Opinion on the proposal for a European Parliament and Council Decision adopting a programme of Community action on the prevention of AIDS and certain other communicable diseases within the framework for action in the field of public health

(95/C 133/08)

On 28 November 1994 the Council decided to consult the Economic and Social Committee, under Article 129 of the Treaty establishing the European Community, on the abovementioned proposal.

The Section for Protection of the Environment, Public Health and Consumer Affairs, which was responsible for preparing the Committee's work on the subject, adopted its Opinion on 3 March 1995. The Rapporteur was Mr Colombo.

At its 324th Plenary Session (meeting of 30 March 1995), the Economic and Social Committee adopted the following Opinion unanimously.

1. Introduction and general comments

1.1. The proposal is preceded by a full and detailed Communication describing the new context of Community action in pursuit of the health protection objectives laid down in Articles 3(o) and 129 of the Treaty establishing the European Community. The proposal also falls within the ambit of the framework communication (COM(93) 559) on which the Committee has already expressed its views ().

1.2. The Committee endorses the proposal, noting that it is consistent with the ESC's express desire to see existing programmes in specific areas strengthened by the formulation of a more general action programme in the public health sector. This point was emphasized in point 1.5. of the ESC Opinion on the extension of the Europe against AIDS programme to the end of 1994 ().

1.3. The Committee considers that Community action will gain in solidity and coherence by being extended to cover other communicable diseases. Such diseases may be easier to prevent if there is Community-level coordination (especially since more and more people are now moving about freely) and if good use is made of the experience acquired in combatting AIDS. To be successful, however, the programme needs adequate financial resources.

1.4. The Committee calls for the required distinction to be made between action on AIDS and action in connection with other infectious diseases. In the case of AIDS, a number of specific features (absence of vaccines and problems of confidentiality of screening results) obtain, but the Community is now able to draw on a solid wealth of experience which will enable progress to be made. With other infectious diseases, however, European-level coordination is already in place. It will therefore be the task of the new programme to improve and develop such coordination, pinpointing centres of excellence that are able to perform functions similar to those of the epidemiological AIDS monitoring centre in Paris.

1.4.1. The Committee would recommend that efforts should be focused initially in particular on those communicable diseases most closely related to AIDS, e.g. diseases which can be transmitted sexually or by blood as well as tuberculosis (development of multi-resistant micro-organisms in AIDS victims). The Committee also hopes that in the case of vaccines, and of nosocomial infections contracted in hospitals and other health-care establishments, action will be more clearly focused and be concentrated on the pooling of information.

1.5. Particular attention is paid in the Communication to the importance of coordination with other Community measures (completion of the single market, social policy, consumer protection, research, etc.) and to cooperation with international organizations and third countries. The Committee is pleased that its comments to this effect - both those expressed in previous Opinions on this specific programme and those set out in its Opinion on the Commission Communication on the framework for action in the field of public health () - have been taken on board.

1.6. Another reason for satisfaction is the approach to consultation and participation mechanisms adopted by the Commission in its Communication. In line with what the Committee has always advocated, emphasis in the Commission's Communication is now placed on the role of health professionals and non-governmental organizations working in the field of AIDS and other communicable diseases.

1.7. The Committee notes the Commission's intention (point 158 of the Communication) to maintain and strengthen links with non-governmental organizations which have 'contributed generously to the realization of Community actions'.

1.8. The Committee deplores once more however the failure of the Communication to refer to the social partners and its underestimation of the scope for action at the workplace. Initiatives such as the April 1990 symposium on AIDS at the workplace, sponsored by ex-Commission President Delors, have not been followed up as they should have been by concrete schemes.

1.9. Whilst it is true that the purely 'health' aspects of protection at the workplace are covered by the Directive on exposure to biological agents (), particular attention should have been paid in the programme to information, prevention and education. The Committee therefore calls upon the Commission to find a place in its Action Programme for specific measures at the workplace, focusing on information, prevention and discrimination.

2. Evaluation of the previous programme

2.1. The Committee notes with interest the Commission's report on the implementation of the plan of action in 1993 () and the Opinions issued by the Advisory Committee on all funding applications submitted to the Commission.

2.1.1. The Committee nevertheless calls upon the Commission to improve the timing of the publication of its reports in such a way that they can be coordinated with the formulation and revision of the programmes and so exert real influence on new policy decisions.

2.2. The Committee agrees that priority should be given to financing a limited number of large-scale projects; given the limited funding available, this is what the Committee has itself recommended.

2.3. The Committee is less concerned about funds being allocated unevenly among the Member States than about the fact that, according to available information, most projects benefiting from Community financial support have not hitherto been located in countries where AIDS is most rampant (Spain, Italy and France).

2.4. Projects should be selected not only on the basis of criteria of quality and effectiveness, but also according to the needs identified by epidemiological data. Funds should therefore not be distributed in a blind bureaucratic way, but in proportion to actual requirements and according to whether the schemes will be effective or not at European level.

2.4.1. The Committee asks whether information about Community actions is being properly disseminated in the Member States and whether it is accessible, in particular, to non-governmental organizations. Responsibility for circulating information undoubtedly lies in the hands of the national authorities but certain initiatives supported by the Community have proved to be valuable, e.g. the drawing up of inventories of existing actions such as the directory of activities carried out by nongovernmental organizations in the European Union in the field of AIDS prevention and assistance ().

2.4.2. The Committee therefore calls upon the Commission to speedily prepare and distribute an information booklet in all languages of the European Union and of principal ethnic minorities in order to facilitate access to Community schemes by all interested organizations and associations. A periodic report on on-going schemes in the form of an information broadsheet might also further transparency and the dissemination of experience.

2.5. 'Community added value' derives not only from projects carried out simultaneously by a number of Member States but may also arise from national projects that can serve as models or are characterized by innovative approaches to specific problems.

2.6. In terms of Committee recommendations in previous Opinions, the most interesting measures supported in 1993 were:

- establishment of an information centre to provide more in the way of information, guidance and support for certain immigrant communities in Europe;

- support for transnational activities designed to educate immigrants living in the European Community about HIV prevention, to overcome the problems of communication with ethnic groups and to establish appropriate methods for educating these groups and increasing their awareness;

- financing of a study of the feasibility of information and prevention campaigns for tourists travelling within the Community, focusing on persuading young people travelling around the Community to use condoms;

- financing of the activities of a European network on AIDS Prevention for Prostitutes (EUROPAP);

- establishment of a European support network for families and children infected with the virus;

- funding of a comparative analysis of Member States' AIDS laws in respect of screening, confidentiality and reporting of the disease, patients' right to treatment, AIDS and imprisonment, and restrictions on freedom of movement and immigration.

2.7. This last area of study might throw up useful information for pinpointing measures and action which the Community could take in the context of civil and social rights to ensure the equal treatment of European citizens and make a contribution to the worldwide campaign against AIDS discrimination.

2.8. On a more general note the Committee is pleased that, in accordance with the views of the Advisory Committee and in keeping with its own recommendations on the need to avoid the dispersal of resources, fewer conferences and congresses, but more comparative analyses and targeted education and prevention campaigns, have been financed.

3. Specific comments on the new action programme

3.1. The Committee notes a discrepancy between the ambitions of the Communication and the modesty of the Action Programme itself. The presentation of the Action Programme is extremely succinct and schematic and the Committee considers that this does not reflect the wealth of the ideas and general thrust of the Communication. The description of the measures should therefore be more systematic, provide justification and incorporate elements of the Communication. The Committee also calls for the inclusion of specific actions at the workplace, as mentioned in point 1.9 above.

3.2. The Committee is pleased that the Action Programme has been divided into two parts, the first on AIDS and the second on other communicable diseases, but regrets that the funding is still modest. This lack of proper funding has already been criticized in earlier Opinions even though the Committee is aware that the purpose of Community finances is to achieve a multiplier effect.

3.2.1. The Committee recommends in particular that staffing levels should be brought up to a level adequate to cope with the increase in and diversification of the commitments entered into under the Action Programme.

3.3. With regard to measures relating to HIV/AIDS victims, the Committee would refer to the comments made in Opinion CES 228/94 () and would stress the importance of data-collection. Data-collection has now quite rightly been moved centre-stage (to point 1 of the programme), but the funds allocated to this area remain extremely modest.

3.3.1. With regard in particular to measures for children and young people, the Committee endorses the premise that the dissemination of information should take account of, for example, cultural and religious backgrounds, unless this cannot reasonably be required in view of the content of the problem.

3.3.2. The Committee recommends close coordination with the BIOMED programme in the interests of using funds effectively. It would in fact be useful if the data-collection measures supported by the current programme could include the acquisition of basic data, thereby leaving research workers free to concentrate on the processing thereof.

3.4. With regard to the 'safety of blood and blood products', mentioned in points 109 and 110 of the Communication and discussed in points 3.3.3. to 3.3.10. of ESC Opinion 228/94 (), the Committee would repeat that 'Community self-sufficiency is not in itself synonymous with safety'. The Committee is pleased that this subject is dealt with in a separate Commission Communication (). The conclusions to be drawn from an examination of this separate Communication should be translated into specific measures and incorporated in the present Action Programme; the Committee asks to be consulted on this in due course.

3.4.1. However, the Committee feels that the Commission should speedily define the necessary rules for checking that blood and blood products are safe for use. Under no circumstances should haemophiliacs and others trying to improve their health through blood transfusions become the innocent victims of HIV or other viruses.

3.5. The Committee thinks it of great importance that the general public's knowledge and understanding of the other infectious diseases (hepatitis, tuberculosis, nosocomial infections) now included in the programme and their consequences should be improved. This would prevent infection and improve the effectiveness of preventive measures.

3.5.1. At the same time it should be noted that action by non-governmental organizations is not particularly well developed so that the main focus of attention will have to be on promoting improvements in the efficiency and coordination of public health agencies.

3.6. The proposed measures cover vaccination of the population at large, qualitative improvement of Member State surveillance schemes, promotion of the exchange of experience between health professionals, and support for the early detection and systematic screening of communicable diseases.

3.7. Given that this is a new area of intervention, existing networks of European public health authority coordination should not be duplicated but refined and put on a formal footing; centres of excellence which are particularly well suited to carrying out pilot studies should also be identified.

3.8. Particular attention should also be paid to the topic of 'new types of infection' and the organization of ad hoc epidemiological surveys. This is because of the transnational nature of a) many infections that have already been recognized and b) other infections that are still to emerge.

3.9. At the present time Member States already operate an informal network of coordination whenever there is a health emergency (e.g. pneumonic plague in India in September 1994 and cholera in Puglia in October of the same year), but if such emergencies are to be tackled with greater efficiency, then a European rapid intervention unit needs to be set up under the Action Programme.

3.10. With regard to the Advisory Committee's practical arrangements for selecting projects, the Committee notes with satisfaction the idea expressed in point 9.2(b) of the Financial Statement that action should be taken in conjunction 'with national coordinating committees to be established at the request of Member States, with participation by all those involved in the prevention of HIV/AIDS and other communicable diseases'.

3.11. This structure should satisfy concerns about current differences between Member States in terms of availability of information and capacity to make use of Community programmes. In this context, subsidiarity should also be seen as a means of strengthening networks of national action plans.

3.12. The Committee finally recommends that the intermediate status report to be forwarded to it should carefully evaluate the feasibility of linking HIV/AIDS and other infectious diseases within the same programme. It may indeed help if action on other infectious diseases uses a solid, preestablished system during the initial start-up phase, but the different features of both projects and operators in this field may require a more clear-cut distinction during the second phase.

Done at Brussels, 30 March 1995.

The President

of the Economic and Social Committee

Carlos FERRER

() OJ No C 388, 31. 12. 1994.

() OJ No C 133, 16. 5. 1994.

() Directive 93/88/EEC, OJ No L 268, 29. 10. 1993, p. 71.

() COM(94) 525 final.

() European Union AIDS Directory, NAM Publications Ltd., London, 1994.

() OJ No C 133, 16. 5. 1995.

() COM(94) 652 final.