At EU level, Decision 1082/2013/EU on serious cross-border threats to health provides the framework to coordinate preparedness and response planning to strengthen capacities for the monitoring, early warning and assessment of, and response to health emergencies. The Decision:
- Supports sharing best practice and experience in preparedness and response planning
- Provides a backbone for developing national plans to address different types of health threats – e.g. pandemic influenza, or other events caused by biological or unknown agents, accidents caused by chemical agents, natural events of environmental origin, or deliberate acts
- Helps ensure the inter-operability of national plans – through coordination mechanisms, analysis and communication tools
- Supports the implementation of core capacity requirements for the the WHO International Health Regulations (IHR) to detect, assess, report, and respond to public health emergencies.
Under the EU Health Programme, support is provided through training and exercises, and by facilitating the sharing of experiences, guidelines and procedures across EU countries. The European Commission organises regular exercises to test EU and national preparedness plans. This ensures that national authorities and institutions are able to work together with the Commission, and one another, to share information in the event of a rapidly evolving crisis.
Public health risk assessment
In responding to an emerging cross-border health threat, the first crucial step is to assess associated risks. Decision 1082/2013/EU on serious cross border threats to health puts in place coordinated EU risk assessment mechanisms. This involves mobilising expertise from relevant EU and international bodies, to provide robust scientific advice to feed into the process of coordinating a response.
As a first step serious cross-border threats to health are notified through the Early Warning and Response system (EWRS). EWRS is a confidential computer system allowing EU countries to send alerts about events with a potential impact on the EU, to share information, and coordinate their response.
Where necessary for the coordination of the response at EU level, the Health Security Committee (HSC), the expert group responsible for coordinating preparedness, response and international cooperation measures, can request the European Commission to provide a risk assessment, including possible public health measures. The risk assessment is carried out by:
- European Centre for Diseases Prevention and Control (ECDC), if the threat is of a) biological origin and consists of communicable diseases or antimicrobial resistance and healthcare-associated infections; or b) threats of unknown origin
- European Food Safety Authority (EFSA), in the case of a serious cross-border threat to health falling under its mandate
- Other relevant EU agencies.
Where the risk assessment required is totally or partially outside the mandate of the EU agencies, the Commission provides an ad-hoc risk assessment. For example, the Scientific Committee on Health, Environmental and Emerging Risks (SCHEER) is mandated to provide public health risk assessment in case of serious cross-border chemical threats.
The risk assessment takes into account, if available, relevant information provided by other entities, in particular by the World Health Organisation (WHO) in the case of a public health emergency of international concern.
Coordination of response
EU national authorities are required to notify the Commission through the EWRS no later than 24 hours after the discovery of a serious cross-border threat to health. The Commission then works closely with all EU countries to ensure their response is coherent, and well-coordinated. An example of EU coordination in action is the Ebola outbreak in West Africa.
Upon the request of the Commission or the affected country representatives from national health services consult within the HSC in liaison with the Commission, with a view to coordinating:
- National responses to the serious cross-border threat to health
- Risk and crisis communication, to the public and healthcare professionals to be adapted to national needs and specificities.
Where one EU country intends to adopt public health measures in response to a serious cross-border threat, it must inform and consult all other EU countries on their purpose and scope before applying them, unless immediate adoption is essential. In this case, it must inform other EU countries and the Commission immediately.
In the event of a serious cross-border threat to health overwhelming national response capacities, an affected EU country may also request assistance from other EU countries through the Community Civil Protection Mechanism (Decision 2007/779/EC, Euratom).
The HSC convenes twice a year for plenary, while other meetings are planned on an ad-hoc basis. Flash reports and minutes of the meetings are made publicly available.
Examples of EU crisis management in health
The European Commission was prominently involved in the response to the 2013-2016 Ebola outbreak in West Africa, and the 2016 Zika epidemic in the Americas and Caribbean. In the framework of Decision 1082/2013/EU on serious cross-border health threats the Commission brought together scientific and national expertise to coordinate EU preparedness and response activities. It was able to mobilise political, financial and scientific resources to help contain and control these international health crises. The EU response incorporated a number of elements, for example:
- The Directorate General for Health and Food Safety (DG SANTE) closely cooperated with Member States in the Health Security Committee (HSC), which kept EU countries abreast of developments and coordinated approaches on preparedness and response; with the ECDC, which maintained risk assessments, epidemiological updates and other information for Ebola and Zika; and with international partners such as WHO and the GHSI
- The Directorate General for Research and Innovation (RTD) facilitated research into Ebola and Zika through investment
- The Directorate General for Humanitarian Aid and Civil Protection (DG ECHO) led the coordination of EU support in the Ebola crisis working alongside EU countries, the WHO and other organisations to support the affected countries.
Risk and crisis communication
Clear and effective information and communication with the public and national authorities is an essential part of crisis response. The European Commission seeks to clearly establish these lines of communication by:
- Developing EU-wide strategies for action
- Better integrating communicators into the crisis-management process
- Strengthening their cooperation with decision-makers and risk managers.
The HSC established a communicators' network that brings together risk-management experts from EU countries, the Commission, and EU agencies who take the lead on communication aspects of a health crisis.
This network facilitates cooperation:
- During a crisis – by facilitating the exchange of information from the beginning, and coordinating common strategies and public messaging
- In the longer term – by facilitating the exchange of best practice on health risks/crisis communication, and providing recommendations for preventative measures
Globally, the network is an important channel for containing and mitigating global health threats. It enables the EU to spread information rapidly worldwide, by connecting with existing communicators' networks under the Global Health Security Initiative and the WHO network under the International Health Regulations (IHR).