EDITORIAL

Dear readers,

Welcome to this new issue of the EU HEALTHY GATEWAYS Joint Action Newsletter.In this issue you will notice a focus on the events the joint action organised as well as the events where the joint action was presented.  This joint action during the COVID-19 pandemic has managed to support the competent authorities in EUMS to respond to this crisis via the development of advice documents and the implementation of training courses and simulation exercises aiming to increase capacities at PoE. Two very successful workshops were organised by EU HEALTHY GATEWAYS; one focusing on the challenges and exchange of best practices in relation to public health measures at ground crossings and the second focusing on Chemical threats at Points of Entry. You can read more about those two workshops in the “Past Events” section. Read also in the  same section an abstract from a workshop titled “Coopera(c)tion” at points of entry – Joint COVID-19 efforts and lessons from the JA Healthy Gateways” organised jointly by the partners of the joint action.

Do not omit to read the news from the coordinator presenting the latest status of digital Passenger Locator Forms in Europe and also all the high level events the joint action was presented.

Training is one of the joint action’s core work packages and the work that is completed or currently under developed is presented under the Thematic Sections by our partners in RIVM. Last but not least please find in the section “Recent Publications” the latest advice documents published by EU HEALTHY GATEWAYS joint action.

Taking this opportunity, I would like to wish you all a very Merry Christmas and a Healthy and Prosperous New Year.

 

 

 

Brigita Kairiene

Advisor of Quality Management and Communication Department

National Public Health Centre under The Ministry of Health

 

NEWS FROM THE CONSORTIUM 

 

 

Prof. Christos Hadjichristodoulou

EU HEALTHY GATEWAYS Joint Action Coordinator, Professor of Hygiene and Epidemiology, Department of Hygiene and Epidemiology, Medical Faculty, University of Thessaly, Greece

 

The joint action is scheduled to end at the end of this year (December 2021). The HEALTHY GATEWAYS consortium has decided to proceed with a request to HADEA (contracting authority) and DG SANTE for a non-cost extension of the joint action by an additional four months, without a change to the overall joint action budget amount. The approval of the amendment by the Commission would mean that the joint action would end in April 2022. As the joint action has been heavily involved in the development of the EU digital Passenger Locator Form (EUdPLF) and most partners have heavy work burdens at national level related to COVID-19, the reason for this amendment is to allow more time to:

1. Finalize the remaining joint action deliverables
2. Partners to conduct national activities within the remaining joint action duration
3. Explore sustainability options for joint action outputs

 

COVID-19 pandemic, as well as past events including the Public Health Emergencies of International Concern from Ebola Virus Disease (2014), Zika Virus Disease (2016) and Pandemic H1N1 (2009), impacted ship, air and ground transport travel challenging authorities. In particular, the global community realised that inability to control an outbreak of a serious disease locally can lead to catastrophic effects globally. Authorities should be in a position to implement health measures proportionate to the public health risk including contact tracing, quarantine, isolation and others at the points of entry. Contact tracing is one of the most important health measures in controlling or interrupting transmission and managing outbreaks. Fast contact tracing is the key to increasing effectiveness of contact tracing. To achieve interruption of transmission via contact tracing, cases should be identified and tested as soon as possible and their contacts should be identified even before confirmation of test results.   However, international contact tracing in the travel sector poses many challenges and this became evident not only during the COVID-19 pandemic but also from previous infectious diseases such as measles, tuberculosis etc.  The major challenge that competent authorities face is to have access to accurate travel data in a timely manner so as to allow tracing of passengers crossing borders that may have been exposed to a SARS-CoV-2 infected person and informing them to take measures accordingly. To facilitate cross-border contract tracing in case travellers are exposed to an infectious disease during their journey Passenger Locator Forms (PLFs) are used. During the COVID-19 pandemic, PLFs have been commonly used by countries globally as a simple and effective tool for contact tracing and some countries nationally developed digital PLF systems. The development of digital PLFs allows for easier, more rapid data collection and exchange between all stakeholders, making contact tracing more effective and efficient.  EU HEALTHY GATEWAYS tasked by the Commission developed and is currently operating the European Union digital Passenger Locator Form with funds allocated by the joint action. The purpose of the EUdPLF is to create a single entry point and database for the digital collection of PLFs.

In addition, the European Commission had developed a technical infrastructure called the “‘EC PLF exchange platform (ePLF)’– to enable the secure, timely and effective exchange of data between the EWRS competent authorities of the Member States, by allowing to transmit information from their existing national digital PLF systems to other EWRS competent authorities in an interoperable and automatic manner” . On May 27^th 2021, the European Commission published the Implementing Decision 2021/858 setting up all provisions for the use of this exchange platform. In addition a Commission Implementing Decision 2021/1212 published on 12^th of July allows the sharing of exposed persons data.

 

The European Commission will be funding the continuation of the operation of the tool via a service contract for the next 13 months starting in December 2021. The tasks included in this service contract is maintenance, update and transfer of the EUdPLF tool to the EC IT environment. 

 

¹ European Commission. Implementing Decision (EU) 2021/858 of 27 May 2021 amending Implementing Decision (EU) 2017/253 as regards alerts triggered by serious cross-border threats to health and for the contact tracing of passengers identified through Passenger Locator Forms (Text with EEA relevance). 2021; Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A32021D0858.

 

² European Commission. COMMISSION IMPLEMENTING DECISION (EU) 2021/1212 of 22 July 2021 amending Implementing Decision (EU) 2017/253 as regards alerts triggered by serious cross-border threats to health and for the  contact tracing of exposed persons identified in the context of the completion of Passenger Locator Forms. 2021; Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A32021D1212.

 

To date (14/12/2021), four countries (Malta, Slovenia, Italy and France) use the EUdPLF and five countries are connected to ePLF (Malta, Slovenia and Italy, France and Spain) allowing fast, automated PLF data exchange improving the contact tracing capacities of EUMS.

Up until 15/10, a total of 12.798.354 passengers have submitted 15.443.142PLFs. Figure 1 shows the current situation concerning use of digital passenger locator forms in Europe.

Over the summer and autumn months, the partnership participated in a series of important events disseminating the achievements of the EU HEALTHY GATEWAYS joint action to the relevant stakeholders.

In particular, the EUHG participated at the WHO global technical consultation on public health and social measures during health emergencies held on 31^st August 2021 and a presentation was given by the Coordinator on public health and social measures in the transport sector: the EU HEALTHY GATEWAYS experience from policy to practice.

On 14^th September 2021 consortium members (Prof. Hadjichristodoulou, Dr Barbara Mouchtouri, Dr Janusz Janiec and Dr Claudia Marotta) participated in the Regional workshop on entry/exit screening - Science and practice. This workshop on entry/exit screening - science and practice was organised within the framework of the projects implemented by Frontex (EU4BorderSecurity) and ECDC (EU Initiative of Health Security), with a substantial support from the EU Healthy Gateways.

EU HEALTHY GATEWAYS was also represented by Dr Barbara Mouchtouri (leader of WP7:Maritime transport) and Mrs Brigita Kairiene (co-leader of WP5:Ground-crossing) in the Joint Regional Workshop on Health and Safety at the Border: Arab, European, and International perspectives organised by FRONTEX on 5-6 October 2021.

Finally a very successful workshop was organised by the consortium members under the 14th European Public Health Conference 2021 held on 12^th November 2021 and detailed information are presented in the other sections of this newsletter.

 

 

THEMATIC SECTIONS

 

Training

 

Author: Jorrit Kabel, Senior policy advisor, National Institute for Public Health and the Environment, Netherlands (Leaders of work package 9: Training)

 

Online Intra Action Reviews

Earlier this year we have successfully performed an Intra Action Review for both ports and airports in two 4-hour online meetings. Participants shared lessons learned and best practices and we had some good discussions on urgent topics, resulting in several joint actions. We made a video that gives an overview of the experiences with such an online IAR. (please find link for video here: http://upload.users.uth.gr/files/210603_IAR_Experience_NL_LQ.mp4)

 

Research project focusing on the cooperation between sectors at designated airports

Since 2020, airports had to prove more resilient, flexible and creative than ever to cope with the demands of the COVID-19 crisis. Because preparedness can be done only to some extent for new emerging diseases, it is the multi-sectoral organization at and around airports that has to be fit to deal with such unforeseen situations. We use the COVID-19 case to learn how different organizations within airports cooperate in these crisis times, and especially how the inter-sectoral cooperation is organized to mount an effective response. Five designated, European airports have joined this study. At these airports, we have invited all involved partners in the response to complete a questionnaire. This questionnaire focuses on their tasks in the response, their considerations when joining the joint response at the airport, and uses two fictious cases to study with what other partners at the airport they are in contact. Using this latter data, we can visualize the network of information provision. The data collection is now running. Results are expected before the end of 2021. We plan to publish the results of study, although anonymously. All joining airports in addition receive an overview of the results for their specific airport. If you wish to know more about the setup of this research project, please contact the research team via doret.de.rooij@rivm.nl.

 

Risk profile tool points of entries

As described under milestone 9.3, a tool will be developed to be able to assess the risk profile for different points of entry. The purpose of the tool is to assign a risk profile based on different vulnerability characteristics, which can serve as an indication for the level of capacities needed at the PoE. Last year, we conducted a study to collect the vulnerability characteristics, which will be used as a basis for the tool. In the coming months, we hope to make progress in gaining additional insights from PoE in the Netherlands to finalize the characteristics. Furthermore, the tool will be constructed and pilot tested. We hope that the tool can be a valuable addition to guide risk profiling and preparedness at PoE.

 

 

EVENTS

UPCOMING EVENTS OF THE JOINT ACTION

 

2^nd General Assembly/Final Conference

The 2^nd General Assembly/Final Conference for Thursday March 10th – Friday March 11th 2022. It is planned that the meetings will take place in a hybrid format (with both face to face and distance participation) on board a cruise ship in Piraeus, Greece. Further information will be provided in due time.

 

PAST EVENTS OF THE JOINT ACTION

 

Webinar: Interim advice for restarting river cruise ship operations and experiences during the COVID-19 pandemic

 

A webinar organised by EU HEALTHY GATEWAYS was broadcasted live on Friday 17^th December 2021 introducing the advise document for restarting river cruise ship operations and experiences during the COVID-19 pandemic.  https://www.healthygateways.eu/Portals/0/plcdocs/EU_HEALTHY_GATEWAYS_COVID-19_RESTARTING_INLAND_CRUISES.PDF

The webinar will be available for playback viewing. Contact EUHG (info@healthygateways.eu)  to receive the link to the recorded webinar.

Moderators:   Prof. Christos Hadjichristodoulou (EU HEALTHY GATEWAYS coordinator, Professor of Hygiene and Epidemiology, University of Thessaly, Medical School, Laboratory of Hygiene and Epidemiology, Greece) Associate Prof. Barbara Mouchtouri (Leader of WP7: Maritime transport of the joint action EU HEALTHY GATEWAYS, Associate professor of Hygiene and Epidemiology, University of Thessaly, Medical School, Laboratory of Hygiene and Epidemiology, Greece)

Presenters:   Thijs Veenstra (National Institute for Public Health and the Environment, Netherlands) Tanja Hartog (Public Health Service of Kennemerland, Netherlands) Dr Martin Dirksen-Fischer (Hamburg Port Health Center, Germany) Maira van Helvoirt (European Barge Union, EBU)

Webinar organisers: EU HEALTHY GATEWAYS joint action with the support of the European Scientific Association for Health and Hygiene in Maritime Transport - EU SHIPSAN ASSOCIATION

 

 

Workshop: Challenges and exchange of practices in relation to public health measures at ground crossings

The workshop took place on the 9^th of November, 2021 and was organised by the leaders of work package 5: Ground Crossings (National Institute of Public Health - National Institute of Hygiene (NIPH-NIH), Poland & National Public Health Center (NVSC), Lithuania). A total 19 specialists from regional and national competent authorities of Lithuania and Poland participated in the workshop. In addition presenters from WHO, ECDC and Thesally university (Greece) participated in the course.

 

The main aim of the workshops was to enable the exchange of experiences and discuss challenges in the field of public health, in particular issues related to the COVID-19 pandemic in the context of to land border crossings and from the perspective of both sides of the border.Participants expressed the opinion that it was a unique opportunity for them to discuss the challenges related to responding to incidents and the implementation of health protection measures at land border crossings. The workshop also made it possible for participants to better understand the procedures and ways of responding to events related to exposure to an infectious person during international journeys.

 

 

NATIONAL TRAINING COURSE FOR PREPAREDNESS AND RESPONSE IN SITUATIONS OF PUBLIC HEALTH EMERGENCY CONCERNE IN AIR SECTOR

 

Croatian Institute of Public Health and Croatian State Inspectorate organized NATIONAL TRAINING COURSE FOR PREPAREDNESS AND RESPONSE IN SITUATIONS OF PUBLIC HEALTH EMERGENCY CONCERNE IN AIR SECTOR. The training was held online on February 25th-26th 2021.

The International Health Regulations (IHR 2005), Annex 1B, stipulate the core capacity requirements at designated points of entries for response to public health events. In the Republic of Croatia, the status of a designated point of entry is assigned to the Dr. Franjo Tuđman International Airport. The response to emergent and re-emergent public health risks  includes establishing a plan and standard operating procedures for extraordinary events, with trained personnel from individual key stakeholders stated in the Strategic Preparedness and Response Plan. The current epidemiological situation with regard to the COVID-19 pandemic has brought forward the importance of building and strengthening capacities for detection and response to public health threats. It has also indicated the importance of ongoing education and training of all concerned parties in order to continuously improve the system and enhance the risk communication platform, which is essential for quick risk assessment and adequate response. Therefore, as a part of the aforementioned project, we have planned educational presentations by individual participants according to their area of authority, and creation of a scenario followed by a drill at the Zagreb International Airport Dr. Franjo Tuđman. This will increase the knowledge of all the participants and test the implementation of the acquired knowledge and skills in practice. Exercises and testing of the standard operating procedures will be recorded so they can be used for further education and knowledge exchange.

The first day of the training was dedicated to identification of diseases of interest to the Republic of Croatia and take, Implementation of the International Health Regulations (IHR 2005) in the Republic of Croatia: The role of CIPH, obligations and cooperation with the relevant authorities and legal framework and the role of  Border Sanitary Inspection  in the management of emergency public health events concerning the Republic of Croatia. In addition to that,  the role of border police in the COVID-19 pandemic was discussed. After above mentioned, there was a discussion regarding the revision of the current situation and definition of ways to conduct it. Moreover, Standard operating procedures were discussed- Why are they necessary? Which participants to include in their creation and what are the possibilities for the implementation of SOPs?

The second day of the training was dedicated to several subjects.  News in the harmonised approach to identification and contact tracing in international traffic were presented, as wel as Disinfection and pest control measures (Legal framework, implementation and possibilities for capacity and implementation strengthening at the designated points of entry). There was also a section organized to provide insight in Procedures and challenges of the Department for Border Sanitary Inspection in maritime ports during the COVID-19 pandemic as well as Differences and similarities between procedures in airports and maritime ports. Example of good practice in the activities of the Department for Border Sanitary Inspection during health surveillance  of passengers at the Zagreb International Airport was presented.

The total number of 31 trainees and 9 trainers from Croatian Institute of Public Health, State Inspectorate and Ministry of Interior, Border Police participated in the training. Participant from two DPoE participated in the training: Zagreb Airport ‘Dr. Franjo Tudman’ and Port of Rijeka.

 

Short seminar & site visit at Istanbul and Kuşadsası, Turkey

Thursday 9^th September – Friday 10^th  September 2021

 

EU HEALTHY GATEWAYS in collaboration with MedCruise organised technical site visits of the EU Healthy Gateways joint action coordination team (Prof. Hadjichristodoulou–JA coordinator, Assoc.Prof.Mouchtouri - Leader of WP: maritime transport and Ms Lemonia Anagnostopoulou – Technical Officer) in the ports of Istanbul and Kusadasi. The site visit was led by MedCruise President and Secretary General.

Nearly all cruise ship itineraries that call Turkish ports also include calls to ports in EU countries. Ships rapidly sail between different countries and therefore, common protocols are essential among the ports of call for effective response to public health events on cruise ships, ensuring that there are no contradictions and no disruption in the scheduled itineraries. This site visit gave the opportunity to work towards a common approach in preparedness and response to public health events focusing on COVID-19, before the Turkish ports receive cruise ship calls during 2021. Moreover, the site visit allowed for exchange of best practices between EU HEALTHY GATEWAYS and Turkey, in addition to exploring future areas of collaboration.

The main objectives of the short seminar & site visit were to exchange experiences, practices and lessons learned during the pandemic regarding preparedness and response to a COVID-19 event or outbreak and to conduct “pilot-port” site visits and review existing port protocols, procedures and plans in relation to European guidance and EU HEALTHY GATEWAYS advice documents.

 

Read here the relevant press release from MedCruise: https://www.medcruise.com/news/medcruise-welcomes-the-re-opening-of-cruise-between-greek-and-turkish-ports

 

2nd Workshop on Chemical threats at Points of Entry

7^th October 2021

 

A web-based half-day workshop for chemicals threats at Points of Entry was organised within the framework of EU HEALTHY GATEWAYS joint action. The workshop was organised by the National Institute of Public Health (NIJZ), Slovenia and the UK Health Security Agency (UKHSA).  

This workshop focused on chemical safety, particularly with regards to chemical containers at ports and ground crossings. This included public health issues surrounding chemical containers and transport of chemicals. A total of 35 persons from 12 countries (Austria, Belgium, Finland, Greece, Ireland, Italy, Lithuania, Malta, Portugal, Slovak Republic, Slovenia, Sweden) participated. Participants were persons working at a competent authority at a country central level (Ministry of Health, National Public Health Institute or other) dealing with chemical safety regarding containers transported across PoE and/or Staff who work at ground crossings and/or ports who deal with chemical containers on a regular basis.

The workshop consisted of 2 parts:

Part 1:

• Introduction on management of chemical incidents (covering IHR overview, incident response, Risk Assessments and the Beirut case study)
• Important elements of Preparedness planning (creating chemical preparedness plans with examples including: chemical inventory, site map)
• Managing transport of chemicals ( covering a variety of topics including dangerous goods, UN regulations for different types of transport, classification/marking/labelling of goods)

Part 2:

• Handling and opening containers (an external lecture from Hertel Engineering, which focussed on fumigation of containers and the occupational safety surrounding these hazards, with many practical examples)
• Example scenario (the last session presented a fictional chemical incident scenario, where a release of chemicals formed a large cloud which spread to a neighbouring country. Participants were asked questions on the incident, based on topics covered earlier in the workshop, followed by the IHR Annex 2 questions - to consider whether this event could be classified as a Public Health Emergency of International Concern).

 

The workshop was very successful with 96.55% of responders of the evaluation survey stating they would recommend the workshop to others.

 

 

Workshop: “Coopera(c)tion” at points of entry – Joint COVID-19 efforts and lessons from the JA Healthy Gateways

Organised by: EU HEALTHY GATEWAYS Joint Action, Chair persons: Varvara Mouchtouri (Greece), Aura Timen (Netherlands)

https://academic.oup.com/eurpub/article/31/Supplement_3/ckab164.657/6405927

Abstract

Although numerous efforts in the past have been supporting and enhancing infectious disease preparedness and response at points of entry and in the transport sector, COVID-19 has provided unprecedented challenges. The sectors were forced to constantly adjust to new epidemiological situations and required measures. Cooperation ánd action has been required amidst a complex set of actors from within and outside public health. The EU Healthy Gateways Joint Action has been founded to improve and support technical experience and cooperation in the transport sector and at points of entry in Europe. COVID-19 did no longer allow gradual improvement through meetings, training and exercises, but only allowed improvising and learning on the job. This pandemic also coincides with the final year of this EU Healthy Gateways (2018 - 2021). The consortium and many partners has spent 2021 so far by combining its predefined and pre-pandemic tasks while supporting in the ‘emergency mode' the European workforce in the ongoing pandemic. Ending the JA halfway a pandemic demands critical reflection made public. In this workshop, we share the diversity of challenges, and reducing these to urgent recommendations for cooperation at and among European points of entry of the near future. In four presentations, we present cooperation alongside coordinated action during COVID-19 at point-of-entry and at European level, sharing several contributions from science and practice. The first presentation will be the experience from the Netherlands with their in-action review (IAR) focused on the response at ports and airports. IAR have flourished this year although organizing one can be challenging amidst response efforts. Is an IAR for points of entry worth the drill? Second, international communication has been secured and tested during the development of a guideline for international communication and a related European table-top exercise that took place in March last year. Have our international communication lines been up to date? European cooperation is essential during international contact tracing. In our third presentation, the development, testing and implementation of the digital passenger locator forms (PLF) for air- maritime- and land-travel will be shown. Is a digital PLF system ready to unite all European countries into one system? The last presentation will provide lessons of organizing and coordinating, and sustaining the products and results for points of entry following from this Joint Action. This presentation will end in a brainstorming session with the panelists and the audience on what a next joint action would look like. Have European cooperation and collaborative action been feasible in transport industries, at and among points of entry? What are the urgent lessons for the near future?

Key messages

• The ongoing COVID-19 pandemic has demonstrated the importance in strengthening cooperation and coordinated action of MS to improve their preparedness and response capacities at points of entry.
• The COVID-19 pandemic emphasizes the need for the availability of a cross-European network to transfer lessons learned for an enhanced preparedness and response to future public health threats.

 

 

 

RECENT SCIENTIFIC PUBLICATIONS

EU HEALTHY GATEWAYS PUBLICATIONS

 

Updated EU HEALTHY GATEWAYS advice documents

EU HEALTHY GATEWAYS responding the continuous changing situation and evidence and aiming to support Europe’s efforts to getting back to normal life had revised two advice documents related to cruise ships operations.

The revised versions include recommendations for diagnostic testing policy for vaccinated crew and passengers, quarantine and isolation measures for vaccinated crew and passengers, special measures in cruises with at least 95% vaccinated passengers and at least 95% vaccinated crew members and specificities for cruise ships with less than 100 guests. 

The revised documents are available on the EU HEALTHY GATEWAYS web-portal here: https://www.healthygateways.eu/Novel-coronavirus#Interim