Mini Public Health Day – First Part (1/2): ‘EMERGING AND RE-EMERGING INFECTIOUS DISEASES’ impressions from the STOA-AVIESAN workshop
June 20, 2012
“It takes many good deeds to build a good reputation, and only one bad one to lose it.” ~Benjamin Franklin
“Mini Public Health Day – 19 June 2012”
(Owner of the photo © Shuttersparks)
Introductory comment: On the 19th June I faced an inconvenient situation which may occur quit frequently in the life of EU professionals in Brussels due to the high intensity of networking events: at least 2 health related workshops took place simultaneously (at the same building of the EP!).
1. Workshop: ‘EMERGING AND RE-EMERGING INFECTIOUS DISEASES: A CONTINUOUS CHALLENGE FOR EUROPE’, 19-06-2012, ASP 5G2, EP, Brussels, 14:30-18:30
2. Workshop: ‘MENTAL HEALTH IN TIMES OF ECONOMIC CRISIS’, 19-06-2012, ASP A1E1, EP, Brussels 16:00-18:00.
What should I have done? As a wise person once said “If you don’t like something, change it. If you can’t change it, change your attitude.” That’s why I tried to realize as much benefits as I could: I simply attended the 1st workshop as long as the 2nd has started.
A few words about STOA and AVIESAN
Science and Technology Options Assesment (STOA) is an official body of the EP mandated to carry out independent scientific assessments to support and reinforce the EP’s political decisions with in-depth technical knowledge.
Alliance Nationale pour les sciences de la vie et de la santé (AVIESAN) is the French National Alliance for Life Sciences and Health which works as an umbrella organisation making scientific and operational coordination among French public health institutes.
After digesting the various presentations of the first session about the stay of play of infectious diseases in Europe I collected my reflections around the following thought-starter sentences.
The End of ‘Europe is Safe from Tropical Infectious Diseases’ Myth
The recent outbreak of epidemics (avian flu, dengue fever, H1N1, West Nile virus, and most recently the EHEC) clearly demonstrated that any kind of declaration upon the victory over infections were premature. Not only forgotten microbes are re-appearing but new forms of pathogens threaten the health of the European society. It is a common place among health professionals that only the timing of the next epidemic is undecided. And taking into account the alarming fact that microbes are more likely to adapt to antibiotics and becoming resistance than ever, the danger of a possible pandemia cannot be overestimated.
An interesting aspect: how do we prioritise NCDs and CDs? Which one is more important?
Any contradiction between Non Communicable Diseases (NCDs – the “silent killers”) and Communicable Diseases (CDs) at public health policy level are illusory and misleading. NCDs are heavy burdens on the society and fortunately they seem to be on a very high rank on the Public Health Community’s agenda. However, this shouldn’t mean in any way either the negligence of CDs or making some kind of hierarchy between them. In the opposite, they are equally important since there is a strong correlation between them as the two sides of the coin. NCDs are often followed by CDs and patients suffering from CDs are more likely to get NCDs. Therefore, the appropriate public health policy shall tackle them simultaneously.
The true ‘European’ dimension of Infectious Diseases
Doubtlessly infectious diseases represent a challenging public health threat in Europe. Diseases do not know borders, and the Schengen area in Europe facilitates not only the free circulation of persons but also the spread of diseases (in some cases through vectors [mosquito, flies, ticks, etc] bearing the pathogens of them). Therefore, a ‘wider-than-just-the-EU’ approach is urgently needed in public health policies. In my opinion, WHO must have a crucial role to play in that regard. From that point it has a crucial importance that the WHO European region is much better suited to appropriately tackle the pandemics than the narrow EU region, since the WHO EURO region includes the whole territory of Russia and other former soviet satellite states. Briefly: let’s address these highly contaminable diseases in this larger ‘European’ dimension wherever it is possible.
Why are infectious diseases so challenging for Europe?
Obviously, in our globalised world the distance between Europe and tropical areas (where some of these diseases usually appear) do not protect the continent from the danger anymore.
There are several factors promoting the spread of pandemics. After the collapse of the former soviet bloc, the globalisation and the European Integration resulted in a relative high level of migration directing from the third world to Europe and the high number of immigrant might occasionally bear some pathogens.
Another problem is the low level of surveillance (not only among migrants) and the latent infection rate which meant that people affected by some types of diseases are not always aware of that circumstance. Thus, the available public data can be in some cases only the top of the iceberg.
The golden rule of the effective healthcare applies here, as well: prevention is always better than cure. Prevention can save lives, and reduce the big amount of used medicines. In some cases of communicable diseases, prevention can be achieved mainly through vaccination.
The high capacity of self-adaptation of viruses and bacteria need improved flexibility from public health actors
The way how these diseases can spread in space requires a strong, co-ordinated answer from our part. This means first the effective implementation of the Health in All Policies (HIAP) approach and secondly, a new partnership between policy makers and the industry, the scientific community, health professionals and ordinary patients. Viruses/Bacteria show very impressive level of adaptability. Let’s learn from them and realize a more enhanced co-operation among the public health sector members.
The example of one of the most commonly known deadly communicable diseases: HIV (AIDS)
The research in that area clearly shows the power of scientific research. Scientific data prove that after the publication of the first guideline in respect of HIV in 1996 in Vancouver, the mortality rate related to HIV went down dramatically. Most importantly, nowadays the life expectancy of an early detected HIV patient is comparable to a healthy person. What does it mean in fact? Although the disease is still incurable, by using various drugs and therapies people don’t die anymore following a HIV infection. In the 90s, affected patients needed 28 pills a day to control the disease. Today, only 1 pill is needed. And another motivating data: by using the right methods it can be avoided that the child of a HIV+ mother become infected.
But there is a lot of thing to do: patients often come late because they don’t know that they are bearing the disease. Therefore, a more developed monitoring system is needed not only to prevent the spread of HIV but also for having more accurate public data. A large part of the used pharmaceuticals are becoming generic in the near future which could be also a useful opportunity for the European health industry.
Last but not least, there is still an existing inequality among the treatment of different patients not only between Europe and other part of the world but also within Europe, among the regions being at different level of development.
What are the main messages of the scientific world to the policy makers?
In other words, what is needed at public policy level?
•Strengthening disease surveillance capabilities
•Creating the evidence base as a core part of public health infrastructure
•Providing the research infrastructure to continue building excellence in basic, translational and clinical sciences and training the next generation of researchers
•Encouraging private sector innovation for health and wealth creation
•Ensuring coherent and co-ordinated action across different policy-making departmental functions, recognising that health issues are often very relevant to strategic decisions in other policy areas.
•Identifying opportunities for European involvement at the global level, for surveillance, research, innovation and strategy development.
You can find further details inthe relating European Academies Science Advisory Council (EASAC) report.
The 3 main messages of the first session were for me the followings:
1.There is a need for strengthening the surveillance through capacity building
2.Only a highly developed public health infrastructure can appropriately handle the situation and the private sector (through Public-Private Partnership constructions)
3. A coherent, strategic co-ordination among policy makers and a Health in All Policies (HIAP) approach is inevitable
What have I missed in the afternoon?
WHO challenges and priorities for immunization policy making
SESSION II: RESEARCH AND INFRASTRUCTURES: STAYING ONE STEP AHEAD OF THE GAME
“Resistance to antibiotics: preserving a precious resources”
“An overview of European Commission research programmes on infectious diseases”
“ECRIN: The European Clinical Research Infrastructures Network”
“ERINHA: Framework for the biological high containment research infrastructures”
ANNEX – LIST OF SPEAKERS
Kent JOHANSSON, STOA MEP
André SYROTA, Alliance nationale pour les sciences de la vie et de la santé (AVIESAN)
Jean-François DELFRAISSY, Agence Nationale de Recherches sur le Sida et les hépatites virales (ANRS),
Robert LODDENKEMPER, German Central Committee against Tuberculosis, Berlin; European Respiratory Society (ERS)
Hervé ZELLER, European Center for Disease Prevention and Control (ECDC)
Stefano VELLA, Istituto Superiore di Sanità (ISS)
Philippe DUCLOS, World Health Organization (WHO)
Laurent GUTMANN, Hôpital Européen Georges Pompidou
Ole OLESEN, DG Research, European Commission
Jacques DEMOTES-MAINARD, European Clinical Research Infrastructure Network (ECRIN), INSERM, Institut
Hervé RAOUL, European Research Infrastructure on Highly Pathogenic Agents (ERINHA), Laboratoire P4 Inserm Jean Mérieux, LYON
THE DESCRIPTION OF THE ‘MINI PUBLIC HEALTH DAY’ WILL BE CONTINUED SOON…
I remain at your disposal.
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Related earlier updates:Zoltán Massay-Kosubek