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Bioterrorism:

the European Union response

George Gouvras Michel Pletschette

European Commission

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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 2003-2008

Resources: Task Force of 14 experts, 2 million euros per year from EU, 2-4 million per year from the EU Member States

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e 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

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e 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

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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

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e2nd 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

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e 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

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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

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e 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

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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

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e3rd 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

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e4th 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

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e4th 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

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e4th 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

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e 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

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eGeneral 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)

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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)

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eBase 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)

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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

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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 warningEarly warning

IncidenIncidence / trendsce / trends Administrative dataAdministrative data

Health indicatorsHealth indicators

Epidemic response

Control activities

Resource allocation

Health Policy

Epidemic Intelligence

Monitoring Health SystemInlc.resources diversion

and baseline preparedness:e.g.general

and burns ICU

Monitoring Health Status

Monitoring diseases

Public Health Monitoring and Public Health Monitoring and Surveillance:Surveillance: Communicable Disease Communicable Disease

SurveillanceSurveillance

•Web scanning•Newsgroups•EWRS•Personal communication

Important?

Confirmed?

SANCOEWRSRELEXGOARN

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

discardno

no

yes

Relevant?

discard

no

1

yes

Output

OutcomeProcess

DAILY and FOLLOW-UP verificationDAILY WEEKLY AD HOCFrequency

4

2

3

4

5

6

8

9

yes

7

- RAS-BICHAT- EWRSSpecific Communication and Response actions

Information sources used in HTU

Source Filters Screening frequency

EMM 7 search strategies 2 strategies: daily5strategies: occasionally

Nexis-Lexis 23 search strategies Daily

Jane’s Security section

All library news Weekly

WHO Outbreak Verification List

all information in weekly lists and other sporadic information

Weekly

Promed-mail all messages real time

CDC Atlanta MMWR weekly

Health Canada All information occasionally

MINSA all information occasionally

UN-OCHA Relief web site occasionally

WHO emergency web page

All information on the page

occasionally

RASFF all alerts occasionally

Eurosurveillance weekly

all articles weekly

* 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

Relevant?

discard

no

1

yes

Event selection criteria

0. Hoax / Not relevant ------------------- Discard 1. Probable / Possible ------------------- Screening Report2. Likely / Confirmed ------------------- Screening Report

For 1 and 2 consider:•New or unknown disease / eventRelevance to international healthPotential for Community involvementPotential need for action

Event selection criteria

0. Hoax / Not relevant ------------------- Discard 1. Probable / Possible ------------------- Screening Report2. Likely / Confirmed ------------------- Screening Report

For 1 and 2 consider:•New or unknown disease / eventRelevance to international healthPotential for Community involvementPotential need for action

The

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e 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