Supplementary Information from Professor
Angus Nicoll, PHLS
The Role of the European Union in Relation to Communicable
Disease Control in the UK
Q. Why is the European Union important to communicable
disease control in the UK?
A. The UK is functionally and politically part of
Europe. Communicable disease events in other parts of Europe will
affect the UK, and vice versa (see Table 1Potential Major
European Health Protection Emergencies). Specific real examples
of acute European communicable disease emergencies" are in
the accompanying article by MacLehose et al.
The increasing movement of people and goods across
Europe, an element of globalisation" means that the risks
from communicable diseases within Europe are rising. This will
increase following the entrant of the Accession Countries",
most of which have a far higher rate of various communicable disease
and lower levels of disease control than other countries.
Equally concerning control of more chronic"
diseases and issues (tuberculosis, HIV, anti-microbial resistance
etc) many control measures need to be co-ordinated if they are
to be effective across Europe as a whole.
The European Union has considerable resource available
for communicable disease control in terms of EU funds and personnel
in the member countries. The funding that is available through
the EU dwarfs that available to WHO (Europe).
European union structures outside of the health directorates
(DG-Sanco) will affect communicable disease control for example
by influencing (and relaxing) controls and regulations on movements
of people and goods.
Q. What has Europe achieved to date?
A. The network model for Europe has been regarded
as a considerable success with a number of effective networks
established for a number of diseases and functions, as detailed
in the article by Van Loock (attached). The funding for this work
has flowed from the Network Decision of the EU (attached). The
networks include those for detection and control of specific or
groups of infections. Of gastrointestinal infections (ENTERNET),
detection and control of travel associated legionnaires disease
(EWGLI), influenza (EISS). There are also function-related networks
for training (EPIET), resource inventories (IRIDE) and information
(Eurosurveillance). These networks all work on the basis of being
shared across all the national surveillance/control centres but
with one centre providing a server function and receiving most
of their funding. This funding only provides a small amount of
the support needed to deliver the function. CDSC and CPHL provides
the server" element for ENTERNET and EWGLI. The central funding
and administration come from the European Union Health Directorate
Q. What weaknesses are there?
A. There are many weaknesses at national levels as
not every country has a complete suite of infection control functions
and quality and investment in individual components is variable.
Consequently the ability to undertake surveillance and response
is highly variable.
At the supra-national (European) level there are
a number of structural and functional weaknesses:
The funding for the networks are usually
on an annual basis, preventing long-term planning.
It has proved almost impossible to attract
and appoint experienced senior public health staff into DG-Sanco.
There have and are exceptions to this but they are just that,
exceptions on short-term secondments.
There is poor co-ordination between the Service
(DG-Sanco) and Research (DG-Research). There is no effective mechanism
for reviewing and strengthening the networks. Consequently almost
the only mechanism for effecting improvements is moving the network
server" from one country to another.
There is no mechanism for responding to a
pan-European incident or outbreak.
The response to 11 September and bio-terrorism
(Civil Protection) has not built on what was pre-existing but
created a separate team and streams of work.
There is no network for reference facilities,
which are generally fragmented, disorganised with considerable
Q. What developments are proposed?
A. It is proposed that there should be a European
Centre that should be active in 2005. There is a commitment to
this from the Commissioner for Health and Consumer Affairs, Mr
David Byrne, and this seems almost certain to go ahead (see attached
transcript of a speech by Mr Byrne).
A. As yet it is unclear what is in Commissioner Byrne's
mind. A list of possible functions is in Table 2 below derived
from the Van Loock article and the CESE statement.
There are strong arguments for a slim (n=40-60 including
out-posted staff) and effective co-ordinating centre (see MacLehose
et al and Van Loock et al). However this will only
work if there is a commitment to this from the stronger countries,
that it works well with the central European structures and the
state epidemiologists (CESE) and it can be guaranteed that it
contains competent and respected senior staff. This can be achieved
by placing the centre in an attractive part of Europe, close to
and supporting the Commission and Parliament and with an arrangement
that will allow secondments for extended periods from the strong
national European centres.
Q. What are the dangers and risks?
There are a number of these:
It could be that the UK government does not
recognise the need for a European centre, not recognising the
essential contribution of Europe to communicable disease control
affecting the UK.
The centre might end up following the CDC
(Centres for Disease Control and PreventionUSA) model of
aiming to be a large multi-purpose centre but without being a
source of significant new resource for member states and effectively
competes for limited European funds.
The centre might end up being large and bureaucratic
or legalistic and regulatory and not attracting the competent
staff needed to make it work.
The centre might be dealing only with communicable
diseases and not the whole range of European health protection.
In particular it needs to encompass the civil protection strand
Direct PHLS Communicable Disease Surveillance Centre
30 December 2002
Table 1: Potential Major European Health Protection
1. A major community-wide outbreak of gastrointestinal
2. An outbreak of an unknown illnesseither
biological or due to chemical or radiological exposure.
3. The appearance of a previously unrecognised pathogen
in the blood supply.
4. Chemical, biological, or radiological contamination
of a water supply.
5. A lost source or an accidental release of radiation
affecting a number of countries.
6. An emergent or re-emergent infection abroad that
could be imported to European countries.
7. International concern over the safety of a vaccine.
8. A serious imported infection affecting a number
9. The emergence of a new sexually transmitted infection
(STI) or the re-emergence of a previously recognised STI.
10. The next influenza pandemic.
11. Suspected deliberate or accidental release of
a serious biological agent.
12. A major international epizootic with implications
for human health.
Table 2: Functions of an EU Communicable Disease
1. Moderation and development of the EU Early Warning
2. Maintenance and development of a Rapid European
Outbreak Response Service by co-ordinating the use and supplementation
of resources in the national centres and disease specific networks
in the EU.
3. Co-ordination of the rapid preparation of technical
advice in emergency situations for the Commission.
4. Provision of technical briefings on policy issues
for consideration by the Network Committee and the Public Health
5. Co-ordination of the structured evaluation of
disease specific networks on behalf of the Network Committee.
6. Production and dissemination of authoritative
information for professionals and the public (eg Eurosurveillance
weekly and monthly).
7. Facilitation of a Designated EU Reference Laboratory
Service" that commissions international reference services.
8. Management of the European public health training
for health protection (eg the EPIET training programme) and other
international training initiatives.
9. Maintenance of the inventory of resources for
communicable disease prevention and control in the EU (IRIDE).
10. Advising the related research programme of DG-Research
so that it supports the Public Health Programme on communicable
11. Liaison and co-ordination action with national
European surveillance and response centres and Ministries of Health.
12. Liaison with other international bodies, eg WHO-Euro,
WHO-GOARN, to ascertain health threats from communicable diseases
outside the EU and to assist the co-ordination of international
Adapted from Van Loock et al
Eurosurveillance 2002 7: 78-84