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The European Union response
Bioterrorism:
the European Union response
George Gouvras
Michel Pletschette
European Commission
The European Union response
HEALTH SECURITY PROGRAMME
 Four Objectives-25 actions
 Timetable: Started 2002 for an initial period
of 3 years; extended to 2008 by the Council
and Parliament through the public health
programme 2003-2008
 Resources: Task Force of 14 experts, 2
million euros per year from EU, 2-4 million
per year from the EU Member States
The European Union response
Objectives
• Threat awareness and command and control
arrangements: Mechanism for information
exchange, consultation, co-ordination
• Surveillance and detection: Capability for
inventorying, detection and identification
• Response and recovery: Medicines’ stocks
and health services database and
arrangements for provision of medicines,
specialists, other medical goods and
infrastructure
The European Union response
Objectives (contd.)
• Prevention and Protection: Interdiction of
agent movement and critical infrastructure
protection
– Legislation, rules and guidance
– co-ordination of the EU response in other
policies
– links with third countries and international
organisations
The European Union response
1st objective:mechanism
• Health Security Committee
• 24h/7 days-a-week restricted access alert
system RAS-BICHAT
• Secure and effective links of the network
with the Early Warning and Response
System and the networks for external
relations, civil protection information
exchange, radiological emergencies alert,
food, animal and plant safety alert systems
The European Union response
2nd objective:detection
• Lists of biological and chemical agents and
materials held:
– CDC’s, Member States’, EU Matrix
– addition to legally-binding pathogen case definitions
(anthrax,Q-fever, tularaemia, smallpox)
– Council “dual use” regulation on export controls
– Biological agents’ Council Directive (1989,amended
2000) :occupational health and safety, public health
• Inventory of EU laboratory facilities
• Network of P4 and co-operation agreements for
laboratories and support in case of emergency
The European Union response
2nd objective (contd.)
CHEMICAL AGENTS
• Clinical guidelines for event scenarios, case
recognition and management
• Clinical and toxicological guidelines
• Expertise available through Directory
• Inventory of treatment facilities
• Network of surveillance: Poison Centres
and Special Regerence Centres
• EMEA guidance on antidotes
The European Union response
2nd objective (contd.)
• Directory of experts for interventionsassistance
• Procedures for the setting-up of joint
investigation teams
• Incident investigation and environmental
sampling: Protocols for incidents
• Planning and modelling
The European Union response
Planning : Scenarios and incidents
Type I Incidents
• the discovery of an unusual or suspicious object
• the discovery of a biological or chemical agent in
the wrong place or in the wrong product
• a threat or a terrorist attack with or without
demands, before or after harm or damage is
manifested
Type II incidents
• an abnormal outbreak of disease or unusual
clustering of cases without readily available
indications or explanations related to natural
causes or adventitious exposure
• an abnormal adverse event or suspected foul play
in an incident which results in prompt (especially
for chemicals) or would be likely to result to
delayed harm to people, animal or plant health
The European Union response
PLANNING AND MODELLING
• Smallpox plans and comparisons
• Scenarios, criteria for counter-measures
• EU-aspects: terminology, movement,
vaccination, other counter-measures
• Exercise (Global Mercury, intra-EU)
• SARS, AI : general plan
The European Union response
3rd objective:stocks-services
• Evaluation of existing stocks and
production capacities for medicines
• Elaboration of concerted stockpiling, siting,
availability and recycling strategies
• Strategies and instruments to allow the
development and deployment of medicines
• Dilution of 1st generation smallpox
vaccines, problems with the 2nd generation,
3rd generation smallpox vaccines and VIG
production
The European Union response
4th objective:
Other policy instruments
• Research: Expert Group, 6th Framework
Programme: diagnostics,detection, new
vaccines and therapeutics, decontamination
• Food safety
• Animal safety
• Plant safety
• Water safety
• Co-ordination of special measures
concerning the movement and residence
The European Union response
4th objective:
Other policy instruments
• Research: Expert Group, 6th Framework
Programme: diagnostics,detection, new
vaccines and therapeutics, decontamination
• Food safety
• Animal safety
• Plant safety
• Water safety
• Co-ordination of special measures
concerning the movement and residence
The European Union response
4th objective: Co-operation
• International co-operation
– Ottawa initiative
• Incident scale, risk management and communication
• Smallpox training,vaccine conference,exercise
Global Mercury to evaluate communications and
plans and check inter-operability
• P4 laboratory co-operation
• Chemical threats
• patient isolation techniques
• Influenza - the SARS paradigm
– Co-operation with the WHO
– NATO
The European Union response
Current priorities
• Development of a unified preparedness and
response capability through general emergency
plans and unified command and control centres
• Risk and crisis communication and management
• Incident investigation and environmental sampling
: protocols and detection
• Health resources and mutual assistance : minimum
requirements
• Exercises and emergency plan evaluation
• Public Health intelligence and threat monitoring
and assessment in liaison with security and law
enforcement services
The European Union response
General plan to cover:
• Disease outbreaks
• Pathogen traffic - foods, pets, laboratory/
research specimens, tyres, etc
• Human pressures and cultural habits that
spread agents illegally
• Inadvertent releases-unauthorised releases
• Deliberate (malicious) acts:
– terrorist
– non-terrorist (vengeance, mental disturbance, etc)
The European Union response
General plan: key headings
• Information management (surveillance,
monitoring, intelligence, sampling, detection, diagnosis,
analysis, correlation, identification)
• Communications (systems, procedures, command
and control, obligations for information and
consultation,media, expert groups, public)
• Scientific advice (procurement, setting criteria and
triggers in support of actions, determine corresponding
actions and the resources and ways to implement them)
The European Union response
Base for action
• Temporal or spatial patterns of disease, illness or syndromes Temporal or spatial patterns of CBRN agents
• Determination of actions at appropriate levels with precise criteria:
– Information transmission, forwarding to authorities and agencies
(local, national, international)
– Stand-by of agents/operators/staff - alert / heightened alert with
personnel and resource deployment
– Communication to groups and public
– Restriction of movement (people, animals, plants, food, water, goods,
energy flows)
– Transport restrictions
– Closure of premises/infrastructure
– Requisition of property (land, vehicles, facilities such as labs,
hospitals, centres, pharmaceuticals)
The European Union response
Support to actions (2)
• Medical/police interventions (triage,observation,
isolation, forceful administration)
• Civil Protection/military support interventions
(interdiction, temporary housing and food distribution)
• Decontamination interventions
• Waste management and disposal interventions
• Recovery interventions
The European Union response
Health system preparedness
• Hospitals
– (disaster plan and procedure, safety and hazard control and QA)
– Capacity fixes : emergency and casualty, isolation, barrier nursing,
intensive care)
– preventive and protective measures’ plan for staff
– staff numbers, training and assignment in teams
• Health centres and mobile units & medical teams
• Ambulance support and victim distribution
• Rest of patient/victim transport and treatment
capacity
Public Health Monitoring and Surveillance:
Communicable Disease Surveillance
Epidemic Intelligence
Early warning
Epidemic
response
Control
activities
Incidence / trends
Monitoring diseases
Monitoring Health Status
Health indicators
Health
Policy
Resource
allocation
Administrative data
Monitoring Health System
Inlc.resources diversion
and baseline
preparedness:e.g.general
Information screening
Verification
•Web scanning
•Newsgroups
•EWRS
•Personal
communication
Import
ant?
- RAS-BICHAT
- EWRS
Specific
Communication and Response actions
discard
no
Action
Communication
4
yes
6
5
1
verify
Releva
nt?
yes
(A)
Screening
report
SANCO
EWRS
RELEX
GOARN
(B)
Verification
report
7
Coordination of
response
8
2
3
9
Confirm
ed?
no
yes
(C)
Outbreak
report
no
discard
archive
DAILY and FOLLOW-UP verification
DAILY
Frequency
Input
Output
Process
Outcome
•SANCO
•RELEX
•WHO
•Health
Authorities
WEEKLY
(D)
Evaluation
report
AD HOC
Information sources used in HTU
Information screening
•Web scanning
•Newsgroups
•EWRS
•Personal
communication
Source
Filters
Screening
frequency
EMM
7 search strategies
2 strategies: daily
5strategies:
occasionally
Nexis-Lexis
23 search strategies
Daily
Jane’s Security
section
1
Releva
nt?
yes
All library news
Weekly
WHO Outbreak
Verification List
all information in
weekly lists and other
sporadic information
Weekly
no
Promed-mail
all messages
real time
discard
CDC Atlanta
MMWR
weekly
Health Canada
All information
occasionally
MINSA
all information
occasionally
UN-OCHA
Relief web site
occasionally
WHO emergency web
page
All information on the
page
occasionally
RASFF
all alerts
occasionally
Eurosurveillance
weekly
all articles
weekly
Event selection criteria
0. Hoax / Not relevant ------------------ Discard
1. Probable / Possible ------------------ Screening Report
2. Likely / Confirmed ------------------ Screening Report
For 1 and 2 consider:
•New or unknown disease / event
Relevance to international health
Potential for Community
involvement
Potential need for action
* This screening frequency is declared by the persons which
voluntarily follow these information sources. In case of absence for
any reason (mission, holidays etc.), such screening frequency
cannot be ensured.
The European Union response
Perspectives
• Regulation for an EU Centre for Disease
Prevention and Control – agreed March
2004 – ECDC Operational in May 2005
• Review of implementation of joint CouncilCommission anti-CBRN programme and
review of overall anti-terrorism programme
• Formulation of a European Security
Strategy
• The EU Constitution and the expanded
powers on health