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Public Health

Surveillance and early warning

In recent decades, rates of infectious diseases have generally either fallen or remained stable in the EU. The majority of deaths in EU countries are now due to non-infectious diseases such as cancer and cardiovascular disease. However, infectious diseases can still bring serious challenges to public health as the coronavirus pandemic has shown us. In our globalised world, diseases can spread very quickly from one country to another.

The early detection of health threats requires continuous robust surveillance and mechanisms for early warning and response. The EU has set up structures to enable the fast exchange of information among Member States public health authorities and global bodies such as the World Health Organization, to detect a threat as early as possible.

Surveillance of infectious diseases and other health threats

Surveillance systems provide information for monitoring communicable disease trends, helping to identify risk factors, and areas for intervention. They provide information for priority setting, planning, implementation and resource allocation for preventive programmes and for evaluating preventive programmes and control measures.

Decision 2119/98/EC of the European Parliament and the Council originally established the network for the epidemiological surveillance and control of communicable diseases.

Decision No 2119/98/EC was repealed and replaced by Decision No 1082/2013/EU of the European Parliament and of the Council of 22 October 2013 on serious cross-border threats to health. This new Decision revived the network for the epidemiological surveillance of communicable diseases and related special health issues. This network brings together the Commission, the European Centre for Disease for Disease Prevention and Control (ECDC) and the competent authorities responsible at national level for epidemiological surveillance. It is operated and coordinated by the ECDC.

Decision No 1082/2013/EU gives power to the Commission to establish and update the list of infectious diseases and relevant health issues such as anti-microbial resistance to ensure their coverage by the epidemiological surveillance network. The Commission also sets the case definitions concerning each infectious disease that Member States use for surveillance and reporting to ECDC, thus ensuring the comparability and compatibility of the collected data at Union level.

List of infectious diseases revised

The Commission adopted an Implementing Decision in June 2018, updating the list of around 50 infectious diseases monitored through the EU’s epidemiological surveillance network. This new list includes communicable diseases that have recently emerged or re-emerged, such as Chikungunya, Dengue, Lyme neuroborreliosis and Zika infections. The Decision also revised case definitions for several other communicable diseases and related health issues such as antimicrobial resistance (AMR) and healthcare associated infections (HAI). The list is in line with the latest scientific data, having been compiled with the help and expertise of ECDC. It corresponds to the World Health Organization (WHO) classifications.

For other types of threat, surveillance to identify trends and changes in the risk profile requires different approaches. The Commission maintains contact with the relevant EU Agencies and EU countries authorities to ensure preparedness plans evolve to meet changing threats.

The Early Warning and Response System (EWRS)

EWRS is a rapid alert system for notifying alerts at EU level on serious cross-border threats to health, as mandated by Article 8 of Decision 1082/2013/EU. This confidential web-based system enables the European Commission and the designated competent authorities responsible at national level (called EWRS competent authorities) to be in permanent communication. EU countries can alert, share information and coordinate national responses to serious cross-border threats in a timely and secure manner.

The system is owned by the European Commission and the IT platform is operated by the ECDC. EWRS has been successfully used to alert, share information and coordinate measures in response to previous outbreaks including SARS, pandemic influenza A(H1N1), Ebola, Zika, COVID-19 and other cross-border outbreaks of communicable diseases.

Commission Implementing Decision (EU) 2017/253 of 13 February 2017 lays down the procedures for the notification of alerts under the EWRS and for the information exchange, consultation and coordination of responses to cross-border health threats.

When and how is EWRS activated

EWRS competent authorities or the European Commission issue an alert when a serious cross-border threat to health

  • is unusual or unexpected for the given place and time
  • causes significant morbidity or mortality, or it grows rapidly in scale
  • exceeds national response capacity and affect more than one EU country
  • may require a coordinated response at Union level

The alerts are posted no later than 24 hours from when the EU country or the Commission first become aware of the threat. For example, the first notification to what later became known as SARS-CoV-2 (the virus causing COVID-19) was posted by the Commission as early as 9 January 2020, days after China signalled the existence of an unknown virus.

Using the EWRS may involve the exchange of personal data necessary to identify infected persons as well as individuals potentially in danger (so called ‘contact tracing data’). This is done in accordance with the data protection legislation in place (Regulation (EU) No 2016/679 and Regulation (EU) 2018/1725 of the European Parliament and of the Council). Further to those, in June 2017 the Commission adopted Recommendation (EU) 2017/1140 on personal data that may be exchanged through the EWRS.

EWRS improvements

The EWRS has been re-engineered to increase situational awareness in case of a cross-border health threat and the new version is fully operational since November 2019.

The following new modules and functionalities were added to the platform:

  • Preparedness and risk communication module to share relevant documentation, national plans and strategies
  • Situational awareness module providing contextual information linked to specific events and the line listing functionality, allowing EU countries to share in a formatted manner the number of cases and additional relevant information

A key objective of this re-engineering process is the interlinking with other EU alert systems. Currently, the EWRS is interlinked with 2 alert systems:

With plans to interlink with more EU Alert and Information System over the coming years, the aim is to allow direct communication and collaboration between different sectors.