Strengthening preparedness and IHR implementation in the EU
SHARP Joint Action aims to strengthen preparedness in the EU against serious cross-border threats to health, and support the implementation of International Health Regulations (2005). “SHARP” stands for Strengthened International HeAlth Regulations and Preparedness in the EU.
SHARP Joint Action (2019 – March 2023) is a collaborative action of 26 countries and 61 partners. The joint action is co-funded by the Health Programme of the European Union (80%) and by partners’ own contributions (20%). By working together, the partners and the European Commission will ensure a safer environment for all EU citizens. The SHARP Joint Action works to strengthen member’s existing capacities as well as supporting improvement in those countries where IHR capability gaps exist.
SHARP started its actions in June 2019, coordinated by the Finnish Institute for Health and Welfare, Finland; and co-coordinated by Robert Koch Institute, Germany; and National Institute of Infectious Diseases Lazzaro Spallanzani, Italy.
Special efforts are made to fill gaps that have been or will be identified in priority countries:
- those with the biggest gaps in the capacity required for full IHR capability
- In line with the exceptional utility criteria; member states whose gross national income (GNI) per inhabitant is less
than 90% of the Union average
Through the Joint Action, the member and partner states and the Union’s common ability to prevent, detect and respond to biological outbreaks, chemical contamination and environmental and unknown threats to human health will be strengthened.
SHARP Joint Action (SHARP JA) aims to strengthen:
- The implementation of Decision 1082/2013/EU, supporting the Member and Partner States’ capacity to handle health threats.
- The implementation of International Health Regulations (2005) and preparedness in EU Member States to increase the capacity on high level protection of health and security.
- The resilience and response capacities of health systems by ensuring coherence and interoperability for preparedness and response planning.
- ‘Public Health Protection’ means protecting individuals, groups and populations from infectious disease and non‑infectious public health threats including radiation, chemical and environmental hazards.
- ‘Health Security’ means the activities required, both proactive and reactive, to minimise vulnerability to acute public health events that endanger the collective health of populations living across geographical regions and international boundaries.
- ‘Serious cross‑border threat to health’ means a life‑threatening or otherwise serious hazard to health of biological, chemical, environmental or unknown origin which spreads or entails a significant risk of spreading across the borders of at least one Member State or may necessitate a coordinated response by national authorities in order to ensure a high level of human health protection. This definition includes events that may constitute public health emergencies of international concern under the IHR.
SHARP Joint Action management structure and work packages
The partnership of the Joint Action consists of 26 Associated Partners and 35 Affiliated Entities, which all receive Commission co-funding. SHARP partners work collaboratively to identify and address gaps in the capacity to prevent, detect and respond to biological, chemical and environmental threats to human health.
Austria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Malta, Netherlands, Poland, Portugal, Slovenia, Spain, Sweden and the United Kingdom. Post Brexit, the UK remains involved under a memorandum of understanding. In addition, EEA member Norway, Bosnia-Herzegovina, Moldova and Serbia are associated partners of this JA.
In addition, there are 10 Collaborating Partners that self-fund all activities that they participate in. In total, 30 countries (24 EU members, 3 EEA/EFTA members and 3 European neighborhood countries) participate in the Joint Action. More about SHARP JA partners.
The Advisory Board of SHARP JA includes HaDEA; DG SANTE; European Centre for Disease Prevention and Control (ECDC); the World Health Organization European Office (WHO Europe); the Scientific Committee for Health, Environment and Emerging Risks (SCHEER) Rapid Risk Assessment Working Group for Chemical Threats; and HEALTHY GATEWAYS Joint Action.
SHARP Joint Action also collaborates with other European Joint Actions, specifically the Healthy Gateways Joint Action that addresses Points of Entry.
Geographical scope of SHARP Joint Action
SHARP JA’s goal is for all member states to adequately ensure that a health threat in one country does not get out of hand and spread to the neighbours.
In addition, an introduction of a high consequence infectious disease from outside of the EU needs to be controlled irrespective of which country it happens to land in. Only by working together for this goal can we ensure the protection of all EU citizens from high consequence health threats, be they infections, chemical or environmental threats.
This SHARP Joint Action covers most of the European countries. Post-Brexit, 21 of the 27 EU Member States are engaged as Associated partners:
EFTA member Switzerland, EEA member Iceland, and EU Member States Belgium and Bulgaria contribute as collaborating partners, which makes a total of 30 countries participating in the Joint Action.
Using 2018 national estimates from Eurostat, the SHARP JA covers 94.8 % of the EU population.
Background to SHARP JA
The state of play in terms of EU Preparedness and Response planning to address health threats at the outset of the Joint Action
A report for the Health Security Committee (HSC) on the EU state of play in terms of Preparedness and Response planning to address health threats identified priority areas for action and prompted Health Security Committee (HSC) area 3 action plans.
SHARP Joint Action (JA) delivers on these plans with a focus on cross sectoral capacity building for preparedness, response and recovery. The JA aims to specifically address four of the priorities*:
- Cross-sectoral capacity building, exchange of knowledge and best practices – focused on gaps in basic IHR core capacity identified through Member State reporting in relation to Article 4 of Decision 1082/2013/EU on serious cross-border threats need addressing.
- Enhancing monitoring and evaluation of actions under decision 1082/2013/EU in alignment with the WHO IHR monitoring and evaluation framework
- Enhancing the health and security interface and preparedness and response to terror attacks (to a certain limited extent)
- Laboratory strengthening through a consolidated laboratory practice
*The other priority areas are addressed through other Joint Actions and commissioned/or internal work by DG SANTE.
Presentations by SHARP Joint Action at the One Health Conference 2019 provide a useful introduction to the programme of work. View the video at SHARP responses and plans – Panel discussion – YouTube (58 minutes). Or view the presentation slides from Brian Doherty: EU Action for Regional Health Security (slideshare.net).
International Health Regulations (2005) (IHR)
IHR provide an overarching legal framework for global health security that defines countries’ rights and obligations in handling public health events and emergencies that have the potential to cross borders. International health regulations (who.int)
Compliance with IHR provisions remains a challenge in several areas, from setting up core capacities to implementing travel measures during health emergencies.
SHARP JA aims to strengthen member’s existing capacities as well as supporting improvement (systems/processes) in those countries where IHR capability gaps exist.
The IHR monitoring and evaluation framework core IHR capacities
|Hazards and points of entry
|1. National legislation, Policy and Financing
|8. National Laboratory System
|17. Point of Entry (PoEs)
|2. IHR Coordination, Communication and Advocacy
|9. Real Time Surveillance
|13. Emergency Response Operations
|18. Chemical Events
|3. Anti-microbial Resistance (AMR)
|14. Linking Public Health and Security Authorities
|19. Radiation Emergencies
|4. Zoonotic Disease
|11. Workforce Development
|15. Medical Countermeasures and Personal Deployment
|5. Food Safety
|16. Risk Communication
|6. Biosafety and Biosecurity
The importance of strengthening preparedness and IHR implementation
•47 of 55 States Parties in the EURO Region have submitted the SPAR for 2020.
•Initial analysis of SPAR 2020 submissions in the EURO Region provides a mixed picture where reported capacities on average have either remained the same or slightly decreased, in comparison to 2019.
•The regional IHR Capacity average in EURO dropped by 1% between 2019 and 2020.
•Only 1 area, C.6 Surveillance, saw an increase of the average reported capacity – up 2% to 81%.
•In 8 of the 13 core capacity areas, the average reported capacity has decreased between 1-4%.
•As of 2020, capacity area 11, Points of Entry, together with capacity area 10, Risk Communication, and capacity area 12, Chemical Events, remain the main challenges in the implementation of IHR capacities in the WHO European Region. Remained unchanged 2018-2020.
•Capacity area 2, IHR Coordination and National IHR Focal Point Functions, capacity area 5, Laboratory, and capacity area 6, Surveillance, are the strongest capacities reported in the Region.
Benefits of SHARP JA to citizens/countries
Strengthening IHR capacities means
● Health threats have no borders: The IHR strengthen countries’ abilities to control diseases that cross borders at ports, airports and ground crossings.
● Travel and trade made safer: The IHR promote trade and tourism in countries and prevent economic damage caused by disease outbreaks.
● Global health security is enhanced: The IHR establish an early warning system not only for diseases but for anything biological and other threats to human health and livelihoods.
● Daily threats are kept under control: The IHR guide countries to detect, assess and respond to threats and inform other countries quickly.
● All sectors benefit: The IHR prepare all sectors for potential emergencies through coordination and information sharing.
EU Added Value
In terms of knowledge, staff and good practices, SHARP JA partners demonstrate European added value by building on their involvement with previous Joint Actions and projects funded from the EU Health Programmes – mainly concentrated on the strengthening of individual components of priority areas, e.g., national Health Security system or IHR core capacities.
The innovative feature of the SHARP JA is that it takes a system approach, i.e., it aims to develop the integration of all necessary preparedness and IHR core capacity functions in a holistic perspective.
The joint action delivers added value in the following seven ways identified in a CHAFEA health programme factsheet (PDF 141 KB)
- Implementing EU legislation and ensuring that the legislation is correctly implemented
- Economies of scale with the aim of using money more efficiently and providing citizens with better services
- Promotion of best practice in all participating Member States in order for EU citizens to benefit from the state of the art best practices
- Bench-marking for decision-making requiring a strong commitment to use result with the aim of facilitating evidence based decision making
- Focus on cross-border threats in order to reduce risks and mitigate their consequences
- Free movement of persons with the aim of ensuring high quality public health across Member States
- Networking as an important tool for disseminating results to all Member States including non participants
Collaboration with other EU projects/Joint Actions
SHARP collaborates with other EU projects /Joint Actions. Notably:
Healthy Gateways The Joint Action: Preparedness and action at points of entry (ports, airports, and ground crossings) 2018–2022
Pandem 2 2021– 2023
The impact of COVID-19 on SHARP Joint Action
On 30 January 2020, the World Health Organization declared that the outbreak of COVID-19 constitutes Public Health Emergency of International Concern (PHEIC). The global response to the COVID-19 pandemic laid bare the weaknesses and major challenges in the international approach to managing public health emergencies.
Enormous pressure was placed on the public health institutes within the Joint Action. The pandemic has put health systems under extreme stress, with personnel having to adapt to unexpected and changing circumstances while continuing to provide high quality deliverables for the Joint Action.
In response to the COVID-19 outbreak, SHARP supported the EC and the Member States, and especially work packages for laboratory preparedness and responsiveness (WP7 in coordination with the ECDC) and for case management and infection prevention and control preparedness (WP10). Read more on SHARP JA’s contribution to the COVID-19 response.
The Work Package teams often being reassigned to their national Covid-19 responses, meant a significant decrease and delay in SHARP activities. In addition, the need to revisit the scope of some work packages arose.
Extension of SHARP Joint Action to September 2023
In the face of these unpredictable and unprecedented challenges and recognising the pandemic is a perfect illustration of the need for multilateral solutions and a coordinated cooperation on crisis preparedness and response, the European Commission approved 12 months, non-cost extension for SHARP JA to March 2023.
Read more on the European Commission’s extension for SHARP JA.
A further 6 month, non-cost extension to September 2023 was agreed in January 2022 to allow the programme to continued its actions with a view to enhancing and further consolidating key achievements. Meeting the needs within the objectives and thematic priorities of the 3rd Health Programme to ‘protect Union citizens from serious cross border health threats’.
The changing EU Health Policy context during the SHARP Joint Action
In her September 2020 State of the Union address, European Commission President Ursula von der Leyen called for a European Health Union as a response to the COVID-19 pandemic.
The European Commission is building a strong European Health Union, in which all EU countries prepare and respond together to health crises, medical supplies are available, affordable and innovative, and countries work together to improve prevention, treatment and aftercare for diseases such as cancer. The European Health Union will
- better protect the health of our citizens
- equip the EU and its Member States to better prevent and address future pandemics
- improve resilience of Europe’s health systems
Changes in SHARP JA’s supranational stakeholder organisations demanded increased efforts to coordinate and communicate.
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