Hope for the best, expect the worst

Two MEPs debate how Europe can prepare for any pandemics

The European Union Solidarity Fund is the ideal vehicle for pan-EU action to guard against avian influenza, Adamos Adamou

the European Commission recently confirmed that avian influenza had been detected in wild birds in 11 member states. This makes us all wonder how well equipped and prepared member states really are and, given the nature of this transnational health threat, how ready the European Union is to deal with a possible pandemic.

Despite the fact that health-related issues do not belong to the competences of the Union, member states are insisting that the Commission take a more co-ordinating role. They seem to abide by the recommendations of the European Centre for Prevention and Disease Control (ECDC) and welcome the assessments of their national pandemic influenza preparedness plans undertaken jointly by the Commission, ECDC and the World Health Organisation's (WHO) regional office for Europe. It is obvious that member states and national governments dread the possibility of an influenza pandemic outbreak, given the significant social stakes that are linked to such a pandemic. The three influenza pandemics of the last century (in 1918-19, 1957 and 1968) killed millions of people and caused widespread disruption to the countries affected. If this is really the case, why is the European Parliament so sceptical about including the reference to public health emergencies in the European Union Solidarity Fund (EUSF)?

The Commission proposal for a regulation establishing the European Union Solidarity Fund includes, among other objectives, the setting up of a fund for public health emergencies. As is obvious these days, the inclusion of health emergency threats in the proposal is above all a highly political choice which nonetheless will allow for grants to pay for emergency measures limited to the event of a declared influenza pandemic, always in accordance with the criteria set out by the WHO. The mechanism stipulated in the EUSF would make it feasible to facilitate the refinancing of the cost of drugs, medicines and medical equipment utilised during an influenza pandemic emergency.

If and when a pandemic strikes, it will by definition be on a vast scale and it will represent a sanitary threat for the whole territory of the EU, not simply for individual member states. There is, thus, an evident Community interest in trying to minimise the consequences of this major health threat and consequently to limit the financial burden it will represent for the economies of the member states. The likely costs of such a potential emergency are not only of sanitary but also of economic nature. For those of us who are more idealistic, I should mention what the Commission has repeatedly stressed: "Resorting to the EUSF in case of influenza pandemic would represent the translation into action of the much debated solidarity among the member states of the European Union." A major health threat, unfortunately, represents the clearest possible occasion for the EUSF actually to be put into practice.

It is thus clear that the inclusion of a reference to health emergencies limited to influenza pandemic lies fully within the rationale of the creation of the EUSF. It is nobody's intention to turn the fund into an instrument to finance preparedness.

The fund will only be used in the event that a pandemic actually occurs. Drugs, medicines and medical equipment will only be reimbursed if and after they have been used during a possible pandemic emergency.

The H5N1 strain, besides Asia has now appeared in birds in several EU member states in several countries neighbouring the EU (Romania, Kazakhstan, Ukraine, Croatia and Turkey), in Africa and it appears that as we speak it is still spreading. It is true that the direct risk to the health of people in Europe from H5N1 is very low, but it is still not zero. Many argue that since the virus has not yet been transmitted from human to human it never will.

Perhaps they are right, perhaps they are not. But why should the EU take such a risk by waiting when it can be one step ahead by having a financial solution already prepared for the member states if and when a pandemic strikes so as to prevent a financial and sanitary collapse?

• Cypriot United Left/Nordic Green Left MEP Adamos Adamou is a member of the Parliament's environment, public health and food safety committee and is a qualified doctor.

Farmers and scientists have a key role in the detection and arrest of mutations of the H5N1 virus, says Mairead McGuinness

Experts tell us that when it comes to a flu pandemic the question is not if, but when, the world will face such a crisis.

So terrifying is such a prospect that many of us find it difficult to imagine.

We know that this H5N1 strain of bird flu can kill those who come in contact with the virus in infected poultry.

So far, human-to-human spread of the disease has not occurred.

The hope must be that it will not and that science and good practice can prevent it.

The World Health Organisation (WHO) has estimated that in the event of a pandemic 50 million people could, at worst, die from the virus.

Given this stern and alarming warning, it behoves all countries to prepare for the worst, while at the same time planning to ensure that it does not happen.

We must, in effect, over-react to the threat so as to be able to look back and say that we avoided a pandemic because we were pro-active and on the alert.

Some countries have already started stockpiling drugs and testing vaccines. This is where the cutting edge of science is vital as part of our global strategy to tackle a pandemic.

The WHO has urged all countries globally to develop or update their influenza 'pandemic preparedness plans'.

Apart from the real threat to human life, we have yet to appreciate fully the impact on healthcare systems, schools, as well as economies - indeed the world as we know it.

Good healthcare will play a central role in reducing the impact. Yet the pandemic itself could disrupt the supply of essential medicines and healthcare workers could fall ill.

As well as developing drugs and vaccines, countries need to examine hospital capacity and the need to provide isolation units for victims.

And given that viruses don't respect borders, we need a pan-European policy. Even in the best-case scenario, a flu pandemic could kill between 2m-7m people and tens of millions would require medical attention.

The first step is to ensure that avian flu does not get into our domestic poultry and in turn infect humans.

This is easier said than done, especially in countries where wild birds and domestic fowl come into close contact.

Already 104 people have died from bird flu through direct contact with infected poultry. Sadly these cases were primarily among poor people living in very close proximity to poultry.

Second, we must, where an outbreak occurs in wild fowl and domestic fowl, ensure that it is contained and prevented from spreading.

This involves good disease-prevention strategies, disinfection procedures, slaughtering of infected stock and proper disposal of carcasses.

And finally, we need to plan for what experts say is the inevitable flu pandemic.

Scientists are using their knowledge about past pandemics, including the 1918-19 outbreak, which killed up to 50 million people, and the more recent outbreaks in Asia to make a prototype vaccine.

The objective is to use this vaccine to beat a pandemic should the H5N1 strain, which spreads from birds to humans, mutate and be capable of spreading from human to human.

The trouble is that scientists do not know if this H5N1 strain will mutate or indeed if another strain will do so.

We may well develop a vaccine only to find that it is not the right one to tackle such an unpredictable disease.

Right now, across the world, scientists are working hard to understand more about this virus and the vaccines needed to tackle it.

What we need to realise is that farmers and scientists are vital to keeping a pandemic at bay: farmers to detect the H5N1 virus in poultry and scientists to develop the necessary vaccines to tackle a pandemic.

• Irish centre-right MEP Mairead McGuinness is a member of the Parliament's environment, public health and food safety committee.

Two MEPs debate how Europe can prepare for any pandemics.

European Commission: DG Health and Consumer Protection: Animal Health & Welfare: Avian Influenza - introduction http://ec.europa.eu/comm/food/animal/diseases/controlmeasures/avian/index_en.htm

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