Recently established as an independent agency of the European Union (EU), the European Centre for Disease Prevention and Control (ECDC) is taking up growing responsibilities in strengthening Europe’s defences against infectious diseases. The Centre was established in 2005; and its headquarters are located in Stockholm, Sweden. ECDC’s start-up phase is over and 2008 represents the start of a new phase. ECDC has made significant progress in starting up its scientific activities, and since 2007, ECDC has experts in place covering all 49 of the infectious diseases that are notifiable at EU level.
The European CDC is built on a very different model than its US counterpart. Though ECDC is set to have a staff of around 350 and an annual budget of over € 50 million by the end of the decade, this is small in comparison with the CDC in Atlanta which numbers its staff in thousands and its budget in billions.
This is because public health remains primarily a Member State’s competence in the EU. ECDC supports the work of Europe’s national disease control agencies and coordinates EU level activities, but does not centralise power or resources. The Centre does not have executive or regulatory powers, and key assets such as laboratories continue to be located in national institutes. The core functions of the Centre can be summarized as follows: reinforce and develop Europe’s system of continent-wide disease surveillance, reinforce Europe’s rapid alert systems against disease outbreaks, support the EU and its Member States in strengthening preparedness and response against epidemics, provide authoritative scientific advice on infectious diseases and the risks they pose, work closely with Member States and other partners to prevent and control such diseases, and not least to communicate all its findings to the European public health community and to a larger European public.
In the context of the EU, with economic integration and open frontiers, cooperation on public health issues is becoming more important. While the idea of creating a European CDC had been around for quite some time amongst public health experts in the EU, the outbreak of SARS in 2003 and its rapid spread across countries confirmed the urgency of the creation of an institution dedicated to EU-level cooperation on public health issues. ECDC was set up in record time for an EU agency: the European Commission presented draft legislation in July 2003 [ ], by the spring of 2004 ECDC’s Founding Regulation had been passed [ ] and by the spring of 2005 the Centre started operating. As it started its activities, another threat – H5N1 avian influenza arriving in the EU’s neighbourhood and the fear that it could adapt or mutate into a pandemic strain of human influenza– confirmed the relevance of its mission.
Main achievements in 2007 and challenges for 2008
- 2007 has seen ECDC attaining some important milestones, both in the development of its infrastructure and the delivery of its scientific programme. Of particular strategic importance are:
- the adoption by the Management Board of a Multi-Annual Strategic Programme covering 2007-2013;
- the agreement on a list of Competent Bodies in the Member States (see below);
- the delivery of ECDC first ever Epidemiological Report in June 2007 [ ]. This analysis of the ‘state of communicable diseases’ in the EU enabled us to identify the key challenges Europe faces;
- the launch of the independent evaluation of ECDC, currently underway.
In 2007 some concrete results have also been achieved. Among many others, the following ones provide an illustration to ECDC’s work:
- ECDC has integrated the surveillance of a number of key diseases, including HIV and TB. From this year onward all EU-level surveillance data are being filed into a single database held at ECDC;
- an Emergency Operations Centre was developed from which ECDC can support the coordination of the EU-response to multi-country incidents. This is already working and will be fully operational in 2008:
- a number of scientific opinions have been produced for Member States, most recently on pre-pandemic influenza vaccines.
ECDC’s Annual Work Programme for 2008 is the first fully based on ECDC’s new Strategic Multiannual Programme (SMP) for 2007-2013. It starts an important new phase of ECDC’s development where annual work programmes are transparently planned, monitored and evaluated according to ECDC’s long-term strategy. This development is directly supportive of the proposed new EU strategy ‘Together for Health: A Strategic Approach for the EU 2008-2013’.
2008 represents the start of a new phase where content is now the focus rather than on infrastructures, tools and procedures as they are in most cases in place. More broadly the European added value is a strong guiding principle behind priority decisions. Partnerships with EU institutions, WHO and others key partners will be very actively pursued for synergy and added efficiency. Cooperation with the Member States will continue stressing quality, networking and synergy. In 2008 key projects will include:
- assisting the Member States and the Commission in implementing the new International Health Regulations;
- taking appropriate initiatives to help Member States raising awareness about antibiotic resistance and the need to use antibiotics wisely;
- planning the development of enhanced surveillance for several diseases including Hepatitis B and C;
- developing tools to make the detection of outbreaks throughout the region easier;
- developing a new multi-lingual portal and offering access to key EU-wide surveillance data, disease facts and scientific advice.
European level epidemiological information
European level disease surveillance is something that has been going on since the 1990s. By end of 2007, 14 out of 17 European-wide dedicated surveillance networks (DSNs) have been evaluated and assessed under ECDC’s guidance. As most of these networks covered one disease group or type of infection and their methods of operation differed, a key long term task for ECDC is to put in place a more systematic approach to European level disease surveillance and, at the same time, to ensure that full use is made of the results of European level surveillance. In October 2005 ECDC started the challenging process of planning The European Surveillance System (TESSy). The database aims at collecting, analysing and disseminating data on the 49 infectious diseases reported at European level. TESSy has been designed to provide comparable information on infectious diseases across the countries. It will give an overview of the current status of infectious diseases in Europe and will help to detect changing trends over time.
Eurosurveillance (http://ww.eurosurveillance.org) a leading European peer-reviewed journal devoted to the epidemiology, surveillance, prevention and control of infectious diseases, has been published by ECDC since March 2007. This partnership helps ensure results from ECDC and the EU funded surveillance networks are rapidly reported to the scientific community. Eurosurveillance is an open source (free of charge to both readers and authors) electronic journal that reports infectious disease issues from a European perspective. The weekly and monthly releases have recently merged to one single scientific journal. New issues are available online every Thursday and the articles reach a global audience of almost 13,000 active subscribers.
In June 2007 ECDC launched its first Annual Epidemiological Report on Communicable Disease in Europe (AER) . The report contains a considerable volume of epidemiological data on 49 communicable diseases (together with healthcare-associated infections and antimicrobial resistant pathogens) collected from 25 EU Member States, Norway and Iceland for the year 2005. Despite the evident problems with the comparability of data [ ], a number of conclusions on the epidemiology of infectious diseases in Europe were still possible.
ECDC is able to create panels of scientific experts to help it answer specific questions posed by its Member States or EU bodies (such as the European Commission and the European Parliament). The Centre published a call for experts in the autumn of 2005 and received nominations from 300 scientists from the Union (as well as a few from countries outside the EU). Scientific Panels consist of 11 members, selected following a well defined procedure, among those who have expressed their interest to work with ECDC.
The Centre set up an ad hoc panel of independent scientific experts at several occasions, such as to answer a series of eight scientific questions concerning H5N1 avian influenza and pandemic influenza or recently to develop the ECDC’s guidance for the introduction of Human Papillomavirus (HPV) vaccines in EU countries. The purpose of the HPV Guidance is to lay down the scientific basis to help the EU Member States make policy choices. The key message delivered by ECDC is that vaccination against HPV could be an effective prevention strategy against cervical cancer, but that vaccination is complementary to cervical cancer screening.
The ECDC has grown continuously since its start up in 2005. The Centre’s Director, Mrs Zsuzsanna Jakab, previously State Secretary at Hungary’s Ministry of Health and before that a Director in WHO Europe, took up her post in March 2005. By May 2005 she had in place a core team of 15 scientists and administrators – enough to enable the Centre to start operating. Total staff – including officials on secondment from national agencies – reached nearly 200 by the end of 2007 and is set to rise to 300 by the end of 2008. ECDC currently has staff from 26 out of the 27 EU Member States with professional backgrounds including medicine, public health, epidemiology, microbiology and veterinary science.
The structure of the Centre is based on key functions and comprises four technical units (Scientific Advise, Surveillance, Preparedness and Response and Health Communication), supported by a Unit for Administrative Services. The responsibility for overall coordination and external relations lies with the Director’s Cabinet. The disease-specific activities lie horizontally in programmes across the four technical units: ECDC has so far established six cross-cutting programmes: Respiratory Tract Infections (Influenza – Tuberculosis); STI including HIV and Blood-Borne Viruses; Vaccine Preventable Diseases; Antimicrobial Resistance and Healthcare-Associated Infections; Food and Water-Borne Diseases and Zoonoses and Emerging and Vector-Borne Diseases.
The Executive Management Committee (EXC) is an advisory committee to the Director and meets every week. The EXC is the main forum for policy, strategic planning and programme development, but also serves as a management forum for consultations and coordination of the day-to-day activities of the Centre, including follow-up of budget and work plans and horizontal coordination. The members of the Executive Management Committee are Director Zsuzsanna Jakab (Chair), Prof Karl Ekdahl, Head of Health Communication Unit, Prof Johan Giesecke, Chief Scientist and Head of Scientific Advice Unit, Dr Andrea Ammon, Head of Surveillance Unit, Dr Denis Coulombier, Head of Preparedness and Response Unit and Mr Jef Maes, Head of Administrative Services Unit.
As an independent EU Agency, the ECDC reports to a Management Board, whose members are nominated by the EU and the 3 EEA/EFTA Member States (Iceland, Liechtenstein and Norway), the European Parliament and the European Commission. Its main functions include appointing the Director, ensuring that the Centre carries out its mission and tasks in line with the Founding Regulation, as well as approving and monitoring the implementation of ECDC’s work programme and budget.
An Advisory Forum, composed of senior representatives of Member States public health institutes, and public health officials from the European Commission, advises the ECDC Director on the quality of the Centre’s scientific work. Other organizations participate as observers, among them WHO Europe, European scientific associations and civil society groups.
In the course of 2007, Member States governments have appointed Competent Bodies on the basis of their expertise. They are institutions or scientific bodies providing independent scientific and technical advice or capacity for action in the field of the prevention and control of human disease. They are providing support to the ECDC, which serves as a Community source of independent scientific advice, assistance and expertise from staff from its own resources or from those of recognised competent bodies acting on behalf of Member States’ authorities responsible for human health. The ECDC cooperates with them in all its missions, and particularly on preparatory work for scientific opinions, scientific and technical assistance, collection of data, identification of emerging health threat and with regard to public information campaigns. An official list has been compiled by ECDC Management Board in December 2007 [ ].
Significant investments will be made to develop ECDC’s infrastructure. One major investment will be the development of a state of the art Emergency Operations Centre. On 4 March 2008, ECDC Emergency Operations Centre was inaugurated by Dr Ouzky. In addition, ECDC will play a central role in the future development of Europe-wide IT systems such as the European Warning and Response System (EWRS), and networks for the sharing of surveillance data.
- Proposal for a regulation of the European Parliament and of the Council establishing a European Centre for Disease Prevention and Control COM(2003) 441.
- Regulation (EC) No 851/2004 of the European Parliament and of the Council of 21 April 2004 establishing a European Centre for Disease Prevention and Control. OJ L 142, 30.4. 2004: 1–11.
- Annual epidemiological report on communicable diseases in Europe. Report on the status of communicable diseases in the EU and EEA/EFTA countries. Stockholm: ECDC; 2007. Available from: http://ecdc.europa.eu/pdf/ECDC_epi_report_2007.pdf
- Amato-Gauci A, Ammon A. ECDC to launch first report on communicable diseases epidemiology in the European Union. Euro Surveill 2007;12(6):E070607.2. Available from: http://www.eurosurveillance.org/ew/2007/070607.asp#2
- List of ECDC’s Competent Bodies at: Available from: http://ecdc.europa.eu/About_us/Key_Documents/Competent_bodies_20dec07.pdf