Fig. 14.1
Biological incident management system in Poland
The Cabinet headed by the Prime Minister ensures internal security and public order in Poland. The Cabinet urges recommendations and updates or changes in regulations regarding planning and implementation of defence preparation tasks, and identifies objects important for national security and defence.
The Governmental Security Center is directly responsible for the governmental coordination of inter-sectorial response and crisis management at the national level. The institution was established in 2008 and is subordinated directly to the Prime Minister. The Ministry of Interior, the Ministry of Health with its subordinate institution, the Chief Sanitary Inspectorate, the Polish National Police, the National Headquarters of the State Fire Service, the National Border Guard Headquarters, the State Sanitary Inspectorate, the Military Sanitary Inspection of the Ministry of National Defence, and scientific institutes such as the Military Institute of Hygiene and Epidemiology and the National Institute for Public Health – National Institute of Hygiene are major players that undertake coordination actions in the case of a biological attack or unusual outbreak. The network for communication and operating procedures for foreseeable scenarios such as “white powder” hoaxes had been established after the 2001 anthrax attacks in the USA.
14.3.1 The Supportive Role of the Polish Armed Forces
The supreme authority of state administration competent for the defence of the State is the Minister of National Defence, who supervises defence tasks realized by the government, state bodies and institutions. In addition, under the Act of 30 May 1996, the Minister is also obliged to ensure defence and national security via mobilization of reserve materials.
In case of an infectious disease threat and/or a bioterrorism attack the Minister of National Defence mobilizes the appropriate military units specialized in health care management and coordination.
The Polish Armed Forces play a supportive role in response to biological events due to both, highly contagious disease outbreaks and bioterrorism acts. The military has its own system to ensure anti-epidemic protection of soldiers, namely an epidemic surveillance and reporting system including detection capabilities, clinical and/or environmental sample collection, preliminary/rapid diagnostic testing for agent identification, measures to secure an area and the infective material, transport procedures, and final confirmation capability conducted in the BSL-3 reference laboratory at the Military Institute of Hygiene and Epidemiology (MIHE). In case of a biological incident, the Minister of National Defence instantaneously mobilizes competent individuals able to eliminate the harmful effects and perform surrounding decontamination.
The Military Health Care Inspectorate is the primary institution responsible for military health care for both troops deployed in the country and those in abroad mission service. The Polish Armed Forces Military Sanitary Inspection supports the Inspectorate in relation to outbreak surveillance. The Military Sanitary Inspection conducts sanitary situation monitoring, preventive medicine and disease control, epidemiological surveillance, medical investigation, and countermeasures against the use of CBRN (chemical, biological, radiological, nuclear) agents.
14.3.2 Surveillance
Disease surveillance is carried out by the national epidemiological system. The State Sanitary Inspection System collects data on a number of reportable diseases (as set down by the Infectious Diseases Act of 2008 and the International Health Regulations, WHO) from health care and state sanitary inspection laboratories. The information is centrally analyzed in the National Public Health Institute.
The diseases reportable under the Infectious Diseases Act are retrospectively analyzed by the National Public Health Institute. Outbreaks are investigated by the State Sanitary Inspection. Active surveillance is feasible through this system, including case and contact tracing, once a case definition is established and the disease is determined to pose an imminent threat to life (like meningococcal encephalitis). No syndrome-based system of surveillance is used. The system is not real-time, but has a descriptive and lessons-learned value.
The Chief Sanitary Inspectorate, with its Anti-Epidemic Department and subordinate system of the State Sanitary Inspection, is responsible for the institution of control measures (e.g. restriction on public gatherings, sanitary cordon, etc.).
Measures regulating crisis communication (nation level, and with EU) are initiated by the Health Security Committee under ECDC recommendations, promulgated by focal points located in key national institutions. The International Health Regulations Point of Contact (IHR POC) is placed in the National Public Health Institute. The Early Warning and Response System Point of Contact (EWRS POC) and the European Centre for Disease Prevention and Control Point of Contact (ECDC POC) are situated in the Chief Sanitary Inspectorate. The points of contact for the Rapid Alert System – Biological and Chemical Attacks and Threats (RAS-BICHAT POC) and the European Union Health Security Committee (EC HSC POC) are established in the Department of Defence Affairs of the Ministry of Health. The World Health Organization Point of Contact (WHO POC) is also placed in the Ministry of Health.
As mentioned above, the Armed Forces have their own system. The data are collected from military treatment facilities and through the Military Preventive Medicine Centers. The Army used to report to the NATO Epidemiological Reporting System as long as it existed. Now the Polish Armed Forces are looking forward to the establishment of the NATO Deployment Health Surveillance Centre, part of the NATO MilMed Centre of Excellence.
14.3.3 Measures Related to Food and Feed Protection, Animal Health Protection, Plant Protection, and the Environment
Routine measures are undertaken by the State Veterinary and Phytosanitary Inspection concerning food security, animal health and plant protection. Hazard Analysis and Critical Control Point (HACCP) measures are observed. No specific measures are undertaken against the possible use of animal and plant pathogens as a means of warfare. Adequate measures for diagnostics for animal and plant diseases and control measures against the spread of disease (e.g. culling animals) have been practiced in natural outbreaks and the response system and public information policy have proven to be effective in public affairs caused by influenza H5N1 and foot and mouth disease outbreaks. The regulation issued by the Minister of Health in 2006 established close cooperation among the State Sanitary Inspection, the Veterinary Inspection, and the Ministry of Environmental Protection in the management of outbreaks of several zoonotic diseases including anthrax, tularemia, and Q fever which are considered potential biological weapon agents.
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