In recent decades, EU countries have fought communicable diseases with success through treatment and prevention. Rates of infectious diseases have either fallen or remained stable, and the majority of deaths in EU countries are now due to non-communicable diseases such as cancer and heart disease.
Communicable diseases however are still a threat to the health of European citizens. In our globalised world, communicable diseases can spread very quickly from one country to another. The (re-)emergence of infectious diseases, antimicrobial resistance and vaccine hesitancy are some of the challenges that the EU has to face. In response to the threat of communicable diseases, EU policy has focused on:
- Rapid detection
- Rapid response
Surveillance of communicable diseases
Surveillance systems provide information for monitoring communicable disease trends and early detection of outbreaks, helping to identify risk factors, and areas for intervention. They provide information for priority setting, planning, implementation and resource allocation for preventive programmes and for evaluating preventive programmes and control measures.
Decision 2119/98/EC of the European Parliament and the Council established the network for the epidemiological surveillance and control of communicable diseases. A number of implementing measures were adopted and a reference list of communicable diseases and related public health issues drawn up (Commission Decision No 2000/96/EC), including their case definitions (Commission Decision No 2002/253/EC).
Decision No 2119/98/EC was repealed and replaced by Decision No 1082/2013/EU of the European Parliament and of the Council of 22 October 2013 on serious cross-border threats to health. The new Decision revived the network for the epidemiological surveillance of communicable diseases and related special health issues. It laid down rules on the data and information that national competent authorities should communicate and provided for continued coordination of the network by the European Centre for Disease Prevention and Control (ECDC).
The list of diseases and case definitions are regularly updated to reflect changes in disease incidence and prevalence, and in light of new scientific information, and evolving laboratory diagnostic criteria and practices.
Communicable diseases do not recognise borders and can spread rapidly if action is not taken in time. EU reactions must be rapid and coordinated in the event of an outbreak.
The Early Warning and Response System (EWRS)
EWRS is a rapid alert system for notifying at EU level on serious cross-border threats to health, as per Article 8 of Decision 1082/2013/EU. This confidential computer system enables the European Commission and EU countries to be in permanent communication for the purposes of alerting, assessing public health risks and determining the measures that may be required to protect public health.
The system is owned by the European Commission and operated by the ECDC. EWRS has been successfully used to alert, share information and coordinate measures in response to previous outbreaks including SARS, pandemic influenza A(H1N1), Ebola, Zika and other cross-border outbreaks of communicable diseases.
Commission Implementing Decision (EU) 2017/253 of 13 February 2017 lays down the procedures for the notification of alerts as part of the early warning and response system and for the information exchange, consultation and coordination of responses to such threats.
Rapid response to serious cross-border threats to health is coordinated at EU level within the Health Security Committee (HSC). The HSC and the EWRS provide the platform and tool for the coordination of measures and response to serious cross-border threats to health. The HSC is composed of representatives of EU countries. It supports the exchange of information between them and coordinates in liaison with the Commission their preparedness, planning, risk and crisis communication and responses.
The HSC meets at regular intervals and when the situation necessitates, upon the request of the Commission or an EU member. All meetings are chaired by a representative of the Commission.
Whenever an EU country intends to adopt public health measures to combat a serious cross-border threat to health, it must inform other EU countries and the Commission on their nature, purpose and scope prior to adoption, unless the need to protect public health makes immediate adoption necessary.
In the event of an influenza pandemic, the Commission takes the lead in EU coordination through the Early Warning and Response System (EWRS), which requires national authorities to notify each other of intended or taken measures. The Commission is also in permanent contact with key partners such as ECDC, the European Medicines Agency (EMA), the WHO and the Global Health and Security Initiative (GHSI).
It may also consider a fast-track procedure for rapid authorisation of pandemic influenza vaccines. Lessons learned from the H1NI pandemic, for example, resulted in strengthened cooperation between the Commission and EU countries to increase the availability of vaccines in the event of a future influenza pandemic.
European Centre for Disease Prevention and Control (ECDC)
The ECDC was set up in 2005 to assist in identifying and assessing the risk of current and emerging threats to human health posed by communicable diseases. Through this work, ECDC supports the work of the European Commission in the areas of preparedness, risk management and crisis response.
An example of the work of ECDC on surveillance is the collection, analysis and dissemination of surveillance data on communicable diseases and related special health issues from all EU countries European Economic Area (EEA) countries (Iceland and Norway). This data is collected through the TESSy database, and disseminated through the Surveillance Atlas.
Rapid Risk Assessments are produced by ECDC upon request of the European Commission, an EU country, or following an internal decision.