Opinion of the Committee of the Regions on:

- the 'Commission Communication concerning communicable disease surveillance networks in the European Community` and - the 'Proposal for a European Parliament and Council Decision creating a network for the epidemiological surveillance and control of communicable diseases in the European Community` (96/C 337/13)

THE COMMITTEE OF THE REGIONS,

Having regard to the 'Commission Communication concerning communicable disease surveillance networks in the European Community` and the 'Proposal for a European Parliament and Council Decision creating a network for the epidemiological surveillance and control of communicable diseases in the European Community` [COM(96) 78 final - 96/0052 (COD)] ();

Having regard to the decision taken by the Council on 11 April 1996, under Article 129 and the first paragraph of Article 198c of the Treaty establishing the European Community, to consult the Committee of the Regions on the matter;

Having regard to its decision on 18 July 1995 to direct Commission 8 'Economic and Social Cohesion, Social Policy and Public Health` to draw up the relevant Opinion;

Having regard to the Draft Opinion adopted by Commission 8 on 13 May 1996 (Rapporteur: Mrs Bente Nielsen) (CdR 157/96),

unanimously adopted the following Opinion at its 13th Plenary Session on 12 and 13 June 1996 (meeting of 13 June).

1. Introduction

The EU Commission has tabled a proposal on the establishment of a Community-wide network for the epidemiological surveillance and control of communicable diseases.

The network is to be more than a permanent monitoring system: it is also to be deployed in disaster situations, i.e. to curb the spread of epidemics as quickly as possible. Such an instrument must also be available for developing preventative policies - for example vaccination policies.

According to the Commission, future Community actions for establishing the network will have two major strands:

Firstly, the establishment of a system for the surveillance and control of communicable diseases at Community level.

Secondly, the development and coordination of intra-Community cooperation and assistance for pilot projects at national level. These measures are to be backed by exchanges of experience through expert meetings and information campaigns.

The Commission believes that implementation of the system will yield added value in a number of areas, including the following:

- it will ensure the setting up of a continuous, well-structured, reliable and effective communication system at Community level between national communicable disease surveillance authorities, something which is lacking at present;

- it will facilitate the rapid, reliable and commonly agreed identification of cases of communicable diseases occurring inside the Community, or occurring outside and therefore being imported or likely to be imported;

- it will give the competent authorities the opportunity and the means to consult together on the preventive measures to be taken, and it will help them with the coordinated introduction of such measures and the evaluation of their effectiveness;

- it will give the authorities the support they need for analysing and interpreting data and for deploying the necessary measures to stop communicable diseases from spreading.

Against this background and given the content of the Communication, the Committee of the Regions hereby submits the following general and specific comments on the Commission draft, including proposals for amendments and further action.

The COR's comments and proposals

2. General Comments

2.1. The COR is gratified by the Commission's interest in public health, as reflected in this draft decision on the establishment of an EU-wide network for the surveillance and control of communicable diseases. The Commission emphasizes the importance of securing a high standard of health protection in the European Union. Health and public health issues in general are a matter of concern for individual citizens and the COR is therefore keenly interested in this matter.

2.2. Some communicable diseases which were believed to have been eradicated, have now begun to re-appear. In some areas, such diseases have assumed epidemic proportions. Higher population mobility, as a result of tourism and immigration for example, increases the risk of further spread. The COR therefore agrees that cooperation is necessary in this area. The Committee therefore generally endorses the Commission initiative.

2.3. The COR notes that the proposal has been submitted under Article 129 of the European Union Treaty which stipulates that the Community may support Member States' action in the field of public health by contributing to preventative action and to public health measures in general.

2.4. In this connection the COR must stress that the establishment of the network does not create scope for influencing how the Member States organize, promote or fund their own health services within their own territory.

2.5. The COR welcomes the fact that the proposal is based on the principle of shared responsibility between the EU and the Member States. Appropriate account is taken of the fundamental principle of subsidiarity which underpins the European venture.

2.6. In this connection, the COR stresses the importance of respecting the subsidiarity principle because health matters vary considerably from one Member State to another and problems are dealt with at different administrative levels. The COR therefore emphasizes that regional authorities must be closely involved in setting-up networks in those Member States where the regional or local authorities have an input into health service administration.

2.7. The COR would also emphasize that the establishment of an international network for monitoring communicable diseases, with provision for rapid action to curb epidemics, must not trigger unnecessary concern amongst the general public. The COR therefore stresses that the proposal is primarily conceived as a preventative measure designed to promote health.

2.8. The COR also feels that there is a tendency to gloss over the differences in national legislation on border checks on immigrants from third countries; this has implications for the spread of diseases. The COR feels that there is a need for a broader overview of national legislation on this area; it therefore urges the Commission to take the appropriate measures to ensure that such legislation is catered for under the proposed system. In general, the establishment of the monitoring arrangements must be seen in conjunction with existing and future legislation on freedom of movement.

3. Specific Comments

3.1. Setting up the network

3.1.1. The COR welcomes the Commission's declaration that the establishment of the surveillance system is contingent on maximum accuracy, reliability and uniformity of the information to be exchanged.

3.1.2. Current data is, the COR believes, extremely disparate and the Committee therefore urges the Commission to take steps to secure an exact description of measures to ensure that the information in question is reliable and uniform and that it is available when it is required. The COR believes that the establishment of a network for monitoring communicable diseases is futile unless adequate account is taken of these conditions in advance.

3.1.3. The COR welcomes the Commission statement that the scope for establishing the network within existing programmes should be investigated.

3.1.4. In this context, the COR notes that the Commission spells out how the system is to be implemented in concrete terms. The COR therefore insists that a detailed investigation be undertaken of the suitability of current telecommunications programmes. In this connection, the COR insists that Commission DG XIII be involved in this work.

3.1.5. The Commission indicates that there are already a number of different regional and national programmes for monitoring communicable diseases. Take for example the mandatory notification arrangements which, in the Commission's view, are more effective in some Member States than in others. It is also pointed out that there are major differences in these systems.

3.1.6. Irrespective of these differences, as regards both content and effectiveness, the COR feels that, as far as possible, the proposed system should be based on existing arrangements, in order to avoid duplication of effort and waste of resources. Special attention should be given to the use of data collected by basic health services. The COR therefore urges the Commission to investigate the suitability of existing arrangements as possible models for the proposed network.

3.1.7. The COR notes that the Commission proposes that the network should inter alia comprise a number of surveillance centres.

3.1.8. The COR feels that these centres should be established on a regional basis in line with regional authorities' responsibility for running the health service. Steps should be taken to ascertain whether local or regional surveillance centres could be incorporated in the network.

3.1.9. The COR notes that the Commission calls on the Member States 'to appoint the structures concerned within 6 months of the instrument's entry into force and to notify the Commission accordingly`.

3.1.10. The COR thinks that 6 months is extremely short for pinpointing the areas covered by the Article; this will entail substantial administrative outlay and the COR therefore proposes that the period be extended from 6 to 12 months.

3.1.11. For the purposes of implementing the network, the Commission is to be assisted by a Regulatory Committee comprising representatives from each Member State and chaired by a Commission representative.

3.1.12. The COR insists that health experts and regional and local authority representatives be involved, possibly on an ad hoc basis. This will be particularly crucial where they are responsible for running the health service and where the local and regional authorities concerned are therefore the relevant players.

3.1.13. The COR therefore welcomes the fact that the Commission is concerned to globalize the information compiled in setting up the network and that it will therefore not be possible to identify individuals.

3.1.14. The COR agrees with this approach because data confidentiality can create ethical and legal problems.

3.2. Relations and cooperation with third countries, etc.

3.2.1. The COR welcomes the Commission's reference to the possibility of involving third countries in cooperation.

3.2.2. The COR endorses such cooperation because communicable diseases are not deterred by national borders. In addition increased immigration from Eastern Europe is a factor in the spread of some diseases. The COR therefore urges the Commission to clarify how such cooperation can be established, not only with Eastern European countries but also with third countries in general.

3.2.3. The COR would emphasize that the state of public health in Eastern Europe and other third countries in general is not the only factor in the re-emergence of diseases which had been eradicated in the EU. There are also internal health problems in the Union. The COR therefore points out that the EU's structural funds also provide for financial assistance for health initiatives in Objective 1 regions. The COR believes that it is important to deploy resources in these areas for the purposes of promoting public health and preventative measures.

3.2.4. The COR notes that the Commission proposes a review of protection measures which should be taken in emergency/disaster situations 'particularly in ports and airports`.

3.2.5. In this connection, the COR stresses that the proposed network must not be discriminatory in regard to entry facilities into the EU. It is not clear what the Commission means by the above comment; it would however be inappropriate to impose tighter checks on third country's citizens when the network is established. National legislation must be respected as far as possible.

3.2.6. The COR welcomes the Commission's intention to involve international organizations in cooperation projects.

3.2.7. There is general agreement on this and the COR urges the Commission to clarify how for example WHO or WHO/Euro (based in Copenhagen) can be involved. The aim must be to avoid duplication.

3.3. Financing and assessment

3.3.1. The COR notes that the Commission proposal refers inter alia to provisions on prompt notification of AIDS and other communicable diseases as the basis for the proposed network.

3.3.2. The COR believes that insufficient attention has been focussed on concrete funding for the network. The COR stresses that the financial circumstances should be fully clarified in advance of any concrete decisions on establishment. The COR takes the view that it would be extremely unfortunate and probably impossible to fund the network from resources which have been earmarked for implementing the AIDS programme, as this programme requires substantial funding itself.

3.3.3. The Commission states that the second strand for establishing the network must provide scope for assisting national pilot projects.

3.3.4. In this context the COR urges the Commission to define the parameters for such assistance, including the scope for economic assistance. The COR also believes that regional and local authorities should be entitled to provide assistance in line with their involvement in running the health service.

3.3.5. There is no direct evidence that the Commission has taken concrete steps to assess the network's efficiency.

3.3.6. Parameters should therefore be established for undertaking an assessment, including the time-scale for setting up the network.

Done at Brussels, 13 June 1996.

The Chairman of the Committee of the Regions

Pasqual MARAGALL i MIRA

() OJ No C 123, 26. 4. 1996, p. 10.