strengthen preparedness and response. • Operate the early warning system and response. • Support Member States in outbreak investigation and risk assessment • Build Member States’ capacity through training. • Health Communication. "Identify, assess and communicate current and emerging health threats to human health from infectious diseases." (Regulation 851/2004) ECDC: scientific and technical institute

9. vCJD DIP-net EARSS Enter-Net EUVAC Measles EWGLINet EU-IBIS ESAC ESSTI ENVID HIV/AIDS Tuberculosis IPSE EU’s disease surveillance system before ECDC Basic Surveillance Network Divine-net EUCAST EISS Surveillance networks funded through the EU public health programme

10. MS Data users in Member States MS National institutes MS Disease experts MS General public MS Advisory Forum members MS MS Management Board members MS WHO MS EMCDDA MS EFSA MS Others MS MS The new European surveillance system: a one-stop shop Data upload and access by Member States (MS) Data access by… TESSyThe European Surveillance System at ECDC

11. ECDC's Scientific Advice:Five strategies 5 • Public health research catalyst • Promote, initiate and coordinate scientific studies • Produce guidance, risk assessment, scientific advice • Prime repository for scientific advice on communicable diseases • Microbiological laboratory support

12. Preparedness and Response Our mission is to identify, assess and communicate current and emerging health threats from communicable diseases. The ECDC Emergency Operation Centre detects and assesses threats, and provides support for response to Member States and the Commission.

13. EPIET courses train field epidemiologists from across the EU Building Member States’ capacity and preparedness • Capacity building through training • European Programme for Intervention Epidemiology Training (EPIET) • Short courses for senior officials • Country visits • Simulation exercises • Implementation of the Emergency Operation Centre (EOC) • Possible use of Structural Funds and other such EU funding mechanisms

14. Some outputs of ECDC activities • Website updates • Weekly Threat Report (restricted access) • Annual Epidemiological Report • Surveillance reports on TB, HIV, Zoonoses (with EFSA) • Risk assessments • Scientific guidance and development of knowledge base • Training and capacity building • Hands-on technical support, when requested

15. The growth of ECDC • BudgetTotal staff • million € • 2005 4.8 40 • 2006 17.1 80 • 2007 28.3 180 • 2008 40.2 250 • 2009 50.7 300 • 2010 60 350

16. ECDC’s role in the EU health protection system

17. The EU health security system: conceptual overview Risk monitoring Collect information and monitor health threats Assess risks, build knowledge and capacity Risk assessment Investigate alerts, issue scientific advice, provide support Risk management Implement control measures ECDC and Member States Communication EC andMemberStates

18. Risk assessment vs. risk managementA complex interrelation… Risk assessment Risk management

19. Report ECDC Advice Report Advice Report Member States Commission Coordinate Success in the EU system depends on three-way collaboration

20. ECDC’s role in regional and global governance

21. ECDC’s network of partnerships with stakeholders Council EU agencies Commission and ECDC MemberStates EP Industry Networks CDCs WHO ResearchCommunity Other countries NGOs

22. Influencing the communicable diseases agenda in the EU family

23. ECDC as the node of the network of national partners • They are called ‘Competent Bodies’ in the ECDC Regulation. • National institutions, agencies and authorities that carry out similar tasks to ECDC • Designated to work with ECDC by the EU Member States • Some countries nominate only one body, others several • This is a major difference between ECDC and the US CDC. • Examples of Competent Bodies: Robert Koch Institute (D), Health Protection Agency (UK), Ministry of Health and Social Policy (E) The EU network of Competent Bodies working with ECDC includes today 87 national organisations

24. ECDC bodies: the Management Board and the Advisory Forum

25. Advisory Forum

26. Management Board: our Governing Body

27. Daily and intensive relations with the European Commission

28. The European Parliament is our strong supporter

29. Working with the EU presidencies

30. Collaboration with other EU Agencies • Network of EU Agencies • Bilateral –multilateral collaboration • EFSA • EMEA • EMCDDA • EEA • ECHA

31. Cooperation with countries outside EU

32. Partnership with non-EU countries • EEA/EFTA countries (Iceland, Liechtenstein, Norway) have participated fully in ECDC since start up • Since 2008, DG ENLARGEMENT funding for Candidate Countries (Croatia, FYROM, Turkey) to participate in ECDC activities • New in 2009 – funding for cooperation with Potential Candidate Countries (Albania, Bosnia Herzegovina, Montenegro, Serbia, Kosovo*) • EC negotiations with Switzerland ongoing (technical agreements) * Under UNSCR1244

33. Partnership with US CDC, Public Health Agency of Canada, Chinese CDC • MoUs and information sharing • Joint projects such as epidemic intelligence for Beijing Olympics • US CDC Liaison Officer based in ECDC Public Health Agency of Canada, Ottowa CDC headquarters in Atlanta, Georgia as seen from Emory University Photo by Nrbelex. Published under a Creative Commons License. See http://www.flickr.com/photos/nrbelex/322790178/

34. ECDC’s partnership with WHO

35. Relationship with WHO of central importance • EU Early Warning and Response System (EWRS) linked to WHO International Health Regulations system • Member States can make simultaneous report in both systems • WHO and ECDC can access both EWRS and IHR • Significant collaboration with WHO/HQ and WHO/EURO at the political, strategic and operational levels on global and European issues, respectively • The breadth, depth and speed of technical collaboration since 2006 has been remarkable.

36. Surveillance and Reporting Threat detection and alerts Outbreak response Health communication ECDC joint activities with WHO across all areas of mandate MoU and two-way secondments with WHO/EURO

37. Collaborating with WHO Euro and WHO HQ

38. John-F.Ryan@ec.europa.eu How to further strengthen governance in Europe

39. Going beyond “memorandums of understanding” A strong and sustainable partnership between the EU and WHO Euro • One Europe-wide system of communicable disease surveillance • Avoid double reporting / duplication of effort • Extend the EU’s Early Warning and Response System to all 53 Euro Region Member States

40. Building a clearer Europe-wide health agenda Identify the right issues, building consensus around the right solutions • Define Europe-wide public health priorities • Build political commitment to common action • Further strengthen policy dialogue WHO / EU • Inspirational European level political leadership • Central role of WHO at Regional and Global level

41. Thank you!