Coordination:
The Norwegian Directorate of Health; Norway
jaterror@helsedir.no

Dissemination:
National institute for public health, Slovenia
jaterror.pr@nijz.si

The framework to improve preparedness and to strengthen the response capacities to health emergencies of biological, chemical, environmental and unknown origin is provided by Decision 1082/2013/EU on serious cross-border threats to health[1] at EU level.

To support this, JA TERROR’s main objectives are to address gaps in health preparedness and to strengthen response to biological and chemical terror attacks by cross-sectoral work with security, civil protection and health sectors.

The EU is an important security actor in numerous policy frameworks, e.g. civil protection, health security, food security, infrastructure protection, hybrid threats and disaster relief. Key initiatives have been adopted recently at the EU level to prevent and prepare for terrorist attacks. Security threats are addressed in the context of the European Agenda on Security[2] and the Security Union. Many security threats are specifically addressed by

  • the Commission Communication on an EU Action Plan to enhance preparedness against chemical, biological, radiological and nuclear security risks[3],
  • the 2016 Joint Communication on the Joint Framework on countering hybrid threats[4] and,
  • the Joint Communication of 2018 on increasing resilience and bolstering capacities to address hybrid threats[5], specifically address many security threats.

Joint Action TERROR will build on work done by relevant projects and exercises under the Health Programme, and other EU programmes, that are relevant to the objectives of the Joint Action. It is also relevant to consider how JA TERROR can cooperate, and benefit from the work already done by Joint Action “Strengthened International Health Regulations and Preparedness in the EU” (SHARP)  Joint Action Bullseye, and the Joint Action “Healthy Gateways”, without duplication of efforts, to contribute to the objectives of the Security Union and the EU CBRN Action Plan.

In order to support cross sectoral objectives of JA TERROR, DG SANTE, DG HOME and DG ECHO, ECHA, EMCDDA, ECDC will be invited to JA TERROR’s Advisory Board.

Whilst this Joint Action has many linkages to work undertaken in these other areas (e.g. laboratory support for analysis of samples; specialised treatment capacities; management of borders and points of entries), chemical and/or biological terror attack events would be severe and unexpected emergencies that would involve different sectors and have increased complexity, urgency and uncertainty. As such, structures in place and preparedness and response planning in times of peace will no longer be enough in times of intentional terror attacks.

 [1] https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A32013D1082

[2] http://www.europarl.europa.eu/cmsdata/125863/EU%20agenda%20on%20security.pdf

[3] https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=COM:2017:610:FIN

[4] https://eur-lex.europa.eu/legal-content/en/TXT/?uri=CELEX%3A52016JC0018

[5] https://eur-lex.europa.eu/legal-content/ga/TXT/?uri=CELEX:52018JC0016

WP1 – Coordination

Leading institution: The Norwegian Directorate of Health, Norway

Bengt Skotheim, MA International Politics and Security, and a Project Manager and Senior Adviser in the Norwegian Directorate of Health, department for Global health. Skotheim has worked on global health issues for the Norwegian government since 2009. Skotheim has was a Project Manager engaged in the setup of, and management of, Norway’s efforts in Sierra Leone during the Ebola outbreak response in 2014-2015.

The Coordinator acts as an interface between representatives from the EC services (e.g. DG SANTE and HADEA), other relevant actors and the project participants. In the inception phase of the project WP1 will focus on the elaboration of concrete operations procedures and financial reporting template and well administrative work related to the Grant Agreement and kick-off of the JA.

The Coordinator will set up the necessary communication channels for JA TERROR to ensure management and cooperation between all work packages in the Joint Action. A Consortium Agreement will be developed and entails the organizational structure and rules of procedure for the work of JA TERROR. The JA includes in total 8 WPs of which 4 horizontal (WP 1, 2, 3 and 4) and 4 core (WP 5, 6, 7 and 8) WPs.

To ensure that EU Member States’ evolving needs are accounted for by JA TERROR for delivering relevant tools and best practices WP1 will set up a

Information about achievements in JA TERROR will be shared with the MS committee throughout the project to engage and ensure commitment and suggest adjustments if relevant. This will be done in collaboration with WP2 and WP4 and all the technical WPs.

WP2 – Dissemination

Leading institution: National institute for Public Health, Slovenia

Nuška Čakš Jager, MD is specialist in Public Health: Čakš Jager is responsible for Planning and Preparedness activities in the Centre of Communicable Diseases, NIJZ. She has broad experience in planning, preparedness and response on Public Health threats. She is involved in many international activities linked with ECDC and WHO. She coordinates the IHR implementation in the country working on multi-sectoral approach and is responsible for preparing and carrying out simulation exercises in the field of public health.

A continuous activity over the project lifetime will be dissemination and communication of the activities of the JA.

The task is to provide the initial strategy for internal and external communication and dissemination. This should give an overview of the aims of the JA dissemination activities. Furthermore, it will set up guidelines for process flow of dissemination for internal project partners. The dissemination strategy will ensure that by the end of 3-year-timeline of the project the relevant stakeholder groups across all countries will be aware of the results. They will be able to align with and support the project objectives, and engage in its activities on a sustainable basis. Care will be taken to ensure the majority of activities will be digitally based, whenever possible using the novel tools available.

Communication strategy consists of

  • developing dissemination plan,
  • identifying key messages,
  • evaluating communication activities, and
  • disseminating reports.

The stakeholders’ engagement and involvement strategy will provide the means for interaction and discussion on the JA findings and recommendations. In order to ensure the results of the project are applicable and appropriate we must identify and engage relevant stakeholders throughout the course of the project. Their engagement will suggest and explore a variety of means to improve JA deliverables.

The JA dissemination strategy provides the basis for engaging with stakeholders through a

  • stakeholder identification,
  • analysis, and
  • interaction process.

WP3 – Evaluation

Leading institution: The European CBRNE Centre, Umeå University, Sweden

Assoc. Prof. Svenja Stöven Project management, molecular biology, host pathogen interactions: is a project coordinator with more than 15 years’ experience in project and science management. Starting in 2011 at the European CBRNE Center she has acted as coordinator, manager and/or work package lead in six European projects and participated in seven projects as subject matter expert. Several of these commitments are of direct relevance for TERROR as they were/are concerned with evaluation/assessment, CBRN training, public health preparedness for infectious diseases, standardization of laboratory methods as well as with CBRN preparedness planning and resilience in general. Svenja graduated from Freie University Berlin with a PhD in Biology (Dr. rer. nat., 1994). After moving to Sweden she carried out research in the field of innate immunity; last focusing on hostpathogen interactions between the etiological agent of tularemia (Francisella tularensis) and insect hosts.

In order to ensure an objective and independent evaluation, the WP3 members are not involved in other parts of the project and are not involved in the implementation of policy based on the project. Furthermore, the evaluation will be conducted by using a theory-based evaluation approach, and by adhering to established norms and standards of evaluation practice such as transparency, impartiality and professional integrity.

The starting point for WP3 is drawing up a detailed evaluation plan for the entire project. This plan will build on the draft at hand and specify

  • evaluation criteria,
  • indicators of good performance,
  • evaluation tools,
  • audience, as well as
  • a time plan for specific activities,

in close connection with other project events and scheduled milestones.

In accordance with the evaluation plan, various tools will be developed in order to collect tangible evaluation results from project partners and stakeholders in a structured and standardized way. Such tools will for example be interview guides, questionnaires or checklists. Importantly, the project plan presented in the relevant section (GANTT chart) includes details such as tasks (and sub-tasks), meetings/events, deliverables and milestones for each WP, that will be used as baseline for both the formative and the summative evaluation. This plan might also be further developed and specified in cooperation with all WP leads, if deemed necessary.

At the onset of the project WP3 will lay the ground for both, the formative, the summative and the effect evaluation by assessing the project logic through a theory-based approach to evaluation. This approach targets

  • how the project is expected to produce its results,
  • which parts of the project are most important for a lasting effect, and
  • how well the Description of Work matches with the project organisation, consortium composition and the stated aims of the project.

In order to warrant good project performance and as part of the formative evaluation, WP3 will regularly provide feedback to WP1 concerning major deviations from the original plan or early detection and mitigation of upcoming challenges. This task also includes evaluation of deliverables and other project results with respect to the project aims and WP-specific objectives. Responsibility for good quality deliverables lies foremost with the respective authors and the relevant WP lead, but ultimately with the coordinator. In order to support the overall quality assurance, process the WP3 team will form a quality assurance committee consisting of one senior subject matter expert from each of the work packages WP2 and WP4-WP8. Together with the WP3 team, the coordinator and the quality assurance committee will review draft deliverables and provide feedback to authors for consideration prior to submission of deliverables.

Furthermore, under this task WP3 will collect recommendations for good project organisation and management resulting from JA TERROR experiences.

WP4 – Sustainability

Leading institution:  Norwegian Institute of Public Health, Norway

Co-leading institution: French Ministry of Solidarity and Health

Karin Nygård DMV PhD is expert on Health Preparedness. Dr Karin Nygård is a senior expert adviser, epidemiologist, IHR focal point, team lead of preparedness at NIPH and team member of the NIPH Global Health Preparedness Program, working with IHR core capacities in multiple countries. She has been project coordinator of multiple international projects working with health preparedness. Nygård has a broad experience with national and international health preparedness, responses and technical programs related to national and international outbreaks of contagious diseases.

Christine Berling, PhD, M.Sc., Head, European & Intl Affairs. Christine is head of European and International affairs department at the Directorate General of Health. She has actively contributed to various European projects, of which Joint Actions. M.Sc in Physics, PhD in Biophysics, C. Berling has over 15 years’ experience of working in public-private partnership and technology licensing, initially with the INSERM, and subsequently at the European Commission, DG RTD Health Directorate, during the setting up of the Innovative Medicine Initiative Joint Undertaking. Besides, Christine and its team are leading WP4 of various Joint Actions related to TERROR, including EU-JAV and SHARP-EU on IHR implementation, preparedness to health threats and have developed this context innovative tools, know-how and methodology that will support and articulate well with TERROR’s own sustainability and integration into national policies’ strategies.

Sustaining the outcomes of the joint action needs strong stakeholder involvement, and appropriate resources both at national and EU level.

The work in WP4 will build on the experiences from the work in WP 4 on sustainability in JA SHARP and Joint Action Vaccination. Moreover, several of the WP leads in the JA are actively involved in managing current COVID-19 crises and will use their experiences in their WPs.

The guidance tool developed for the JA SHARP will be used to assess uptake and implementation capacity of the JA TERROR outputs and results into national context. All the while considering the available resources and the national context. The purpose is to ensure that all WPs take into account the sustainability of their outcomes during their development.  The first section of the tool is a checklist of essential elements to consider to help the uptake process/integration into national policies. The second section corresponds to the first part in practice, with

  • per selected best practices,
  • the medium and long term action items, and
  • operational measures (a road map).

As the JA develops, the use of the tool will permit important aspects to be considered like:

  • existing policy and institutional support,
  • existing organizational and regulatory frame that could facilitate uptake and ownership by the relevant stakeholders on a long run,
  • contextual factors (e.g. health and social policies, innovation, cultural trends and general economy, epidemiological trends, migration and cross-border movement).

The idea is to use the tool at the onset of the JA TERROR, so as to identify and pilot at least one selected cross sectorial response arising from WP5 to 8. For this purpose, at the start of the project, a review of the WP objectives will be performed by WP leaders and presented to the HSC and MS Committee.

Selection of best practices and other key outcomes (tools, guidelines) from the JA TERROR technical Work packages will be included in the sustainability plan. The purpose of this is to define for each one a specific sustainability and integration approach.  This will be done in collaboration with the WP leads, partners and consultation with the Health Security Committee, during its bi-annual meeting. The selection will start at the onset of the JA.

The purpose of this task is to develop a sustainability plan to foster long term integration of selected WP outcomes into EU/ national / regional policies and mechanisms. Furthermore it will define the conditions for operationalization and sustained governance. The purpose is also to work on the long-term impact of the Joint Action activities and results. The intention behind this is to improve the EU coordination mechanism related to knowledge exchange/update on selected agents, including threat assessment and risk profile. The plan will also describe areas where further effort or action would be beneficial at EU level after the conclusion of JA TERROR.

This sustainability plan will be developed in close collaboration with WP1 and with consultation with Health Security Committee members/multisectoral member state committee, to ensure optimal uptake.  A workshop involving the Steering Committee and Advisory Board as well as the EC Health Security Committee members will be organized. The aim of the workshop is

  • to present the pilot actions and sustainability plan,
  • to receive feedback, and
  • discuss further actions to ensure sustainability of the outcomes and potential areas for further work.

WP5 – Health Preparedness & Response planning to biological and chemical terrorist attacks

Leading institution: National Institute for Infectious Diseases L. Spallanzani, Italy

Co-leading institution: UK Health Security Agency

Expert on Health Preparedness: Dr Antonino Di Caro MD is an expert in laboratory diagnosis of emerging pathogen infections, including the infection due to the deliberate release of the pathogens. Dr Di Caro is the Director of the Microbiology lab at INMI, and have a wide experience in participating to EU research and PH project. He is member of several laboratory network and scientific society and coauthor of more than 180 scientific papers.

Dr Tom Gaulton (PhD) is a Health Protection Scientist in the Chemical and Environmental Effects Department within the UK Health Security Agency (UKHSA) and has over 10 years of experience working in public health, on both microbiological and chemical health threats. Tom has worked on many Joint Actions and public health projects previously and has experience on the risk assessment of chemicals and preparedness and response for chemical incidents.

The main objective of this WP is to strengthen the presence of a comprehensive European preparedness and response strategy against possible chemical and biological terrorist attacks. Acknowledging the diverse social, cultural and political contexts across participating EU Member States, understanding the different levels of preparedness, and response capacities could improve capacity and cooperation in case of terrorist events. This means including cross-border events and response.

Moreover, a clear map of available infrastructures, tools, guidelines and expertise could be key to managing a terrorist attack. This task will be carried out in strict collaboration with WP6. We will conduct an investigation of

  • differences between planning for natural or deliberate release events, as well as
  • assessment of impact of overt vs covert release of a biological or chemical agent.

As most of the biological and some chemical agents are rarely seen outside of events related to terrorist attacks, it is important to develop or update guidelines, training and raising awareness.

An update of both clinical and non-pharmaceutical management guidelines could be key in controlling an intentional event. Timely recognition of the involved agent followed by an appropriate implementation of control measures and appropriate pharmacological treatment could reduce the risk of further spread. The case of the new recommendation for Anthrax vaccine use from US CDC is an example on the need for updating and harmonize scientific technical documents at the EU level.

Particularly critical will be data regarding national and guidance on the implementation of non-pharmaceutical control measures where support from non-public health organization (i.e. security) is required. This cross-sectoral aspect will be handled together with WP6.

The above-mentioned activities will be complementary to the activities performed by the other ongoing Join Actions, i.e. SHARP and Health Gateways, but will ensure that there is no duplication of efforts. In particular, information and analysis on preparedness and inventory of available infrastructure are key activities of the SHARP and TERROR JA. Nevertheless, institutions and plans involved in the natural unintentional causes (SHARP) and in intentional events (TERROR) have often different decisional flow and dedicated infrastructure. The evaluation/assessment will be constantly shared by the two JA. This is also facilitated by the presence of SHARP participants into the WP5 and vice versa.

WP6 – Cross sectoral collaboration: Security, Civil protection & Health

Leading institution: Ministry of Health (dep. Centro de Coordinación de Alertas y Emergencias Sanitarias), Spain

Co-leading institution: Sciensano, Belgium

Dr. Berta Suárez is expert on epidemiology, surveillance, public health Preparedness and Response: Medical Doctor specialized in Preventive Medicine and Public Health. Berta Suárez is working at the Coordination Centre for Health Alertas and Emergencies at the Ministry of Health since 2011, currently as Head of Unit on Preparedness and Response. Her current position includes coordinating issues related to communicable diseases surveillance and the detection, assessment and response to health alerts signals. She is responsible for the development of Preparedness and Response Plans against public health threats.

Dr. Ir. Franck Limonier, M.Sc., PhD. CBRN coordinator and POC chemical risk orientation. Dr. Franck Limonier is a project coordinator and scientist at the Department of Chemical and physical health risk, at Sciensano. Limonier coordinates CBRN expertise, including national reference centers in CBRN bacteria, toxins, GMOs-GMMs, virus, counterfeits/illegal drugs, pesticides and risk assessment. Limonier is also detached at the CBRN expertise centre, which gathers national CBRN responders (both first and second line) from different involved sectors (health, civil protection, law enforcement and defense). 

The overall objective of WP6 will be to contribute to the improvement of national structures, plans and procedures. We will do this through the improvement of cross-sectoral and cross-border collaboration between health, security and civil protection sectors. It is important to look at national level in preparedness and response to BioChem terror attacks with cross-border potential impact. Additionally, it will require taking EU regulations framework into account.

This calls for involvement of all:

  • public health emergency planning and response agencies,
  • civil protection departments,
  • law enforcement agencies, and
  • judicial authorities.

Specifically, WP6 will:

  • increase the knowledge on existing structures for cross-sectoral collaboration within the participating Member States,
  • understand relative roles and responsibilities between public health, security, and civil protection sectors,
  • improve collaboration between sectors at operational and strategic level and raise stronger relationships within each country, and with neighboring countries,
  • identify good practices and examples of systems and mechanisms for cross-sectoral and cross-border cooperation.

WP7 – Risk and crisis communication (Internal & Public)

Leading institution: ETHNIKOS ORGANISMOS DIMOSIAS YGEIAS, Greece

Dr. Dimitrios Iliopoulos DDS, MD, MPH, MSc, PHD is head of Emergency Operations Centre and Bureau for risk assessment and CBRN threats. Senior Public Health Officer, Former Health Security Committee member, expert in Public health, editor of the National CBRN hospital manual, National Focal point for Preparedness & Response and Threat detection (ECDC), National Focal Point for EWRS and IHR , instructor for chemical weapons (certificate from Spietz Geneva, OPCW), Appointed National Expert for Biological Threats.

The specific objective of WP7 is to promote the implementation of Risk and Crisis Communication in all stages of risk management, on both national and EU level.

The expected results of this Work Package are to provide tools that all collaborating sectors will be able to use. The tools will help establish robust communication channels between relevant sectors, as well as towards the public. In addition, we will present legally and technically tangible solutions for unified platforms. They will serve to rapidly exchange information between heterogeneous sectors, including potentially classified data. Partners, and Member States, will be able to use the experience of already applied community resiliency plans for other health threats, and adapt them to the field of biological/chemical terrorist attacks.

We will develop guidance on risk and crisis communication between experts and towards the public in case of terrorist attacks. This will be done based on identifying gaps in inter-sectoral risk communication procedures at all levels of crisis management, including command post and decision makers.

All JA partners will collect information from previous co-funded programs on information exchange platforms. Additionally, a mapping of already existing mechanisms and platforms designed/or in use by Member States will be conducted, both on national and EU level. On top of this, we will develop secured mechanisms / platforms for

  • rapid information exchange,
  • notifications, sharing and analyzing information

for the purposes of cross-sectoral threat assessment, threat profiles and incident evaluation. In essence, what can be communicated and how.

Along with all of the above, an assessment of the role of community preparedness and engagement in crisis communication. We will build this upon an analysis of how already implemented community engagement strategies can be modified to include terrorist attacks.

WP8 – Novel threats

Leading institution: Department of Health, United Kingdom

Co-leading institution: Norwegian Institute of Public Health

Dr. Jackie Duggan, Ph.D., is expert on Health Preparedness, a Principal Scientist and project manager for the Rare and Imported Pathogens Laboratory at Public Health England. Duggan is a specialist in CBRN, new and emerging pathogens and detection and diagnosis. Duggan has worked in this field for 32 years, and had led, as Principal Investigator, a number of EU and NIAID funded programmes on biosecurity and health preparedness.

Siri Laura Feruglio, MD, PhD, DTM&H is expert on Health Preparedness/laboratory detection. Dr Siri Laura Feruglio is a senior medical officer, specialist in internal medicine and infectious diseases. She is the team lead of the national preparedness laboratory for highly pathogenic diseases, is the biosafety and biosecurity medical offices at NIPH and team member of the NIPH Global Health Preparedness Program working with IHR core capacities in multiple countries. Feruglio has a broad experience working with detection, surveillance and countermeasures for highly dangerous and/or emerging pathogens?CBRNe medicine.

Work package 8 will focus on health preparedness for novel threat agents, to include synthetic biology and “DIY” biology, synthetic opioids and dual use technology. The main objectives of this Work Package are

  • to produce risk assessments on novel threat agents and guidance on health preparedness for Member States,
  • to collate information on dual use regulations and recommend standardized guidelines and practices,
  • to gain information on the current state of the art of novel threat agents, to include information on:
    • threat assessment,
    • novel technologies capable of producing such agents,
    • detection and diagnostic methods,
    • novel delivery systems,
    • trade and access to production materials,
    • molecular forensics.

Methodology for different tasks include literature review and expert workshop to be hosted by a WP8 partner in the low GNI country. There will also be desk activities / research to produce risk assessment and recommendations for future governance  guidelines.