Trade, foreign policy, diplomacy and health

8. International Health Regulations and Epidemic Control

Johan Giesecke


International alert and control: the EU example

Maastricht and Amsterdam treaties (1993/8) led to network for surveillance and control of:

  • outbreaks of communicable disease in > 1 Member State
  • spatial/temporal clustering of cases of a similar type if
    • if pathogenic agents are a possible cause and there is a risk of propagation between States
    • outside the Community, if pathogenic agents are a possible cause and there is a risk of propagation to the Community
  • the appearance or resurgence of a communicable disease or an infectious agent that may require timely, co-ordinated Community action to contain it

The realization that outbreaks need to be detected and reported early is perhaps best illustrated by the European Union. The creation of its internal market requires free movement of people, animals and goods between the Member States. From an infectious disease control perspective, this means that the Union is effectively becoming one country with no internal borders.

The Maastricht and Amsterdam treaties (1993/8) gave the EU competency in the field of public health, leading to the establishment of a network for surveillance and control of infectious diseases, covering: (1) outbreaks of communicable diseases extending to more than one Member State; (2) spatial or temporal clustering of cases of disease of a similar type, if pathogenic agents are a possible cause and there is a risk of propagation between States; (3) spatial or temporal clustering of cases of disease of a similar type outside the Community, if pathogenic agents are a possible cause and there is a risk of propagation to the Community; or (4) the appearance or resurgence of a communicable disease or an infectious agent that may require timely, co-ordinated Community action to contain it. States should coordinate prevention and control, and inform the Commission about control measures adopted.

It should be noted that this international system for surveillance (and, to a lesser degree, control) did not primarily grow out of the concerns of the public health professionals of Europe, but as a consequence of the trade demands from the open internal market: that there should be as little ground as possible for Member States to revert to the 'shut-all-borders' reflex in the face of outbreaks or epidemics. However, there have been several instances when this collaboration within EU has had a clear public health benefit in preventing further spread of disease to the citizens of the Community.

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