1. SHIPSAN ACT – Joint Action The impact on maritime transport of health threats due to biological, chemical & radiological agents, including communicable diseases. Health Security Workshop: How to benefit from European projects? 13-14 November 2014 – Brussels Professor Gordon Nichols Consultant Epidemiologist, Gastrointestinal Emerging and Zoonotic Infections, Centre for Infectious Disease Surveillance and Control, Public Health England DG HEALTH & CONSUMERS PUBLIC HEALTH PROGRAMME 2008-2013 Contract No: 2012 2103

2. EU SHIPSAN ACT Joint Action Plague in ships sailing from Asia to the Crimea, 1348 Smallpox, measles, influenza, and typhus introduced to the New World in 1492 Influenza on the 2 nd Colombian expedition in 1493 Smallpox in a ship sailing from Mauritius to France, 1792 Yellow fever in a ship sailing from Cuba to Wales, 1865 Cholera transmission initiating pandemics – 19 th century Diseases on ships: A historical perspective

3. EU SHIPSAN ACT Joint Action 2006 - 2008 2008 - 2011 2013 - 2016 Shipsan - Situation analysis and needs assessment Addressing passenger ships State of the art: Communicable diseases & outbreaks from 1970 to 2006 Study: 32 countries and 176 authorities Needs, gaps, legislation - EU MS categorised in 4 groups according to their capacity Use experience of existing programmes Manual for health and hygiene - outline Shipsan Act - Joint Action for all types of threats in maritime transport Cargo ships Inland navigation vessels Fishing vessels Passenger ships Three SHIPSAN projects Shipsan Trainet - Developing materials and a training network Manual for health and hygiene Training network and pool of experts Training material Training modules for PHO & seafarers EU SHIPSAN Integrated Program/pilot inspections Web-based Communication Network

4. EU SHIPSAN ACT Joint Action The partnership 1.Austria 2.Belgium 3.Bulgaria 4.Croatia 5.Cyprus 6.Denmark 7.Estonia 8.France 9.Germany 10.Greece 11.Iceland 12.Ireland 13.Italy 14.Lithuania 15.Malta 16.Netherlands 17.Norway 18.Poland 19.Portugal 20.Romania 21.Slovakia 22.Slovenia 23.Spain 24.United Kingdom

5. EU SHIPSAN ACT Joint Action European Centre for Diseases Prevention and Control (ECDC) European Agency for Safety and Health at Work (EU-OSHA) Advanced National Networks for Administrations (AnNa) project EU AIRSAN project European Chemical Emergency Network project Mediterranean Programme for Intervention Epidemiology Training (MediPIET) World Health Organisation Collaboration with Chinese authorities (training/manual) Brazilian Health Surveillance Agency (ANVISA) EUROMED countries Cruise Line Industry Association Synergies

6. EU SHIPSAN ACT Joint Action To strengthen an integrated strategy and sustainable mechanisms at EU level for safeguarding the health of travelers and crew of passenger and cargo ships and preventing the cross-border spread of diseases. Facilitate the implementation of the EU legislation: Decision No 1082/2013/EU of the European Parliament and of the councilDecision No 1082/2013/EU of the European Parliament and of the council on serious cross-border threats to health Directive 2010/65/EUDirective 2010/65/EU on reporting formalities for ships arriving in and/or departing from ports of the Member States by supporting EMSA to implement MDH Directive 2009/13/ECDirective 2009/13/EC based on ILO convention on occupational health by developing an outline of a risk assessment tool for occupational health on ships – OSHA-OiRa tool Facilitate the implementation of the EU legislation: Decision No 1082/2013/EU of the European Parliament and of the councilDecision No 1082/2013/EU of the European Parliament and of the council on serious cross-border threats to health Directive 2010/65/EUDirective 2010/65/EU on reporting formalities for ships arriving in and/or departing from ports of the Member States by supporting EMSA to implement MDH Directive 2009/13/ECDirective 2009/13/EC based on ILO convention on occupational health by developing an outline of a risk assessment tool for occupational health on ships – OSHA-OiRa tool Facilitate implementation of IHR by supporting core capacities Annex 1b by training, inspections, contingency planning guidance and IHR provisions for conveyances and conveyance operators including SSC Prevention, identification, assessment & link with existing mechanisms for response coordination to serious cross border threats to health caused by communicable diseases, chemical, biological and radiological agents. Shipsan Act Joint Action: Objectives Duration: 39 Months (January 2013 - April 2016)

7. EU SHIPSAN ACT Joint Action Guidelines under development for competent authorities in support to their risk assessment and response to chemical and radiological incidents on ships while the ship is at port. Two Simulation exercises to be conducted 1 st Simulation exercise: – test a multi agency working in response to chemical and radiological incident – practice procedures for the alerting and notification of significant cross border health threats – enable organizations to develop appropriate systems if gaps are identified 2 nd Simulation exercise: – Table top & operational exercises for the EU SHIPSAN ACT Information System (SIS) European Manual for Hygiene Standards and Communicable Disease surveillance Guidelines for the prevention and control of influenza Prevention and control of gastroenteritis on passenger ships Guidelines for the prevention and control of legionellosis Improving planning, preparedness and response at ports

8. EU SHIPSAN ACT Joint Action Facilitation of communication in real time within and outside countries – 19 public health events on ships followed up using the web-based Communication Network http://www.shipsan.eu/comnet/ http://www.shipsan.eu/comnet/ Planning a European database for storing the Maritime Declaration of Health submitted in the National Single Window (Directive 2010/65/EU) – functions for analysing data to the competent health authorities – facilitate risk assessment Strengthening capacities for event detection and response on ships for all types of health threats (biological, chemical, radiological) Sharing of information and avoiding duplication of efforts and repetition of actions in event management Improvement of preparedness and response at ports Event detection and response

9. EU SHIPSAN ACT Joint Action – Maintaining an information system for recording and issuing Ship Sanitation Certificates (IHR 2005) for all types of ships based on WHO guidelines. http://ssc.shipsan.eu/ http://ssc.shipsan.eu/ 172 registered inspectors from 10 European countries A total of 5062 SSCs have been issued and recorded in the SHIPSAN information system based on the WHO Handbook for inspection of ship and issuance of SSCs – Coordinated passenger ship inspection programme and database of inspection results based on the “European Manual for Hygiene Standards and Communicable Diseases Surveillance on Passenger Ships” – Sharing results Improvement of preparedness and response at ports 2013:2014 (ongoing):2015: 50 inspections conducted 48 passenger ships in 22 ports 13 EUMS based on EU standards By trained inspectors 51 inspections scheduled Unannounced inspections by trained port health officers / Non voluntary participation of passenger shipping companies Conducting inspections using common standards of WHO and EU legislation

10. EU SHIPSAN ACT Joint Action Training courses Face to face courses focused on IHR(2005) and the issuance of SSCs and on European manual and SIS: 4 at European Level (3 completed, 1 scheduled: June 2015) 6 at National Level (Ireland, Bulgaria, Greece, Italy, Spain, Croatia) E-learning: 325 registered users Pool of Trainers 83 trainers from 20 countries Trainees 101 port health officers trained in 3 face to face training courses 104 inspectors in training/on the job training Improvement of preparedness and response at ports Support training of port health officers in risk assessment, response and ship inspections

11. EU SHIPSAN ACT Joint Action Ad hoc working group for Ebola Inquiry on potable water for human consumption from sea water in Japan through reverse osmosis and evaporator Consultation on 2 outbreaks Developed Water Safety Plans for 2 ships upon request Request to monitor and participate in a research protocol Analysis of a cruise companies' data for Gastrointestinal Illness Analysis of data for meningitis outbreak Outbreak investigation on cruise ship accommodating earthquake victims Advice on water microbiological testing Improvement of preparedness and response at ports Providing expert public health advice for biological, chemical and radiological events including communicable diseases events

12. EU SHIPSAN ACT Joint Action EU SHIPSAN ACT JA further protects health of crew working on ships, by providing training on ILO MLC health related issue: – 96 seafarers were trained in 3 face to face training courses Develops a web-based risk assessment tool for occupational health risks per cargo ship type by using the European Agency for Safety and Health at Work (EU- OSHA) Online Interactive Risk Assessment (OiRA) tool http://www.oiraproject.eu/ http://www.oiraproject.eu/ Survey on the current status of implementation of ILO Maritime Labour Convention, 2006. EU SHIPSAN ACT JA activities focused on seafarers Activities focussed on Seafarers

13. EU SHIPSAN ACT Joint Action Different policies at designated and authorized ports for issuing Ship Sanitation Certificates. Different inspection practices. Contingency plans not available for all the countries (67%) Most countries have specific personnel to inspect ships but not for outbreaks management. There is a lack of training. Lack of coordination of outbreak investigation, inspection and control Lack of guidance - Recent example Fukushima, Japan = impacted ship travel challenging authorities due to lack of guidance Lack of communication and differences in IHR implementation Diversity of inspectors’ knowledge, qualifications, training practices, heterogeneity in MS occupational health policies, seafarers medical certification/ infectious disease reporting Identification of gaps and needs - Survey on training training needs related to core capacities at points of entry-ports

14. EU SHIPSAN ACT Joint Action Almost half of the countries don’t have specific legislation for the inspection on fishing vessels. Most of the countries do not perform regular inspections. Most of the countries there is no evidence for the issuance of Ship Sanitation Certificates. 7/12 countries require to report health events. 5/7 use the Maritime Declaration of Health. Identification of gaps and needs - Survey on hygiene inspection practices on fishing vessels: Legislation and contingency plans are not specific for ships or at ports. Responsible authorities for radiological events easier to identify than for chemical events. Competent authorities are not usually health authorities & are mainly national authorities. There is lack of training. Identification of gaps and needs - Survey on chemical and radiological incidents in maritime transport:

15. EU SHIPSAN ACT Joint Action Activities Yes Activity 1 - Training programme 51/52 (98.1%) Activity 2 - Maintaining an information system for recording and issuing Ship Sanitation Certificates 50/52 (96.2%) Activity 3 - Coordinated passenger ship inspection programme and database and manual 52/52 (100%) Activity 4 - Maintaining a European database for storing the Maritime Declaration of Health 39/52 (75%) Activity 5 - Maintaining a communication network platform of competent authorities for ports in EU Member States 50/52 (96.2%) Activity 6 - Providing expert public health advice on responding to biological, chemical and radiological events 43/52 (82.7%) Activity 7- Supporting and developing a risk assessment tool for occupational and public health risks on cargo ships 37/51 (72.5%) In your opinion, should this activity be part of the long-term strategy and be implemented sustainably in the EU countries? Sustainability Survey – results from associate partners, collaborative partners and port health officers participating in SHIPSAN inspections

16. EU SHIPSAN ACT Joint Action Any outcome of the Joint Action in regards to the legal framework should be supplementary to the current legislation – IHR 2005 – Decision No 1082/2013/EU for cross border health threats – Directive 2010/65/EU for the NSW. The EU SHIPSAN ACT General Assembly members decided to proceed with a consensus document that will be sent to the European Commission services, the Health Security Committee and other competent bodies to be considered for a future Recommendation – it will address elements not currently covered by existing legislation. Sustainability – 1 st General Assembly Meeting – Results 17th October 2014, Luxembourg

17. EU SHIPSAN ACT Joint Action – Transport and Health Joint Action (SHIPSAN, AIRSAN, LANDSAN) OR Maritime transport Joint Action OR Joint Action involving EUROMED countries DEVCO OR/AND Operating grant – Fees: Inspection Training Consultation New build ships – Funding specific activities (training etc.) DG DEVCO IMO WHO MONALISA project AnNa project MediPIET Other projects Sustainability – Funding options considered by the partnership

18. EU SHIPSAN ACT Joint Action Protecting the EU population against health threats by improving health security. – Helps country preparedness planning, responding to events in a coordinated manner by developing contingency plans and IHR core capacities. Protects the health of passengers travelling on ships in the EU by: – strengthening compliance of ships with MS/and EU legislation, standards and guidelines related to hygiene, CBRN events management and ; – implementing an integrated strategy for epidemiological investigation; Protects health of crew working on ships, by: – providing training on ILO MLC health related issues. Strengthens the EU’s capacity to monitor and respond to health threats by: – developing EUMS cooperation – facilitating rapid ship-to-port and port-to-port information exchange using web-based tools. Provides risk assessment data and implementation of response measures at the port level to existing monitoring and early warning mechanisms at local, national and EU levels. Shipsan Act Joint Action: Conclusions

19. EU SHIPSAN ACT Joint Action For further information: www.shipsan.eu www.shipsan.eu Subscribe to the SHIPSAN ACT bimonthly e-newsletter