Regulation 2022/2371 - Serious cross-border threats to health - Main contents

EN

Official Journal of the European Union

L 314/26

A network for the epidemiological surveillance and control of communicable diseases was set up by Decision No 2119/98/EC of the European Parliament and of the Council (4). Its scope was extended by Decision No 1082/2013/EU of the European Parliament and of the Council (5) to strengthen and provide for a more coordinated and wider approach to health security at Union level. The implementation of that legislation confirmed that coordinated Union action on monitoring, early warning of and combatting those threats adds value to the protection and improvement of human health.

In light of the lessons learnt during the ongoing COVID-19 pandemic and in order to facilitate adequate Union-wide preparedness for and response to all cross-border threats to health, the legal framework for epidemiological surveillance, monitoring, early warning of, and combatting serious cross-border threats to health, including zoonotic-related threats, as provided for in Decision No 1082/2013/EU, needs to be broadened with regard to additional reporting requirements and analysis regarding health systems indicators, and with regard to cooperation between Member States and Union agencies and bodies, particularly the European Centre for Disease Prevention and Control (ECDC), the European Medicines Agency (EMA), and international organisations, in particular the World Health Organization (WHO), while taking into account the burden faced by national competent authorities depending on the actual public health situation. Moreover, in order to ensure the Union’s effective response to novel cross-border threats to health, the legal framework to combat serious cross-border threats to health should make it possible to immediately adopt case definitions for the surveillance of novel threats and should provide for the establishment of a network of EU reference laboratories and a network to support monitoring of disease outbreaks that are relevant to substances of human origin. The capacity for contact tracing should be strengthened via the creation of an automated system, using modern technologies, while respecting Union legislation on data protection such as Regulation (EU) 2016/679 of the European Parliament and of the Council (6).

It is important that public investments in research, development, manufacturing, production, procurement, stockpiling, supply and distribution of medical countermeasures for the purpose of preparing for and responding to cross-border threats to health are transparent in accordance with applicable legislation.

The Health Security Committee (HSC), as formally established by Decision No 1082/2013/EU, plays an important role in the coordination of prevention, preparedness and response planning for serious cross-border threats to health. The HSC should be given additional responsibilities with regard to the adoption of guidance and opinions to better support Member States in the prevention and control of serious cross-border threats to health, and to support better coordination between Member States to address those threats. A representative designated by the European Parliament should be able to participate in the HSC as an observer.

In order to increase the effectiveness of the preparedness for and response to serious cross-border threats to health, the Commission including, where relevant, the Health Emergency Preparedness and Response Authority (HERA) established as a Commission service by Commission Decision of 16 September 2021 (7), and the HSC, the ECDC, EMA and other relevant Union agencies and bodies should coordinate and cooperate in relation to such preparedness and response. The coordination between those bodies should build on the participation of relevant stakeholders and aim to avoid any duplication of efforts.

In their joint opinion ‘Improving pandemic preparedness and management’, the Group of Chief Scientific Advisors to the Commission, the European Group on Ethics in Science and New Technologies and the Special Advisor to the President of the Commission on the response to COVID-19 recommend establishing a standing EU advisory body for health threats and crises.

All recommendations, advice, guidance and opinions mentioned in this Regulation are inherently non-binding on their addressees. Recommendations allow the Commission, the ECDC and the HSC to make their views known and to suggest a line of action without imposing any legal obligation on those to whom such recommendations are addressed.

This Regulation should apply without prejudice to other binding measures concerning specific activities or quality and safety standards for certain goods, which provide for special obligations and tools for monitoring, early warning of and combatting specific threats of a cross-border nature, such as the International Health Regulations (IHR) of the WHO adopted in 2005. Those measures include, in particular, relevant Union legislation in the area of common safety concerns in public health and environmental matters, covering goods such as medicinal products, medical devices, in vitro diagnostic medical devices, and foodstuffs, substances of human origin, such as blood, plasma, tissues and cells, and organs, and exposure to ionising radiation.

The over-exploitation of wildlife and other natural resources and the accelerated loss of biodiversity pose a risk to human health. As the health of humans, animals and the environment are inextricably linked, it is crucial to follow the One Health approach to addressing current and emerging crises.

In line with the One Health and Health in All Policies approaches, the protection of human health is a matter which has a cross-cutting dimension and is relevant to numerous Union policies and activities. It is crucial that the Union support Member States in reducing health inequalities, within and between Member States, in achieving universal health coverage, in addressing the challenges of vulnerable groups and in strengthening the resilience, responsiveness and readiness of healthcare systems as regards addressing future challenges, including pandemics. In order to achieve a high level of human health protection, and to avoid any overlap of activities, duplication or conflicting actions, the Commission, in liaison with the Member States, and all relevant stakeholders, should ensure coordination and exchange of information between the mechanisms and structures established under this Regulation, and other mechanisms and structures established at Union level and under the Treaty establishing the European Atomic Energy Community (‘the Euratom Treaty’), whose activities are relevant to prevention, preparedness and response planning, and monitoring, early warning of, and combatting serious cross-border threats to health. In particular, the Commission should ensure that relevant information from the various rapid alert and information systems at Union level and under the Euratom Treaty is gathered and communicated to the Member States through the Early Warning and Response System (EWRS) set up by Decision No 1082/2013/EU. The EWRS is to implement robust, accurate and interoperable data processes with Member States to ensure data quality and consistency. The ECDC should coordinate with Member States throughout such data processes, from assessing the data requirements, transmission, and collection to updating and interpretation, with a view to fostering strong collaboration between the Commission, the ECDC and national and regional competent bodies.

Prevention, preparedness and response planning are essential elements for effective monitoring, early warning of and combatting serious cross-border threats to health. As such, a Union health crisis and pandemic plan needs to be established by the Commission and approved by the HSC. This should be coupled with updates to Member States’ prevention, preparedness and response plans so as to ensure they are compatible within the regional level structures. It is crucial that those Union and national plans be prepared with particular attention paid to cross-border regions in order to enhance their health cooperation. Where appropriate, regional authorities should be able to participate in the drawing up of such national plans. To support Member States in this endeavour, the Commission and the relevant Union agencies and bodies should provide targeted training and facilitate the sharing of best practices for healthcare staff and public health staff to improve their knowledge and necessary skills. Cross-border elements should also, where relevant, be included in the Union plan, in order to foster the sharing of best practices and a smooth exchange of information in times of crisis, such as concerning capacities for specialised treatment and intensive care across neighbouring regions. To ensure the implementation of the Union plan, the Commission should facilitate stress tests, simulation exercises and in-action and after-action reviews with Member States. The Union plan should be functional and updated, and have sufficient resources for its operationalisation. Following reviews of the national plans, proposed recommendations should be addressed in an action plan and the Commission should be kept informed of any substantial revision of the national plans.

Member States should provide the Commission with an update on the latest situation with regard to their prevention, preparedness and response planning and implementation at national level, and where applicable at regional level. Information provided by the Member States to the Commission should include the elements that Member States are obliged to report to the WHO in the context of the IHR. Access to timely and complete data is a precondition for prompt risk assessments and crisis mitigation. To avoid duplication of efforts and diverging recommendations, standardised definitions, where possible, and a secured network are needed between Union agencies and bodies, the WHO and national competent authorities. In turn, the Commission should report to the European Parliament and to the Council, every three years, on the state of play and progress with regard to prevention, preparedness, response planning and implementation at Union level, including on recommended actions, to ensure that national prevention, preparedness and response plans are adequate. In order to support the assessment of those plans, the ECDC should conduct assessments in Member States, in coordination with other Union agencies and bodies. Such planning should include, in particular, adequate preparedness of critical sectors of society, such as agriculture, energy, transport, communication or civil protection, which rely, in a crisis situation, on well-prepared gender-sensitive public health systems that are also in turn dependent on the functioning of those sectors and on maintenance of essential services at an adequate level. In the event of a serious cross-border threat to health originating from a zoonotic infection, it is important to ensure the interoperability between the health and veterinary sectors for prevention, preparedness and response planning through the One Health approach. The obligations of Member States to provide information under this Regulation do not affect the application of Article 346 (1), point (a), of the Treaty on the Functioning of the European Union (TFEU) pursuant to which no Member State is obliged to supply information the disclosure of which it considers contrary to the essential interests of its security.

Experience from the ongoing COVID-19 pandemic has demonstrated that there is a need for further firmer action at Union level to support cooperation and coordination among the Member States, in particular between neighbouring border regions. The national prevention, preparedness and response plans of Member States sharing a border with at least one other Member State should therefore include plans to improve the preparedness for, prevention of and response to health crises in border areas in neighbouring regions, including through cross-border training for healthcare staff and coordination exercises for the medical transfer of patients.

Health literacy plays a fundamental role in preventing and mitigating the impact of cross-border threats to health and contributing to a better understanding on the part of the population of the countermeasures for and risk assessment of different threats. Health education campaigns based on the latest available evidence could help to improve population behaviour in this regard.

Building on lessons learnt from the COVID-19 pandemic, this Regulation should create a more robust mandate for coordination at Union level. The declaration of a public health emergency at Union level would trigger increased coordination and could enable the timely development, stockpiling and joint procurement of medical countermeasures, under Council Regulation (EU) 2022/2372 (8).

This Regulation should strengthen the tools to safeguard the security of supply of critical medical countermeasures within the Union, while respecting the proper functioning of the internal market in the event that serious cross-border threats to health arise.

In order to prevent shortages of critical medical countermeasures and protect the security of their supply at Union and national levels, as well as to support an effective and strategic stockpile location, the Commission should ensure coordination and information exchange between the entities organising and participating in any action under the different mechanisms established under this Regulation and other relevant Union structures related to procurement and stockpiling of medical countermeasures, such as the framework of measures adopted under Regulation (EU) 2022/2372, and the strategic rescEU reserve established under Decision No 1313/2013/EU of the European Parliament and of the Council (9), taking due account of the accessibility of those medical countermeasures for people in remote, rural and outermost regions.

A Joint Procurement Agreement for medical countermeasures was approved by the Commission on 10 April 2014. That Joint Procurement Agreement provides for a voluntary mechanism for participating countries and the Union institutions to jointly purchase medical countermeasures for different categories of cross-border threats to health including vaccines, antivirals and other treatments. It lays down common rules for the practical organisation of joint procurement procedures. This Regulation should strengthen and extend the framework for joint procurement of medical countermeasures, in accordance with measures concerning monitoring, early warning of and combatting serious cross-border threats to health, laid down in Regulation (EU, Euratom) 2018/1046 of the European Parliament and of the Council (10). In the event of a serious cross-border threat to health, the joint procurement of medical countermeasures laid down in this Regulation should constitute an effective operational instrument at the Union’s disposal, together with other procurement instruments provided for in Union legislation. In particular, contracts under the joint procurement procedure laid down in this Regulation may be concluded or activated in times of crisis, pursuant to Regulation (EU) 2022/2372. In such instances, those contracts should abide by the conditions laid down in the Joint Procurement Agreement, as provided for in this Regulation. The Commission should ensure coordination and information exchange between the entities organising and participating in any action under the different mechanisms established under this Regulation and other relevant Union acts related to procurement and stockpiling of medical countermeasures.

The Commission should support and facilitate the joint procurement of medical countermeasures by providing all relevant information for the negotiation of such joint procurement, such as information on envisaged prices, manufacturers, delivery time frames and modalities of joint procurement. The Joint Procurement Agreement determining the practical arrangements governing the joint procurement procedure established under Article 5 of Decision No 1082/2013/EU should also be adapted to provide for an exclusivity clause regarding negotiation and procurement for participating countries in a joint procurement procedure, to allow for better coordination within the Union, a strengthened negotiation position and more efficient action to protect the Union's security of supply. Under the exclusivity clause, participating countries commit to not procuring the medical countermeasure in question through other channels and to not running parallel negotiation processes for that countermeasure. The Commission should facilitate the decision of Member States on participation by providing an assessment, inter alia, of the application of the exclusivity clause, its necessity and the conditions thereof, to be jointly agreed with the participating countries. Member States should decide on their participation in the joint procurement procedure once all the necessary information has been provided to them. In any event, limitations to parallel procurement activities and negotiations should occur only when the participating countries have agreed to such restrictions. Due to the sensitive content of the assessment and its relevance for the financial interests of the Union and the participating Member States during a joint procurement procedure, the possibility of making it public should be duly weighed against the exceptions provided for in Regulation (EC) No 1049/2001 of the European Parliament and of the Council (11), and, in particular, Article 4 of that Regulation.

As serious cross-border threats to health are not limited to Union borders, the Union should adopt a coordinated approach, characterised by solidarity and responsibility, in combatting such threats. Therefore, joint procurement of medical countermeasures should be extended to include European Free Trade Association States, Union candidate countries, in accordance with applicable Union legislation, the Principality of Andorra, the Principality of Monaco, the Republic of San Marino and the Vatican City State, by way of derogation from Article 165(2) of Regulation (EU, Euratom) 2018/1046 and in accordance with Article 3(2) of that Regulation. Joint procurement of medical countermeasures is aimed at strengthening the negotiating position of participating countries, contributing to the contracting authorities’ security of supply and ensuring equitable access to medical countermeasures against serious cross-border threats to health. Joint procurement procedures should abide by high standards of transparency in relation to Union institutions, including the European Court of Auditors, and Union citizens, in accordance with the principle of transparency as referred to in Article 15 TFEU. While taking into account the protection of commercially sensitive information and the protection of essential national security interests, transparency should also be encouraged in relation to the disclosure of information related to the delivery schedule of the medical countermeasures, terms of liabilities and indemnifications and the number of manufacturing locations. A high degree of transparency should be applied in accordance with Regulation (EC) No 1049/2001. This includes the right of citizens to request access to documents regarding jointly procured medical countermeasures in accordance with Article 2 of Regulation (EC) No 1049/2001. When joint procurement is deployed, in addition to cost, qualitative criteria should be considered in the award process.

Prevention is one of the essential steps in the crisis management cycle, according to the WHO. Under the four categories of prevention that have been recognised at the international level, namely primary, secondary, tertiary and quaternary categories, a number of activities constitute a cornerstone for early warning of, monitoring and combatting serious cross-border threats to health. Those activities include the monitoring of vaccination coverage for communicable diseases, surveillance systems for the prevention of communicable diseases and measures to decrease the risk of communicable disease spreading at the personal and community levels, in line with the One Health approach. Investment in prevention activities in relation to serious cross-border threats to health would directly contribute to the objectives of this Regulation. The term ‘prevention’ or ‘disease prevention’ under this Regulation should therefore be understood as covering prevention activities which aim to minimise the burden of communicable diseases and associated risk factors for the purposes of early warning of, monitoring and combatting serious cross-border threats to health.

The strengthened Union health framework addressing serious cross-border threats to health should work in synergy with and in a manner that is complementary to other Union policies and funds, such as actions implemented under the EU4Health programme, established by Regulation (EU) 2021/522 of the European Parliament and of the Council (12); the European Structural and Investment Funds (ESIF), namely the European Regional Development Fund and the Cohesion Fund, established by Regulation (EU) 2021/1058 of the European Parliament and of the Council (13), the European Social Fund Plus, established by Regulation (EU) 2021/1057 of the European Parliament and of the Council (14), the European Agricultural Fund for Rural Development, established by Regulation (EU) No 1305/2013 of the European Parliament and of the Council (15), and the European Maritime, Fisheries and Aquaculture Fund, established by Regulation (EU) 2021/1139 of the European Parliament and of the Council (16); Horizon Europe, established by Regulation (EU) 2021/695 of the European Parliament and of the Council (17); the Digital Europe Programme, established by Regulation (EU) 2021/694 of the European Parliament and of the Council (18); the rescEU reserve; the Emergency Support Instrument (ESI), provided for in Council Regulation (EU) 2016/369 (19); and the Single Market Programme (SMP), established by Regulation (EU) 2021/690 of the European Parliament and of the Council (20).

The decision taken by the World Health Assembly during its Special Session on 1 December 2021 is set to start a global process for a WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response. In accordance with Council Decision (EU) 2022/451 (21), the Union should engage with the WHO and its Member States to develop a WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response. The Union will engage with the WHO and its Member States to develop a new legally binding instrument that complements the IHR, thereby strengthening multilateralism and the global health architecture. The Union should also support efforts to strengthen the implementation of and compliance with the IHR.

The COVID-19 pandemic has highlighted that major diseases can put severe pressure on the capacities of healthcare systems, with a negative impact, for example, on the provision of healthcare for patients with other communicable or non-communicable diseases, such as the continuity of healthcare, delay of or interruption to treatment for cancer patients and survivors and people with mental health issues. The impact of serious cross-border threats to health may thus pose further challenges in ensuring a high level of human health protection. While respecting the responsibilities of Member States for the definition of their health policy and for the organisation and delivery of health services and medical care, it is important to consider the impact of public health emergencies on the provision of healthcare services for other diseases and conditions, in order to safeguard the detection and treatment of other serious diseases and minimise delays or interruptions to such detection and treatment. Hence, the impact an important outbreak of a communicable disease, which absorbs an important part of health system capacities, can have on the continuity of healthcare and on the prevention and treatment of non-communicable diseases and comorbidities needs to be considered.

In times of crisis, ensuring the security of supply within the Union of critical medical countermeasures is paramount, and the experience derived from the COVID-19 pandemic has shown that this could be prejudiced by a number of factors. Union actions to safeguard commitments and protect the supply of medical countermeasures include, among others, an export authorisation mechanism pursuant to Regulation (EU) 2015/479 of the European Parliament and of the Council (22), enhanced cooperation agreements and procurement activities. Where relevant, actions taken under this Regulation should consider the potential activation of such mechanisms, pursuant to applicable Union legislation.

Unlike communicable diseases, the surveillance of which at Union level is carried out on a permanent basis by the ECDC, other serious cross-border threats to health do not currently necessitate systematic monitoring by Union agencies and bodies. A risk-based approach, whereby monitoring is carried out by Member States’ monitoring systems and available information is exchanged through the EWRS, is therefore more appropriate to those threats.

The Commission should strengthen cooperation and activities with the Member States, the ECDC, EMA, other Union agencies or bodies, research infrastructures and the WHO to improve, through the One Health approach, the prevention of communicable diseases, such as vaccine preventable diseases, as well as other health issues, such as antimicrobial resistance.

In the case of cross-border threats to health posed by a communicable disease, the ECDC should cooperate with Member States to safeguard patients in need of treatment by substances of human origin from the transmission of such a communicable disease. The ECDC should therefore establish and operate a network of services supporting the use of substances of human origin.

The EWRS, a system enabling the notification at Union level of alerts related to serious cross-border threats to health, has been put in place by Decision No 1082/2013/EU in order to ensure that competent public health authorities in Member States and the Commission are duly informed in a timely manner. All serious cross-border threats to health covered by this Regulation are covered by the EWRS.

In order to foster the effectiveness of alert systems for cross-border threats to health, the Commission should be encouraged to integrate information in an automatic manner from different important databases, such as those comprising environmental data, climate data, water irrigation data and other data relevant to serious cross-border threats to health, which could facilitate understanding and mitigate the risk of potential health threats. The operation of the EWRS should remain within the remit of the ECDC. The notification of an alert should be required only where the scale and severity of the threat concerned are or could become so significant that they affect or could affect more than one Member State and require or could require a coordinated response at Union level. The EWRS should be further developed and improved to augment the automation of information collection and analysis, reduce the administrative burden and improve the standardisation of the notifications. To avoid duplication and ensure coordination across Union alert systems, the Commission and the ECDC should ensure that alert notifications under the EWRS and other rapid alert systems at Union level are interoperable and, subject to human oversight, automatically linked to each other to the extent possible so that the competent authorities of the Member States can avoid as much as possible notifying the same alert through different systems at Union level and can benefit from receiving all-hazard alerts from a single coordinated source. Those national authorities should notify the relevant serious cross-border threats to health events in the EWRS. It allows simultaneous notification to be provided to the WHO of events that may constitute public health emergencies of international concern in accordance with Article 6 of the IHR.

In order to ensure that the assessment of risks to public health at Union level from serious cross-border threats to health is consistent as well as comprehensive from a public health perspective, the available scientific expertise should be mobilised in a coordinated and multidisciplinary manner through appropriate channels or structures, depending on the type of threat concerned. That assessment of risks to public health should be developed by means of a fully transparent process and should be based on principles of excellence, independence, impartiality and transparency. The involvement of Union agencies and bodies in those risk assessments needs to be broadened according to their speciality in order to ensure an all-hazard approach, via a permanent network of agencies and bodies and relevant Commission services to support the preparation of risk assessments. It is important that the Commission, at the request of the HSC or on its own initiative, and in close cooperation with the relevant Union agencies and bodies or Commission services, provide any relevant information, data and expertise at its disposal. Serious cross-border threats to health could require a multidisciplinary approach for their assessment and analysis, and coordination among Union agencies and bodies or Commission services might therefore be essential to ensure a swift and coordinated reaction. Where relevant, such coordination could, in particular, take the form of a multi-source risk assessment under the lead of a particular Union agency or body designated by the Commission. Union agencies and bodies should have adequate financial and human resources to achieve a sufficient degree of expertise and effectiveness in the framework of their mandates.

Member States, the Commission and Union agencies and bodies, while following the One Health approach, should identify recognised public health organisations and experts, and other relevant stakeholders across sectors, which are available to assist in Union responses to health threats. Such experts and stakeholders, including civil society organisations, should be engaged in the context of Union preparedness and response activities to contribute, where relevant, to the decision-making processes. National authorities should also consult and involve representatives of patient organisations and national social partners in the healthcare and social services sector in the implementation of this Regulation, where appropriate. It is essential that there be full compliance with transparency and conflict of interest rules for stakeholder engagement.

Member States have a responsibility to manage public health crises at national level. However, measures taken by individual Member States could affect other Member States if they are inconsistent with one another or based on diverging risk assessments. The objective of coordinating the response at Union level should, therefore, seek to ensure, inter alia, that measures taken at national level are proportionate and limited to public health risks related to serious cross-border threats to health, and do not conflict with obligations and rights laid down in the TFEU, such as those related to free movement of persons, goods and services.

The HSC, which is responsible for the coordination of response at Union level, should assume additional responsibility for the adoption of opinions and guidance for Member States related to the prevention and control of serious cross-border threats to health. Furthermore, should the coordination of national public health measures prove insufficient to ensure an adequate Union response, the Commission should further support Member States via the adoption of recommendations on temporary public health measures. In addition, regular dialogue between the HSC and relevant Council bodies should be reinforced in order to ensure better follow-up of the HSC's work at national level.

Inconsistent communication with the public and stakeholders, such as healthcare and public health professionals, can have a negative impact on the effectiveness of the response from a public health perspective, as well as on economic operators. The coordination of the response within the HSC, assisted by relevant subgroups, should, therefore, encompass rapid information exchange concerning communication messages and strategies and address communication challenges with a view to coordinating risk and crisis communication, based on holistic, robust and independent evaluation of public health risks, to be adapted to national and regional needs and circumstances where relevant. Such exchanges of information are intended to facilitate the monitoring of the clarity and coherence of messages to the public and to healthcare professionals. To that end, relevant public institutions should contribute to sharing verified information and fighting disinformation. Given the cross-sectoral nature of health-related crises, coordination should also be ensured with other relevant constituencies, such as the EU Civil Protection Community.

The recognition of public health emergencies and the legal effects of this recognition provided for in Decision No 1082/2013/EU should be broadened. To that end, this Regulation should allow for the Commission to formally recognise a public health emergency at Union level. In order to recognise such an emergency, the Commission should establish an independent advisory committee that will provide expertise on whether a threat constitutes a public health emergency at Union level, and advise on public health response measures and on the termination of such emergency recognition. The advisory committee should consist of independent experts, including representatives of healthcare and social care workers and civil society representatives, selected by the Commission from the fields of expertise and experience most relevant to the specific threat that is occurring. Representatives of the Member States, of the ECDC, of EMA, and of other Union agencies or bodies or of the WHO, should be able to participate as observers. All members of the Advisory Committee should provide declarations of interest. Recognition of a public health emergency at Union level should provide the basis for introducing operational public health measures for medicinal products and medical devices, flexible mechanisms to develop, procure, manage and deploy medical countermeasures as well as the activation of support from the ECDC to mobilise and deploy outbreak assistance teams, known as the ‘EU Health Task Force’.

Before recognising a public health emergency at Union level, the Commission should liaise with the WHO in order to share the Commission’s analysis of the outbreak and to inform the WHO of its intention to adopt such a recognition decision. Where such a recognition decision is adopted, the Commission should also inform the WHO thereof.

The occurrence of an event that corresponds to a serious cross-border threat to health and is likely to have Union-wide consequences should require the Member States concerned to take particular control or contact-tracing measures in a coordinated manner in order to identify people already contaminated and those persons exposed to risk. Such coordination could require the exchange of personal data, including sensitive information related to health and information about confirmed or suspected human cases of the disease or infection, between those Member States directly involved in the contact-tracing measures.

Cooperation with third countries and international organisations in the field of public health should be fostered. It is particularly important to ensure the exchange of information with the WHO on the measures taken pursuant to this Regulation. This reinforced cooperation is also required to contribute to the Union’s commitment to strengthening support to health systems and reinforcing partners’ preparedness and response capacity. The Union could benefit from concluding international cooperation agreements with third countries or international organisations, including the WHO, to foster the exchange of relevant information from monitoring and alert systems on serious cross-border threats to health. Within the limits of the Union’s competences, such agreements could include, where appropriate, the participation of such third countries or international organisations in the relevant epidemiological surveillance monitoring network, such as the European Surveillance Portal for Infectious Diseases, operated by the ECDC, and the EWRS, exchange of good practice in the areas of preparedness and response capacity and planning, public health risk-assessment and collaboration on response coordination, including the research response. Those international cooperation agreements could also facilitate the donation of medical countermeasures, in particular for the benefit of low- and middle-income countries.

Any processing of personal data for the purpose of implementing this Regulation should be fully compliant with Regulation (EU) 2016/679, Regulation (EU) 2018/1725 of the European Parliament and of the Council (23) and Directive 2002/58/EC of the European Parliament and of the Council (24). Processing of personal data should be limited to what is strictly necessary and, whenever possible, those data should be anonymised. In particular, the operation of the EWRS should provide for specific safeguards for the safe and lawful exchange of personal data for the purpose of contact-tracing measures implemented by Member States at national level. In this regard, the EWRS includes a messaging function in which personal data, including contact and health data, can be communicated where necessary to relevant authorities involved in contact-tracing measures, medical evacuation or other cross-border procedures. In the case of cooperation between the health authorities of the Union and third countries, the WHO or other international organisations, transfers of personal data to third countries or international organisations should always comply with the obligations laid down under Regulation (EU) 2018/1725.

In order to avoid an administrative burden and the duplication of efforts, overlap of reporting and reviewing activities with existing structures and mechanisms for prevention, preparedness and response planning and implementation at national level in relation to serious cross-border threats to health should be avoided as far as possible. To that end, Member States should not be requested to report data and information if already required by the Commission or other Union agencies and bodies, pursuant to applicable Union legislation. In addition, the Union should further enhance its cooperation with the WHO, in particular under the IHR reporting, monitoring and evaluation frameworks.

Since the objectives of this Regulation, namely to address serious cross-border threats to health and the consequences thereof, cannot be sufficiently achieved by the Member States but can rather be better achieved at Union level, the Union may adopt measures, in accordance with the principle of subsidiarity as set out in Article 5 of the Treaty on European Union. In accordance with the principle of proportionality, as set out in that Article, this Regulation does not go beyond what is necessary in order to achieve those objectives.

As responsibility for public health is not an exclusively national matter in certain Member States, but is substantially decentralised, national authorities should, where appropriate, involve the relevant competent authorities in the implementation of this Regulation.

In order to ensure uniform conditions for the implementation of this Regulation, implementing powers should be conferred on the Commission in relation to: templates to be used when providing the information on preparedness and response planning; the organisation of the training activities and programmes for healthcare and public health staff; the establishment and updating of a list of communicable diseases and related special health issues subject to the network of epidemiological surveillance and the procedures for the operation of such a network; the adoption of case definitions for those communicable diseases and special health issues covered by the epidemiological surveillance network and, where necessary, for other serious cross-border threats to health subject to ad hoc monitoring; the functioning of the digital platform for surveillance; the designation of EU reference laboratories to provide support to national reference laboratories; the procedures for the information exchange, for consultation with Member States and for coordination of the responses of the Member States; the recognition of public health emergencies at Union level and the termination of such a recognition; the procedures for the interlinking of the EWRS with contact-tracing systems and the procedures necessary to ensure that the processing of data is in accordance with the data protection legislation.

Those powers should be exercised in accordance with Regulation (EU) No 182/2011 of the European Parliament and of the Council (25). As the implementing acts provided for in this Regulation concern the protection of human health, the Commission cannot adopt a draft implementing act where the Committee on serious cross-border threats to health delivers no opinion, in accordance with Article 5(4), second subparagraph, point (a), of Regulation (EU) No 182/2011.

The Commission should adopt immediately applicable implementing acts where, in duly justified cases relating to the severity or novelty of a serious cross-border threat to health or to the rapidity of its spread between the Member States, imperative grounds of urgency so require.

In order to supplement certain aspects of this Regulation and to assess the state of implementation of the national preparedness plans and their coherence with the Union plan, the power to adopt acts in accordance with Article 290 TFEU should be delegated to the Commission in respect of: the cases and the conditions under which third countries and international organisations can be granted partial access to the functionalities of the digital platform for surveillance, certain data, information and documents which can be transmitted using the platform and the conditions under which the ECDC can participate and be granted access to the health data accessed or exchanged through digital infrastructure, the detailed requirements necessary to ensure that the operation of the EWRS and the processing of data complies with the data protection regulations, a list of categories of personal data that might be exchanged for the purpose of contact tracing and the procedures, standards and criteria for the assessment of the prevention, preparedness and response planning at national level. It is of particular importance that the Commission carry out appropriate consultations during its preparatory work, including at expert level, and that those consultations be conducted in accordance with the principles laid down in the Interinstitutional Agreement of 13 April 2016 on Better Law-Making (26). In particular, to ensure equal participation in the preparation of delegated acts, the European Parliament and the Council receive all documents at the same time as Member States' experts, and their experts systematically have access to meetings of Commission expert groups dealing with the preparation of delegated acts.

The European Data Protection Supervisor was consulted in accordance with Article 42(1) of Regulation (EU) 2018/1725 and published formal comments on its website on 8 March 2021.

This Regulation fully respects the fundamental rights and principles recognised by the Charter of Fundamental Rights of the European Union.

Decision No 1082/2013/EU should therefore be repealed and replaced by this Regulation,

the Health Security Committee (HSC);

prevention, preparedness and response planning, including;

joint procurement of medical countermeasures;

emergency research and innovation;

epidemiological surveillance and monitoring;

the network for epidemiological surveillance;

the Early Warning and Response System (EWRS);

risk assessment;

coordination of response; and

recognition of a public health emergency at Union level.

a network of EU reference laboratories for public health;

a network for substances of human origin; and

an advisory committee for the occurrence and recognition of a public health emergency at Union level.

threats of biological origin, consisting of:

threats of chemical origin;

threats of environmental origin, including those due to the climate;

threats of unknown origin; and

events which may constitute public health emergencies of international concern under the International Health Regulations (IHR) (‘public health emergencies of international concern’), provided that they fall under one of the categories of threats set out in points (a) to (d).

‘serious cross-border threat to health’ means a life-threatening or otherwise serious hazard to health of biological, chemical, environmental or unknown origin, as referred to in Article 2(1), which spreads or entails a significant risk of spreading across the national borders of Member States, and which may necessitate coordination at Union level in order to ensure a high level of human health protection;

‘case definition’ means a set of commonly agreed diagnostic criteria that have to be fulfilled in order to accurately identify cases of a serious cross-border threat to health in a given population, while excluding the detection of unrelated threats;

‘communicable disease’ means an infectious disease caused by a contagious agent which is transmitted from person to person by direct contact with an infected individual or by indirect means such as exposure to a vector, animal, fomite, product or environment, or exchange of fluid, which is contaminated with the contagious agent;

‘contact tracing’ means measures to identify persons who have been exposed to a source of a serious cross-border threat to health, and who are in danger of being infected or being infectious or who have developed a communicable disease, through manual or other technological means, with the sole objective of rapidly identifying potentially newly infected persons who may have come into contact with existing cases, in order to reduce further onward transmission;

‘epidemiological surveillance’ means the systematic collection, recording, analysis, interpretation and dissemination of data and analysis on communicable diseases and related special health issues;

‘monitoring’ means the continuous observation, detection or review of changes in a condition, in a situation, or in activities, including a continuous function that uses systematic collection of data on and analysis of specified indicators relating to serious cross-border threats to health;

‘One Health’ means a multi-sectoral approach which recognises that human health is connected to animal health and to the environment, and that actions to tackle threats to health must take into account those three dimensions;

‘Health in All Policies’ means an approach to the development, implementation and review of public policies, regardless of the sector, whereby the health implications of decisions are taken into account, and which seeks to achieve synergies and to avoid harmful health impacts being caused by such policies, in order to improve the health of the population and health equity;

‘public health measure’ means a decision or an action which is aimed at preventing, monitoring or controlling the spread of diseases or contamination, combatting severe risks to public health or mitigating their impact on public health;

‘medical countermeasures’ means medicinal products for human use as defined in Directive 2001/83/EC of the European Parliament and of the Council (27), medical devices as defined in point 12 of this Article and other goods or services that are necessary for the purpose of preparedness for and response to serious cross-border threats to health;

'International Health Regulations' means the International Health Regulations (IHR) adopted by the World Health Organization (WHO) in 2005;

‘medical device’ means both a medical device as defined in Article 2, point (1), of Regulation (EU) 2017/745 of the European Parliament and of the Council (28), read in conjunction with Article 1(2) and Article 1(6), point (a), of that Regulation, and an in vitro diagnostic medical device as defined in Article 2, point (2), of Regulation (EU) 2017/746 of the European Parliament and of the Council (29);

‘health system capacity’ means the degree to which a health system maximizes its performance on the following six health system core components or building blocks: (i) service delivery, (ii) health workforce, (iii) health information systems, (iv) access to medical countermeasures, (v) financing, and (vi) leadership/governance; for the purposes of this Regulation, this definition applies only to the parts of health system components or building blocks affected by serious cross-border threats to health.

a senior level working group for regular discussions on serious cross-border threats to health and for the adoption of opinions and guidance as referred to in paragraph 3, point (d); and

technical working groups to discuss specific topics if necessary.

enabling coordinated action by the Commission and the Member States for the implementation of this Regulation;

coordinating in liaison with the Commission prevention, preparedness and response planning in accordance with Article 10;

coordinating in liaison with the Commission the risk and crisis communication and responses of the Member States to serious cross-border threats to health, in accordance with Article 21;

adopting opinions and guidance, including on specific response measures, for the Member States for the prevention and control of serious cross-border threats to health, based on the expert opinion of relevant technical Union agencies or bodies; and

adopting, on an annual basis, a work programme setting its priorities and objectives.

the procedures for plenary meetings;

the participation of experts in plenary meetings, the status of possible observers, including from the European Parliament, Union agencies and bodies, third countries and the WHO; and

the examination by the HSC of the relevance to its mandate of a matter submitted to it and the possibility of recommending referral of that matter to a body competent under a provision of another act of the Union or under the Euratom Treaty.

the timely cooperation between the Commission, the Council, the Member States, the HSC and the relevant Union agencies or bodies. The Union prevention, preparedness and response plan shall take into account the services and support potentially available under the Union Civil Protection Mechanism, and, in particular, the capacities under the rescEU stockpile as laid down in Commission Implementing Decision (EU) 2019/570 (30) or other mechanisms, the capacities and resources made available for its purposes by the Union and the Member States, and the cooperation with the WHO for cross-border threats to health;

the secure exchange of information between the Commission, the Member States, in particular the competent authorities or designated bodies responsible at national level, the HSC and the relevant Union agencies or bodies;

the epidemiological surveillance and monitoring;

the early warning and risk assessment, especially regarding cross-border interregional preparedness and response;

the risk and crisis communication, including to health professionals and citizens;

the health preparedness and response and multi-sectoral collaboration, such as identifying risk factors for disease transmission and the associated disease burden, including social, economic and environmental determinants, following the One Health approach for zoonotic, food and waterborne diseases and relevant other diseases and related special health issues;

the drawing up of an overview of the production capacities for relevant critical medical countermeasures in the Union as a whole to address serious cross-border threats to health as referred to in Article 2;

emergency research and innovation;

the management of the plan; and

support to Member States for the monitoring of the impact of a serious cross-border threat to health on the provision and continuity of healthcare services, including for other diseases and conditions during health emergencies.

identification of, and an update on, the status of the implementation of the capacity standards for prevention, preparedness and response planning as determined at national and, where appropriate, cross-border interregional level for the health sector, as provided to the WHO in accordance with the IHR, as well as, where available, the interoperability arrangements between the health sector and other critical sectors in emergency situations;

an update, where necessary, on the elements of emergency prevention, preparedness and response planning, in particular:

implementation of national prevention, preparedness and response plans, including where relevant implementation at the regional and, if appropriate, local levels, covering epidemic response; antimicrobial resistance, healthcare-associated infection, and the other serious cross-border threats to health as referred to in Article 2;

where applicable, consultation with relevant partners on risk assessment and national prevention, preparedness and response plans; and

actions taken to improve gaps found in the implementation of national prevention, preparedness and response plans.

regulatory actions, if necessary;

training initiatives;

an overview of good practices.

share best practice and experience in prevention, preparedness and response planning;

promote the interoperability of national prevention and preparedness planning and the multi-sectoral dimension of prevention, preparedness and response planning at Union level;

support the implementation of capacity requirements for surveillance and response as referred to in the IHR;

support the development of the prevention, preparedness and response plans referred to in Articles 5 and 6;

monitor and discuss progress for gaps identified and actions to strengthen prevention, preparedness and response planning, including in the field of research, at cross-border regional, national and Union levels; and

facilitate the exchange, outside the joint procurement procedure laid down in Article 12, of information on medical countermeasures, including, where appropriate, on pricing and delivery dates.

participation in the joint procurement procedure is open to all Member States, European Free Trade Association States and Union candidate countries, as well as the Principality of Andorra, the Principality of Monaco, the Republic of San Marino and the Vatican City State, by way of derogation from Article 165(2) of Regulation (EU, Euratom) 2018/1046;

the rights and obligations of the countries referred to in point (a) that do not participate in the joint procurement are respected, in particular those relating to the protection and improvement of human health;

before the launch of a joint procurement procedure, the Commission prepares a joint procurement assessment which shall indicate the general envisaged conditions of the joint procurement procedure, including as regards possible restrictions to parallel procurement and negotiation activities by the participating countries for the countermeasure in question during the specific joint procurement procedure; that assessment shall take into account the need to ensure security of supply of medical countermeasures concerned to the participating countries. Based on the joint procurement assessment and the relevant information provided therein, such as on envisaged price ranges, manufacturers, delivery time frames and the proposed deadline for decision on participation, the parties to the Joint Procurement Agreement shall express their interest in participating at an early stage. Those parties to the Joint Procurement Agreement which have expressed their interest shall subsequently decide on their participation in the joint procurement procedure under the conditions jointly agreed with the Commission, taking into account the information proposed in the joint procurement assessment;

the joint procurement does not affect the internal market, does not constitute discrimination or a restriction of trade and does not cause distortion of competition; and

the joint procurement does not have any direct financial impact on the budget of the countries referred to in point (a) that do not participate in the joint procurement.

stockpiling under rescEU referred to in Article 12 of Decision No 1313/2013/EU;

Regulation (EU) 2016/369;

the Pharmaceutical Strategy for Europe;

the EU4Health Programme established by Regulation (EU) 2021/522;

Regulation (EU) 2021/697 of the European Parliament and of the Council (34); and

other programmes and instruments supporting biomedical research and development at Union level for enhanced capacity and readiness to respond to cross-border threats and emergencies, such as measures adopted under Regulation (EU) 2022/2372.

monitor trends in communicable diseases over time, across Member States and in third countries, to assess the situation, respond to rises above warning thresholds and facilitate appropriate evidence-based action;

detect and monitor any cross-border communicable disease outbreaks with regard to source, time, population and place in order to provide a rationale for public health action;

contribute to the evaluation and monitoring of communicable disease prevention and control programmes in order to provide the evidence for recommendations to strengthen and improve those programmes at the national and Union levels;

identify and monitor risk factors for disease transmission, and population groups at risk and in need of targeted prevention measures;

contribute to the assessment of the burden of communicable diseases on the population, using such data as disease prevalence, complications, hospitalisation and mortality;

contribute to the assessment of the capacity of health systems to diagnose, prevent and treat specific communicable diseases, with the objective of contributing to patient safety in the context of serious cross-border threats to health;

contribute to modelling and scenario development for response;

contribute to the identification of research priorities and needs, and implement relevant research activities aimed at strengthening public health; and

support the contact-tracing measures of competent health authorities.

comparable and compatible data and information in relation to the epidemiological surveillance of communicable diseases and related special health issues referred to in Article 2(1), points (a)(i) and (a)(ii);

relevant information concerning the progression of epidemic situations, including for modelling and scenario development;

relevant information concerning unusual epidemic phenomena or new communicable diseases of unknown origin, including those in third countries;

molecular pathogen data, if required for detecting or investigating serious cross-border threats to health;

health systems data required for managing serious cross-border threats to health; and

information about contact-tracing monitoring systems developed at national level.

the list, on the basis of the criteria listed in Section 1 of Annex I, of communicable diseases and related special health issues referred to in Article 2(1), points (a)(i) and (a)(ii), in order to ensure coverage of communicable diseases and related special health issues by the network for epidemiological surveillance;

case definitions, on the basis of the criteria listed in Section 2 of Annex I, concerning each communicable disease and related special health issue subject to epidemiological surveillance, in order to ensure the comparability and compatibility at Union level of the collected data; and

procedures, as set out in Section 3 of Annex I to this Regulation, for the operation of the network for epidemiological surveillance, as developed pursuant to Article 5 of Regulation (EC) No 851/2004.

enable the automated collection of surveillance and laboratory data, make use of relevant non-personal health data from a previously defined and authorised list from electronic health records and health databases, and of media monitoring, and apply artificial intelligence for data validation, analysis and automated reporting, including statistical reporting; and

allow for the computerised handling and exchange of information, data and documents.

the technical specifications of the digital platform for surveillance, including the electronic data exchange mechanism for exchanges with existing international and national systems, identification of applicable standards, definition of message structures, data dictionaries, exchange of protocols and procedures;

the specific rules for the functioning of the digital platform for surveillance, including for the protection of personal data and security of exchange of information;

contingency arrangements including secure data backups to be applied in the event of unavailability of any of the functionalities of the digital platform for surveillance; and

arrangements for promoting standardisation of the infrastructure for storage, processing and analysis of data.

the cases where, and the conditions under which, the third countries and international organisations concerned may be granted partial access to the functionalities of the digital platform for surveillance and the practical arrangements for such access;

the cases where, and the conditions under which, the data, information and documents referred to in Article 13 are to be transmitted using the digital platform for surveillance and the list of such data, information and documents; and

the conditions under which the ECDC can participate and be granted access to health data accessed or exchanged through the digital infrastructure referred to in paragraph 5.

reference diagnostics, including test protocols;

reference material resources;

external quality assessments;

scientific advice and technical assistance;

collaboration and research;

monitoring, alert notifications and support in outbreak response, including to emerging communicable diseases and pathogenic bacteria and viruses; and

training.

be impartial, free from any conflict of interest, and, in particular, not be in a situation which may, directly or indirectly, affect the impartiality of their professional conduct as regards the exercise of their tasks as EU reference laboratories;

have, or have contractual access to, suitably qualified staff with adequate training in their area of competence;

possess, or have access to, the infrastructure, equipment and products necessary to carry out the tasks assigned to them;

ensure that their staff and any contractually engaged staff have good knowledge of international standards and practices, and that the latest developments in research at national, Union and international levels are taken into account in their work;

be equipped, or have access to, the necessary equipment to perform their tasks in emergency situations; and

where relevant, be equipped to comply with relevant biosecurity standards.

the processing of personal data of authorised users of the system; and

the processing of health data and other personal data when strictly necessary for the purpose for which those data were transmitted, through the EWRS selective messaging functionality, in accordance with Article 28.

it is unusual or unexpected for the given place and time, it is causing or may cause significant morbidity or mortality in humans, it is growing rapidly or may grow rapidly in scale, or it is exceeding or may exceed national response capacity;

it affects or may affect more than one Member State; and

it requires or may require a coordinated response at Union level.

the type and origin of the agent;

the date and place of the incident or outbreak;

means of transmission or dissemination;

toxicological data;

detection and confirmation methods;

public health risks;

public health measures implemented or intended to be taken at national level;

measures other than public health measures, including multi-sectoral measures;

whether there is an urgent need for or shortage of medical countermeasures;

requests and offers for cross-border emergency assistance, such as the medical transfer of patients or provision of healthcare staff by one Member State to another, in particular in cross-border areas in neighbouring regions;

personal data necessary for the purpose of contact tracing in accordance with Article 28;

any other information relevant to the serious cross-border threat to health in question.

the ECDC, in accordance with Article 8a of Regulation (EC) No 851/2004, in the case of a serious cross-border threat to health referred to in Article 2(1), points (a)(i) and (a)(ii), including where it relates to substances of human origin that can potentially be impacted by communicable diseases, or in Article 2(1), point (d), of this Regulation;

the European Medicines Agency (EMA), in accordance with Article 1 of Regulation (EU) 2022/123 of the European Parliament and of the Council (37), where the serious cross-border threat to health is linked to medicinal products and medical devices;

the European Food Safety Authority (EFSA), in accordance with Article 23 of Regulation (EC) No 178/2002 of the European Parliament and of the Council (38), in the case of a serious cross-border threat to health referred to in Article 2 of this Regulation where that threat falls under the mandate of EFSA;

the European Chemicals Agency (ECHA), in accordance with Regulation (EC) No 1907/2006 of the European Parliament and of the Council (39), in the case of a serious cross-border threat to health referred to in Article 2(1), point (b) or (c), of this Regulation where that threat falls under the mandate of the ECHA;

the European Environment Agency (EEA), in accordance with Regulation (EC) No 401/2009 of the European Parliament and of the Council (40), in the case of a serious cross-border threat to health referred to in Article 2(1), point (c), of this Regulation, where that threat falls under the mandate of the EEA;

the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), in accordance with Regulation (EC) No 1920/2006 of the European Parliament and of the Council (41), in the case of a serious cross-border threat to health referred to in Article 2(1), point (b), of this Regulation, where that threat falls under the mandate of the EMCDDA.

national responses, including research needs, to the serious cross-border threat to health, including where a public health emergency of international concern is declared in accordance with the IHR and falls within Article 2 of this Regulation;

risk and crisis communication, to be adapted to Member State needs and circumstances, aimed at providing consistent and coordinated information in the Union to the public, to healthcare professionals and public health professionals;

the adoption of opinions and guidance, including on specific response measures for the Member States for the prevention and control of a serious cross-border threat to health, based on the expert opinion of relevant technical Union agencies or bodies; and

support for the EU Integrated Political Crisis Response Arrangements (IPCR) as referred to in Council Decision 2014/415/EU (43) in the event of its activation.

be based on, in particular, recommendations of the ECDC and the WHO, other relevant Union agencies or bodies, or the Advisory Committee referred to in Article 24;

respect the responsibilities of the Member States for the definition of their health policy and for the organisation and delivery of health services and medical care;

be necessary, suitable and proportionate to the public health risks related to the serious cross-border threat to health in question, avoiding, in particular, any unnecessary restriction on the free movement of persons, of goods and of services, and promote coordination of measures between Member States; and

be made available to the national competent authorities promptly through the EWRS and to the HSC, and, if appropriate, through linked alert systems; where the recommendation is to be made public, the national competent authorities shall receive it 24 hours prior to its publication, unless the need is so urgent that the immediate publication of the recommendation is necessary.

whether a threat constitutes a public health emergency at Union level;

the termination of a public health emergency at Union level; and

response, including:

measures, which are applicable during a public health emergency, related to medicinal products and medical devices provided for in Regulation (EU) 2022/123;

mechanisms to monitor shortages of, and to develop, procure, manage and deploy, medical countermeasures, in accordance with Article 12 of this Regulation and with applicable Union legislation, in particular Regulation (EU) 2022/123, and with Regulation (EU) 2022/2372;

activation of support from the ECDC as referred to in Regulation (EC) No 851/2004 to mobilise and deploy the EU Health Task Force; and

activation of the IPCR Arrangements.

detailed requirements necessary to ensure that the operation of the EWRS and the processing of data complies with Regulation (EU) 2016/679 and Regulation (EU) 2018/1725, including the respective responsibilities of the national competent authorities and of the ECDC; and

a list of the categories of personal data that may be exchanged for the purpose of the coordination of contact-tracing measures.

procedures for the interlinking of the EWRS with contact-tracing systems at Union and international levels; and

the modalities for processing contact-tracing technologies and their interoperability, as well as the cases where, and the conditions under which, the third countries may be granted access to contact-tracing interoperability and the practical arrangements for such access, in full compliance with Regulation (EU) 2016/679and the applicable case law of the Court of Justice of the European Union.

significant morbidity, significant mortality or emerging disease (increasing five-year trend) in a sizeable percentage of Member States;

potential to cause cross-border outbreaks;

high-threat pathogen (transmissibility and severity);

specifically targeted national or Union public health programmes in place that require monitoring and evaluation;

Union surveillance adds public health value to national surveillance systems other than what is implied in criteria 1 to 4.

clinical criteria;

laboratory criteria;

epidemiological criteria.

possible case;

probable case;

confirmed case.

membership and appointment;

terms of reference (detailing responsibilities of the national representatives and the ECDC secretariat of the network, including roles and tasks);

administrative, for example relating to the convening of meetings and decision-making, and technical work procedures, for example relating to data reporting mechanisms, tools and platforms, data analysis and dissemination; and

mechanism for periodic evaluation/review of administrative and technical work procedures.