Europe: Public Health Plans
When the H1N1 influenza pandemic broke out two years ago, the 27 member nations of the European Union found themselves in some disarray. Large countries like France and Germany swung into action, implementing prompt and effective disaster-response plans, while many smaller nations did little or nothing. "Had H1N1 been more serious than it was, Europe could have been in real trouble," says Scott Greer, a UM SPH assistant professor of health management and policy and expert on EU health policy.
The crisis shed light on the absence of a comprehensive public health infrastructure in the EU. To shed further light on that issue—and to give EU officials a rare chance to analyze current trends and map out future steps—Greer convened a conference on "The European Governance of Communicable Disease Control" at the University of Michigan in May.
Two revelations emerged. One was the degree of fragmentation that exists in the EU when it comes to public health. There is no overarching public health entity as there is in the U.S., where the Centers for Disease Control and Prevention oversees much of the country's public health infrastructure. Nor is there any concerted effort to coordinate individual member nations' public health activities. Such efforts are instead overseen "by some combination of medicine and government, often with a level of enthusiastic authoritarianism as you go east," Greer says. There's little understanding of who's advising government leaders, buying vaccines, and running laboratories, or even how much critical public health work is actually getting done.
The second revelation was that Europe is in the process of formulating its own uniquely European response to the situation. In 2000, EU officials and policymakers from member states established a European CDC (ECDC). Headquartered in Stockholm, the ECDC is designed to implement basic surveillance and reporting systems across the EU and to provide resources to strengthen the capacity of smaller member states to respond to health emergencies.
Despite its small budget and modest size (some 150 staff members, as compared to the U.S. CDC's 15,000), the ECDC has done a good job to date and has a bright future, Greer believes.The organization runs an effective website and publishes a journal, EuroSurveillance, which is able to quickly disseminate information to member nations on outbreaks and other emergencies.
Almost by default, Europe is emerging as an important player in public health. In recent years, EU officials have made key decisions about agricultural and border policy as well as health services financing, all of which are critical components of a public health infrastructure. There is increasing recognition throughout the EU that such an infrastructure is necessary, and efforts to build one are growing. The UM conference was an important part of that process. Much work remains, however. Greer notes that currently there's no EU vaccine fund, so in a crisis, every country—rich or poor—remains on its own. "An offer of lab capacity in Stockholm is not much help if you have no field system for collecting samples." <