Examination of Witnesses (Questions 900
- 911)
MONDAY 28 APRIL 2008
Mrs Zsuzsanna Jakab
Q900 Chairman:
Is it not agreed yet? Have you got access or is just not agreed
yet?
Mrs Jakab: Not yet, but it is agreed. We had
a high-level meeting of WHO leaders and this was on the agenda.
The WHO headquarters staff told us that under Article 14 of the
International Health Regulations they can give access to ECDC
to the IHR website.
Q901 Chairman:
The agreement is there in principle but it is not yet happening?
Is that right?
Mrs Jakab: Yes, exactly. It has not yet happened,
but the political levels of the WHO are seriously considering
it and it will happen.
Q902 Lord Jay of Ewelme:
To some extent this follows the answer you gave a moment or two
ago to Lord Soley. You mention in your submission (which was extremely
helpful) the Early Warning and Response System that the ECDC operates
and you also talked about the EU Health and Security Committee
that is in charge of pandemic planning. As I understand it, you
also recently launched an Emergency Operations Centre which, on
the face of it, seems a very sensible thing to do. I wonder if
you could very briefly say how those organisations relate to each
other and how they relate to the WHO's Global Outbreak Alert and
Response Network, the GOARN, which we were hearing about in our
visit to Geneva last week?
Mrs Jakab: First of all, I can say that there
is close collaboration between ECDC, the European Commission and
WHO. The Early Warning and Response System of the EU foreshadowed
the IHR by about ten years when the IHR were put in place, the
EWRS was already established. This is a communication platform
among the EU Member States the Commission and ECDC to exchange
information and coordinate the public health measures in case
of an outbreak. Then there is the Health Security Committee which
is an advisory committee of the European Commission looking at
the health security perspective of the EU. Many times the WHO
is invited to those meetings in its observer capacity. Then we
have recently launched the Emergency Operations Centre, which
is modelled on a similar emergency operation centre in WHO Geneva,
which is called the Strategic Health Operation Centre. The leader
of that Strategic Health Operation Centre was invited by us to
contribute to the specifications of our Centre in very close collaboration.
The GOARN, is a WHO network of institutions that can mobilise
international expertise. ECDC is part of the GOARN. I think the
coordination is in place and, as I said before, I do not think
there can be too much coordination on this issue.
Q903 Baroness Whitaker:
I want to stay with coordination but from a different perspective.
Your evidence has pointed out that the majority of pathogens come
to humans from animals, and we have heard evidence that that is
about three quarters of the emergent infections but also that
there is not enough coordination between the international organisations
that monitor human and animal health. We would like to ask you:
what is your view about the synergy at the moment between the
WHO, FAO and OIE and also how your own organisation coordinates
its work with these other bodies in respect of the jump from animal
to human health.
Mrs Jakab: I think we need to have more coordination
for sure, but I must say that with the avian influenza the cordination
has improved to a great extent. In recent years there was a meeting
in New Delhi for avian influenza and pandemic flu preparedness
globally. This was the first time that the Director-Generals of
WHO, FAO and OIE came to the same platform to address these issues.
Also within the European Union the avian influenza outbreak brought
in the collaboration between the Chief Medical Officers and the
Chief Veterinary Officers in the Member States, coordinated by
the European Commission. This has taken place a few times and
we were discussing all these pandemic issues. Also, here in Uppsala
we organised a conference on the strengthening of pandemic flu
preparedness to which we invited OIE, FAO and of course WHO. I
think that is a positive start and positive progress. We are not
there yet, but I think the progress is positive. From an ECDC
perspective, we are working very closely with EFSA, because we
are jointly preparing a zoonosis report every year. From our perspective
we also collaborate with European Commission veterinary unit whenever
there is a need for that.
Q904 Baroness Whitaker:
Could I just take it for a minute to the operation level? If there
were an outbreak among a group of animals which came to the attention
of the FAO or the OIE, would you hear about it very rapidly from
them? What leverage would you then operate? How would you then
operate as ECDC to safeguard European citizens?
Mrs Jakab: This is the responsibility of the
European Commission. If there is an outbreak in animal health
or there is an animal issue, this is something which is very much
coordinated by the European Commission. In case of an outbreak
of this type, the European Commission would take action. We would
only be involved if there were implications for human health.
In the case of avian influenza, it was considered as an animal
disease until we had the first human case: for example in Turkey
we went there with WHO, the Commission and others to investigate
the human cases of avian influenza.
Q905 Baroness Whitaker:
Is that satisfactory in your view, that you only hear of the outbreak
when it has finally made the jump into infecting humans? Are you
happy with that?
Mrs Jakab: Our mandate comes from the founding
regulation of ECDC, which gives us the mandate for human health
issues. We do not have a mandate for animal health issues. We
have to follow our mandate. There is always an update on the ECDC
mandate taking place now for the next period of time. So, if the
founding fathers want to change anything in our mandate, they
will do so; but for the time being we do not have a mandate for
animal health issues. EFSA have much more of a mandate than we
do, that is the European Food Safety Agency of the European Union.
Q906 Baroness Hooper:
Turning now to the wider picture, in your evidence you referred
to the fact that economic development will and must continue.
You have already touched on the area of research and strengthening
the health sector in all this, but you also referred to continued
investment in careful health impact assessments. Bearing in mind
that environmental impact assessments were also a creature of
the European Union, would you care to define a little more what
you actually mean by health impact assessments and whether these
are effective in other countries (or in certain countries) and
whether in fact other intergovernmental organisations in sectors
other than health use health impact assessments in deciding the
relevance of their policies?
Mrs Jakab: I think that health impact assessment
is a very important issue because, if you want to introduce a
new policy or you want to introduce new legislation in any sector,
it is extremely important to look at the health impact of this
new legislation or new policy. This is mainly to safeguard the
health of the citizen and to avoid any detrimental effect from
policies that have been made. So this is the idea. The European
Commission has been very strong on health impact assessments and
this has been an initiative in health in all policies, which was
strongly supported by the European Commission and later on it
was picked up by WHO. Some Member States are also doing it, others
are not, but on the whole our message is that the health impact
assessment is a very healthy exercise. It really safeguards and
protects the health of the citizens by looking at the health impact
of various decisions before the decisions are taken.
Q907 Chairman:
If the World Trade Organisation made a certain proposal on trade
affecting animals, for example, and you saw a health risk, would
you see it as your responsibility to approach the WTO and suggest
a health impact assessment?
Mrs Jakab: No, it would not fall into the mandate
of ECDC.
Q908 Chairman:
The World Trade Organisation does obviously have views about trade
in animals; trade in animals can then spill over into problems
for human health. In circumstances where you feared that might
happen, where you feared there might be a spill over, could you
approach the WTO with the idea of a health impact assessment?
Or would that not be something the ECDC could do?
Mrs Jakab: First of all, we would consider it
ourselves, discuss it with partners like EFSA, if needed because
they have a mandate for food safety whereas and we have a mandate
for human health. Then we would get in touch with the European
Commission and inform the European Commission accordingly and
the European Commission would be the one who would take it up
with the WTO if it considers necessary.
Q909 Lord Desai:
We have many people observing—and indeed you said in your
evidence—that there is very little development of new drugs
to treat TB, and the re-emergence of TB may be partly because
of lack of new drugs. Some witnesses have argued that the lack
of new drugs is a market failure instance. Do you share this view,
that market failure causes this? Will initiatives like Advanced
Market Commitments or UNITAID or the International Finance Facility
for Immunization help to speed up the invention of new drugs?
Mrs Jakab: That is an extremely important issue
both for TB drugs and also for antibiotic development and drugs
for other diseases. With regard to TB, I agree that it is a market
failure that we do not have new drugs on the market. But I would
like to add two comments. What I want to say is that the clinical
trials for TB drugs development are very long: they have to be
tested and they need another large trial period. In the past decade
we have seen a number of TB drugs in the pipeline and there are
at least seven drugs now in the development stage, and three of
these are in clinical development, which is a very positive thing.
Some of them are funded by different international donors and
a number of them are funded by DG Research. This is also extremely
positive that DG Research has considered this as a priority. Again,
it is a long clinical and field-testing period on the drugs before
they can be put into use. As said before the positive thing that
is that they are in the pipeline whilst not yet ready for use
because there is a lengthy testing period. I also want to add
to this that there is a very specific feature of the research
and development business model of the pharmaceutical industry,
because they favour a large market where the consumer is able
to afford a high market price. Therefore, these initiatives that
you have also mentioned, the Advanced Market Commitments initiative,
this is a very promising strategy which we have already seen on
one or two occasions and it has to be tested more in the future.
We have to experiment with similar approaches in order to start
work on the development of TB drugs, but also the development
of antibiotics because, with increasing antibiotic resistance
not only in the UK but everywhere in Europe, there is a need to
develop new antibiotics. Such initiatives as you mentioned are
important. We are working with the EMEA and other partners on
these issues.
Q910 Lord Geddes:
I would like to address the possible links between international
travel and the spread of infectious diseases. The Royal Society
in this country said, in September of last year, that "the
healthcare screening and treatment processes for migrants entering
the European Union need to be better evaluated and coordinated
across Member States to prevent the potential spread of infectious
diseases such as TB and HIV". Do you accept that comment?
If so, what action is the ECDC taking to address the situation?
Mrs Jakab: It is very important that migrants
benefit from healthcare and health assessments, of which the screening
is one very important component. I also believe that the evaluation
of such processes is very important and it is obvious that they
take time. What we are doing currently is that, during the Portuguese
Presidency, migration and health were high on the agenda and there
was an important Council conclusion which referred to the ECDC
to develop a report by ECDC, by the end of 2008 on migration and
health. We are looking at these issues in various areas of TB,
HIV and other diseases. We are in the process of compiling such
a report which we would be very honoured to share with you.
Q911 Lord Geddes:
When do you expect that report to be published?
Mrs Jakab: Not before the end of 2008, but of
course certain elements will be ready before that. I would imagine
that around early autumn we would have a first draft, which we
would be happy to share with you.
Chairman: Thank you very much, Mrs Jakab.
Thank you for your time; my apologies for the interruption with
the vote. If there is anything you want to add, please write to
us. You indicated that in principle WHO Europe had agreed to allow
you access to the website on IHR events. You might need to check
this with them, but could you let us know why it is that there
is a delay in doing that, given that the agreement in principle
has been taken? Could I also ask you to let us know when you will
have access to it? If you could write to us on that basis I would
be very grateful. Meanwhile, thank you very much indeed; thank
you for your time and your efforts.
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