Enhancing ECDC's Role in Controlling Contagious Diseases

The European Centre for Disease Prevention and Control (ECDC), established in 2005, had the mandate to strengthen Europe Union’s defenses against infectious diseases through developing surveillance networks and early warning systems across EU, by coordinating relevant scientific studies and by identifying emerging health threats (Suk, et al., 2011). ECDC is considered to be a hub for controlling disease. It does so by drawing on networks across the EU. The question is whether or not it could become the centre of these networks that could monitor, prevent, and control any contagious diseases in EU. Greer (2012) observes that it could become so when it has the ability to secure its future by organising multiple political connections and obtaining a reputation in terms of unique and useful advice regarding the diseases (Greer, 2012). Thus, in addition to developing surveillance networks and early warning systems, ECDC must also manage political connections and build a reputation offering unique and quality advice in regard to contagious diseases.

Tournier and his colleagues observes that ECDC focuses on developing a tool for disease prioritisation, which provides for weighing criterion that prioritises ever-changing public opinion (Tournier, et al., 2019). This will be particularly relevant with the purpose of ECDC to monitor, prevent, control contagious diseases. If diseases could be prioritise based on the impact of the harm or damage they could cause, controlling will be more effective. Tournier and his colleagues, thus, suggest for regular assessment of bioterrorist threat keeping in regard the quick evolution of threats with viral disease eradications and new pathogens. Observing that with the advent of highly media exposure, the society has become more sensitive to unexpected events, they observed that any low-cost bioterrorist attack may provoke a global deflagration, which may cause an immediate and long-lasting fear. As such, the public opinion must be taken into account while conducting any bioterrorist risk assessment, response, or preparedness (Tournier, et al., 2019). Public opinion is necessary given that bioterrorism is a variation of natural emergence of infectious diseases. As such, medical counter-measures overlap while addressing natural emergence or bioterrorist. The implementation of such measures will benefit global health and security (Tournier, et al., 2019).

The need for organising multiple political connections in order to secure ECDC future’s role in regard to handling contagious diseases is one instance of the need for coordinated role of ECDC. Such coordinated approach was adopted nearly a decade ago when a series of tropical mosquito-borne diseases, including chikungunya fever and dengue, broke out. Zellera and his colleagues observe that the diseases put a challenge to the national public health authorities in EU (Zellera, et al., 2013). At that time, diseases such as malaria re-emerged, for example in Greece or spread to other countries, for example West Nile fever. ECDC had collected information and provided the EU member states with the topical assessments of the diseases, the threat and risks they pose, and the trends inn order that the states could take prompt and appropriate public health action (Zellera, et al., 2013). ECDC also has employed disease-specific expert networks. It used the European Surveillance System (TESSy) in order to collect in a database standardised comparable information on diseases identified as communicable. In terms of monitoring, ECDC had used an event-based surveillance in order to detect early any potential public health threats so as to enable timely response and decision making support (Zellera, et al., 2013). ECDC also implemented laboratory capacity through external quality assessments in order to detect threats of diseases early. It also had developed surveillance guidelines and maps for mosquito vectors (Zellera, et al., 2013).

The coordinated role of ECDC above comprises the use of multiple actors in order to address the communicable diseases. Such approach is found in the concept of the “golden triangle” of response. It comprises the coordinated response by the team of clinicians and clinical microbiologists, public health officials and the health-care delivery system. The employment of the golden triangle was seen in the anthrax cases during the September 11, 2001 anthrax attack cases in the United States (Hughes & Gerberding, 2002). In the anthrax cases, there were multiple activities conducted by various actors (University of Illinois at Urbana-Champaign, 2002). There were epidermiologic and laboratory investigations; application of research findings; managing workplace safety; environmental assessment and remediation; collecting and sharing prophylaxis and clinical care information; and collaboration between public health officials and law enforcement (University of Illinois at Urbana-Champaign, 2002). There were involvement of many medical personnel, emergency response team, public health officials, and law enforcement across the court and the world. At the national level, there was the Department of Health and Human Services (DHHS). At the local level, there was the clinicians and laboratorians. Monitoring, testing, visits, emergency responses and other such activities were being conducted. Centers for Disease Control and Prevention (CDC)’s role was prominent. DHHS was provided through CDC.1013 CDC brought all necessary expertise in one common platform (University of Illinois at Urbana-Champaign, 2002).

In the area of epidemiology in context of contagious diseases, scientists have developed the concept of the Epidemiologic Triangle in order to study health problems related to infectious diseases and how the disease spread (CDC, 2021). This triangle has three vertices. Firstly, it is ‘what’ signifying the Agent or the microbe that causes the disease. Secondly, it is the ‘who’ signifying the Host, or the organism that is harbouring the disease. Thirdly, it is the ‘where’ signifying the environment or the external factors that are causing or allowing the disease transmission (CDC, 2021). The three vertices correspond with the three core systems of ECDC. Each core covers different areas of disease control. The first core system is EWRS, which handles the threat detection alerts. The second core system is the EPIS, which handles the epidemic intelligence. The third core system is TESSy, which handles the disease surveillance (ECDC, 2019).

ECDC was founded by the Regulation (EC) No 851/2004 of the European Parliament and of the Council of 21 April 2004 (ECDC, 2019). The mission of ECDC is ‘identify, assess and communicate current and emerging threats to human health from communicable diseases’. In addition, Its Article 9 provides that ‘the Centre shall provide scientific and technical expertise to the Member States, the Commission and other Community agencies in the development, regular review and updating of preparedness plans, and also in the development of intervention strategies’ (ECDC, 2019). ECDC has also the responsibility to monitor, identify and respond to cross-border health threats. It identifies, assesses and communicates current and new health threats from communicable diseases. Its 2019 report shows how effective ECDC has been in regard to its role (ECDC, 2019). The report shows that 78% of the consulted stakeholders were satisfied (“high” or “very high”) with the manner in which ECDC disseminated information regarding threats. In terms of early detection of threat and response, 71% of them showed satisfaction to “high” or “very high”. 70% of them showed the same response in. terms of investigation and assessments of threats. The rate of satisfaction with coordinated response measures in ECDC’s response to mild threats and sever crises showed 61% and 62% respectively (ECDC, 2019). The following chart is a representation of survey result regarding early detection of threat and response.

The positive result indicates that the three core systems are effective in the role they are designated. For instances, the ECDC report also shows that the respondents showed the tool, ECRS effective in terms of managing public health threats in the form of 82% of the respondents rated its effectiveness to a “high” or “very high” and 77% in regard to the usefulness of information for risk communication (ECDC, 2019). Interestingly, the respondents showed similar lower percentage, as seen above, of 60% and 62% in regard to the coordinated measures in response to “mild’” threats and “severe” crises (ECDC, 2019). This lower percentage indicates that ECDC has an area of improvement in regard to coordinated effort.

ECDC is not a European “CDC”, but a “hub” (Greer, 2006). ECDC coordinates a network of different authorities that are in charge of epidemiological surveillance. It is based on coordination and synergies between existing national centres for control of diseases (Deruelle, 2016). The function of ECDC is predominated by national information and expertise. However, ECDC is considered an agency without regulatory powers and a discreet agency with limited competences (Deruelle, 2016). This criticism is also shared by concerned shareholders in the COVID-19 pandemic highlighting ECDC’s lack of authority and executive power even though ECDC has been playing an important part in response to the pandemic in terms of systematically updated risk assessments and guidance and advice to EU Member States and the European Commission regarding public health response activities (Scholz, 2020). As such, the lack of power or authority in ECDC reflects the preferences of the member states' over the need and interest of the EU Commission (Deruelle, 2016). The lack of regulatory powers may be the reason behind the lower effectiveness of its coordinated function. Such lack in coordination may render measures taken to have a uniform and effective disease control measures.

Irrespective of the criticism, the role of ECDC in addressing communicable diseases affecting the EU region or the world cannot be undermined. An aspect of the golden triangle of response could be seen in ECDC’s role and involvement regarding the use of Pathogen reduction (PR) of selected blood components. PR is a technology that offer facilities to improve safety of the blood supply (Domanović, 2019). However, it is observed that PR incurs limitations, such as increased costs that restricts their broader use. In such kind of situations, an agency that ECDC that has broader reach may help reduce the limitation (Domanović, 2019). For instance, ECDC co-operated with the Italian National Blood Centre (INBC). They had organised an expert consultation meeting with the objective of understanding the potential role of PR, which could be used as a blood safety intervention when there are outbreaks of infectious diseases. PR may become useful to address gaps arising from the absence of laboratory screening of blood donations (Domanović, 2019). In 2018, ECDC and INBC had managed to bring 26 experts and representatives of national competent authorities for blood together from 13 EU and European Economic Area (EU/EEA) member states, Switzerland, the WHO, the US Food and Drug Administration, ECDC and the European Directorate for the Quality of Medicines and Health Care of the Council of Europe (Domanović, 2019). The meeting had led to ECDC gave its opinion on the use of PR in the event of infectious disease outbreaks. ECDC opined that PR may be implemented in case of a risk of infectious disease outbreaks that may threaten the safety of the blood supply (Domanović, 2019). PR may also be used to improve national capability and capacity in that regard in absence of a screening test. In regard to public emergency preparedness, the extent of PR implementation could be determined subject to sustainability, anticipated magnitude of the outbreak, geographical spread of an outbreak and types of transfusion-transmissible pathogen (Domanović, 2019).

The role of ECDC in case of diseases that have the potential of affecting EU region or global geography is not less important. The 2018 meeting between the multiple stakeholders and member states conform to the mission of ECDC to coordinate scientific studies and identify emerging health threats (Suk, et al., 2011). The meeting shows ECDC coordinated concerned stakeholders and organised all relevant political connections. The recommendation of PR by ECDC serves as an example of ECDC’s reputation to provide unique and useful advice regarding the diseases as Greer (2012) observed earlier. The opinion also validates Tournier’s observation that ECDC focuses on developing a tool for disease prioritisation (Tournier, et al., 2019), in the form of PR to be used to address risks of infectious disease outbreaks affecting safety of the blood supply.

The role of ECDC in the above example is in accordance to the Regulation of ECDC. Along with that, it is responsible for risk identification and assessment (Paquet, et al., 2006). ECDC must identify and assess new threats of communicable diseases to human health. ECDC must establish cooperation with member states and their procedures. This is in particular regard to the data collection and analysis in regard to identifying new emerging health threats, which may affect EU (Paquet, et al., 2006). The Designated Surveillance Networks (DSNs) specific for specific groups of diseases have important roles in the coordination effort of ECDC. DSNs are projects financed under EU's Public Health Programme (UK Parliament, 2008). They relied on consortiums comprising national public health institutions. EU funding is routed through such national public health institutions, which are the project leaders for DSN consortiums. However, the lower coordinated effort of ECDC could also be seen in the DSNs also (UK Parliament, 2008). DSNs function in uncoordinated manner with different Standard Operating Procedures (SOPs), organisational structures, methods for collecting data and reporting formats. Some DSNs collect data on only one disease, while some collect data on several diseases. Some of them covered all EU member states while some covered only a limited number. Some have good data on a few diseases while some had scarce data on important diseases. These challenges pose barrier to getting finances for DSNs projects (UK Parliament, 2008).

The functioning or DSNs and its lack of effectiveness in terms of having uniform governance procedures cannot be said about ECDC. ECDC is the central agency and maybe this made it possible for them to collect and disseminate data and share uniform update and guidelines, such as it did with COVID-19 risk assessment. ECDC has been providing regularly updated information on COVID-19 in relevance to regular risk assessments (Eurosurveillance editorial team, 2020). In regard to response strategies, ECDC opines that they should be guided by continuously monitoring and assessing the situation and consider sustainable public health measures in order to protect vulnerable groups, to decrease community transmission, to conduct extensive testing and contact tracing, and to isolate and treat identified cases (Eurosurveillance editorial team, 2020).

ECDC, in context to the current COVID 19 crisis, cannot be considered ready to tackle any bioterrorism in case an attack in the scale of COVI 19 occurs. As Greer (2012) observed earlier, ECDC should be able to organise multiple political connections and obtain a reputation of giving unique and useful advice (Greer, 2012), the example of the challenges faced by DSNs is a failure on the part of ECDC to mobilise local agencies. The challenge to handle a new crisis such as COVID 19 is also an example of failure to consider public opinion while conducting bioterrorist risk assessment, response, or preparedness.

The 2018 ECDC report showed lower level of coordination that ECDC’s role in collecting and disseminating data and information regarding communicable diseases (ECDC, 2019). Preferences of member states of EU may be the reason behind this result. Thus, unless the level of coordination is not brought up to an agreed standard, in the event of a bioterrorist attack, the lack of coordination would fail all responses. Some learnings could be achieved from the response to the anthrax attack when the golden triangle of response was employed.

In terms of collecting data and coordinating networks by ECDC at national level, ECDC seems to be effective. This is seen with the 2018 meeting regarding the use of PR. However, in terms of enforcing measures, ECDC, because of its lack of certain executive power, seems to lack the edge to enforce measures to address any contagious disease or in case a bioterrorist attack occurs.

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