Opinion of the European Economic and Social Committee on the "Proposal for a Regulation of the European Parliament and of the Council establishing a European Centre for Disease Prevention and Control" (COM(2003) 441 final — 2003/0174 (COD))
Date: 2003-10-29
Institutions: European Economic and Social Committee
Subjects: ESC opinion, EU office or agency, disease prevention, epidemiology, health control, health policy, information network

5.2.2004

EN

Official Journal of the European Union

C 32/57

Opinion of the European Economic and Social Committee on the ‘Proposal for a Regulation of
the European Parliament and of the Council establishing a European Centre for Disease
Prevention and Control’

(COM(2003) 441 final — 2003/0174 (COD))

(2004/C 32/11)

On 5 September 2003 the Council decided to consult the European Economic and Social Committee,
under Article 152 of the Treaty establishing the European Community, on the above-mentioned proposal.

The Section for Employment, Social Affairs and Citizenship, which was responsible for preparing the
Committee’s work on the subject, adopted its opinion on 6 October 2003. The rapporteur was
Mr Bedossa.

At its 403rd plenary session (meeting of 29 October 2003), the European Economic and Social
Committee adopted the following opinion with 125 votes in favour and two abstentions.

1.

Introduction

In other words, the spread of these outbreaks is hastened
considerably by international
travel and communications
systems.

1.1.
Two major factors have prompted the Commission of
the European Communities to lose no time in submitting this
proposal to establish a European Centre for Disease Prevention
and Control.

The first of these is the imminent adoption of the
1.1.1.
draft treaty establishing a constitution for Europe, which has
identified common security problems in the area of public
health as a field in which the European Community’s powers
should be quite substantially increased.

1.1.2.
The second is the recurrence in the news of public
health problems, which have been emerging around the world
over the last twenty years or so, and which may be said to
have started with the discovery and explosion of mutant
viruses, such as HIV in the early 1980s, and most recently,
earlier this year, with the mutation of the Corona virus, which
caused a worldwide alert, from China to Canada, with the
emergence of SARS (severe acute respiratory syndrome), with
its many and complex implications that have yet
to be
thoroughly assessed.

Not to be forgotten is the emergence over the same

1.2.
period of bio-terrorist threats in Japan and USA.

1.3.
Looking at the recent history of disease outbreaks,
their most obvious feature is that the risks are immediately
worldwide in scale: HIV, which undoubtedly came into being
on the banks of the Congo River, was first identified in
Norfolk, USA, and the mutation of the Corona virus ’travelled’
in less than three months from Quandong (China) to Toronto
in Canada.

1.4.
A further constraint has arisen: although social protec-
tion arrangements differ considerably from country to country,
European citizens demand that the State afford them ever
greater protection against health risks and that, as far as public
health is concerned, the authorities apply the principles of
information and transparency in
precaution, promptness,
their reactions and decisions, even though this is a set of
requirements which is not always easy to meet.

1.4.1.
The situation in the EU is very uneven: some
countries have modern structures with appropriate facilities,
whereas others are much less well prepared. Divergences are
set to worsen with EU enlargement, so the establishment and
effective operation of a European Centre for Disease Prevention
and Control is undoubtedly necessary.

1.5.
The European Commission has been managing a
network on communicable diseases since 1999, but it is an
isolated and inadequate example of cooperation.

The system needs to be substantially enhanced forthwith so
that the EU can control it effectively. In June 2001, at the
Gothenburg European Council, the Council also called for this
centre for the control and prevention of communicable
diseases to be set up.

It should be noted that, since June 2003,
following the
outbreak of the SARS epidemic, support from the Member
States for the proposed centre has grown considerably.

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2. General comments

3.3.

Two parameters must be addressed:

There is a need for a systematic and structured
2.1.
approach to controlling communicable diseases and other
serious health threats. This demonstrates the importance of
the preventive approach, which is rightly mentioned in the
name of the centre and specified as part of its mission (Article
3 of the proposal).

In the agrifood sector, successive BSE crises, Creutzfeldt-Jakob
disease, scrapie in sheep and avian influenza have posed
widespread and serious threats.

2.2.
In the environmental field, the sudden surge in illness
and death rates due to asbestos and exposure to chemical
agents, the development of respiratory illnesses due to pol-
lution, and the large number of deaths as a result of the
heatwave, i.e. global warming, are also now considered to be
serious health crises which are of epidemic proportions. If
these new health crises are to be prevented and controlled,
an epidemiological model suitable only for communicable
diseases must be abandoned, particularly since environmental
factors are of increasing importance, even for these diseases.
These crises show the importance of studying the interaction
and cumulative effect of various risk factors which can lead to
serious illnesses and health crises. The Centre must be properly
structured and equipped to undertake complex analyses of this
type.

3. Health threats

3.1.
These may in future have very different origins: many
regions of the industrialised world, as well as developing
regions with little health infrastructure, may be affected,
particularly when it is borne in mind that there is currently no
way of controlling fast-acting haemorrhagic fevers, such as
that caused by the Ebola virus.

There is also a real threat of serious crises originating from
influenza, the viruses of which are constantly evolving.

— The time and speed of reaction, as well as having
operational coordination structures, are essential factors
in the response to such serious health crises. The SARS
crisis was the most recent demonstration of this.

— The system of networks to be put in place must also be
connected to global networks: in particular, links to the
World Health Organisation (WHO) and to the network
of the US Center for Disease Control and Prevention
network in Atlanta.

3.4.
The impact of such crises is not only felt in terms of
public health, necessitating responses to widespread public
concern, but also in economic terms, since in the SARS crisis,
the economies of a number of Asian countries were affected
and, to a lesser degree, the economy of the European tourism
and transport industry.

3.5.
The European Parliament and Council Decision 2119/
98/EC setting up a network for the epidemiological surveillance
and control of communicable diseases in the European Com-
munity was intended to address the existing lack of organis-
ation.

3.6. Many EU Member States have efficient and effective
structures within their own territories, but little coordination
between them. Europe-wide surveillance, early warning and
response are needed, and although the Member States make
up the ‘network of networks’ as a Community basis, further
action and technical measures are needed.

In order to do this, there will have to be a substantial

3.7.
increase in long-term funding to sustain these operations.

The scientific consultation and coordination of public health
policies needed to meet these many requirements and heavy
demands require major funding if the intention is to extend
capacity to provide independent scientific advice and effective
operational coordination.

3.8.
The fragmentation of the present structures has a
detrimental effect; new mechanisms need to be put in place to
help the Member States and the Commission to do their work.

3.2.
Add to this the ‘ordinary’ chemical, toxic or microbial
hazards and those which could arise from a deliberate act of
bio-terrorism, such as sarin gas in Japan, anthrax in the USA,
botulism, nerve gas and poison gas in Iraq.

Enlargement to take in ten new countries, most of which are
under-equipped, may make surveillance activities less effective.

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The EU must be able to put the Member States and
3.9.
dedicated structures on a permanent health watch against any
type of threat to the public health of their citizens. Wide-
ranging liaison with the WHO and other specialist bodies
around the world should facilitate an ongoing exchange of
information between networks so that the appropriate material
can be put in place quickly and at any time to respond to
threats from whatever source.

The EESC agrees wholeheartedly with the Com-
4.4.
mission’s analysis regarding the definition and conception of
the remit of the European Centre for Disease Prevention and
Control:

— Surveillance and the networking of existing laboratories
to achieve rapid harmonisation of surveillance methods
and to speed up the comparability and compatibility of
surveillance data as soon as possible.

3.10.
The health crises suffered over the last ten years by
the countries of the EU have raised the awareness of EU
decision-makers, the Member States and the general public,
increasing acceptance for the efforts needed to combat public
health crises.

— High-level scientific advice recognised by scientific auth-
orities and academics and standardisation of laboratory
procedures. The high quality and independence of these
laboratories’ work must be guaranteed.

4. Specific comments

4.1.
In order to deal with the growing demands of EU
citizens faced with health crises of various types, some of
which happen concurrently, an individual EU Member State
needs skills, expertise and experience from all quarters able to
provide coordinated specialist knowledge.

The network needed must have a number of elements

4.2.
in particular:

— A sufficient number of trained and skilled staff.

— The existing epidemiological centres must have a privi-
leged place in the set-up, and must ensure that their
prevention and control models keep pace with the
changing nature of risks and encompass environmental
health.

— The resulting source of information must be available to
all partners. Scientific advice should be authoritative,
providing a basis for the Commission to draw up all
kinds of proposals for action and draft legislation.

4.3.
The Centre, which acts as an independent European
agency, could mobilise and significantly strengthen synergies
between existing national disease control centres. It should
enhance cooperation in an enlarged EU, as well as with
other Community agencies, namely the European Food Safety
Authority (EFSA) and the European Agency for the Evaluation
of Medicinal Products (EMEA), which has specific competences
regarding pharmacovigilance, so that their activities do not
needlessly overlap.

4.5.
The EESC would press the point that scientific surveil-
lance should be constant so as to permit an extremely rapid
early warning and response, thus preventing any deterioration
into a serious and/or major crisis.

The EESC feels that,

4.6.
assistance cannot be limited only to EU Member States.

in some instances,

technical

Care should be taken to remain attentive to all signals coming
from elsewhere which might call for a rapid response: the EU
should be able to obtain and/or provide help to all those able
to give support in any theatre of operations: Community
agencies,
the US Center for Disease Control,
humanitarian medicine and foreign agencies faced with out-
breaks which could affect other regions, especially the EU.

the WHO,

4.7.
After research and prevention measures, the EESC
agrees that the agency should have a major role in coordinating
the response to serious Community-wide health threats,
coordinating the work of the various parties concerned, such
as the authorities responsible for public health and civil
protection, the military, and civil society.

The EESC notes with interest how it is proposed that

4.8.
this European Centre should be organised:

— Small

in size, but with great influence thanks to its

synergies with national institutes.

However, the EESC has some doubts as to whether the
Centre will be able to begin operating with such a small
number of staff.

— The administrative structure appears to be straightfor-
ward and flexible, allowing continuous monitoring of the
coherence of its work with action taken under Com-
munity policies and national initiatives.

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The EESC is strongly in favour of an Advisory Forum
4.9.
(Article 18), emphasising that its members should be selected
with extreme care and rigour and should be drawn not only
from similar national bodies because, alongside the Director,
the forum is the key element in the structure underpinning the
Centre, which is essential for a wider EU public health policy.

The EESC is convinced that there will be many more such
threats in future on a range of fronts — chemical, toxic,
climatological, viral or microbial — and that these will be
aggravated by resistance to treatment, such as in the case of
tuberculosis, AIDS, malaria and fast-acting hemorrhagic fevers.

5. Conclusions

The European Commission has reacted quickly in the

5.1.
wake of the international health crisis caused by SARS.

The creation of this Centre is a boost to the EU’s public
5.2.
health policy as defined in Treaty Article 152 and provided for
in the draft EU constitution, now on the table before the IGC.

Brussels, 29 October 2003.

The President

of the European Economic and Social Committee

Roger BRIESCH

Opinion of the European Economic and Social Committee on the ‘Communication from the
Commission to the Council, the European Parliament, the European Economic and Social
Committee and the Committee of the Regions Strengthening the social dimension of the Lisbon
strategy: Streamlining open coordination in the field of social protection’

(COM(2003) 261 final)

(2004/C 32/12)

On 28 May 2003, the Commission decided to consult the European Economic and Social Committee,
under Article 262 of the Treaty establishing the European Community, on the above-mentioned
communication.

The Section for Employment, Social Affairs and Citizenship, which was responsible for preparing the
Committee’s work on the subject, adopted its opinion on 6 October 2003. The rapporteur was
Mr Beirnaert.

At its 403rd plenary session of 29 and 30 October 2003 (meeting of 30 October), the European
Economic and Social Committee adopted the following opinion by 62 votes in favour, two votes against
and no abstentions.

1.

Introduction

1.1.
In its Spring Report of 2003, the Commission under-
took to adopt a communication on ‘the streamlining of current
disparate actions linked to social inclusion and pensions and,
in time, cooperation in relation to healthcare and “making
work pay” into a single Open Method of Coordination’.
Furthermore, the Brussels European Council asked the Com-
mission in March of 2003 ‘to report on the advisability of
simplifying and streamlining the various strands of work on

social protection into a coherent framework within the Open
Method of Coordination’.

1.2.
In March 2000, the Lisbon European Council outlined
its vision of an integrated socio-economic strategy for Europe,
bringing cooperation in the field of social protection into the
picture alongside the coordination of economic policies within
the framework of the Broad Economic Policy Guidelines
(BEPGs) and of employment policies within the framework of
the European Employment Strategy.