Communication from the Commission to the Council, the European Parliament, the European Economic and Social Committee and the Committee of the Regions on strengthening coordination on generic preparedness planning for public health emergencies at EU level
Date: 2005-11-28
Institutions: European Commission
Subjects: emergency aid, epidemic, health policy, health risk, information system, public health, terrorism

COMMISSION OF THE EUROPEAN COMMUNITIES 

Brussels, 28.11.2005 
COM(2005) 605 final 

COMMUNICATION FROM THE COMMISSION TO THE COUNCIL, THE 
EUROPEAN PARLIAMENT, THE EUROPEAN ECONOMIC AND SOCIAL 
COMMITTEE AND THE COMMITTEE OF THE REGIONS 

on strengthening coordination on generic preparedness planning for public health 
emergencies at EU level 

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TABLE OF CONTENTS 

1. 

2. 

3. 

3.1. 

3.2. 

3.3. 

3.4. 

3.5. 

3.6. 

4. 

Background .................................................................................................................. 3 

Purpose and scope ........................................................................................................ 4 

Essential components of generic preparedness planning ............................................. 5 

Information management ............................................................................................. 5 

Communications .......................................................................................................... 6 

Scientific advice ........................................................................................................... 7 

Liaison and command and control structures............................................................... 8 

Preparedness of the health sector ................................................................................. 9 

Preparedness in all other sectors and inter-sectorally ................................................ 11 

Conclusions ................................................................................................................ 13 

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1. 

BACKGROUND  

The terrorist attacks in the USA in September 2001 prompted governments and international 
bodies,  with  responsibilities  related  to  health  protection,  to  review  and  reinforce  policies, 
contingency plans and resources to prevent and mitigate the effects of such attacks. The need 
for  joint  action  in  the  EU  to  complement  national  measures  led  to  the  establishment,  in 
October 2001, of the Health Security Committee, made up of high-level representatives of the 
Health  Ministers,  to  serve  as  the  coordination  platform  for  public  health  preparedness  and 
response  to  deliberate  releases  of  biological,  chemical  and  radio-nuclear  agents.  A 
communication1  containing  a  progress  report  on  the  implementation  of  the  health  security 
programme was published on 2 June 2003.  

The  SARS  epidemic  in  2003  opened  up  a  new  dimension  in  the  public  health  area:  a 
previously  unknown  disease  with  features  similar  to  influenza  and  common  cold  was 
spreading  rapidly  causing  high  mortality  and  morbidity,  fast  travel  and  global  trade 
facilitating transmission in the absence of relevant vaccines and drugs. The epidemic resulted 
in a major re-think of public health defences against communicable diseases and demands for 
research  to  find  effective  counter-measures.  Above  all,  it  stressed  the  need  for  world-wide 
cooperation  to  nip  such  diseases  in  the  bud  by  detecting  outbreaks  early  and  acting  at  their 
source.  Action  by  the  countries  affected  with  support  and  guidance  from  the  World  Health 
Organisation helped prevent catastrophic developments; coordination in the EU based on the 
Early Warning and Response System (EWRS)2 contributed to Member States’ knowledge of 
the situation and readiness to stem any potential spread of the disease. 

More recently, the risk of a global influenza pandemic of devastating consequences had to be 
re-assessed  with  the  rise  of  avian  influenza  in  Asia  and  its  spread  in  the  world.  A  strategy 
advocated by the Commission on Community influenza preparedness and response planning 
was outlined in a working paper published in March 20043. In its conclusions adopted at the 
meeting  on  June  20044  the  Council  acknowledged  the  plan,  and  identified  as  a  priority  the 
drawing  up  and  inter-operability  of  national  plans.  The  strategy  on  pandemic  influenza  has 
now  been  revised  and  adapted  to  new  developments,  notably  the  new  World  Health 
Organisation’s  recommendations5  on  pandemic  influenza  and  the  establishment  of  the 
European Centre for Disease Prevention and Control (ECDC)6 and is the object of a separate 
Communication on Pandemic Influenza Preparedness and Response Planning in the European 
Community7.  

The proliferation of disease-specific plans led Health Ministers at their Council meetings of 6 
May 2003 and 2 June 2003 to request the Commission to develop and prepare a rationale for 
generic plans for all sorts of public health emergencies. Such generic plans would involve not 
only  medical  counter-measures,  such  as  diagnosis,  isolation  and  treatment  of  cases  and  the 
administration  of  vaccines  and  prophylactic  drugs  to  at-risk  groups  and  the  population  at 
large, but also public order measures, such as restriction of movement and border controls, the 

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7 

COM (2003) 320 final, 2.6.2003 
OJ L 21, 26.1.2000, p.32 
COM(2004) 201 final, 26.3.2004 
SAN 104, 9882/04, 2.6.2005 
http://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_GIP_2005_5.pdf 
OJ L 142, 30.4.2004, p. 1 
COM(2005) 607 final, 28.11.2005 

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closing  down  of  premises  and  the  cordoning  off  of  specific  areas,  civil  protection  measures 
such  as  rescue  operations,  the  provision  of  food,  water,  shelter  and  other  essential  items, 
market  and  trade  measures  concerning  food,  animals,  plants  and  goods,  as  well  as  external 
affairs  measures  concerning  their  nationals  abroad  and  international  cooperation  to  help 
stopping the spread of diseases or pathogens. Most importantly, infrastructures and equipment 
and materials must be in place and benefit from proper protection, whereas the persons with 
duties  in  the  implementation  of  plans  must  be  trained  and  be  protected  through  appropriate 
personal and collective means to do their job properly. All such measures should be based on 
sound  scientific  and  technical  grounds  and  socio-economic  considerations  and  should  be 
explained  and  communicated  in  due  time  to  citizens  and  third  parties  concerned  to  ensure 
compliance at national level and compliance and/or coherence at EU level and internationally.  

This Communication presents such a rationale, setting out the essential components that need 
to  be  addressed  in  a  planning  process  by  which  Member  States  and  the  Community  can 
develop  and  implement  plans  addressing  general  public  health  as  well  as  disease  specific 
emergencies. The development of plans based on this rationale would help co-ordination and 
interoperability and add to their effectiveness in implementation. 

2. 

PURPOSE AND SCOPE 

Public health emergencies are dominated primarily by events related to pathogens transmitted 
from person to person or through unsafe food or products; or through animals and plants or by 
harm to individuals by the dispersion or action of biological, chemical or physical agents in 
the  environment.  Common  to  all  such  emergencies  are  assets  and  resources  to  be  used  and 
consequence  management  aspects  to  go  through  in  developing  emergency  or  contingency 
plans.  This  communication  identifies  the  key  building  blocks  of  generic  preparedness 
planning. It is based on experience gained through the exchange of information and sharing 
between  the  Commission  and  Member  States  of  plans  concerning  smallpox  and  pandemic 
influenza  and  extensive  work  with  the  help  of  the  Health  Security  Committee  and  the 
Community  Network  for  the  epidemiological  surveillance  and  control  of  communicable 
diseases  in  the  European  Community8.  This  led  to  the  elaboration  of  a  detailed  technical 
guidance  document9  which  contains  individual  attention  points,  objectives,  checklists  and 
division  of  public  health  roles  and  functions  for  Member  States,  for  relevant  Community 
Agencies10  and  for  Commission  services  for  each  of  the  key  components  of  the  planning 
process.  This  technical  guidance  document  is  continuously  updated  with  contributions  from 
the  Member  States  and  the  Commission  services  competent  for  the  relevant  sectors  of 
Community action. It also sets out the topics that need further work and additional efforts in 
order to inform and reinforce national plans and enhance coordination at EU level. 

The overall goal is to assist Member States in developing their plans and factoring in the EU 
dimension, with its body of laws in various sectors with a bearing on public health emergency 
plans.  The  Communication  together  with  the  technical  guidance  document  provides  the 
backbone  for  developing  core  elements  in  national  plans,  addressing  generically  different 
types of health threats, whether anticipated (such as pandemic influenza) or unexpected (e.g. a 
SARS–like epidemic) and aims at improving the interoperability of such plans.  

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OJ L 268, 3.10.1998, p.1 
http://europa.eu.int/comm/health/horiz_keydocs_en.htm#3 
http://www.europa.eu.int/agencies/index_en.htm 

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The framework for cooperation in generic preparedness planning in the EU covers three main 
activities:  first,  sharing  national  plans  and  making  comparisons,  evaluations,  in  particular 
through joint tests and guidance on peer reviews of plans, and improvements on the basis of 
specific checklists set out in the technical guidance on generic preparedness planning; second, 
identifying  the  contribution  and  role  of  existing  Community  legislation  and  ensuring  that 
national  plans  take  them  fully  into  account,  as  well  as  examining  the  need  for  further 
Community  measures;  and  third,  examining  and  improving  implementing  arrangements, 
which  could  help  improve  the  timely  flow  of  information  and  the  interoperability  and 
congruence of plans and responses.  

3. 

ESSENTIAL COMPONENTS OF GENERIC PREPAREDNESS PLANNING 

The  key  components  that  need  to  be  fully  addressed  in  order  to  arrive  at  public  health 
emergency plans are: 

1. 

2. 

3. 

4. 

5. 

6. 

information management,  

communications,  

scientific advice, 

liaison and command and control structures,  

preparedness of the health sector and  

preparedness in all other sectors and inter-sectorally. 

The  principles  and  issues  underlying  each  component  are  developed  in  separate  chapters 
below. The experience gained from cooperation on planning at EU level has shown that the 
ability to respond to a public health emergency depends heavily on the extent to which these 
issues have been considered in advance and whether plans have been put in place that address 
each and every component. 

Particular  topics  under  each  component  will  require  special  attention  in  the  future,  e.g. 
triggering  levels  for  specific  counter-measure  introduction,  incident  investigation  and 
environmental  sampling,  use  of  models  in  decision-making,  procedures  for  triage  and 
quarantine,  hospital  emergency  and  resilience  plans,  etc.  The  Commission  will  develop 
further  these  topics  with  a  view  to  sharing  best  practice  and  helping  Member  States  gain  a 
better insight as to best practicable options to be incorporated in their plans.  

3.1. 

Information management 

Information  management  concerns  the  gathering,  handling,  use  and  dissemination  of 
information related to an emergency, to detect and identify the hazards and risks, monitor the 
status  and  evolution  of  emergency,  identify  the  assets  and  resources  available  and  their 
distribution and use and the status of systems serving information needs for the various actors 
involved.  Information  is  all  manners  of  description  and  representation  as  well  as  the 
generation  of  knowledge  and  the  understanding  of  implications  of  facts  and  figures.  It 
involves surveillance and medical intelligence, data from sensors and monitors and meters of 
all  sorts,  clinical  and  epidemiological  data,  health  data  and  statistics,  and  data  on  products, 
goods, infrastructure and services relevant to the emergency.  

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Organising  adequate  health  and/or  medical  surveillance  by  Member  States  before  an  event 
and  improving  afterwards  is  necessary  to  identify  potential  public  health  threats,  their  scale 
and extend and their international relevance at a very early stage and follow their evolution 
and changing circumstances. Pre-event surveillance and monitoring applies to communicable, 
toxic,  chemical,  radionuclear  and  physical  threats,  whether  deliberate  or  not  and  changes  in 
the  environment  that  may  precipitate  natural  phenomena  with  public  health  consequences. 
Standards  for  surveillance  in  different  areas  (human,  veterinary,  environmental,  etc.), 
including case definitions and trigger levels need to be comprehensive and applied rigorously. 
Since the first indications of  an upcoming event  might  come  from  outside  the  public  health 
sector,  such  as  from  the  media,  veterinarians,  law  enforcement  and  security  services  and 
others, collaboration with and between such sources of information is necessary.  

The  Community  has  played  a  key  role  in  setting  requirements  and  organising  the  co-
ordination  of  surveillance  and  monitoring  related  to  a  wide  range  of  emergencies  through 
several rapid alert systems, dedicated surveillance networks, radiation protection monitoring 
systems and information systems for chemical substances.  

Medical intelligence and the scanning of media reports provide information for risk analysis 
purposes and allow suspicious or unusual situations and events to be spotted at an early stage 
and  advance  warnings  to  be  issued.  Member  States  and  the  Commission  have  developed 
powerful tools to cater for this purpose.  

Clinical and laboratory diagnosis is part of the organisation of information management, both 
to identify unknown agents and to confirm known agents. Member States are responsible for 
diagnosis  and  the  Community,  through  reference  laboratories,  together  with  the  ECDC, 
provides  a  EU-wide  cooperative  platform  on  laboratory  and  quality  procedures,  collating 
clinical  data  and  secondary  confirmation,  which,  however,  needs  to  be  improved  further. 
Laboratory  capacity  must  be  available  at  Member  State  level  and,  for  issues  beyond  the 
national capacity or when no national capacity is available, cooperation between laboratories 
within the Community must be organised to ensure comprehensive coverage throughout the 
EU.  

Collecting  and  sending  for  analysis  of  environmental  samples  to  laboratories  require  the 
application of protective measures. International transfer of materials in this respect is subject 
to rules negotiated under the appropriate UN-bodies and further work is required in which the 
Member States and the Commission are key players, to ensure that transfers for public health 
purposes are not obstructed or unduly delayed.  

Once decisions have been taken on appropriate actions to counter the health threat, systems to 
monitor  their  impact  and  any  side-effects  must  become  operational  if  normal  operation 
surveillance  and  monitoring  systems  are  not  sufficient,  with  development  of  a  shared 
database, contact points and recommendations on potential treatment. 

3.2. 

Communications 

The distribution of accurate and timely information at all levels is critical in order to minimise 
unwanted and unforeseen social disruption and economic consequences and to maximise the 
effective  outcome  of  the  response.  The  information  management  described  in  the  previous 
section  cannot  be  achieved  without  accurate  and  timely  distribution  of  the  information. 
Communications can come in many forms such as text, voice, and video and, for command 
and control purposes, their infrastructure must be in place and be as robust as possible, so as 

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to  preserve  communication  channels  even  in  emergencies  when  some  forms  may  be 
incapacitated  and  sufficient  redundancy  must  be  built  in  to  cater  for  the  loss  of  particular 
systems  (e.g.  telephony)  or  premises  or  a  collapse  due  to  excessive  traffic  (e.g.  computer 
system  or  Internet  crashes).  In  the  case  of  a  major  public  health  emergency,  existing  wired 
communications infrastructure might have been damaged or destroyed, preventing the use of 
wired  networks  for  communications.  Alternatives  must  be  provided,  including  wireless 
transmission. 

Communication procedures from and between those in charge of planning, those in charge of 
making  the  final  public  health  input  to  the  political  decision-making  authority  and  those  in 
charge of the final inter-sectoral input to these authorities is essential if the right decisions are 
to be taken. Authorities at national level as well as the Commission have the communication 
systems  and  standard  operating  procedures  in  order  to  understand  and  agree  the  scientific, 
economical, political and social implications of messages.  

Public authorities should communicate effectively with the public and the media before and in 
anticipation of events that may lead to public health emergencies, from an early stage in any 
major incident, establishing themselves as the leading, if not the only, source of authoritative 
information and continuously during the unfolding of the event and its consequences. Member 
States,  the  Commission  and  relevant  Community  agencies  are  working  to  co-ordinate  their 
crisis communications to ensure the messages they give are accurate and comprehensive. 

At the level of each Member State as well as the Commission, this requires the existence of 
systems  and  procedures  for  communication  between  authorities  and  with  professionals  and 
the public in clear and unambiguous terms. Co-ordination  is  paramount to  obtain  in the EU 
consistency and accuracy in the messages to the public, preserving confidence in the ability of 
authorities to face up to an emergency and avoiding a public health crisis. This implies clear 
flow  of  data  input  and  feed  back,  uninterrupted  flow  of  information  and  data  transfer,  and 
responsibilities  of  each  relevant  actor  to  collect,  analyse  and  report  the  surveillance  and 
monitoring response data from the first notification to the appropriate structures. Connecting 
the  competent  authorities  and  decision  makers  requires  24h/7d  operational  contact  points  in 
the  Member  States  and  in  the  Commission  and  these  have  already  put  in  place  for  many 
sectors of EU activity. 

3.3. 

Scientific advice 

The preparation and rendering of scientific advice needs to be integrated in the management 
of  the  emergency,  through  the  establishment  at  all  levels  and  areas  of  structures  such  as 
groups  of  experts  or  committees  and  through  rapid  consultation  on  risk  assessment  and 
examination  of  the  scientific  and  technical  basis  for  options  for  response.  The  scientific 
advice  will  include  support  to  the  command  and  control  and  liaison  structures  to  help  in 
arriving at corresponding control actions and identifying scientific and technical expertise and 
resources for implementation.  

Mechanisms  and  structures  for  rendering  scientific  advice  at  Community  level  exist  for  the 
various sectors relevant to public health emergencies and allow for the integration of scientific 
evidence from the Member States and the Commission as well as consideration of social and 
economic aspects. In the health field, the Joint Research Centre and six Community agencies 
are  key  to  rendering  scientific  advice  relevant  to  public  health  emergencies,  namely  the 
ECDC,  the  European  Medicines  Evaluation  Agency  (EMEA),  the  European  Food  Safety 
Authority  (EFSA),  the  European  Environment  Agency  (EEA),  the  European  Monitoring 

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Centre for Drug and Drug Addiction (EMCDDA) and the European Agency for Occupational 
Health and Safety at Work (EU-OSHA).  

Once the emergency has been recognised, scientific guidance, including predictions based on 
scientific  modelling,  should  be  available  on  options  for  response  and  recovery  and  the 
resilience of key systems such as water supply, sanitation, health services and medical goods 
and  supplies,  etc.  shelter  sites  and  rescue  structures  and  protection  materials,  ports  and 
transport  networks,  warehouses  and  communications  systems.  Member  States  and  the 
Commission are working together to improve the predictive capability of models. In the area 
of communicable diseases, a coordinated real-time EU forecast modelling capability is being 
set up and funded11 to help identification of the most appropriate actions to counter the spread 
of disease and agents and to assist authorities by informing public health policy and planning 
ahead of time.  

Mechanisms  to  locate  rapidly  expertise  in  Member  States  and  at  EU  level  and  make  it 
available to the Member States have been and are being developed  by the  Commission and 
relevant  Community  Agencies.  EU  directories  of  experts  allow  Member  States  to  request 
specific services in times of need.  

3.4. 

Liaison and command and control structures 

The  three  phases  of  a  response  during  a  public  health  emergency  are  detection-diagnosis, 
control  and  treatment,  but  these  may  exist  simultaneously  during  the  emergency.  The 
interaction  between  the  three  poses  serious  problems  in  terms  of  taking  the  right  steps  and 
following  the  proper  course  of  action  throughout  the  response  by  all  the  intervening  actors 
and resources. Command and control is charged with the challenge of solving these problems 
and for achieving the control of the spread of disease or contamination through the population 
and the environment and is a central responsibility for Member States. 

The requirements for proper command and control include situational awareness of casualties 
and resources, co-ordination of the response and of communications, information analysis and 
management and simulation for event-analysis and training. 

Command  and  control  encompasses  all  planning  and  response  functions  and  operations  and 
integrates  them  into  a  meaningful  whole.  It  is  the  means  by  which  a  hierarchy  of  decision 
making is organised between intervening agents in a multi-sector response, persons in charge 
(PICs)  are  designated  for  all  foreseeable  situations,  especially  when  diverse  services  and 
authorities  intervene  and  these  PICs  recognise  what  needs  to  be  done  and  see  to  it  that 
appropriate  actions  are  taken.  Who  does  what,  when,  how  and  with  what  implications  for 
resources and impact on the overall response is central to the role of command and control. 

In  command  and  control,  the  main  factor  to  reckon  is  time  and  the  primary  challenges  are 
uncertainty, complexity, and variability. In some cases, there is little or no information about 
a  situation;  in  other  cases,  the  available  information  might  be  confusing,  conflicting,  or 
incomplete. In almost all cases, PICs and personnel will operate under severe time constraints, 
with little time to make critical decisions. PICs must manage the level of uncertainty, while 
still recognizing that it can never be completely eliminated. Command and control helps those 
in  charge  to  operate  effectively  despite  the  complexity  while  simulation  can  be  used  as  a 

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http://europa.eu.int/comm/health/ph_projects/2003/action2/action2_2003_03_en.htm 

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valuable tool to untangle complexity and anticipate variable outcomes. A balance is sought in 
order to empower PICs at every level to focus resources upon a mission, while enabling the 
inventiveness  and  initiative  of  subordinates.  At  Member  State  level,  an  over-arching  centre 
exists,  at  the  heart  of  government,  as  well  as  a  web  of  lower-level  command  and  control 
centres, at regional and local levels, linking authorities and services integrated in the response 
system  by  horizontal  and  vertical  chains  of  authority  command  and  communication  flows, 
each operating within set limits of autonomy and discretion. 

Command and control centres in the Member States need to have good liaison systems with 
other  Member  States,  the  Commission  and  Community  agencies  as  well  as  international 
organisations,  in  particular  the  WHO.  The  Community  has  many  liaison  systems,  most 
addressing  early  warning  and  alert  needs  and  based  on  Community  legal  instruments,  in 
particular  in  the  areas  of  radiation  protection,  food  safety,  animal  health,  plant  health,  civil 
protection, external affairs, customs etc. Health threats which the EWRS or the Community’s 
Rapid  Alert  System  on  biological,  chemical  and  radio-nuclear  attacks  and  threats  12  report, 
according to agreed criteria, may lead to the recognition of a public health emergency and will 
activate  appropriate  liaison  and  coordination  structures  at  EU  level  as  well  as  within  the 
Commission. 

The Commission is setting up the ARGUS13,14 system which interlinks all Community rapid 
alert  systems  and  a  crisis  coordination  centre  with  appropriate  coordinating  structures  to 
ensure  timely  initiatives  and  responses  in  each  area  of  Community  policy  in  case  of 
emergency.  

3.5. 

Preparedness of the health sector 

Catering for the persons affected will vary from one Member State to another, depending on 
the  health  infrastructure  and  care  organisations  in  each.  There  will  be  many  similarities, 
however,  in  the  planning  principles  and  it  will  be  valuable  to  exchange  information  in  this 
area.  Furthermore,  when  there  is  a  need  for  support  across  borders,  it  will  be  necessary  to 
understand  the  procedures  employed  in  the  receiving  Member  State.  To  achieve  this,  it  is 
necessary  to  share  information  on  planned  activities  and  assistance  in  the  review  and 
development of national plans. National plans should include the necessary crisis support to 
the population affected in general and healthcare personnel in particular and experience on the 
actual  execution  of  the  plans  to  provide  these  resources  should  be  shared  between  Member 
States.  

Resources for epidemiological and laboratory investigation are pooled and shared at EU level 
to  a  considerable  degree  through  networks  with  the  help  of  the  Commission  and  will  be 
overseen and further improved by the ECDC.  

Procedures  for  transfer  of  patients  between  Member  States  need  extension.  Cross-border 
collaboration,  closely  linked  to  ambulance  services  and  hospitals,  should  be  planned  by 
Member States through all the internal regions in the EU. Resource-sharing to allow possible 
extension of staff and stocks of additional equipment between Member States already exists in 
some  and  is  actively  being  considered  in  other  border  areas.  Procedures  for  transferring 
resources such as mobile hospitals are envisaged and have been developed in the military and 

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COM(2003) 320 final, 2.6.2003 
COM(2004) 701 final, 24.11.2004 
Draft Commission Decision of xxx amending its internal Rules of Procedure 

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civil protection fields. Mobile resources might be the choice in some settings, in which case 
the possibilities to share them at international level could then be explored. The Commission 
proposes  in  the  future  Community  Programme  for  Health  and  Consumer  protection  2007-
201315,  to  support  projects  on  the  establishment  and  the  maintenance  of  a  trained  and 
permanently  available  core  group  of  public  health  experts  for  global  rapid  deployment  to 
places  of  major  health  crises  together  with  mobile  laboratories,  protective  equipment  and 
isolation facilities. 

Isolation  procedures,  including  definition  of  cases  to  be  isolated  and  when  they  can  be 
released, are already available for some diseases and need to be developed for others. For new 
diseases, procedures should be put in place to develop guidelines quickly, based on a common 
consensus at EU level under the auspices of the ECDC. 

Research on management of health threats is expected to allow improved identification of the 
threat and treatment of those affected, limiting the spread of the disease and eradicating the 
threat.  

One  special  area  of  research  is  the  development  of  new  medicinal  products  and  medical 
devices.  For  many  health  threats,  no  adequate  medicinal  products  are  available,  yet 
development  has  been  slow,  due  to  a  lack  of  market  prospects  and  consequent  failure  to 
attract sufficient interest on the part of industry, biotechnology undertakings and academia to 
invest  in  the  development  of  such  products.  This  calls  for:  1)  an  EU-wide  effort  to  identify 
and ensure equitable access and storing of essential medicinal products against major health 
threats; The Commission is considering what measures should be proposed in this area and 2) 
an  EU-wide  strategy  for  the  development  and  production  of  priority  medicinal  products 
against major health threats in collaboration with the pharmaceutical industry. 

The Community has already extensive legislation in the area of pharmaceuticals that creates a 
favourable  environment  for  the  development  and  placing  on  the  market  of  medicines, 
including provisions and arrangements to speed up the delivery of advice and the waving by 
EMEA  of  fees  for  mock  up  dossiers  for  vaccines.  It  is  also  channelling  funds  under  the 
Research and Technology Development Programme for vaccines and anti-virals research and 
is  planning  to  install  a  new  mechanism  that  will  allow  unforeseen  research  needs  resulting 
from  infectious  disease  emergencies  to  be  supported.  The  Commission  makes  available  via 
the  Civil  Protection  Mechanism16  17  18  19  information  on  medicines  and  other  assets  that 
Member  States  can  make  available  to  other  requesting  Member  States  and  other  countries 
party to the Mechanism.  

15 
16 

17 

18 

19 

COM(2005) 115 final 
Communication  from  the  Commission  to  the  Council,  the  European  Parliament,  the  Economic  and 
Social  Committee  and  the  Committee  of  the  Regions  (Text  with  EEA  relevance)  -  Improving  the 
Community Civil Protection Mechanism, COM (2005) 137 final, dated 20.04.2005 
Proposal  for  a  Council  Regulation  establishing  a  Rapid  Response  and  Preparedness  Instrument  for 
major emergencies COM(2005) 113 final, dated 06.04.2005 
2005/12/EC: Council Decision of 20 December 2004 amending Decision 1999/847/EC as regards the 
extension of the Community action programme in the field of civil protection. OJ No. L 6, 08.01.2005, 
page 7 
2001/792/EC,  EURATOM:  Council  Decision  of  23  October  2001  establishing  a  Community 
mechanism  to  facilitate  reinforced  cooperation  in  civil  protection  assistance  interventions.  OJ  No.  L 
297, 15.11.2001, page 7 

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Moreover, the Commission has already taken a series of initiatives aimed at making available 
antivirals  and  vaccines  for  the  case  of  an  influenza  pandemic20.  With  the  proposal  for  a 
Regulation  establishing  the  European  Union  Solidarity  Fund21,  the  Commission  suggests 
strengthening and widening the possibilities for responding also to public health emergencies. 
This covers the immediate medical assistance and measures to protect the population against 
imminent  health  threats,  including  the  cost  of  vaccines,  drugs,  medical  products,  equipment 
and  infrastructure  used  during  an  emergency.  The  use  of  this  fund,  however,  is  linked  to 
specific requirements and represents in its basic concept a refunding and thus response type 
instrument, with standard procedures that usually take some time. Therefore, the Commission 
had  suggested  an  advance  funding  mechanism  to  allow  for  a  limited  funding  with  short 
reaction time. 

With its Proposal22 on the Community strategic guidelines for cohesion policy in support of 
growth and jobs (2007-2013) the Commission suggested to include the prevention of health 
risks  and  filling  the  gaps  in  health  infrastructure  as  strategic  parameters  for  the  future 
cohesion  policy.  For  those  Member  states  planning  to  develop  horizontal  cohesion  policy 
programmes  on  health  and  those  regions  that  intend  to  integrate  health  related  priorities  in 
their operational programmes, the Commission recommends a thorough linking between them 
and  the  National  preparedness  plans.  Special  attention  should  be  paid  also  to  possibilities 
offered  by  the  forthcoming  cohesion  policy  instruments  on  territorial  cooperation,  in 
particular the cross-border cooperation. 

3.6. 

Preparedness in all other sectors and inter-sectorally 

The processes required to deal with public health emergencies beyond the health sector work 
in  two  ways:  they  serve  to  prepare  other  sectors  to  assist  the  public  health  authorities  in 
medical  interventions,  such  as  triage,  isolation,  quarantine,  treatment  and  medicine 
administration  and  vaccinations,  and  they  also  serve  to  introduce  and  apply  measures  dealt 
with mostly by other sectors, such as logistics (e.g. establishment of  stocks – resources  and 
minimal  requirements  for  protective  gear  and  medical  devises  and  other  counter-measures), 
culling  decontamination  issues,  power  and  drinking  water  supplies,  transport  measures,  in 
particular at points of entry and exit of the territory of Member States, telecommunications, 
civil protection and civil defence operations on shelter, rescue, and on making available vital 
supplies such as food, water equipment and materials and transfers between countries of such 
resources  and  assets;  co-operation  between  medical  and  law  enforcement  intervention  on 
banning public gatherings and closing down premises, forensic epidemiology and on legal and 
ethical  implication  of  countermeasures  (e.g.  quarantine;  confidentiality  of  passengers  lists, 
transport  of  dangerous  goods,  customs,  controls  and  enforcement,  requisitioning  of 
property…) etc.  

In  particular,  Community  customs  risk  management  systems  should  be  used  to  send 
information  directly  to  targeting  centres  and border posts. The use  of international  Customs 
co-operation will also assist in securing the supply chain and so facilitate the rapid movement 
of vital supplies to target areas. 

20 
21 
22 

http://europa.eu.int/comm/health/ph_threats/com/Influenza/influenza_key03_en.pdf 
COM (2005) 108 final, 6.4.2005 
COM(2005) 304final, 5.7.2005 

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Management of threats to security is primarily a law enforcement function that focuses on the 
measures  taken  to  anticipate,  prevent,  and/or  resolve  a  terrorism  threat  or  incident.  Law 
enforcement authorities or agencies of Member States are in the lead for threat management. 
The Commission is setting up a network connecting the relevant authorities of Member States 
to provide EU-level coordination in this area23. 

Consequence  management  by  Member  States  includes  measures  to  detect  and  diagnose 
releases  and  outbreaks  and  protect  public  health:  search,  rescue,  and  medical  treatment  of 
casualties;  evacuation  of  people  at  continuing  risk;  protection  of  first  responders;  and 
prevention of the spread of disease through contact-tracing, isolation and treatment of cases, 
quarantine of those exposed and restriction of movement24 for specific areas and closing down 
of  premises  (social  venues,  schools,  theatres,  other  mass  gatherings).  The  latter  two  will 
require  the  intervention  of  authorities  other  than  health  services  and  therefore  coordination 
between  the  services  and  authorities  involved.  Consequence  management  also  focuses  on 
restoring  essential  government  and  local  services  and  providing  emergency  relief  to 
government,  businesses  and  individuals  affected  by  the  consequences  of  the  emergency 
response. If wider community assistance is required in the event of a major health emergency, 
the  Community  Civil  Protection  Mechanism  could  prove  a  valuable  tool  for  ensuring  rapid 
deployment of the required assistance19. To assist Member States efforts, the Commission has 
set  up  a  programme  on  critical  infrastructure  protection  in  the  fight  against  terrorism25  The 
Commission is set to publish a Green Paper on the key issues of the European Programme for 
Critical Infrastructure Protection (EPCIP)26. 

Preparedness in other countries is crucial if the European Union is to be protected from health 
risks  that  could  spread  from  these  countries  to  the  EU.  Addressing  a  co-ordinated  approach 
inside and outside the EU is required to protect the health of EU citizens from already known 
and  unanticipated  health  threats.  As  regards  the  external  policy,  the  EU  is  already  working 
with third countries and international organisations, in particular, the UN agencies, such as the 
Food  and  Agriculture  Organisation  (FAO),  WHO,  the  World  Bank,  etc,  to  assist  countries 
affected by public health emergencies. The EU undertakes to assist all countries who request 
it,  both  in  preparatory  and  pandemic  phases,  particularly  the  least  developed  and  thus  most 
vulnerable  countries,  specifically  referring  to  Africa  and  Asia.  Moreover,  the  Commission 
facilitates  increasing  involvement  of  the  European  Neighbourhood  Policy  (ENP)  partners  in 
the European networks, such as on communicable diseases and has action plans with Ukraine, 
Moldova, Israel, Jordan, Morocco, and Tunisia. 

The  crisis  co-ordination  structure  being  set  up  by  the  Commission,  backed  up  by  the 
operations of the ARGUS system, would ensure co-ordination across sectors in case of major 
emergencies. 

23 
24 

25 
26 

COM(2004) 701 final 
Directive 2004/38/EC of the European Parliament and of the Council of 29 April 2004 on the right of 
citizens  of  the  Union  and  their  family  members  to  move  and  reside  freely  within  the  territory  of  the 
Member  States  amending  Regulation  (EEC)  No  1612/68  and  repealing  Directives  64/221/EEC, 
68/360/EEC,  72/194/EEC,  73/148/EEC,  75/34/EEC,  75/35/EEC,  90/364/EEC,  90/365/EEC  and 
93/96/EEC (Text with EEA relevance) Official Journal L 158, 30/04/2004 P. 0077 - 0123 
20.10.2004 COM(2004) 702 final 
COM(2005) 576 final 

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4. 

CONCLUSIONS 

This  communication  set  out  the  needs  and  objectives  of  generic  planning  for  public  health 
emergencies and for developing coordinated approaches inside and outside the EU to protect 
the health of EU citizens from already known and unanticipated public health threats. There is 
a  continuous  need  to  integrate  into  a  common  platform  plans  and  arrangements  made 
separately in individual areas of policy at EU level and ensure joint consideration of all facets 
of a public health emergency so as to arrive at coherent and timely actions and initiatives in 
all the sectors concerned. In this context, identification and liaising of command and control 
structures  in  the  EU  and  peer-to-peer  contacts  and  communications  in  real  time  among 
Member States and the Commission between those in charge of planning, those in charge of 
making  the  final  public  health  input  to  the  political  decision-making  authority  and  those  in 
charge of the final inter-sectoral input to these authorities is essential and work on finalising 
arrangements for this needs to advance as a matter of urgency. 

Consideration will also be given by the Commission to the extent that existing EU measures 
relevant for public health emergencies are sufficient for rapidly changing circumstances and 
heightened expectations or they need updating and whether new initiatives are needed.  

•  The  Commission  will  continue  to  build  coordination  across  all  sectors  of  EU  policy  by 
operating the ARGUS system of Community rapid alert system inter-connection and using 
the structures of its crisis coordination centre to ensure timely initiatives and responses in 
each area of policy.  

•  The  prerequisite  for  responding  adequately  to  public  health  threats  to  the  EU  is  the 
existence  of  regularly  updated  national  preparedness  plans  for  health  emergencies  in  the 
Member States. The Commission will continue the work that was started with sharing and 
comparing  and improving national plans on smallpox, SARS  and influenza, updating the 
technical guidance document on generic preparedness planning and producing algorithms, 
terminology  and  commonly  agreed  or  equivalent  levels  for  introducing  specific  counter-
measures. One urgent task for the future is to organise further exercises and a peer review 
process for national plans. Follow-up, tests and exercises focussing on the interoperability 
of  the  plans,  already  undertaken  for  public  health  emergencies,  such  as  on  smallpox  and 
pandemic 
influenza  and  civil  protection  emergencies  resulting  from  natural  or 
technological disasters, should strengthen confidence-building in the national plans within 
the EU. 

•  Beyond these planning requirements, it is essential that the persons who will in practice be 
leading  at  national  level  the  response  to  foreseeable  common  future  events  should  work 
together  sufficiently  to  create  a  common  network  and  a  shared  vision  of  the  scope  for 
coordinated  reactions  across  the  EU:  only  when  these  human  networks  function  will  the 
citizens  of  the  EU  be  assured  of  receiving  the  full  benefits  of  a  coherent  cross-border 
response to a real crisis. 

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