Europe contemplates US-style disease-control centre
Authors: Arthur Rogers
Journal: The Lancet (2003)

Plans to create a European Centre for Disease Prevention and Control (ECDPC) will be unveiled in the coming weeks. Commissioner David Byrne, responsible for European Union (EU)public health affairs, told the European Parliament's April session in Strasbourg that he will publish legislative proposals “by the summer”. Byrne's officials have been working on the draft for several months. But anxieties about SARS (severe acute respiratory syndrome) have given the project added political urgency. Byrne hopes to launch the ECDPC during 2004, to synchronise with EU enlargement from 15 to 25 member nations. Currently, orchestrating EU responses to SARS is the task of the Communicable Diseases Network (CDN), an inter-governmental body set up in 1999 to encourage contact between national surveillance networks. In Strasbourg, Byrne warned: “The capacity of the Commission to extend its coordinating and facilitating role any further is currently at its very limit. In the absence of new arrangements to pool existing expertise, we will not be able to go beyond our current efforts.” At a subsequent, extraordinary meeting of CDN convened in Luxembourg, Byrne said, SARS had “demonstrate[d] only too clearly that contagious diseases require a high level of preparedness across borders”. Creating the ECDPC would offer “the most effective response” to “the contemporary public health threat of communicable diseases”, he contended. Byrne foresees that the ECDPC will be “small, but influential”—small, that is, by comparison with the US Centers for Disease Control and Prevention, headquartered in Atlanta, Georgia, with its nationwide workforce of around 8500. But the new body will join a burgeoning list of freestanding EU organisations seen as proto-federal agencies. Byrne wants the ECDPC to “enhance surveillance, coordinate common responses, set up and maintain a network of reference laboratories and collaborate with [EU] member states, candidate countries, and international organisations such as WHO”. Commissioner Byrne judges that concerns about SARS will help overcome national governments' reluctance to cede influence over health policy. Thus, true to the observation by the late German Chancellor Willy Brandt that “nothing happens in the EU without a crisis”, the ECDPC is likely to be the lasting legacy of SARS—just as the bovine spongiform encephalopathy (BSE) crisis spawned the European Food Safety Agency (FSA). At the height of the BSE outbreak, Commission President Romano Prodi called for a food agency “on the lines of” the powerful US FDA. But that ambition was resisted by national ministers. Hence Byrne's emphasis on the ECDPC's modest size. However, squabbling between governments over the location of agencies is likely to be an obstacle. Byrne had to set up the FSA on a provisional basis in Brussels, pending a recent, belated decision to award the agency to Finland. He may have to follow a similar approach with the ECDPC. However, Byrne has grounds for optimism: the European Convention currently working on a constitutional treaty for the enlarged EU is reportedly warming to suggestions that the EU should have a bigger say on health policy. Byrne spoke in Strasbourg of his “cautious optimism that the Convention will take these ideas on board”. For the moment, Byrne's limited mandate for public-health affairs is based on competences established by the 1999 Treaty of Amsterdam, powers he invoked later that year to set up the CDN. Byrne hopes that the new treaty will offer “a legal base for harmonising legislation in the area of communicable diseases and other areas”. References to “harmonising” national health legislation were deliberately excluded from the Amsterdam Treaty. But latterday concerns about the risks of bioterrorism, and now SARS, may ease opposition to EU “interference”. For its part, the European Parliament has consistently called for pan-EU health monitoring not necessarily confined to communicable diseases. But suggestions that the EU should identify disease «hot spots» related to deprivation or environmental problems have unnerved national administrations fearful of unfavourable comparisons. However, EU expansion into central and eastern Europe will reduce the risk of current member states finishing bottom of health-league tables. Meanwhile, according to CDN data on April 30 there are 32 “probable” SARS cases in seven EU states: Italy, nine; Germany, seven; the UK, six; France, five; Sweden, three; Ireland and Spain, one each. Among 18 neighbouring states, Bulgaria, Romania, and Switzerland each reported one suspected case. No deaths were noted.