New health initiative in the Baltic sea region

 1 Published: 30.05.05 Updated: 30.05.2005 11:16:28
Stein Andresen, Preben Aavitsland
The Council of the Baltic Sea States has agreed to create a Task Force to launch a concerted effort for controlling emerging diseases in the region.

In March 1992, the Foreign Ministers from Denmark, Estonia, Finland, Germany, Latvia, Lithuania, Norway, Poland, Russia, Sweden and a member of the European Commission established the Council of the Baltic Sea States (CBSS). The Ministers found that the recent dramatic changes in Europe heralded a new era of European relations where the confrontation and division of the past had been replaced by partnership and co-operation. An enhanced and strengthened Baltic co-operation was a natural and logical consequence of these events. The aim of the co-operation should be to achieve a genuinely democratic development in the Baltic Sea Region, a greater unity between the member countries and to secure a favourable economic development.

The summit meeting in Kolding

The Heads of Government and representatives of the member states met in Kolding (Denmark) on 12-13 April 2000. Present were also the President of the European Commission and the Presidency of the European Union.

At a press briefing, the Chairman, Prime Minister Jens Stoltenberg (Norway), presented three areas of particular importance for CBSS:

  • human security; the fight against organised crime and the spread of disease
  • the removal of obstacles to trade and investment
  • co-operation on energy and the environment, including climate policy.

Mr. Stoltenberg further said on the spread of diseases:

"People-to-people co-operation will not come far if people are not secure when they travel in the region. That is why we need to place the fight against organised crime and the spread of diseases at the top of the agenda."

Serious diseases are emerging in the region, such as AIDS and tuberculosis. Nowhere in the world is the growth in the number of cases of multidrug resistant tuberculosis higher than in parts of our region. This is serious for countries with the highest burdens, but also for other countries at risk of containment. The bottom line is that it is a serious threat to people. Inspired by our experiences in uniting our forces in the fight against diseases, we have agreed to create a Task Force of our special representatives to launch a concerted effort for controlling emerging diseases in the region. Norway has been asked to chair the Task Force and we have accepted this responsibility.

The Task Force will link together public health authorities in the 11 member states. We have asked the Task Force to produce its recommendations to the heads of government by the end of the year. We wish to see a full presentation of trends and facts. We wish to see concrete recommendations on best practices as well as strategies for closer co-operation. In addition to drawing on national expertise, we suggest that the Task Force stays closely in touch with international organisations such as the WHO, UNAIDS and the EU."

Prime Minister Stoltenberg opens the first meeting of the Task Force

The first meeting of the Task Force on Communicable Disease Control in the Baltic Sea Region was held in Oslo, 6 June 2000 under the chairmanship of State secretary for health Lars Erik Flatø of Norway. Delegates from the five Nordic countries, the Russian Federation, the three Baltic countries, Poland, Germany and the European Commission and Presidency were present, all representing their Heads of Government. The meeting was opened by Norwegian Prime Minister Jens Stoltenberg who said:

"We are transforming the Baltic Sea region into what it really is - a powerful European centre for growth and human progress."

He then went on: "It is when people travel, trade, exchange ideas and link up that economies develop. That confidence is being built. That peace is being secured. However, he raised concerns about the spread of HIV, sexually transmitted diseases and multi-resistant tuberculosis, stating that few obstacles are stronger to people-to-people co-operation and integration than the fear of disease."

Stoltenberg drew up four principles for the Task Force work:

"First; fighting disease is no mystery; ... all of these diseases can be effectively fought. Second; we need to be innovative. The old quarantine regime, implying detailed health controls at the borders, is both ineffective and counterproductive. Effective strategies against diseases in modern societies require coordinated and consistent efforts in all countries concerned. This is inter-dependence in practice. Third; disease is not a simple physical condition of ill-health. HIV and tuberculosis are social diseases where some segments of the population are worse off than others. And fourth; what you start here today has implications far beyond health. It adds a new chapter to an emerging culture of cooperation in the Baltic Sea region - and it sends signals to other regions in Europe and beyond."

Challenges ahead

Preben Aavitsland of the National Institute of Public Health in Norway presented a list of five main challenges in the region: 1) tuberculosis, 2) HIV and sexually transmitted diseases, 3) hospital infections and antimicrobial resistance, 4) organisation of health care systems and infectious disease control, and 5) trade and travel.

He presented maps showing tenfold differences between the Western and Eastern parts of the region in the incidence of syphilis and tuberculosis. Furthermore, he alluded to the rapidly increasing HIV incidence in Kaliningrad and St Petersburg. These epidemics would soon move from the drug injectors and other marginalised groups to the general population.

Aavitsland warned that trade with and tourism to Russia, Estonia, Latvia and Lithuania could be threatened if the public perceived these countries as dangerous. Also, he speculated, the EU would not admit new member states who had deficiences in their food control and infectious disease control systems.

Aavitsland urged the representatives to committing themselves to combating the problems:

"The Baltic Sea used to be divided by an iron curtain. Today, a decade after that curtain was removed, a new divider may be developing across the Baltic Sea. This is a divider between areas with high and low levels of infectious diseases. Such a divider may threathen stability and substainable growth in the region. I think you, as representatives of the Baltic Sea governments, should not allow this to happen. The spread of communicable diseases is a complex problem. There are no easy solutions. But there are difficult solutions, and they require commitment from the governments. You need to act now. Now is the time to invest in health in the Baltic Sea region of Europe."

Work plan

The Task Force will work hard during the summer and autumn and present to the CBSS a plan of action by the end of the year. See also CBSS homepage: