The European Union response Bioterrorism: the European Union response George Gouvras Michel Pletschette European Commission

The European Union response HEALTH SECURITY PROGRAMME  Four Objectives-25 actions  Timetable: Started 2002 for an initial period of 3 years; extended to 2008 by the Council and Parliament through the public health programme  Resources: Task Force of 14 experts, 2 million euros per year from EU, 2-4 million per year from the EU Member States

The European Union response Objectives Threat awareness and command and control arrangements: Mechanism for information exchange, consultation, co-ordination Surveillance and detection: Capability for inventorying, detection and identification Response and recovery: Medicines’ stocks and health services database and arrangements for provision of medicines, specialists, other medical goods and infrastructure

The European Union response Objectives (contd.) Prevention and Protection: Interdiction of agent movement and critical infrastructure protection –Legislation, rules and guidance –co-ordination of the EU response in other policies –links with third countries and international organisations

The European Union response 1st objective:mechanism Health Security Committee 24h/7 days-a-week restricted access alert system RAS-BICHAT Secure and effective links of the network with the Early Warning and Response System and the networks for external relations, civil protection information exchange, radiological emergencies alert, food, animal and plant safety alert systems

The European Union response 2nd objective:detection Lists of biological and chemical agents and materials held: –CDC’s, Member States’, EU Matrix –addition to legally-binding pathogen case definitions (anthrax,Q-fever, tularaemia, smallpox) –Council “dual use” regulation on export controls –Biological agents’ Council Directive (1989,amended 2000) :occupational health and safety, public health Inventory of EU laboratory facilities Network of P4 and co-operation agreements for laboratories and support in case of emergency

The European Union response 2nd objective (contd.) CHEMICAL AGENTS Clinical guidelines for event scenarios, case recognition and management Clinical and toxicological guidelines Expertise available through Directory Inventory of treatment facilities Network of surveillance: Poison Centres and Special Regerence Centres EMEA guidance on antidotes

The European Union response 2nd objective (contd.) Directory of experts for interventions- assistance Procedures for the setting-up of joint investigation teams Incident investigation and environmental sampling: Protocols for incidents Planning and modelling

The European Union response Planning : Scenarios and incidents Type I Incidents the discovery of an unusual or suspicious object the discovery of a biological or chemical agent in the wrong place or in the wrong product a threat or a terrorist attack with or without demands, before or after harm or damage is manifested Type II incidents an abnormal outbreak of disease or unusual clustering of cases without readily available indications or explanations related to natural causes or adventitious exposure an abnormal adverse event or suspected foul play in an incident which results in prompt (especially for chemicals) or would be likely to result to delayed harm to people, animal or plant health

The European Union response PLANNING AND MODELLING Smallpox plans and comparisons Scenarios, criteria for counter-measures EU-aspects: terminology, movement, vaccination, other counter-measures Exercise (Global Mercury, intra-EU) SARS, AI : general plan

The European Union response 3rd objective:stocks-services Evaluation of existing stocks and production capacities for medicines Elaboration of concerted stockpiling, siting, availability and recycling strategies Strategies and instruments to allow the development and deployment of medicines Dilution of 1st generation smallpox vaccines, problems with the 2nd generation, 3rd generation smallpox vaccines and VIG production

The European Union response 4th objective: Other policy instruments Research: Expert Group, 6th Framework Programme: diagnostics,detection, new vaccines and therapeutics, decontamination Food safety Animal safety Plant safety Water safety Co-ordination of special measures concerning the movement and residence

The European Union response 4th objective: Other policy instruments Research: Expert Group, 6th Framework Programme: diagnostics,detection, new vaccines and therapeutics, decontamination Food safety Animal safety Plant safety Water safety Co-ordination of special measures concerning the movement and residence

The European Union response 4th objective: Co-operation International co-operation –Ottawa initiative Incident scale, risk management and communication Smallpox training,vaccine conference,exercise Global Mercury to evaluate communications and plans and check inter-operability P4 laboratory co-operation Chemical threats patient isolation techniques Influenza - the SARS paradigm –Co-operation with the WHO –NATO

The European Union response Current priorities Development of a unified preparedness and response capability through general emergency plans and unified command and control centres Risk and crisis communication and management Incident investigation and environmental sampling : protocols and detection Health resources and mutual assistance : minimum requirements Exercises and emergency plan evaluation Public Health intelligence and threat monitoring and assessment in liaison with security and law enforcement services

The European Union response General plan to cover: Disease outbreaks Pathogen traffic - foods, pets, laboratory/ research specimens, tyres, etc Human pressures and cultural habits that spread agents illegally Inadvertent releases-unauthorised releases Deliberate (malicious) acts: –terrorist –non-terrorist (vengeance, mental disturbance, etc)

The European Union response General plan: key headings Information management (surveillance, monitoring, intelligence, sampling, detection, diagnosis, analysis, correlation, identification) Communications (systems, procedures, command and control, obligations for information and consultation,media, expert groups, public) Scientific advice (procurement, setting criteria and triggers in support of actions, determine corresponding actions and the resources and ways to implement them)

The European Union response Base for action Temporal or spatial patterns of disease, illness or syndromes - Temporal or spatial patterns of CBRN agents Determination of actions at appropriate levels with precise criteria: –Information transmission, forwarding to authorities and agencies (local, national, international) –Stand-by of agents/operators/staff - alert / heightened alert with personnel and resource deployment –Communication to groups and public –Restriction of movement (people, animals, plants, food, water, goods, energy flows) –Transport restrictions –Closure of premises/infrastructure –Requisition of property (land, vehicles, facilities such as labs, hospitals, centres, pharmaceuticals)

The European Union response Support to actions (2) Medical/police interventions (triage,observation, isolation, forceful administration) Civil Protection/military support interventions (interdiction, temporary housing and food distribution) Decontamination interventions Waste management and disposal interventions Recovery interventions

The European Union response Health system preparedness Hospitals – (disaster plan and procedure, safety and hazard control and QA) –Capacity fixes : emergency and casualty, isolation, barrier nursing, intensive care) –preventive and protective measures’ plan for staff –staff numbers, training and assignment in teams Health centres and mobile units & medical teams Ambulance support and victim distribution Rest of patient/victim transport and treatment capacity

Early warning Incidence / trends Administrative data Health indicators Epidemic response Control activities Resource allocation Health Policy Epidemic Intelligence Monitoring Health System Inlc.resources diversion and baseline preparedness:e.g.general and burns ICU Monitoring Health Status Monitoring diseases Public Health Monitoring and Surveillance: Communicable Disease Surveillance

Web scanning Newsgroups EWRS Personal communication Import ant? Confirm ed? SANCO EWRS RELEX GOARN Coordination of response Information screening Verification Communication Action Input archive SANCO RELEX WHO Health Authorities (A) Screening report (B) Verification report (D) Evaluation report (C) Outbreak report verify discard no yes Releva nt? discard no 1 yes Output Outcome Process DAILY and FOLLOW-UP verification DAILY WEEKLY AD HOC Frequency yes 7 - RAS-BICHAT - EWRS Specific Communication and Response actions

Information sources used in HTU SourceFiltersScreening frequency EMM7 search strategies2 strategies: daily 5strategies: occasionally Nexis-Lexis23 search strategiesDaily Jane’s Security section All library newsWeekly WHO Outbreak Verification List all information in weekly lists and other sporadic information Weekly Promed-mailall messagesreal time CDC AtlantaMMWRweekly Health CanadaAll informationoccasionally MINSAall informationoccasionally UN-OCHARelief web siteoccasionally WHO emergency web page All information on the page occasionally RASFFall alertsoccasionally Eurosurveillance weekly all articlesweekly * This screening frequency is declared by the persons which voluntarily follow these information sources. In case of absence for any reason (mission, holidays etc.), such screening frequency cannot be ensured. Web scanning Newsgroups EWRS Personal communication Information screening Releva nt? discard no 1 yes Event selection criteria 0. Hoax / Not relevant  Discard 1. Probable / Possible  Screening Report 2. Likely / Confirmed  Screening Report For 1 and 2 consider: New or unknown disease / event Relevance to international health Potential for Community involvement Potential need for action Event selection criteria 0. Hoax / Not relevant  Discard 1. Probable / Possible  Screening Report 2. Likely / Confirmed  Screening Report For 1 and 2 consider: New or unknown disease / event Relevance to international health Potential for Community involvement Potential need for action

The European Union response Perspectives Regulation for an EU Centre for Disease Prevention and Control – agreed March 2004 – ECDC Operational in May 2005 Review of implementation of joint Council- Commission anti-CBRN programme and review of overall anti-terrorism programme Formulation of a European Security Strategy The EU Constitution and the expanded powers on health