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Where are we now and what needs to be done – pandemic preparedness in EuropeProfessor Angus Nicoll CBE, Influenza Coordinator European Centre for Disease Prevention and Control (ECDC)
French Presidency
Vilamoura , 16 September 2008
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We know everything we need to know For preparing for the next
pandemic …
… apart from a few details
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Known unknowns
• When
• Where will start
• The severity
• The viral type
• The antiviral resistance pattern
• The target groups for prevention
• Clinical details
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Introduction – The Vulnerability of Europe
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1.Free movement of people *
2.Free movement of services *
3.Free movement of goods*
4.Free movement of monies *
*Adapted from Summary of Legislation - Internal Market. Availbale from http://europa.eu.int/scadplus/leg/en/s70000.htm
Expanded Europe – the four freedoms
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1. Free movement of people *
2. Free movement of services *
3. Free movement of goods4. Free movement of monies *
5.Free Movement of Influenza
*Adapted from Summary of Legislation - Internal Market http://europa.eu.int/scadplus/leg/en/s70000.htm
Expanded Europe – the fifth freedom
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Diverse, not centrally controlled but highly
interdependent
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…but effective countermeasures
• Unprecedented effort by Member States and the EU since 2005, counteracting a threat to health and assuring well-being
• Modern approaches:– public health and personal
measures;– medical care (antibiotics, antivirals);– influenza vaccines.
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History since 2005 – EU level
• WHO Plan and Check-List• Commission Communication in 2005• Major political initiatives • Four joint Commission-ECDC-WHO
workshops with all Member States to sustain momentum
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‘Bird Flu’ was both a stimulus and a distraction
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Highly pathogenic avian influenza in wild birds in Europe (Autumn 2005 to 2 August 2006)
Source: European Commission D1 http://ec.europa.eu/food/animal/diseases/adns/map/20060802/europe.htm
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ECDC’s role
• Technical guidance and information – as can be seen every week in Influenza News http://ecdc.europa.eu/en/Health_Topics/influenza/news_archive.aspx
• Preparing for surveillance in a pandemic with EISS and WHO.• Helping Member States prepare their influenza
communications. • Regular EU/EEA surveys of pandemic preparedness 2006,
2007, and to come 2009. • Collecting and disseminating innovations and developments
from the MS and abroad. • Developing and enacting a methodology for pandemic
preparedness self-assessments in all thirty EU/EEA member states – done jointly with WHO Regional Office for Europe and the European Commission
• The recent reports all published by the countries: Ireland, Finland, Netherlands, Norway & Sweden
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Methodology of Joint ECDC, WHO, European Commission Country Self Assessments
• Standardised published protocol http://www.ecdc.eu.int/Health_topics/Pandemic_Influenza/Assessment_tool.html
• Six month process• Four to Five day Visit• Initial report draft report
– Description – Turkey authorities– Comments and Recommendations agreed with Turkey
Authorities• First draft comments and recommendations – • First draft text sent to Turkey November • Final report agreed with and sent to Turkey
Authorities before December• ? Published
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So where are we now on pandemic preparedness?
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Practice
National Local and front line
Prepared-ness
ECDC model for national pandemic preparedness
Plans
multi-sectoral
unprepared
adequately prepared
health
only
1
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Practice
National Local and front line
Prepared-ness
ECDC model for national pandemic preparedness
Plans
multi-sectoral
unprepared
adequately prepared
health
only
2
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Practice
National Local and front line
Prepared-ness
ECDC model for national pandemic preparedness
Plans
multi-sectoral
unprepared
adequately prepared
health
only
3
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Practice
National Local and front line
Prepared-ness
ECDC model for national pandemic preparedness
Plans
multi-sectoral
unprepared
adequately prepared
health
only
4
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So where are we now on pandemic preparedness?
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Practice
National Local and front line
Prepared-ness
ECDC model for national pandemic preparednessWhere we are now
Plans
multi-sectoral
unprepared
adequately prepared
health
only
3
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Not just national
Interoperability
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European interoperability and pandemics. What does it mean? Negative Interoperability
1. I do something in my state that impacts on a neighbouring state, e.g. closing borders and stopping daily commutes to work
2. I do something in my state that causes questions or disquiet in a neighbouring state – especially if it is done without warning e.g. closing schools
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Good news – MS Level
• There has been massive progress since 2005.
• Every Member State has a plan and many have advanced further.
• Many innovations and developments at the MS and EU level. http://ecdc.europa.eu/en/Health_topics/Pandemic_Influenza/innovations.aspx
• Some states are working at all levels, down to the local level.
• Multi-sectoral approaches.
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Bad news: Major gaps remain and there is some loss of momentum
• ‘Flu fatigue’.• Policies are not yet alligned• Only 12 of 29 Member States had a national
contingency plan for maintaining essential services.
• One third of countries were yet to do work with neighbouring countries.
• Antiviral stockpiles do not seem to have underpinning strategies, are difficult to manage and distribute and now need to encompass antiviral resistance.
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The five major gaps
• Local preparedness• Intersectoral work• Interoperability • Research that is more targeted• Improving use of seasonal vaccine
and developing pandemic vaccine capacity
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Local preparedness: most countries failmost of ECDC’s local ‘acid tests’
Are you convinced that you can – deliver and manage your stocks of antivirals in
the 24–48 hour window, manage the stocks and not run out?
– distribute specific pandemic vaccines efficiently and equitably when they start to become available?
– maintain local essential services?
http://www.ecdc.europa.eu/pdf/Acid%20Tests.pdf
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Intersectoral work – “The Whole Society Approach”Explicit policy options
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between Member States,between Member States and neighbouring states,between regions and areas inside states.
Interoperability
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More targeted research
• A lot done • Much by the European
Unionbut
• Tended to be research-led, not driven by what questions need answering
• Need to answer specific questions, e.g. how influenza is transmitted
• See call for research on public health measures
ECDC Influenza transmission research needs for informing infection control policies and practice Eurosurveillance 12, Issue 19, 10 May 2007
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How to Find the Call? Deadline December 3rd
http://cordis.europa.eu/fp7/dc/index.cfm?fuseaction=UserSite.FP7DetailsCallPage&c
all_id=140#infopack
or Influenza News on ECDC Site http://ecdc.europa.eu/en/Health_Topics/influenza/news_archive.aspx
September 4th
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Seasonal vaccine use and availability of pandemic vaccine
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Data from VENICE Survey
and other sources 2008, Version 18 March 2008
From pandemic preparedness report (2007)
Vaccination coverage estimated through telephone surveys (University of Zurich)
Recommended WHO target for 2010
Data not available for: Bulgaria,Cyprus, Estonia, Greece, Iceland, Latvia, Malta
Vaccination coverage for seasonal influenza vaccine in the elderly (65 years and older) in EU and EEA countries Latest seasonal data available in spring 2008
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Connection between seasonal influenza and pandemic vaccines?
www.evm-vaccines.org
Influenza vaccine, worldwide production
in 2003*
ROW(5 %)
North AmericaCanadaJapanAustralia(25 %)
90 million dosesdistributed in Europe
100 million doses Distributed outside Europe(97 % of doses for the Americas, Eastern Europe, Middle East, Africa, Asia)
Worldwide production 2003:292 million doses(9 countries, excluding purely local production)EU production:190 Million doses(65%)
* MIV. Vaccine 2005;23:5233-43
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Desirable Features of pandemic preparedness
• Measures must be centrally applied and detailed• Actions should be uniform • Precise priorities for prophylactic drugs• Decide if and when schools should close• Evidence based approach to personal measures
(masks, hand washing etc)• Scientific evidence for the public health measures
Anderson R. Plagues & People: Preparing for Pandemics
ESWI Lecture 2008
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Conclusions
• A lot done, but not yet ready and there is a lot more to do.
• Europe is not yet prepared• At least three years more hard work needed in five
areas: – making plans operational at the local level; – the Whole Society approach - integrated planning
across governments using explicit policy options; – interoperability at the national level;– making influenza research more targeted;– stepping up prevention efforts against seasonal
influenza; and improving vaccine capacity for a pandemic.
