Stock-taking on Europe’s pandemic preparedness Zsuzsanna Jakab Director European Centre for Disease Prevention and Control (ECDC) European Parliamentary

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


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


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


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


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


H5N1 in the UK and Hungary February 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

http://www.ecdc.europa.int/pdf/Pandemic_preparedness.pdf

http://www.ecdc.europa.int/pdf/Pandemic_preparedness.pdf

http://www.eurosurveillance.org/ew/2007/070222.asp#Slide%200


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


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



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


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


Direct Infection of Humans andReassortment to for a Pandemic Strain


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


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!


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


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]


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


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


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.


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%)


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


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


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+


Street Hand-Washing Facilities USA and Hong Kong – in the EU?


Hong Kong and Influenza Prevention


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

Documents

Stock-taking on Europe’s pandemic preparedness Zsuzsanna Jakab Director European Centre for Disease Prevention and Control (ECDC) European Parliamentary