EUROPE AND INTERNATIONAL
Published on 08/06/2011
International programs / activities
When the European Centre for Disease Prevention and Control (ECDC) was set up in 2005 it significantly changed InVS’s contribution to European-wide activities in the areas of surveillance, monitoring and alert with regard to infectious diseases, as the ECDC’s mandate is confined to that field of activity. As a result, four projects that had been initiated in the 1990s by the previous iterations of InVS (CESES and RNSP) and for which InVS continued to ensure coordination until the ECDC was established, have since been integrated into the ECDC:
- Two monitoring networks covering the countries of the WHO-Europe area, including the Member States of the European Union: EuroTB (tuberculosis surveillance) and EuroHIV (HIV surveillance) (both were transferred to the ECDC in December 2007);
- The European Program for Intervention Epidemiology Training (EPIET), which was coordinated by InVS between 1997 and 2001, then transferred to the Swedish Institute for Infectious Diseases Control before being integrated into the ECDC in November 2007;
- The Eurosurveillance scientific journal (transferred to the ECDC in March 2007).
These projects, which used to be co-funded by the European Commission as part of invitations to tender, have come to an end in 2007, but their integration into the ECDC ensures continuity.
Pursuant to the provisions of regulation (EC) N° 851/2004 the ECDC Board of Directors approved the list of relevant entities in December 2007 to help it implement its missions. In France, three relevant organizations will thus have a role to play in the ECDC’s activities: InVS, the Directorate General of Health (DGS) and the National Institute for Prevention and Health Education (INPES). Because surveillance and alert missions are so important to the ECDC, InVS is the relevant entity that is most often mobilized in France. InVS’s contribution as a relevant entity is carried out without the funding of time spent by the ECDC.
As part of this framework InVS contributes to 17 dedicated surveillance networks by transmitting surveillance data to the ECDC on a yearly basis and by providing its experience and expertise in analyzing and interpreting data.
With regard to EPIET a framework agreement exists between the ECDC and InVS since October 2007, following a call for tender to support the ECDC in ensuring scientific coordination of the EPIET program.
As one of the relevant bodies, several of InVS’s entities match the duties for which the ECDC wanted to identify correspondents in the various Member States: communication (Communication Department), training (Scientific Department – Training), threat detection (Department of Infectious Diseases, International Department, Department for the Coordination of Alerts and Regional Offices), scientific opinions (Department of Infectious Diseases, Department for the Coordination of Alerts and Regional Offices), surveillance (Department of Infectious Diseases). As for liaising with the National Reference Centres (CNR), the CNR Secretariat is managed by the Department of Infectious Diseases and serves as France's focal point for microbiology.
Furthermore, InVS’s General Manager is one of ECDC’s Board members, where he represents France. InVS’s Chief Scientific Officer is a member of the advisory forum. Some InVS agents are expected to participate in working groups and expert panels. As is the case with all French agencies the ECDC compensates experts (acting in their personal capacities) for the time they spend while they serve as members of scientific panels. However, InVS agents contributing to working groups and various meetings at the ECDC as representatives of InVS are not paid.
Consequently, ECDC’s increasing importance has a significant impact on InVS’s role in the area of surveillance, monitoring and alerts at European level, and on sources of funding for projects in the area of communicable diseases:
- The public health program no longer funds operations (projects, conferences, etc.) that are part of ECDC’s remit;
- InVS no longer coordinates European projects pertaining to communicable diseases;
- InVS is currently unable to respond to calls for tender initiated by the ECDC (due to limited room to manoeuvre in terms of human resources, which are almost entirely devoted to carrying out priority national missions).
Ever since the National Public Health Network (RNSP) InVS has been closely involved in successive European projects (APHEA, APHEIS) pertaining to the health impact of atmospheric pollution. For example, InVS coordinated the APHEIS projects (1 and 2). These projects relied on a surveillance network monitoring the health effects of urban atmospheric pollution in more than 20 European cities, including the nine French cities of InVS’s Air and Health Surveillance Program (PSAS). This network was again mobilized as part of the APHEKOM project, which was coordinated by InVS from 2008 to 2011. The project was aimed at better identifying the health impact of urban atmospheric pollution so as to provide more informed decisions at political and individual level throughout Europe. Specifically, within the network of participating cities, new health impact indicators have been developed, with a special focus on road traffic in the light of recent data on health hazards affecting people living next to major thoroughfares. The cost of such health impacts has been assessed and tools aimed at fostering dialogue between stakeholders have been developed.
By getting involved in these various projects InVS has not only created an international network of expertise in the field of health effects caused by atmospheric pollution, but has also kept active a surveillance network that can be deployed in case of health crises with an environmental cause (such as heat waves in Europe, collecting excess mortality data relating to the impact of the 2003 heat wave in several countries, or monitoring trans-border atmospheric pollution events (fires, volcano eruptions) as well as their impact on health).
InVS has also been involved in outlining a roadmap of indicators that can be used to assess the impact of public policies on environmental health through two successive projects (ENHIS and ENHIS-2).
All these projects have produced a strong effect on activities carried out by the World Health Organization (in developing guideline values for the quality of air) and the European Commission (in developing threshold limits and objectives for the quality of air) and generally speaking, on the European strategy for the quality of air (CAFE).
In other words, since the inception of the RNSP, InVS has developed specific know-how in setting up surveillance networks on the health effects of air quality and in designing methods to assess health impacts.
In addition, through the Intarese project, InVS has refined its knowledge about the various methods to assess the impact of public policies on environmental health (and related indicators). All these European projects have received funds from the public health program (and from previous programs) or from the PCRD (Framework Program for Research and Development); as a result, it was possible to allocate dedicated resources to these projects based on a revenue agreement.
The end of the APHEKOM project temporarily marked the end of European projects coordinated by InVS in the field of environmental health. However, InVS was and still remains involved as a simple partner or as a participant to scientific meetings, to various European projects such as information sharing forums in the field of biosurveillance (ESBIO, COPHES, DEMOCOPHES), to studies focusing on the analysis and prevention of health effects stemming from heat waves (EuroHEAT), to multicenter studies based on the use of cohorts to assess the long-term effects of air pollution (ESCAPE), etc. Being involved in these projects continues to provide InVS with new knowledge, new methods that are needed to help surveillance systems and risk assessment methods become more advanced. Other forms of European cooperation (and even international cooperation with CDCs) are currently being implemented: bilateral exchanges on specific topics (epidemiological preparation to industrial or natural disasters) with sister institutes, or setting up workshops and conferences (climate change, biosurveillance) so as to create more dynamic exchanges and break free from the cumbersome administrative procedures that are inherent to the management of European projects.
InVS has earned recognition at European and international level for the quality of its know-how in global surveillance. It is very active with the ECDC with extensive sharing of information on (daily) alerts but also in terms of approaches for global surveillance in order to avoid duplication and bring synergy to actions. InVS is also very active within several international surveillance networks such as the EpiSouth project (EpiSouth and now Episouth+) that brings together 27 countries in the Mediterranean region (Southern Europe, the Balkans, Maghreb, Middle East). This project plays a key role in InVS’s strategy in the area of global surveillance (awareness of alerts in countries that have major exchanges with France in this geographical area) and in the French strategy for the development of a Euro-Mediterranean policy (Union for the Mediterranean). The project is co-funded by the European Commission (Community Public Health Program and the Development and Cooperation DG), the Italian Ministry of Health as well as various institutes and ministries in participating countries. Thanks to subsidies received by InVS through the public health program and DG DEVCO, InVS was able to hire the necessary personnel to facilitate this global surveillance network.
Since 2003, InVS has developed a syndromic surveillance system (SurSaUD®). As few European countries have such a system it seemed important for InVS to position itself as a key player at both European and international level in terms of implementing such systems. As a result, InVS is the coordinator of the Triple S project (2010-2013), whose purpose is to design a European strategy to develop such systems.
In the area of chronic diseases and trauma the European Commission has funded the development of a number of health indicators (ECHI: European Community Health Indicators) through a large number of projects; InVS was involved in developing these indicators through occasional cooperation and meetings organized by the European Commission (diabetes indicators, cardiovascular diseases, trauma and injuries). In terms of accidents, InVS coordinated the ANAMORT project (Analysis of Mortality Data due to Accidents, 2005-2008) that focuses on harmonizing health indicators, in particular mortality statistics, to be able to compare health risk factors between European countries and assess the responses of health-care systems. Recommendations on indicators were submitted to Eurostat as part of its work on health statistics.
 Regulation (EC) No. 851/2004 of the European Parliament and of the Council of 21 April 2004 establishing a European Centre for Disease Prevention and Control
 CESES: European Centre for the Epidemiological Monitoring of AIDS
 RNSP: National Public Health Network
 Relevant entities or organizations: any facility, institute, body or any scientific entity recognized by Member State authorities as a provider of independent scientific and technical advice or as having capacity for action in the area of prevention and control of human diseases.
- Air pollution and heat waves
- Environmental health indicators
COPHES: http://www.eu-hbm.info/ (ongoing)
DEMOCOPHES: http://ec.europa.eu/environment/life/project/Projects/index.cfm?fuseaction=search.dspPage&n_proj_id=3759 (ongoing)
- Assessment methodologies of the impact of public policies on environmental health
ANAMORT (coordinated by InVS): http://www.invs.sante.fr/display/?doc=publications/2008/anamort/index.html
- Syndromic surveillance
TRIPLE S: http://www.syndromicsurveillance.eu/ (coordinated by InVS)
- Communicable diseases in countries in Southern Europe and the Mediterranean basin
EpiSouth: http://www.episouth.org/ (global surveillance aspects are coordinated by InVS)
- Other links