Haemoglobinopathies on the Move: Is Europe Ready?
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Haemoglobinopathies on the Move: Health and Migration Is Europe ready? Policy Perspectives AUGUST 2013 01 Contents Foreword and poor patient access to diagnosis have been proposed to EU countries and treatment. since 2009. However, little progress has been made with regards to the Although we recognise that notable development and establishment of European Union initiatives do exist to national programmes for the prevention reduce the psychological and economic of this specific group of rare diseases, Haemoglobinopathies (thalassaemia impact of rare diseases on patients highly influenced by global mobility flows Foreword and sickle cell disease) are genetic and society at large, we believe that and immigration, reflecting the increased a tailored, comprehensive, holistic diversity of our societies. Piel et al. disorders that in their severe forms are approach to haemoglobinopathies is not (2013) state “HbS [sickle haemoglobin] associated with chronic, life-impairing equally applied across the EU member will have an increasing effect on public 02 and -threatening diseases with inherent states. Furthermore, a clear effort to health systems. Our estimates can Collaborating Experts and Organisations ensure equal access to healthcare by help countries and the international serious health sequelae that can Collaborating Experts 02 Collaborating Organisations 04 migrant populations and ethnic minority communities gauge the need for lead to disability or even death. The groups is lacking. appropriate diagnoses and genetic World Health Organization (WHO) has counselling to reduce the number of In Europe, inside and outside mobility neonates affected”.3 Accordingly, the recognised that haemoglobinopathies flows and migration are broadly related need to act at the national level with the Key Facts and Figures about Haemoglobinopathies 06 represent a growing health problem in to demographic and socio-economic support of the EU is increasingly urgent, 71% of 229 countries (which account realities, and for this reason, their and is supported by recent research. for 89% of all births worldwide). effects on healthcare, welfare and social systems costs should not be As experts, we deemed it important underestimated. We should be investing to develop this policy report, Methodology 10 Haemoglobin disorders are traditionally more in responsive and evidence-based ‘Haemoglobinopathies on the Move: endemic among populations originating policy making, research, preventive care, Is Europe ready?’, which, for the first from Southern Europe (Italy, Greece healthcare professionals’ education, time, places a spotlight on the different and Cyprus), Africa, the Middle East diagnostics and treatment. policies and practices of ten EU 11 and Asia. Through both older and more countries. The report builds on previously EU and Country Factsheets recent migration and mobility flows, these In 2006 and 2007, the WHO, through described initiatives by providing updated EU Factsheet 12 Country Factsheets 17 disorders are today occurring widely its Executive Board Meeting and evidence for decision makers on the across the world, including the American World Health Assembly, adopted two need to act. It also highlights the value of continent, Australia, Western Europe and, Resolutions on thalassaemia1 and cost-effective policy measures, and maps in more recent years, in Northern Europe. sickle cell disease,2 which represented areas and countries where progress is an important step forward as political needed. We are confident that it will be Key Findings and Conclusions 64 As a result of significant scientific recognition of the global challenge of of value to European policy makers in and medical advances, especially in haemoglobinopathies. Moreover, in 2007, shaping the future health, migrant and the last three decades, haemoglobin the European Network for Rare and social policies of the European Union disorders can be effectively prevented, Congenital Anaemias (ENERCA), with and its member states. 70 treated and managed. Increased the participation of the WHO and the Policy Recommendations survival, life expectancy and improved Thalassaemia International Federation We sincerely hope that our findings quality of life of patients in countries (TIF), organised a symposium on and recommendations will encourage where programmes have been Immigration and Haematology: Towards policy makers across Europe to address developed, implemented and nationally the prevention of haemoglobinopathies the current gaps in the management 72 coordinated are well documented in in Europe (Budapest, 30 August, 2007), of haemoglobin disorders. We hope to List of Consulted Organisations the literature. Despite this, affected where a joint action was proposed engage in a deeper debate on health babies are still being born every to call on public authorities and and migration policy measures that are year and patients are inadequately governments to follow up on the WHO able to adequately respond to the rise managed – the majority of which in the recommendations and draw attention of haemoglobinopathies in Europe and developing world, but also throughout to the need for targeted policies to ensure equitable access to healthcare Europe, mainly due to increased tackle severe haemoglobinopathies, and and social support, thereby contributing global and intra-EU mobility and immigration and mobility flows in Europe. to improved quality and long-term cost- migration. Accordingly, figures on the effectiveness of healthcare delivery. This report was developed by a group of experts from the European Network for Rare and Congenital Anaemias (ENERCA) and the Thalassemia prevalence of haemoglobin disorders Haemoglobin disorders are included International Federation (TIF) in collaboration with the International Organization for Migration (IOM), Migration Health Division, Regional Office are largely considered underestimated in the field of rare diseases and Brussels. Novartis Farma S.p.A. sponsored this project through in-kind support services from Burson-Marsteller Brussels. due to the lack of national registries recommendations for action in this field |1 WHO Executive Board, 118th Session EB118.R1, Thalassaemia and other haemoglobinopathies. http://apps.who.int/gb/ebwha/pdf_files/EBSS-EB118-2006-REC1/english/Res/listing/b118_r1- en.pdf | 2 WHO Fifty-Nine World Health Assembly, WHA59.20 on Sickle-cell anaemia, 2007. http://apps.who.int/iris/bitstream/10665/21447/1/A59_R20-en.pdf | 3 Piel FB et al. Global NOTE: In this report, the term migrant is used in a very broad sense, referring not only to those who change their country of residence voluntarily but also to asylum seekers, refugees and victims of human trafficking. epidemiology of sickle haemoglobin in neonates: a contemporary geostatistical model-based map and population estimates. Lancet 2013; 381:142–51 02 HAEMoglobInopathIES on the MoVE: IS Europe READY? Collaborating Experts and Organisations Collaborating Experts Collaborating Experts and Organisations Collaborating Experts 03 Collaborating Experts Collaborating Experts and Organisations Michael Angastiniotis Androulla Eleftheriou Béatrice Gulbis Maria del Mar Mañú Pereira Patricia Aguilar Martinez Roumyana Petrova-Benedict Joan-Lluis Vives-Corrons Michael Angastiniotis, MD Androulla Eleftheriou, BSC, MSC, PhD Béatrice Gulbis, MD, PhD Maria del Mar Mañú Patricia Aguilar Martinez, Roumyana Petrova- Joan-Lluis Vives-Corrons, ThalassaeMIA InternatIonal FEDeratIon ThalassaeMIA InternatIonal FEDeratIon ErasME HOSPItal – UNIVERSITÉ LIBRE DE BRUXELLES Pereira, BSc, PhD MD, PhD, CHU Benedict MD, PhD (BELGIUM) HOSPItal CLÍNIC DE Barcelona MontpellIER - SAInt ELOI InternatIonal ORGANIZatIon HOSPItal CLINIC - UNIVERSItat (SpaIN) HOSPItal (France) for MIgratION (BelgIUM) DE Barcelona (SpaIN) Born in Famagusta, Dr Michael Angastiniotis graduated Dr Androulla Eleftheriou obtained her graduate and Dr Béatrice Gulbis graduated in Medicine in 1984, and Dr Maria del Mar Mañú Pereira Dr Patricia Aguilar Martinez graduated Dr Roumyana Petrova-Benedict, IOM Dr Vives had been Professor of Medicine with a degree in Medicine from the University of postgraduate degrees in Biochemistry, Microbiology obtained her specialisation in Clinical Biology in 1989 graduated with a degree in Biology with a degree in medicine from the Senior Regional Migration Health and Head of the Haematology Laboratory Aberdeen (Scotland) in 1966, and obtained his DCH and Virology. She has been awarded a number of from the Université Libre de Bruxelles (Belgium). from the University of Barcelona Montpellier Medical School (France) Manager for Europe and Central Asia, Department of the Hospital Clinic i (Diploma in Child Health) in Paediatrics in 1976 scholarships by the Cypriot government, the World Dr Gulbis is head of the Department of Clinical (Spain) in 2002 and specialised in 1988 and specialised in Biology and is responsible for the development, Provincial (University of Barcelona) since from the Royal College of Physicians and Surgeons Health Organization and the Fulbright Commission. Chemistry and since 2010, Director of the Departments in Human Genetics. She obtained Genetics in different French Universities, implementation and coordination of 1976, with a high input into haematology of Glasgow. He received his graduate training in Her postdoctoral fellowship was completed at the Centre of Clinical Biology and Molecular Genetics. She is also her PhD in 2009, with a thesis including Lyon and Paris. She obtained IOM Migration Health