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Status Brief

Developmental Milestones/Developments to Date:

Current Assessment/State of the Field:




Roffey, R.; Lantorp, K.; Tegnell, A.; Elgh, F.  “Biological Weapons and Bioterrorism Preparedness: Importance of Public-Health Awareness and International CooperationClinical Microbiology and Infection, Volume 8 Number 8, 2002

  1. “In Sweden, every county (population approximately 400 000) has an infectious disease clinic with containment facilities. In order to treat patients with highly contagious serious infectious diseases, Sweden has a special containment unit at the university hospitals in Linko¨ping and Stockholm.  Sweden also has a special field epidemiologic group that can be called upon to investigate outbreaks of disease of different types, on both a
    national and an international level.”  p525
  2. “The Swedish Defence Research Agency Division of NBC Defense analyzes the international developments and threats concerning biological weapons and bioterrorism. The research is, among other things, focused on the development of methods and technology for detection/identification of and protection against biological warfare agents. The Swedish Defense Research Agency cooperates with the Swedish Institute for Infectious Disease Control with regard to identification of specific biological warfare agents.” p525
  3. “There is a themselves, temptation for these scientists to immigrate to countries that want to acquire biological weapons.  In order to meet this threat, several initiatives have been taken by the world community. An example of this the Department of Defense Cooperative Threat Reduction Program (DOD CTR) in the USA, as well as other US agencies. Economic support is also given through the International Science and Technology Center (ISTC) in Moscow and the Science and Technology Center Ukraine (STCU) in Kiev, which are financed by the USA, the European Union (EU), Japan, and others.” p526
  4. “In Sweden, the Ministry for Foreign Affairs has supported research cooperation between the Swedish Defense Research Agency (FOI), the Swedish Institute for Disease Control (SMI) and the Scientific Research Institute Vector in Novosibirsk, Russia in the areas of biosafety and diagnostics.”  p526

Public Health, Sweden, Russia


Enhorn v Sweden (2005) 41 EHRR 30 (56529/00)

  1. “In 1994 it was discovered that the applicant, a homosexual, was infected with the HIV virus and that he had transmitted it to a young man. A medical officer issued instructions to the applicant designed to prevent him from spreading the disease. In February 1995, finding that he had failed to comply with those instructions, the Court ordered that he be kept in compulsory isolation in a hospital for up to three months. Thereafter, orders to prolong his detention were issued every six months until December 2001. Since the applicant absconded several times, his actual deprivation of liberty lasted almost one-and-a-half years.”
  2. “The applicant complained that the compulsory isolation orders and his involuntary placement in hospital had deprived him of his liberty in violation of Art.5(1) of the Convention”
  3. “Held, unanimously that there had been a violation of Art.5(1);”
  4. “The compulsory isolation orders and the applicant’s involuntary placement in hospital constituted a “deprivation of liberty” within the meaning of Art.5(1).”
  5. “Since the purpose of the applicant’s detention was to prevent him from spreading the HIV infection, Art.5(1)(e) was applicable.”
  6. “The expressions “lawful” and “in accordance with a procedure prescribed by law” stated the obligation to conform to the substantive and procedural rules of national law. It was particularly important to comply with the principle of legal certainty. The conditions for deprivation of liberty had to be clearly defined and the law had to be foreseeable in its application. Furthermore, a deprivation of liberty had to be free from arbitrariness, necessary in the circumstances and in accordance with the principle of proportionality.”
  7. “The applicant’s detention had a basis in Swedish law. In the light of the relevant statutory provisions, the national courts considered that he had not voluntarily complied with the measures needed to prevent the virus from spreading; that there was reasonable cause to suspect that, if released, he would fail to comply with the instructions issued by the medical officer; and that such non-compliance would entail a risk of the infection spreading.”
  8. “The essential criteria when assessing the lawfulness of detention “for the prevention of the spreading of infectious diseases” were whether the spreading of the disease would have been dangerous for public health or safety, and whether detention of the person infected was the last resort in order to prevent the spreading of the disease, because less severe measures had been considered and had been found to be insufficient to safeguard the public interest. When these criteria were no longer fulfilled, the basis for the deprivation of liberty ceased to exist.”
  9. “Since the HIV virus was dangerous for public health and safety, the first criterion was fulfilled.”
  10. “As to whether the applicant’s detention had been the last resort in order to prevent the virus spreading, the Government had not provided any examples of less severe measures which might have been considered but which had been found to be insufficient to safeguard the public interest.”
  11. “Despite being at large for most of the period from February 16, 1995 until December 12, 2001, there was no indication that during this time the applicant had transmitted the HIV virus to anybody, or that he had had sexual intercourse without first informing his partner about his infection, or that had not used a condom, or indeed that he had had any sexual relationship at all. Although he had infected the young man with whom he had first had sexual contact in 1990, this had only been discovered in 1994 after he had become aware of his own infection. There was no indication that he had transmitted the virus deliberately or through gross neglect.”
  12. “The applicant’s compulsory isolation had not been a last resort in order to prevent him from spreading the HIV virus. Moreover, by extending the order for his compulsory isolation over almost seven years, with the result that he had been involuntarily detained in hospital for almost one-and-a-half years, the authorities had not struck a fair balance between the need to ensure that the HIV virus did not spread and the applicant’s right to liberty. Accordingly, there had been a violation of Art.5(1)”

Detention, Law, Sweden, Public Health, Europe


Kelland, Kate, “Insight: Evidence grows for narcolepsy link to GSK swine flu shot,” Janury 20, 2013, Yahoo Health-Reuters http://health.yahoo.net/news/s/nm/insight-evidence-grows-for-narcolepsy-link-to-gsk-swine-flu-shot Last checked January 24, 2013.

  1. ”Emelie is one of around 800 children in Sweden and elsewhere in Europe who developed narcolepsy, an incurable sleep disorder, after being immunized with the Pandemrix H1N1 swine flu vaccine made by British drugmaker GlaxoSmithKline in 2009.”
  2. ”Europe’s drugs regulator has ruled Pandemrix should no longer be used in people aged under 20.”
  3. ”In total, the GSK shot was given to more than 30 million people in 47 countries during the 2009-2010 H1N1 swine flu pandemic. Because it contains an adjuvant, or booster, it was not used in the United States because drug regulators there are wary of adjuvanted vaccines.”
  4. ”Independent teams of scientists have published peer-reviewed studies from Sweden, Finland and Ireland showing the risk of developing narcolepsy after the 2009-2010 immunization campaign was between seven and 13 times higher for children who had Pandemrix than for their unvaccinated peers.”
  5. ”Narcolepsy is estimated to affect between 200 and 500 people per million and is a lifelong condition. It has no known cure and scientists don’t really know what causes it. But they do know patients have a deficit of a brain neurotransmitter called orexin, also known as hypocretin, which regulates wakefulness…. Around 25 percent of Europeans are thought to have this genetic vulnerability.”
  6. ”Scientists investigating these cases are looking in detail at Pandemrix’s adjuvant, called AS03, for clues. Some suggest AS03, or maybe its boosting effect, or even the H1N1 flu itself, may have triggered the onset of narcolepsy in those who have the susceptible HLA gene variant.”
  7. ”GSK is funding a study in Canada, where its adjuvanted vaccine Arepanrix, similar to Pandemrix, was used during the 2009-2010 pandemic. The study won’t be completed until 2014, and some experts fear it may not shed much light since the vaccines were similar but not precisely the same.”
  8. ”While estimates vary, Stiernstedt says Sweden’s mass vaccination saved between 30 and 60 people from swine flu death. Yet since the pandemic ended, more than 200 cases of narcolepsy have been reported in Sweden. With hindsight, this risk-benefit balance is unacceptable. ‘This is a medical tragedy,’ he said. ‘Hundreds of young people have had their lives almost destroyed.’”
  9. ”Pandemrix was authorized by European drug regulators using a so-called “mock-up procedure” that allows a vaccine to be authorized ahead of a possible pandemic using another flu strain. In Pandemrix’s case, the substitute was H5N1 bird flu.”
  10. ”The ECDC’s Nicoll says early warning systems that give a more accurate analysis of a flu strain’s threat are the best way to minimize risks of this kind of tragedy happening in future.”

Vaccination, Adjuvant, Flu, Syndromic Surveillance, Pharma, Europe, Sweden