Archive for August, 2013

The European Centre for Disease Prevention and Control: Science and Political Integration in Europe

By Mark R Roberts, on 2 August 2013

John Krige (1997) has alerted us to the contribution of scientists and not governments in re-organising where and how science is done, particularly in the organisation of transnational scientific cooperation. When viewed from this perspective, new and unexplored histories of science and politics are written. Since the Second World War, the most active geo-political region of scientific cooperation has been Europe, and this cooperation forms a significant part of what we call European integration. Yet what we know about European integration is dominated by political histories which privilege conventional ‘political’ integration commonly thought of as Member States ceding sovereignty to the European Community. Such histories according to Neil Rollings (2007) focus on top political figures and civil servants as the decisive actors. What is surprising is that when we look at European scientific cooperation this often precedes and draws after it conventional ‘political’ integration. From this perspective, scientific cooperation can be seen as a politically creative and binding force. The European Centre for Disease Prevention and Control is a good example of precisely this.

Based in Stockholm, the European Centre for Disease Prevention and Control (ECDC), an agency of the European Union officially began life in May 2005. The only serious history yet to be written about the ECDC, as far as I am aware, is by Scott Greer whose account of the ECDC’s origin follows the approach taken by many ‘politician-centric’ histories. Greer tells us that if we want to know why the ECDC came into being, we will have to know more about the activities of a top civil servant Fernand Sauer, and a former European Union Commissioner of public health David Byrne. This is misleading. The ECDC’s mission and organisational structure is based on the planning and lobbying of European epidemiologists and microbiologists during the 1990s who developed, often in competition with one another, what they thought would be more effective ways to control and prevent disease.

In 1992, two epidemiologists Chris Bartlett and Gijs Elzinga proposed to the European Commission that it would be beneficial to identify gaps and duplications in all of the international surveillance and training collaborations that were then currently taking place in the European Union. Following the conclusion that there were gaps (for example in food-borne diseases) and duplications, Bartlett and Elzinga asked for funding from the European Commission for twice-a-year meetings and for a small technical support unit so epidemiologists from participating Member States could strategically develop the surveillance and research of communicable diseases. The Commission agreed to fund this, and what was known as the ‘Charter Group’ emerged at the beginning of 1994 bringing together heads of communicable disease centres from around the EU on a voluntary basis.

Under the Charter Group, a network of disease-specific programmes were developed which used existing national centres like the Réseau National de Santé Publique in France to serve as focal points for the European surveillance of specific diseases such as AIDS and Salmonella infection. This approach to controlling disease became known as the Network Approach. The Charter Group established European data-sets, identified emerging diseases, and assisted in the response to national outbreaks. In 1995 the Charter Group initiated a new monthly and weekly bulletin called EuroSurveillance (now under the auspices of the ECDC) as a way to bring the editors of national surveillance bulletins together from EU member states. Also established by the Charter Group in 1995 was a European training programme for epidemiologists, the European Programme in Intervention Epidemiology Training (EPIET) to produce individuals competent to undertake epidemiological investigations at an international level, which has also been absorbed since by the ECDC.

What was distinctive about this new approach to controlling disease was that it went beyond research collaboration and involved coordinating and harmonising the surveillance and research of communicable diseases between existing national centres of disease control. A new mechanism in choosing what research to undertake was created; prioritising research against the need for it on a European scale and gauging the urgency of research on the increasingly integrated surveillance network. The Charter Group’s network approach was politically sanctioned in September 1998 with A Network for the Epidemiological Surveillance and Control of Communicable Diseases in the Community established by an Act of the European Parliament and the Council of the European Union. This was complemented in 1999 by an EU-wide rapid alert system, intended to enable rapid transmission of confidential data between national health authorities in the event of an emergency.

The Charter Group was not the only organised lobby for the future of communicable disease control however. Since 1996, another and competing vision of what the future of communicable disease control would look like in Europe was emerging. It was led by microbiologists for instance from the European Society of Clinical Microbiology and Infectious Diseases, but most prominently Michel Tibayrenc of the Centre d’Etudes sur le Polymorphisme des Micro-organismes in France who were in favour of a central European organisation. The institutions of the European Union paralleled this divide. The European Parliament was in favour of a centre for communicable disease as an institution of the European Union. The European Commission and the Council of Ministers however were in favour of the network approach. In October 1998, a month after the act declaring the network approach as the preferred technique of surveillance, two voluble epidemiologists Weinberg and Giesecke, attempting to staunch the flow of the idea of a central organisation, declared that the ‘idea of a central edifice seems to be politically dead’.

In the wake of the pronouncement that the idea of a central edifice had been defeated, in 1998 Michel Tibayrenc initiated discussions at the International Board of Scientific Advisors in September 1998 and created a European Centre for Infectious Disease (ECID). This was essentially a lobby group, mostly comprised of microbiologists, advocating a European centre. The ECID had a ‘scientific board’ of around 30 people and a steering committee who advocated a European equivalent of the US Centers for Disease Control (CDC f.1946). The US CDC, mirroring a long history of US promotion of European integration, took a personal interest in furthering the cause of the ECID with the head of the CDC’s parasitic diseases division Dan Colley, sitting on the scientific board of advisers to the ECID. Furthermore, public health representatives from developing countries and former Soviet states were also supportive of a European centre for controlling communicable diseases, because the ECID promised to provide expert assistance and exchange information with these nations.

Advocates of both the network approach and the ECID explicitly contested each other’s claims about what benefits each approach had. Leading epidemiologists argued that the proposed coordinating functions of a centre were already being performed by the network approach. The ECID specifically countered this, arguing the network approach alone was not good enough as national centres of communicable disease were ill-prepared to face a major challenge such as bioterrorism and were not fulfilling their aim of preventing gaps and duplications in research. The idea of an initiating but disunited science community mirrors John Krige’s history (1989) of the origins of CERN in the early 1950s. Krige shows how two competing visions existed within the physics community of how European states should cooperate in nuclear physics research. One side advocated a network of nuclear research using existing laboratories and another advocated a European research laboratory and to build there a nuclear accelerator to compete in power with the nuclear accelerators at Brookhaven and Berkeley in the United States. Krige points out the two sides were not in opposition, both saw the value in cooperating, but had different views on how to cooperate.

Tibyrenc’s vision of what a central organisation should do has been reflected in the creation of the ECDC to a remarkable extent. Tibayrenc thought a central organisation would strengthen the effectiveness of the ‘network approach’ but should also take an active researching and surveillance role, and this dual function has been incorporated by todays ECDC. A good example of how the ECDC mirrors the ideas of Tibayrenc is shown in the first actions by the ECDC upon its inception. The ECDC was established concomitantly with the 2005 outbreak of H5N1 Influenza (Bird Flu) and formed part of outbreak investigation teams. In Turkey and Romania, three ECDC staff were on the ground all the time and an ECDC scientist was leading the investigation in Iraq. Here, the ECDC emulated Tibayrenc’s vision of a future ECDC having a mobile scientific staff and his conviction that disease within Europe can only be controlled by a European centre working in non-EU states as well as in EU member states.

Distribution of the Aedes Albopictus mosquito, a native of southeast Asia, and a vector of many emerging diseases in Europe

This map, produced by the ECDC shows the distribution of the Aedes Albopictus mosquito in Europe and bordering nations. The mosquito, a native of southeast Asia is a vector of emerging diseases in Europe such as West Nile Fever.

We don’t know how far the ECID’s lobbying and Tibyrenc’s efforts directly influenced the political conviction to create the ECDC. But we do know the European Parliament was largely in favour of the centre from the start of Tibyrenc’s lobbying. We know that from 2002, the European Commissioner for public health David Byrne seems to have come on board with the idea, announcing in a speech to the Red Cross and Red Crescent in Berlin, that ‘plans are in preparation to set up a European centre for communicable diseases, to become operational in 2005’. There were other factors involved too that could have triggered or given substance to justifying the need for a centre of disease control such as the threat of bioterrorism after 9/11 or the 2003 severe acute respiratory syndrome (SARS) outbreak. But perhaps we should not place too much emphasis on these causes. They obscure the fact that the ECID had already lobbied for a European centre from 1998 and anticipated how it would work, as well as the fact that there was already in place a formal European network approach to disease control which took shape from the early 1990s.

According to Colin Talbot (2004), agencies such as the ECDC have been created in the wake of a citizenry increasingly sceptical of experts and politicians. Talbot says that agencies gain public trust through being autonomous from a centralised government. However, this approach mistakenly views agencies only through the eyes of worried politicians seeking to gain trust for expertise. As we have seen however, the ECDC was not founded on a need to gain support from a sceptical citizenry, it was the culmination of many years of lobbying to improve the effectiveness of disease control. Moreover, agencies can be very different to one another. For instance, Waterton and Wynne (2004) argue that upon its inception in 1993, the European Environment Agency (EEA) was in competition with other institutions and organisations, the European Commission’s DG for the Environment in particular. Moreover, they argue that the EEA was not intended to influence policy networks (despite it might have the ambition to do this). Scott Greer’s account of the ECDC differs from this in arguing that the crowded but fragmented institutional landscape of communicable disease control, rather than being a source of competition, is the raison d’etre for the existence of the ECDC, and is the sinews of its future growth. Of course, what Greer misses is that this rationale was developed independently by the Charter Group and the ECID.

This brief account of the ECDC has been all about its origins and not about the ECDC itself. But there is a reason for this. How the origin of a European agency is perceived, or any other type of science-based organisation, changes what we think of that agency in its current form. If looked at from a conventional political perspective, the ECDC looks like a weak organisation amongst what Scott Greer calls ‘a crowded institutional landscape’. However, if we acknowledge that the ECDC assimilated novel and ambitious projects to coordinate the research and surveillance of, and the training for, communicable diseases in Europe, the ECDC represents a new way of controlling and preventing disease which did not exist prior to the 1990s. When the origins of the ECDC are taken into consideration, the ECDC does not look like a beginning in the European control and prevention of communicable disease, but the culmination of a new way to govern communicable disease in Europe.

 

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