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The recent anthrax attacks in the USAhave increased everyone’s awarenessof the extreme difficulty of handlingmajor health dangers in a coordinatedmanner.Evenwithoutthislatestdrama,the need for improved coordination isobvious in the light of recent outbreakssuch as those of bovine spongiformencephalopathy and foot-and-mouthdisease, and the cacophony of theEuropean response to these problems.The Americans are fortunateenough to have a central agency fordealing with such matters: the Centersfor Disease Control and Prevention(CDC), of which the National Centerfor Infectious Diseases (NCID) is animportant part. This is a big federalorganization with more than 1500employees. It combines advancedresearch, surveillance, control, andtraining. Each US state has its ownhealth policy and disease surveillanceand control system, but the NCIDplays an important role in coordinatingactivities and collecting data. In termsof research, the NCID’s work iscomplemented by that of many otherresearch centres, including theNational Institutes of Health (NIH),theUSArmylaboratoriesandthousandsof university laboratories.Clearly an organization in Europeanalogous to the NCID — a EuropeanCentre for Infectious Diseases (ECID)— is sorely needed, and this idea hasbeguntotakeshape(1,2).Theprincipleis to set up a central structure with walls,which, like its American counterpart,would coordinate advanced research,surveillance and professional training.The ECID would not be limited to theEuropean Union, and would includecountries such as Switzerland, as wellas those of Eastern Europe. It wouldalso have strong links with developingcountries, because if we want tocontrol epidemics in Europe, we haveto do it in developing countries too:microorganisms are no respectersof national borders (2). And as far asbioterrorism is concerned uncoordi-nated health systems offer a strategicadvantage for causing havoc.It is important to underline thatthe ECID would be only one piece ofthe European system in this domain.It does not aim to replace nationalstructures such as the Pasteur Institutesin France or the Karolinska Institute inSweden. Nor would it aim to competewith national control structures such astheInstitut deVeille Sanitaire inFrance.On the contrary, its goal would be tocomplement and optimize the actionof existing structures.The harsh reality is that the taskbefore us is huge, and so far there is noEuropean system to tackle it. Europeneeds a centralized structure even morethan the USA, because of the politicalcompartmentalization of this continent.In spite of the excellence of theexisting institutions, European workon researching and controlling infec-tiousdiseasesisadistressingcacophony,like an orchestra with no conductor(3). It has been argued that a centralstructure would be useless, and that a‘‘virtual CDC’’ (surveillance networkselectronically operated) would be moreefficient (4, 5). Actually, the twoconcepts are complementary. TheEuropean Centre would be efficientlycompleted by electronic networks,outposts and cooperation centres.It is proposed that as part of theirongoing work the ECID programmeswould take advantage of the genomicandpost-genomicrevolutiontodevelopfar-reaching holistic research on theepidemiology of infectious diseases.In doing so it would find ways toreconcile new powerful technologiessuchasmassivesequencing,DNAchipsand bioinformatics with valuable butvanishing savoir-faires such as classicalmedical entomology, parasitology andbacteriology. The European dimensionof the enterprise would make itpossibletoworkonascalethatishardlypossible within national frameworks.By analogy, only the successful Eur-opean Space Agency made it possibleto develop the Ariane launchers.Much discussion has been alreadygenerated around the idea of thisproject (6, 7). It has enabled the ECIDscientific board and its steering com-mittee to develop the concept, andour goal now is to relaunch the debatethroughaseriesofmeetingsandarticles,to turn the idea into a reality. Prepared-ness for disease emergencies is sucha hot topic now (8) that there is no wayto avoid the question and its practicalimplications. In the end, of course, it isa matter that has to be taken up bypoliticians and decision-makers. In itspresent state, the ECID is a privateundertaking supported by a group ofscientists and health professionals,andnotanofficialprojectofanynationalinstitution.

A European centre to respond to threats of bioterrorism and major epidemics.