Published on 28/12/2011


The Episouth programme: Network for transmissible disease control in the countries of southern Europe and the Mediterranean basin

Context and issues

In 2005, to mark the Year of the Mediterranean, several countries joined forces to develop the EpiSouth project, the aim of which is to create a framework for collaboration and a work platform in the area of epidemiology to improve monitoring of transmissible diseases, communication and training in the Mediterranean basin.

The countries of the Mediterranean basin share the same ecosystems and the same history. Beyond the political divisions, there have always been significant movements of people and goods between these countries. From the epidemiological point of view, these countries form a continuum.

Today, this project includes 27 participating countries (southern European, Balkan, North African and Middle Eastern). The EpiSouth network has been organised into two separate phases.

Phase 1 of the EpiSouth project officially began in December 2006 and ended in October 2010.

The project was composed of 8 Work Packages (WPs) coordinated by various European public health institutes. The cohesion of the project was ensured by the principal partner (the Istituto Superiore di sanita - ISS in Italy), which developed the operational framework and ensured dissemination of the epidemiological information.

Three vertical programmes, "International monitoring and cross-border alerts" (InVS, France), "Vaccination and migrant populations" (Bulgaria) and "Emerging cross-border zoonoses" (Greece) constituted the technical basis of the project.

Two horizontal programmes, Network (Italy) and Training (Spain), provided the tools necessary for harmonisation of these vertical programmes, in particular in terms of improving the network’s capacities and organisation.

At the end of this phase, the project was renewed, thus initiating the second phase: EpiSouth PLUS.


The objective of this network is to consolidate public health safety around the Mediterranean basin through creation of a work platform in the area of epidemiology to improve monitoring for transmissible diseases, communication and training.


Phase 2 of the project was called EpiSouth PLUS. Overall, it is the continuation of phase 1, with the same countries. The work packages have changed. There are now seven of them, and all the packages managed by a European public health institute also have a co-leader from a non-EU country.

Coordination of the project is still based in Italy at the ISS, with Tunisia as the co-leader. The specific work packages now include the following sections:

  • WP3: "evaluation", coordinated by the ISS (Italy);
  • WP4: "laboratory network", coordinated by the Pasteur Institute (France) and Turkey;
  • WP5: "training in risk management and response preparedness", coordinated by Spain (Istituto de Salud Carlos III) and Algeria (Institute of Public Health);
  • WP6: "international monitoring and cross-border alerts", coordinated by France (InVS) and the MECIDS network (Middle-East Consortium for Infectious Diseases Surveillance);
  • WP7: "Evaluation in the framework of the IHR (international Health Regulations) and data collection", coordinated by the ISS (Italy) and the WHO-Lyon office.

Section WP6, "international monitoring and cross-border alerts", is coordinated by the international department of the InVS. International monitoring aims to detect and characterise international alerts that could have a public health impact for the EpiSouth countries, as well as promote the exchange of national alerts with cross-border potential. EpiSouth monitoring uses the same methodology as the international monitoring performed by the French Institute for Public Health Surveillance. Information is disseminated in a weekly alert bulletin (eWEB: EpiSouth Epidemiological Bulletin).

This bulletin is in English and is available online at the following address:

It is possible to subscribe to receive it automatically and free of charge at the following address:

Information on cross-border alerts is exchanged on a voluntary basis via a secure platform managed by the international department of the InVS. One of the objectives of EpiSouth PLUS is to strengthen the trust established in the network, to fine-tune exchange procedures and to improve the interoperability of this alert system with the existing systems (WHO, European Union, etc.).

This WP6 programme has a steering committee made up of representatives from each region of the EpiSouth area. This committee is composed of Algeria, Israel, Jordan, Kosovo, Malta, Morocco, Montenegro, Palestine, Romania, Tunisia and Turkey.

EpiSouth is one of the rare projects in the health area covering this entire region. The additional benefits of this project are:

  • close collaboration between countries of the Mediterranean basin;
  • better approach to the contexts specific to this area;
  • rapid exchanges of information in the event of a health crisis: sharing of data and risk analyses between competent institutions and a network of epidemiologists;
  • communication between partner countries;
  • identification of any deficiencies in the public health area;
  • overall reinforcement of the capacities for detection and response (to infectious diseases).

EpiSouth PLUS is co-financed by the European Commission (DG SANCO and DG AIDCO) and the Italian Ministry of Health. In March 2007, for the first time, representatives of the 25 Mediterranean countries gathered to design their future partnership and confirmed their desire to collaborate actively in this ambitious project


internet site:

EAR-GHSAG Project (Early Alerting and Reporting, Global Health Security Action Group)

Context and issues

In 2001, after 9/11, the G7 countries (Germany, Canada, France, the UK, Japan, Italy and the USA), in partnership with Mexico, the European Commission (EC) and the World Health Organisation (WHO), initiated a collaboration on early detection of biological, chemical, and radiological-nuclear (NRBC) threats and of pandemic influenza, the "Global Health Security Initiative" (GHSI). A working group, the "Global Health Security Action Group" (GHSAG), was instituted with representatives of the GHSI.

Within this framework, a project named EAR ("Early Alerting and Reporting"), dedicated to international monitoring ("Epidemic Intelligence"), was initiated in 2009. This project, financed by the participating countries, aims to develop a joint tool for international monitoring by optimising:

  • Detection of alert signals through creation of a computer platform collecting information from various systems used for international monitoring (Argus, BioCaster, HealthMap, ProMed, GPHIN, MedISys, and PULS). These "expert" systems, which are independent but complementary, collect health information from many sources. They operate automatically for the most part using the media (press, social networks, etc.) on the Internet and official sites (Ministries of Health, Public Health Institutes, WHO, etc.), but also through networks of public health experts;
  • Expertise, through pooling of skills within the participating institutions. These fields of expertise cover international monitoring, risk analysis, and NRBC, but also linguistic and computing expertise;
  • Communication: via use of the exchange platform and collaborative links between the national institutions;
  • Response to health alerts in the event of a major health crisis, by pooling knowledge (harmonisation of procedures and reduction in duplication of activities).

The members of the EAR project are:


Participants in international monitoring

Developers of expert systems in international monitoring

Public Health decision-makers


Robert Koch Institute (RKI)


Representative of the Ministries of Health


Public Health Agency of Canada (PHAC)



United States

Centers for Disease Control and prevention (CDC)

ProMed (International Society for Infectious Diseases)
HealthMap (Harvard University)
Argus (Georgetown University)



InVS (international department)



Institute of Infectious Disease (IID)

BioCaster (National Institute of Informatics)       



Istituto Superiore di Sanità (ISS)


United Kingdom 

Health Protection Agency (HPA)



European Centre for Disease prevention and Control (ECDC)

MedISys (Joint Research centre/EC)

European Commission


WHO Observatory




PULS (university of Helsinki)


Objectives and role of the InVS

An initial phase of 18 months, started in 2009, demonstrated the feasibility and relevance of developing a joint platform for early detection of NRBC and pandemic influenza threats.

The second phase of the project started with the development of this platform.

The InVS occupies a transversal and strategic role in this project, with responsibility for evaluation of systems to detect health alerts as well as the interface between epidemiologists and providers of information.

Methodology of the GHSAG working groups

The main focuses of the work are divided into seven groups, involving all the project participants. Aside from development of the platform, the working groups focus on strengthening expertise in NRBC and on the framework and governance that would allow this project to be sustained.


Portal of the GHSAG working group on risk management and communication.

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