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Stock-taking on Europe’s pandemic preparedness
Zsuzsanna Jakab
Director
European Centre for Disease Prevention and Control (ECDC)
European Parliamentary Group
June 12th 2007
2Zsuzsanna Jakab - European Parliamentary Group – Brussels June 2007
Bird Flu Threat to the European Union Much Reproduced Cartoon from Autumn 2005
3Zsuzsanna Jakab - European Parliamentary Group – Brussels June 2007
Highly pathogenic avian influenza in wild birdsin Europe (Autumn 2005 to 2 August 2006)
Source: European Commission D1 http://ec.europa.eu/food/animal/diseases/adns/map/20060802/europe.htm
4Zsuzsanna Jakab - European Parliamentary Group – Brussels June 2007
Animal Disease Notification System summaryreport for highly pathogenic avian influenza inwild birds (1 February to 9 November 2006)
Source: http://ec.europa.eu/food/animal/diseases/adns/adns_wildbirds_09112006.pdf
5Zsuzsanna Jakab - European Parliamentary Group – Brussels June 2007
Director and Director’s CabinetManagement Governance External relations Country cooperation
Scientificadvice
Surveillance Preparedness &response
Administrativeservices
Antimicrobial resistance & healthcare-associated infections
Food- & waterborne diseases
HIV, STI & blood-borne viruses
Influenza
Other diseases of environmental & zoonotic origin
Tuberculosis
Vaccine preventable diseases & invasive bacterial infections
Healthcommunication
6Zsuzsanna Jakab - European Parliamentary Group – Brussels June 2007
Animal Disease Notification System summaryreport for highly pathogenic avian influenza inwild birds (1 February to 9 November 2006)
Source: http://ec.europa.eu/food/animal/diseases/adns/adns_wildbirds_09112006.pdf
7Zsuzsanna Jakab - European Parliamentary Group – Brussels June 2007
H5N1 in the UK and Hungary February 2007
8Zsuzsanna Jakab - European Parliamentary Group – Brussels June 2007
ECDC Report on EU preparedness for the CommissionSee http://www.ecdc.europa.eu/pdf/Pandemic_preparedness.pdf A short Eurosurveillance article on the Report
http://www.eurosurveillance.org/ew/2007/070222.asp#1
9Zsuzsanna Jakab - European Parliamentary Group – Brussels June 2007
Acknowledgements-1
Marja Esveld, Centre for Infectious Disease Control, National Institute for Public Health and Environment, Netherlands
Ralf Reintjes, Department of Public Health, Faculty of Life Sciences, Hamburg University of Applied Sciences, Germany
Jane Leese, Department of Health. Immunisation Policy, Monitoring & Surveillance, UK
Bernardus Ganter, World Health Organization Regional Office for Europe
Michala Hegermann-Lindencrone, World Health Organization Regional Office for Europe
Angus Nicoll, European Centre for Disease Prevention and ControlReinhard Kaiser, European Centre for Disease Prevention and
ControlDr Sophie Maes, Scientific Institute of Public Health (IPH), BelgiumDr Emmanuel Robesyn, Agency of Care and Health, BelgiumDr Sigrid Poulsen, National Board of Health, DenmarkDr Steffen Glismann, Statens Serum Institut, DenmarkDr Argo Parts, Dept of Public Health, EstoniaDr Kuulo Kutsar, Health Protection Inspectorate, EstoniaDr Petri Ruutu, National Public Health Institute, FinlandDr Tuula Putus, Ministry of Social Affairs & Health, FinlandDr Pierrette Huberty-Krau, Ministry of Health, LuxembourgDr Isabelle Welter, High Commission, LuxembourgMr Andre Jacobi, VWS, NetherlandsDr Philip van Dalen, Ministry of Health, Welfare & Sport, NetherlandsDr Anders Tegnell, The National Board of Health & Welfare, SwedenMs Hanna Lindberg, The National Board of Health & Welfare,
SwedenMr Anders Lindberg, The National Board of Health & Welfare,
Sweden
Ms Gudrun Sigmundsdottir, Directorate of Health, IcelandDr Bjorn Iversen, Norwegian Institute of Public Health, NorwayMs Iris Marelsdottir, RLS, IcelandDr Farmasoyt Ragnar Salmen, Directorate for Health & Social
Affairs, NorwayDr Reinhild Strauss, Ministry for Health and Women, AustriaDr Chrystalla Hadjianastassiou, Medical and Public Health Services,
CyprusDr Olga Kalakouta, Medical and Public Health Services, CyprusDr Jan Kyncl, National Institute of Public Health, Czech RepublicDr Reinhard Kaiser, European Centre for Disease Prevention and
Control (ECDC)Dr Angus Nicoll, European Centre for Disease Prevention and
Control (ECDC)Dr Karoline Fernandez de la Hoz, European Centre for Disease
Prevention and Control (ECDC)Dr Sarah de Martin, European Centre for Disease Prevention and
Control (ECDC)Dr Amanda Ozin, European Centre for Disease Prevention and
Control (ECDC)Dr Carmen Varela, European Centre for Disease Prevention and
Control (ECDC)Dr Paula Vasconcelos, European Centre for Disease Prevention and
Control (ECDC)Dr Kornelia Molnar, Chief Medical Officer’s Bureau, HungaryDr Agnes Csohan, National Institute of Epidemiology, HungaryDr Derval Igoe, Health Protection Surveillance Centre, IrelandMs Teresa Cody, Ministry of Health and Children, IrelandDr Denis Vella Baldacchino, Department of Public Health, Malta
10Zsuzsanna Jakab - European Parliamentary Group – Brussels June 2007
Acknowledgements-2
Dr Marija Seljak, Ministry of Health, SloveniaDr Alenka Kraigher, Institute for Public Health, SloveniaDr Patricia Santa Olalla Peralta, Ministry of Health and Consumer Affairs,
SpainDr Maria Jose Sierra Moros, Ministry of Public Health, SpainDr Frank Karcher, DG SANCO, European CommissionDr Bernardus Ganter, World Health Organization Regional Office for
EuropeDr Dragan Jankovic, World Health Organization Regional Office for EuropeInge Jooris, Interministerial Commissariat Influenza, BelgiumJan Eyckmans, Interministerial Commissariat Influenza, BelgiumDemetris Constantinou, Ministry of Health, CyprusKirsten Bohl, Danish Board of Health, DenmarkBen Duncan, European Centre for Disease Prevention and Control (ECDC)Andrea Würz, European Centre for Disease Prevention and Control
(ECDC)Alun Jones, European Food Safety Authority (EFSA)Mart Soonik, Ministry of Social Affairs, EstoniaAngus Nicoll, European Centre for Disease Prevention and Control (ECDC)Marie-Paule Benassi, DG SANCO, European CommissionCarmen Marqués Ruiz, DG SANCO, European CommissionEwa Hedlund, DG COMM, European CommissionJari Kirsilä, National Public Health Institute, FinlandDelphine Brard, Service d'information du Gouvernement, FrancePatrick Brasseur, Ministry of Health, France
Cornelius Bartels, Robert Koch-Institut, GermanyAndreas Deffner, Federal Ministry of Health, GermanyAnna Maria Leoutsi, Hellenic Centre for Diseases Control and Prevention
(HCDCP), GreeceMitrou Kostas, Hellenic Centre for Diseases Control and Prevention
(HCDCP), GreeceIlona Tasary, National Public Health and Medical Officer Service, HungaryTimea Kiss, National Public Health and Medical Officer Service, HungaryHelgi Mar Arthusson, Ministry of Health and Social Security, IcelandZaiga Barvida, Ministry of Health, LatviaNatalja Keturkiene, Ministry of Health, LithuaniaCeline Flammang, Service Information et Presse du Gouvernement
Luxembourgeois, LuxembourgJovanka Kostovska, Ministry of Health, FYROMSaso Stafanovski, Ministry of Health, FYROMBrian Cassar, Health Division – MHEC, MaltaLynette Wijgergangs, National Institute for Public Health and the
Environment, NetherlandsCecile Groenhaug, Directorate for Health and Social Affairs, NorwayPaweł Trzciński, Ministry of Health, PolandAna Morais, General Directorate of Health – UESP, PortugalCristina Perez Canto, Ministry of Health, SpainSara Johansson, National Board of Health and Welfare, SwedenHana Kubecek, Bundesamt für Gesundheit, SwitzerlandSander Gürbüz, Turkish Embassy in Athens, TurkeyMorten Giersing, UNICEF – CER / CIS, UNICEFSteve Thorogood, Department of Health, United KingdomEmily Collins, Health Protection Agency, United KingdomLiuba Negru, World Health Organization Regional Office for Europe
11Zsuzsanna Jakab - European Parliamentary Group – Brussels June 2007
12Zsuzsanna Jakab - European Parliamentary Group – Brussels June 2007
H7N2 Outbreak in Wales and England May 2007 – 3 in hospital and hundreds of adults and children on antivirals http://www.eurosurveillance.org/ew/2007/070215.asp#3
13Zsuzsanna Jakab - European Parliamentary Group – Brussels June 2007
Who is at Direct Risk from Avian Influenza in the EU
Group 1 - Low but Real Risk – Precautions ObligatoryThe risk of infection is almost entirely confined to people who have close contact with domestic poultry (chickens, ducks etc) or their droppings. Human cases have almost entirely been in this category
People with small domestic and hobby flocks are most at risk as they are less likely to be able to take precautions than those working in industry
ECDC Risk Assessment non-H5N1 avian influenzas June 2007
14Zsuzsanna Jakab - European Parliamentary Group – Brussels June 2007
Direct Infection of Humans andReassortment to for a Pandemic Strain
15Zsuzsanna Jakab - European Parliamentary Group – Brussels June 2007
Estimated additional deaths if a 1918-1919 Pandemic occured now (Murray et al - Lancet 2006 368: 2211-2218 )
Austria 13000 Latvia 13 800 Netherlands 23100
Belgium 14900 Lithuania 18800 Poland 155 200
Bulgaria 47100 Germany 116400 Portugal 25 100
Czech Rep 34100 Greece 27400 Romania 149 900
Cyprus 1900 Hungary 37700 Slovenia 5000
Denmark 7300 Ireland 6700 Slovakia 20600
Estonia 6100 Italy 95200
Spain 87100
Finland 8100 Luxembourg 500 Sweden 13300
France 89600 Malta 1100 UK 93000
EU Total 1.1m Iceland 420 Norway 5800
16Zsuzsanna Jakab - European Parliamentary Group – Brussels June 2007
Preparing for a Pandemic -Some Givens
• A pandemic is inevitable• We cannot predict when, what virus type or how
severe it will be• Even “milder” pandemics – like those of 1957
and 1968 – will disrupt societies and result in many avoidable deaths
• By preparing we can save lives, and avoid disruption
• After two years of preparations EU citizens probably now expect us to be prepared!
17Zsuzsanna Jakab - European Parliamentary Group – Brussels June 2007
Findings – the Good News
• EU overall made considerable progress since 2005 in pandemic preparedness
• High level political commitment • All countries have made major efforts to
develop national preparedness plans Health sector priorities well addressed Work underway to operationalise these plans Much good practice Innovative approaches
18Zsuzsanna Jakab - European Parliamentary Group – Brussels June 2007
A Few of Many European Influenza Control Innovations
• Communicating with the public and children [UK and Portugal],
• Cascade training of health care staff [France], • Getting Businesses to Prepare for a Pandemic
[Ireland] • Exercises to help get hospitals prepared [parts of
Spain] • Communicating with poor rural communities
[Poland]• Stimultating multi-sectoral planning going at the
local level [Sweden]
19Zsuzsanna Jakab - European Parliamentary Group – Brussels June 2007
A Few of Many European Influenza Control Innovations
• Communicating with the public and children• Cascade training of health care staff • Getting Businesses to Prepare for a
Pandemic• Exercises to help get hospitals prepared• Communicating with poor rural communities• Stimultating multi-sectoral planning going at
the local level
The Member State to Member State Approach
A Theme of the 4th European Pandemic Preparedness Workshop in Luxemburg
September 24-28th
Haven’t we Done Enough?
Shouldn’t ECDC be Doing Other Things Now?
Haven’t we Done Enough? – No!
Shouldn’t ECDC be Doing Other Things Now?- Yes – but as well
not instead of
23Zsuzsanna Jakab - European Parliamentary Group – Brussels June 2007
Director and Director’s CabinetManagement Governance External relations Country cooperation
Scientificadvice
Surveillance Preparedness &response
Administrativeservices
Antimicrobial resistance & healthcare-associated infections
Food- & waterborne diseases
HIV, STI & blood-borne viruses
Influenza
Other diseases of environmental & zoonotic origin
Tuberculosis
Vaccine preventable diseases & invasive bacterial infections
Healthcommunication
Further 2 to 3 years effort needed for EU countries to
be confident they can respond well to a pandemic
especially from their citizens point of view
25Zsuzsanna Jakab - European Parliamentary Group – Brussels June 2007
Published targeted levels of antiviral stockpiles > 5% Published Data Assembled by Roche - in % of total population based on treatment
0%
10%
20%
30%
40%
50%
60%
% c
ove
rag
e b
ased
on
trea
tmen
t
Sources: Media / National pandemic plans (as of April 1, 2007) 1. This represents the number of treatments in percentage of total population that governments have stockpiled or intend to stockpile and
that governments have made publicly available either in their pandemic plans or through media releases.2. This is not (but can) be a reflection of actual stockpiles. Some governments might have more, but have not publicly communicated, others
might have less, but intend to increase to reach a greater coverage. 3. The slide only shows countries that have or intend to stockpile for more than 5% of their population and have made this publicly available.4. In some of the cases the coverage includes Tamiflu and Relenza, in others only Tamiflu.
26Zsuzsanna Jakab - European Parliamentary Group – Brussels June 2007
Some specific weaknesses from the ECDC Indicators (Items where less than 80% of Member States were able to self-report - yes we have done that)
• Planning document for local health services including
planning assumptions (no such document 22%)
• National strategy on non-pharmaceutical interventions (22%)
• National pandemic vaccination strategy developed (25%)
• National communication strategy (30%)
• Public education material on pandemic influenza (35%)
• National health sector exercise undertaken (42%)
• National contingency plan for maintinance of non-health
essential services (50%)
27Zsuzsanna Jakab - European Parliamentary Group – Brussels June 2007
Five Key areas where further efforts needed
1.Integrated planning across governments.
2.Extending influenza research3.Interoperability at the national level4.Making plans operational at the local
level 5.Stepping up prevention efforts against
seasonal influenza
28Zsuzsanna Jakab - European Parliamentary Group – Brussels June 2007
Being prepared locally – the ECDC Acid Testshttp://www.ecdc.eu.int/Influenza/AssessmentToolPandemicInfluenzaPreparedness_13_9_2006.pdf
Can you ensure? – Some examples from the tests
At Primary Health Service levelTimely deliver antiviral treatments for all with symptoms within 24 or 48
hours of symptoms starting Hospitals
Deliver acute care for influenza patientsContinue to provide essential treatment for non-influenza related
conditions Essential services continue to function locally
PowerFoodFuel supplies…
Pandemic vaccine will arrive within 6 months of start of pandemic at primary care
29Zsuzsanna Jakab - European Parliamentary Group – Brussels June 2007
Source Population (2003) Data: Eurostat http://epp.eurostat.cec.eu.int/portal/page?_pageid=1996,45323734&_dad=portal&_schema=PORTAL&screen=welcomeref&open=/&product=EU_MAIN_TREE&depth=1
Estimated Elderly Population Immunized (Percentage) N = 18 EU countries Forty Fold Variation 2% to 80%ECDC Survey April 2006
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
10 13 9 14 23 3 19 18 7 16 20 8 15 4 21
Member States
Up
take
in a
ge
gro
up
65+
30Zsuzsanna Jakab - European Parliamentary Group – Brussels June 2007
Street Hand-Washing Facilities USA and Hong Kong – in the EU?
31Zsuzsanna Jakab - European Parliamentary Group – Brussels June 2007
Hong Kong and Influenza Prevention
32Zsuzsanna Jakab - European Parliamentary Group – Brussels June 2007
Conclusions
• A lot done, but not yet ready and a lot more to do. • Two to three years more hard work needed in the five
areas Integrated planning across governments. Extending influenza research Interoperability at the national level Making plans operational at the local level Stepping up prevention efforts against seasonal influenza
• We need your help to keep governments on track
Thank you for your Attention
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