BIO3R Supporting Activity Title: Scenario Launching Report Id: <BIO3R reference> Version: 1.0 PREPARATORY ACTION IN SECURITY AND RESEEARCH (PASR) BIO 3R PROJECT “BIOTERRORISM RESILIENCE, RESEARCH, REACTION” OPERATIONAL REQUIREMENTS 1.1 GENERAL OPERATIONAL REQUIREMENTS The issues discussed hereafter are concerning the global response to BioT crises. They are relevant for all nine scenarios. 1.1.1 Crisis management at the national level Perception of the BioT risk in the different MSs The organisation of response to BioT events varies significantly between the MSs. Differences related to the political history, the economic development, or demography and geography could probably be addressed in a specific study. Major differences in the level of preparedness are also observed between SMs with similar economical, demographic and geographical constraints. The best prepared MSs have developed comprehensive global BioT plans, while others have only BioT plans restricted for example to protocols for the treatment of suspect parcels. It appears that the perception of the BioT risk differs significantly from one MS to another. The rationale for these differences is unclear. It deserves further analysis, as the harmonization and coordination of the response at the European level requires a consensus among MSs about the priorities in health security. “Natural” resilience of Public Health System The lack of global BioT emergency plans does not necessarily means that resilience will be low in any case. The general robustness of European medical care systems together with the plans already existing or specifically developed for the response to “naturally” occurring outbreaks or major national incident or international cooperation in major crisis may provide efficient response to several scenarios. Governmental crisis centres <UCL> Status:UCL final Page 1/21 This document is produced under the EC contract. SEC6-SA-204300 It is the property of BIO3R Parties and shall not be distributed or reproduced without the formal approval of the BIO3R SC BIO3R Supporting Activity Title: Scenario Launching Report Id: <BIO3R reference> Version: 1.0 Most MSs have organised the coordination of their response around a governmental crisis centre (GCC) usually depending on the Home Affairs. Despite the fact that differences exists between MSs, the general principles for these structures can be presented as follows. The general scope of a GCC is to assist the government in the planning and the management of crises including major sanitary events that require rapid decision making and demands coordination between different departments. GCC have different functions that they assume with the support of experts from different organisms. At the national level, they can be in charge of risk analysis and emergency planning. They are 24/24 on duty and ensure continuous monitoring with the support of police, intelligence, and crisis centres from the other departments and ministries (Health, transport etc...). They plan, coordinate and follow-up major events at risk. They install infrastructure for crisis management and last but not least they are the national and international focal point for alarm networks. They usually organise and coordinate the emergency planning. They draw up procedures for cooperation between departments at regional, national and international level. They develop crisis management know-how. Their action is based on national emergency plans for crisis events including 4 main components: - Decision making founded on correct assessment of the risk - Coordination of the resources to use - Information to the public - Contact with foreign countries and international organisations. In case of crisis their actions will be: - Alert notification - Global organisation and crisis management - Permanent link between the different departments - Coordination and dialogue between the regional and local authorities - Communication to the mayors and the population - Logistic support Balance between local and national management Efficient response is resulting from a good balance between the local and the national level (decision making, operational capacities) with subsidiarity as a general principle. The figure 1 is a schematic representation of the overall chain of reaction in a typical national security system. The system will be efficient if it combines prompt reaction at local level with excellent coordination at national level. A more detailed analysis of a decentralized national security system has been provided for Italy in the annexes. Figure 1: Chain of reactions in a national security system (from Pauwels, 2006, on www.influenza.be) National Management Emergency Home Affairs Committee Planning Emergency Plan Regional for the Regional Governor coordination Phase Committee Emergency Plan Municipal for the Municipal Mayor coordination Phase Committee Disparities in the level of preparedness observed at the local level <UCL> Status:UCL final Page 2/21 This document is produced under the EC contract. SEC6-SA-204300 It is the property of BIO3R Parties and shall not be distributed or reproduced without the formal approval of the BIO3R SC BIO3R Supporting Activity Title: Scenario Launching Report Id: <BIO3R reference> Version: 1.0 It is also of primary importance to harmonize the level of preparedness among the different local emergency plans. In MS characterized by a large autonomy of the regions, there is a risk that disparity in the level of preparedness between the regions will weaken the national response. To some extent, the support offered by the national structure in case of crisis contributes to reduce this risk. However an additional mechanism should ensure homogeneity of the response. For example, task forces combining know-how and technical means could help the weaker regions to reach a minimal level of preparedness compatible with the national and international standards. Such a task force may be seen as a component of the armed forces or the civil protection assisted by technical experts. The advantage of these two organisms is that they do have their own technical means and staff (material, and human resources) trained for emergency and rapid reaction but without the burden of routine duties often overloading the civilian health professionals and infrastructures. Regarding the armed forces the compatibility between military and civilian tasks in case of military crisis should be further investigated and clarified. Alert activation, the central role of biomedical assessment Regarding the alert notification, the nine scenarios are reporting 3 different situations combining 2 types of critical information in different order or proportion. The first type of critical information is including the biomedical evidences; declaration of confirmed clinical cases or laboratory results demonstrating the presence of a BioT agent in the environment. The early warning systems have been developed in order to ensure optimal notification of such data. In case of covered attack, these biomedical evidences will be the very first elements to reach the crisis governmental centre through the Public Health crisis centre. The second type of critical information includes statements and claims from the terrorists themselves as well as the information or evidences collected by the police itself. In case of declared attack, the information will be transmitted via the governmental crisis centres before any biomedical evidences. The public health crisis centre will be asked to activate the biomedical capabilities, to provide credibility assessment by health experts and to pre-alert and inform health care and laboratory facilities. In some scenarios the alert notification is resulting from a concomitant arrival of both types of information at the same time. Excellent communication and coordination will be a key component of the response. Regardless of the scenario, activation of the highest level of alert always results from biomedical evidences. Communication to the public The basis for a robust communication to the public regarding the level of alert declared by the authorities is: “transparency but validation first”. Validation requires in most cases biomedical evidences. Communication about the risk is centralised at the level of the governmental crisis centre and is usually taken in charge by professionals. It sounds logical considering the convergence and centralisation of the flow of informations generated by the different departments and the tight interaction and link with the governmental instances. Emergency plans For obvious reasons, existing emergency plans against BioT are usually classified. However, the headlines of those plans are known and have been extensively commented. The aim of these plans is to prevent, survey and alert, to fast respond in case of crisis and to reinforce the European collaboration in different fields: Prevention: The security of facilities involved in the production and/or the storing of sensible materials, pharmaceutical plans, biological resource centres as well as the security of distribution of water and food products must be considered. Surveillance and early warning: The national system for mandatory declaration of relevant infectious diseases (24/24 on duty) must be reinforced trough the implementation of a diagnostic <UCL> Status:UCL final Page 3/21 This document is produced under the EC contract. SEC6-SA-204300 It is the property of BIO3R Parties and shall not be distributed or reproduced without the formal approval