Discours sur la grippe pandémique H1N1 2009 à la Commission de l'environnement, de la santé publique et de la sécurité alimentaire du Parlement européen

5 October 2010, Brussels, Belgium

Chairman and members of the ENVI Committee,
Dear colleagues,

First of all, thank you for inviting me to this very important event and let me say that it is a real pleasure for me to be back to the European Parliament again after a few months of absence, as I always feel inspired by the atmosphere and spirit of this European Union (EU) institution. I am looking forward to working with you also in my new capacity.

Let me start with the positive message: many things worked well during the pandemic, but we have also learned a lot of lessons that will be useful for the next public health emergencies.

During this period I was the first, founding Director of the European Centre for Disease Prevention and Control (ECDC). This was a new EU agency, which started to work on 1 March 2005 (with, at that time, only me and a secretary), and in a few months the avian influenza arrived at Europe and we had to build up ECDC with record speed.

Preparedness in the EU

I still remember that in the autumn of 2005, Commissioner Kyprianou called on us to ask us to visit every single country in the EU and assess their pandemic preparedness plans. At that time, we were only a handful of people, and therefore it was a real challenge to deal with this request, but nevertheless we did it. Over the following years we visited every EU country, jointly assessed the pandemic plans, made recommendations to further develop them, worked with the countries to do so, regularly prepared status reports to the Commission about the status of preparedness in the EU and European Economic Area (EEA) countries – and with this work ECDC, the Member States and the Commission greatly contributed to the level of preparedness in the EU. I am convinced that the EU became one of the best prepared regions in the world.

And, let me add, this was an investment in the future, and an investment in the generic preparedness of the countries that we can build on now and draw the lessons learned from this pandemic and further develop our preparedness.

The role of ECDC in the EU, according to its Founding Regulation, is risk assessment and not the whole spectrum of public health. It is a scientific technical institute that provides evidence for sound decision-making.

It is to monitor, assess and communicate threats, and to provide evidence, advice, training and practical support to EU institutions and Member States. You have to note, however, that risk management is not an ECDC responsibility; decisions about public health measures are adopted by the Member States coordinated by the Commission but using the evidence provided by ECDC.

In this regard, we regularly developed independent risk assessments, updated them, shared with our Advisory Forum, put them on our web site. These risk assessments were balanced, independent, transparent.

We also published daily updates, weekly surveillance overviews, guidance for public health measures. All these were discussed with our Advisory Forum and then shared with the Member States and put on our web site in a transparent way. 

We organized numerous meetings and training courses which greatly facilitated the information exchange and cooperation between public health institutions, experts, and ECDC. Our Advisory Forum and Management Board were always kept in the loop. Furthermore, there was a very good collaboration with the European Commission Directorate-General for Health and Consumers and the other agencies, like the European Medicines Agency (EMA) and European Food Safety Authority (EFSA). I regularly came to the European Parliament to update you on the situation and always enjoyed your support. The EU presidencies, in particular the Swedish Presidency during phase 6 of the pandemic, were all actively engaged and put this issue on the agenda of Council meetings and made sure that the necessary decisions were made. Overall the EU system worked well.

We also worked outside Europe, with the US Centers for Disease Control and Prevention (CDC), the Chinese Center for Disease Control and Prevention (China CDC) and many other institutions.

Overall we have to say that public health experts around the world worked together with great professionalism to understand the new virus and the threat it posed, as well as to fill the gaps in science and our knowledge. They have to be commended for this great work.

We also collaborated with WHO, as the International Health Regulations (IHR) provide the framework at the global level for public health emergencies of international concern and clarifies roles and responsibilities. All Member States are part of this legally binding global instrument, which was now used for the first time. According to the IHR, it is the WHO Director-General who declares a public health emergency of international concern, the pandemic. Global action was guided by this framework. The evaluation of the pandemic is taking place now at the global level within the IHR Review Committee and will be presented in January and May to the WHO Executive Board and the World Health Assembly, respectively. Many other evaluations are taking place: we have seven ongoing in Europe now.

In reply to your question, overall I can say that the ECDC reacted in an appropriate, responsible and transparent manner to the pandemic. I am not aware of any deficiency in the independence, excellence and transparency of the decision-making.

The situation was, however, complex and we acted in an environment full of uncertainties. We had to make decisions on the basis of the information that was available at that time. We had a high degree of uncertainty about how the pandemic was going to unfold, about the degree of severity of the pandemic and how the politicians, media and public were going to react. Therefore decisions taken at that time should be judged in this context.

When the pandemic came, it turned out to be a different pandemic than the one we expected: it was moderate, if not mild. But, as influenza viruses are unpredictable, most public health officials opted for caution. Flexibility to adapt to the emerging situation is crucial. We have to build it into our preparedness plans for the future.

We have also had other challenges.

• The availability and amount of vaccines differed from country to country; countries also took different decisions on whom to vaccinate. This and other differences in public health measures were not understood by members of the public.
• In addition, they did not see the disease around them, and this, together with information from a wide range of sources, including the social media, gradually led to mistrust.
• For the public the pandemic became an overreaction, an exaggerated threat, and this undermined confidence in the national vaccination programmes, which in many countries was made worse by the disconnect between the public health experts and primary health care (PHC) physicians.

These all point to the direction that we have to learn from this. Although this will be the task of the next panel, it is quite important to review the parameters we use next time for the pandemic. We have to build flexibility in our plans; we have to be even more rigorous with the assessment of risks and benefits, and we have to do better with risk communication.