The European Journal of Public Health Advance Access originally published online on April 6, 2006
The European Journal of Public Health 2006 16(2):121; doi:10.1093/eurpub/ckl035
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Commentary: Europe's preparedness for an influenza pandemic
W. John PagetEuropean Influenza Surveillance Scheme (EISS) Co-ordination Centre, Netherlands Institute for Health Services Research (NIVEL) Utrecht, The Netherlands
Correspondence: W. John Paget, European Influenza Surveillance Scheme (EISS) Co-ordination Centre, Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands, e-mail: j.paget@nivel.nl
The paper in this month's edition of the European Journal of Public Health on Europe's preparedness for an influenza pandemic1 is highly relevant in the light of the emergence of the influenza A(H5N1) virus in humans in Southeast Asia and, more recently, in Turkey and Iraq.2 The paper provides a nice overview of the different organisations in Europe that are active in the field of influenza pandemic preparedness and highlights some important challenges that need to be addressed: how to make vaccination and antivirals available to all persons in Europe when these are organised at a national rather than European level? The paper misses out on one important development and this concerns how much Europe's preparedness has improved in a very short period of time.
Only 6 years ago, in 2000, Europe was in a much more vulnerable position. The European Influenza Surveillance Scheme only included 14 countries and presented very crude epidemiological and virological data.3 There was no European pandemic preparedness plan and national plans were few and lacked important components.4 Initiatives to establish a European Centre for Disease Control and Prevention (ECDC) were held back by arguments that electronic communication via the internet and national institutes could do the job more effectively.5 Vaccine manufacturers were not working together and antivirals were only just being introduced.
Today things have changed considerably. The European Influenza Surveillance Scheme now collects and reports detailed epidemiological and virological data on 28 countries across Europe and includes all 25 EU member states. A pandemic plan for Europe has been prepared and published as a Working Paper,6 and considerable improvements in the number and quality of published national pandemic plans have been observed.7 As part of this plan, a Community Network of Reference Laboratories for Human Influenza in Europe has been created and this now includes 38 laboratories in all EU countries, Norway, Romania, and Switzerland.8 In May 2005 the European Centre for Disease Prevention and Control (ECDC) was established and it is quickly establishing itself as an important player in the area of influenza pandemic preparedness, particularly in the areas of outbreak management, surveillance, and scientific advice.
European vaccine manufacturers are also responding to the pandemic threat and have established the European Vaccine Manufacturers association to better address issues of importance, for example, increasing their production capacity and discussing equal access to vaccines, both in Europe and globally. As outlined in the paper, WHO Europe has also become an active player, supporting countries develop their pandemic plans and leading outbreak investigations in countries affected by the H5N1 virus in the Europe region. In a very short time, the different stakeholders in Europe have responded to the pandemic threat and considerable progress has been achieved. This should be recognised, supported, and further encouraged.
Whilst considerable progress has been achieved, some additional institutional tools probably need strengthening or creating to further improve the overall level of preparedness in Europe. Whilst the United States can rely on a Centres for Disease Control and Prevention (CDC) to co-ordinate a broad national response to an influenza pandemic (with a budget of $7.7 billion in 2005 and 9300 employees), the ECDC will have a budget of 
17.2 million and a core staff of 50 persons in 2006. Whilst the United States can rely on the National Institutes for Health (with a total annual budget of $28 billion in 2004 and more than 17 000 employees) to co-ordinate, initiate, and implement research on health, including influenza, the European Union does not have an institution of this type. In conclusion, much has been achieved since 2000 but there are still important issues that need resolving: providing equal access to vaccines and antivirals to all persons in the European Union1 and constructing the appropriate institutional infrastructures to allow a co-ordinated European public health and research response to an influenza pandemic.
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The opinions in this commentary are personal and do not reflect those of NIVEL, the members of EISS or any of the institutions mentioned in the text.
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1 Mounier-Jack, Coker Richard. Pandemic influenza: are Europe's institutions prepared? Eur J Public Health 2006.
2 WHO. Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO; 6 February 2006. Available at: http://www.who.int/csr/disease/avian_influenza/country/cases_table_2006_02_06/en/index.html (Accessed 14 February 2006).
3 European Influenza Surveillance Scheme. Influenza activity in Europe generally falling to low levels. EISS Weekly Electronic Bulletin 2001;28. Available at: http://www.eiss.org (Accessed 14 February 2006).
4 Paget WJ, Aguilera J-F. Influenza pandemic planning in Europe. (on behalf of EISS). Eurosurveillance 2001;6:136–40.
5 Editorial. Not another European institution. Lancet 1998;352:1237.[Medline]
6 European Commission. A Working Paper on Community Influenza Pandemic Preparedness and Response Planning. Brussels 26 March 2004. Available at: http://europa.eu.int/comm/health/ph_threats/com/Influenza/com_2004_201_en.pdf (Accessed 14 February 2006).
7 Olaf Horstick, Reinhard Kaiser, Massimo Ciotti, et al. Europe makes progress in preparing for influenza pandemic, but further work needed. Eurosurveillance Weekly 2006;10.
8 Meijer A, Valette M, Manuguerra J-C, et al. Implementation of the Community Network of Reference Laboratories for Human Influenza in Europe. J Clin Virol 2005;34:87–96.[Medline]
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