Opinion on the proposal for a Decision of the Council and the Ministers for Health of the Member States, meeting within the Council, concerning the extension to the end of 1994 of the 1991-1993 plan of action in the framework of the 'Europe against AIDS' programme (94/C 133/04)

On 21 October 1993 the Council decided to consult the Economic and Social Committee, under Article 198 of the Treaty establishing the European Economic 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 1 February 1994. The Rapporteur was Mr Colombo.

At its 313th Plenary Session (meeting of 23 February 1994) the Economic and Social Committee adopted the following Opinion unanimously.

1. Introduction

1.1. The Committee welcomes the proposal to extend the Europe against AIDS plan of action to the end of 1994.

1.2. Its examination of this proposed extension follows the entry into force of the Maastricht Treaty -Title X of which provides the legal basis for a Community public health policy.

1.3. The Committee is particularly pleased with this development since its earlier Opinion (1) on the plan of action militated in favour of a Community public health policy by underlining 'the need for greater European-level coordination of public health measures in the light of a People's Europe'.

1.4. The Committee therefore considers that its examination of this latest proposal should not only be based on an evaluation of the action taken during the first three years (2) of operation of the plan of action, but should also be placed in the context of the prospects opened up by the consolidation of Community cooperation on health matters.

1.5. It goes without saying that the 'Europe against AIDS' and 'Europe against Cancer' programmes will be strengthened by the formulation of a more general action programme in the public health sector, as called for in the Council of Ministers' Resolution of 27 May 1993.

1.6. The Committee intends to take a stand on such aspects in its Opinion at present being drawn up on the Commission communication on the framework for action in the field of public health (3).

2. General comments

2.1. Given the serious spread of AIDS and the disturbing increase in the number of HIV carriers, as evidenced in the latest WHO figures, the ESC considers that very great efforts need to be made at Community level in terms of information, prevention, and preservation of the quality of life of people with AIDS and those infected with the HIV virus; this requires the close coordination of current initiatives in individual Member States and the adoption of an integrated, multi-sector approach. Coordination is all the more necessary as people are now moving about more and more freely as a result of the opening up of frontiers and European citizens consequently require equal protection.

2.2. Whilst acknowledging that the Community's budget is limited and that other health programmes also have to be financed, the ESC considers that the MECU 8,3 earmarked for the AIDS programme falls short of what is required, even if Community funds are only used to promote coordination and not replace national appropriations, as already made clear in its previous Opinion.

2.3. The ESC would therefore reiterate that work at international level must not duplicate work at national level. In particular, the Community should not finance activities which could be carried out nationally or locally and do not require transnational cooperation. It is likewise important to find out what action has already been taken by other international organizations, particularly the WHO.

2.4. The ESC believes that the extension of the 'Europe against AIDS' programme should as of now be accompanied by guarantees regarding the future development of the programme, bearing in mind the achievements to date. A fresh look should also be taken at the functioning of the advisory committee; the role of this committee should be strengthened and expanded.

2.5. The Committee is pleased that some switches of emphasis in the current plan of action are consistent with the suggestions made in its earlier Opinion, and particularly the emphasis on epidemiological monitoring systems (an area where the ESC has called for the allotment of greater resources) and on better targeted information campaigns.

2.6. One area, however, which continues to be neglected in the programme is the need for AIDS prevention and information at the workplace with the participation of the social partners. The Committee notes that this aspect has been covered in the Community Directives on health and safety at the workplace, and particularly the Directive on biological agents. The Committee nevertheless feels that initiatives in this specific area should fall within the compass of the 'Europe against AIDS' programme.

2.7. In this connection the Committee would reiterate its desire to be actively involved in the programme and to be sent the report provided for in Article 3 of the Decision; this already happens in the Europe against Cancer programme.

2.8. Eliminating all forms of discrimination is one of the main prerequisites for prolonging the life of the AIDS sufferer; protecting the jobs of AIDS victims for as long as possible is likewise of fundamental importance.

2.8.1. The Committee believes in fact that AIDS sufferers and HIV carriers must be treated no differently from other workers when it comes to the applications of labour laws and employment contracts.

2.8.2. Cataloguing risks and providing accurate information about a) the limited possibilities of transmission and b) the precautionary measures taken, is essential if work colleagues are to change their attitudes and unjustified discrimination is to be fought against more successfully on both medical and legal grounds.

2.9. In addition to prevention, another area which needs to be developed is the 'preservation of the quality of life of AIDS sufferers and HIV carriers'.

2.10. A further requirement, if quality of life is to be improved, is achievement of a quantum leap in health care. The health services must be geared to ensuring that, for as long as possible, the AIDS sufferer is not isolated from society.

2.11. This means giving preference as far as possible to home care and 'day hospitals' (rather than traditional hospitalization) so that there is no breakdown of family relations and no isolation from society.

2.12. Another particularly odious form of discrimination that occasionally rears its head concerns the treatment of seropositive children in kindergartens and schools. Information campaigns targeted at parents and teachers should help to create conditions conducive to the smooth integration of such children in school life.

2.13. Guaranteeing housing rights is particularly important if the quality of life is to be maintained; social measures are therefore necessary to protect AIDS victims against any form of housing discrimination.

2.14. The aspects dealt with above need to be the subject of specific actions; they might also, however, be advantageously incorporated into the first three 'areas of activity', forming a suitable subject for the exchange of experiences and pilot projects. Information campaigns must not be directed exclusively at high-risk groups; indeed, if the rights of AIDS/HIV victims are to be guaranteed, it is essential to change the attitude of the general public by providing it with proper information about means of prevention (condoms, disposal syringes, etc.) and about the various ways in which the HIV virus can be transmitted, though without over-dramatizing the issues.

3. Specific comments on the 1994 plan of action

3.1. With regard to area of activity 1, the Committee agrees that alongside information campaigns targeted at the general public to ensure that it is better informed about the real risks of AIDS and the effectiveness of preventive measures, there is also a need for direct contact with individual citizens (primarily through the introduction of 'hot lines' providing relevant information from members of the health care and medical professions).

3.1.1. It is essential to evaluate the impact on behaviour of preventive measures adopted by the Member States, and more particularly the campaigns regarding the use of condoms and the distribution of disposal syringes.

3.2. Education from infancy is particularly important for prevention. Programmes for children of pre-school age should therefore be included under area of activity 2. (It is enough to think of the risks run outside school by children playing with used syringes, especially in major urban areas).

3.2.1. With regard to action aimed at young people of school age, the Committee agrees that information about HIV/AIDS should form part of the health education and/or sex education syllabus.

3.3. Area of activity 3 is concerned with specific actions for specific groups and settings. Apart from transmission of the virus through sexual relations and intravenous injections (which can be prevented by specific means such as condoms and disposal syringes), there are in fact specific risks associated with certain situations and groups.

3.3.1. One critical area calling for particularly urgent measures is the prison environment where living conditions and isolation have caused a dramatic increase in the number of HIV carriers.

3.3.2. The document is likewise correct to highlight the increased risks associated with mobility; there are therefore good grounds for promoting preventive action in tourist resorts and border areas.

3.3.3. Another major pathway of transmission is blood transfusions and the use of blood derivatives.

3.3.4. Given recent cases in many Member States, the ESC believes that stringent controls are necessary to avoid any risk of transmission of the HIV virus via blood transfusions and/or the use of medicines.

3.3.5. As far as blood-based products are concerned, methods of preparation have now been devised which render them perfectly safe.

3.3.6. It is not, however, sufficient for makers to certify that their blood-based products are safe. This practice, where it exists, must be replaced by proper external health authority controls.

3.3.7. Tighter controls must be accompanied by a campaign to stimulate Community blood-doning in order to achieve self-sufficiency in Europe and so eliminate the need for blood supplied from 'high-risk' countries.

3.3.8. It should be pointed out, however, that Community self-sufficiency is not in itself synonymous with safety, as the Commission document erroneously seems to suggest. The safety of blood and labile blood products can only be guaranteed if there are stringent, obligatory controls.

3.3.9. The Commission text should therefore make a clearer distinction between blood/labile blood products (red and white blood corpuscles, platelets, plasma) on the one hand and pharmaceutical blood-based products on the other.

3.3.10. The Commission text should also make it clear that self-sufficiency from 'voluntary non-remunerated blood donations' does not automatically ensure the safety of blood and blood products.

3.3.11. With regard to vertical transmission of HIV from mothers to children, attention should be drawn to the increased risks young HIV-positive children run from vaccinations; information campaigns on the subject should therefore be run for the benefit of doctors and families.

3.4. As far as area of activity 4 is concerned, the initiatives taken by non-governmental organizations to preserve the quality of life of AIDS/HIV victims deserve to be encouraged; mention should be made here of the need to give support to family members, as requested in the ESC's previous Opinion.

3.5. Area of activity 5 (gathering of data) is one of the main areas where the Community can usefully act, and maximum importance is quite rightly attached to this in the introduction; the funds made available for this area of activity nevertheless fail to reflect this assessment of its value. More funds should therefore be released and greater importance attached to the European Epidemiological AIDS Monitoring Centre in Paris in which the WHO and the EC work hand in hand.

3.5.1. The ESC shares the view that it is important to exchange information and standardize epidemiological methods. It is likewise important to disseminate information concerning assessments of preventive action; prevention after all is still the most effective weapon in the battle against AIDS and would continue to be so, even if specific vaccines became available.

3.5.2. In this context the Committee would restate its opposition to mandatory and systematic screening (with the exception of blood donors) since this would, in the view of many medical schools and the health authorities themselves, entail a heavy burden in terms of financial expenditure and human resources without bringing much in the way of benefits.

3.5.3. Voluntary and free tests should however be encouraged and promoted, especially in high-risk professions, and the absolute confidentiality of the results should be guaranteed.

3.6. With regard to area of activity 6, it is particularly important to take measures to combat discrimination at the workplace and in schools; socio-occupational organizations can play an active role here by providing, among other things, ad hoc training courses in the mother tongue of the workers concerned.

3.6.1. In addition to adopting all possible safety measures and precautions in working environments and high-risk situations, information about actual risks can help to facilitate the acceptance of persons affected by AIDS and diffuse any problems associated with their entry into working life.

3.7. Coordination with other Community and international programmes, provided for under area of activity 7, is essential if action is to be effective and all possible synergies exploited.

3.7.1. The Committee wonders whether the fragmentation of Community initiatives, with a) prevention and information, b) research and c) assistance to developing countries all in separate compartments, is not likely to reduce the effectiveness of the action taken.

3.7.2. Well worth studying here are the moves in some Member States (e.g. in France under the guidance of Professor Montagnier) towards setting up an intersectoral authority covering the social, health, research, educational and other aspects of fighting AIDS.

3.8. Finally, Community research programmes should be given as much encouragement as possible to develop vaccines against AIDS, drawing on the experience and valuable contribution made by European laboratories in the discovery of the HIV virus.

3.9. Whilst recognizing the tremendously complicated scientific problems of developing a vaccine against AIDS, Europe can play a leading role if it achieves synergies by combining its scientific skills, technological ingenuity and industrial capacity to develop vaccines.

Done at Brussels, 23 February 1994.

The Chairman

of the Economic and Social Committee

Susanne TIEMANN

(1) OJ No C 191, 22. 7. 1991.

(2) See the Commission Report on the implementation of the plan of action - COM(93) 42 final.

(3) COM(93) 559 final.