Preparedness and response against diseases with epidemic potential in the European Union: a qualitative case study of Middle East Respiratory Syndrome (MERS) and poliomyelitis in five member states

John Kinsman,Paloma Carrillo Santisteve,Paola A Mosquera,John Angrén,Maria Furberg,Massimo Ciotti,Svetla Tsolova,Tarik Derrough,Laura Otero-García,René Snacken,Fredrik Elgh

doi:10.1186/s12913-018-3326-0

Abstract

BackgroundEU Decision 1082/2013/EU on serious cross-border health threats provides a legal basis for collaboration between EU Member States, and between international and European level institutions on preparedness, prevention, and mitigation in the event of a public health emergency. The Decision provides a context for the present study, which aims to identify good practices and lessons learned in preparedness and response to Middle East Respiratory Syndrome (MERS) (in UK, Greece, and Spain) and poliomyelitis (in Poland and Cyprus).MethodsBased on a documentary review, followed by five week-long country visits involving a total of 61 interviews and group discussions with experts from both the health and non-health sectors, this qualitative case study has investigated six issues related to preparedness and response to MERS and poliomyelitis: national plans and overall preparedness capacity; training and exercises; risk communication; linking policy and implementation; interoperability between the health and non-health sectors; and cross-border collaboration.ResultsPreparedness and response plans for MERS and poliomyelitis were in place in the participating countries, with a high level of technical expertise available to implement them. Nevertheless, formal evaluation of the responses to previous public health emergencies have sometimes been limited, so lessons learned may not be reflected in updated plans, thereby risking mistakes being repeated in future. The nature and extent of inter-sectoral collaboration varied according to the sectors involved, with those sectors that have traditionally had good collaboration (e.g. animal health and food safety), as well as those that have a financial incentive for controlling infectious diseases (e.g. agriculture, tourism, and air travel) seen as most likely to have integrated public health preparedness and response plans. Although the formal protocols for inter-sectoral collaboration were not always up to date, good personal relations were reported within the relevant professional networks, which could be brought into play in the event of a public health emergency. Cross-border collaboration was greatly facilitated if the neighbouring country was a fellow EU Member State.ConclusionsInfectious disease outbreaks remain as an ongoing threat. Efforts are required to ensure that core public health capacities for the full range of preparedness and response activities are sustained.

Highlights

EU Decision 1082/2013/EU on serious cross-border health threats provides a legal basis for collaboration between EU Member States, and between international and European level institutions on preparedness, prevention, and mitigation in the event of a public health emergency
Material provided by the European Centre for Disease Prevention and Control (ECDC) National Focal Point (NFP) included (i) Policies that may be related to the EU Decision on serious cross-border public threats; (ii) Relevant reports and findings from previous EU-supported studies; (iii) Standard Operating Procedures, contingency plans and guidelines in the event of a pandemic respiratory disease threat; (iv) Lessons learned from any simulation or training exercises that may have been conducted
For the interviews and focus groups, we developed pools of questions for both Middle East Respiratory Syndrome (MERS) and polio, in cooperation with the ECDC NFPs, which aimed at reflecting the objectives of the study concerning planning and preparedness policies and practices, risk communication, training and exercises, vaccination, surveillance, and issues to do with inter-sectoral and cross-border coordination

Summary

Introduction

EU Decision 1082/2013/EU on serious cross-border health threats provides a legal basis for collaboration between EU Member States, and between international and European level institutions on preparedness, prevention, and mitigation in the event of a public health emergency. EU Decision 1082/2013/EU (October 2013) on serious cross-border health threats provides a legal basis for collaboration and information exchange between EU member states, and between international and European level institutions on preparedness, prevention, and mitigation in the event of a public health emergency [1]. The importation and spread of MERS or a reintroduction of poliomyelitis into the EU could have significant social, economic and political ramifications In this sense, the legal framework provided by EU Decision 1082 offers an effective basis for discussions about European preparedness and response. MERS has not been declared by WHO to be a Public Health Emergency of International Concern (PHEIC), but the Committee responsible for this decision has stated that “the progress [made to date against MERS] is not yet sufficient to control this threat and until this is achieved, individual countries and the global community will remain at significant risk for further outbreaks” [15]

Methods

Results

Discussion

Conclusion