Case
Before the EHEC and HUS outbreaks, numerous organizations regarding food safety as well as healthcare were active at local, federal and international level. According to the German prevention of Infection Act, these organizations were mostly collaborating on a weekly basis and the stream of information was going upward and was skimmed at each level to avoid the organizations at the top to be overloaded.

The main problem faced when the outbreak occurred was the lack of ability of these organizations to collaborate in an efficient way and to enable a quick information flow. A single authority was therefore needed to coordinate and to lead activities related to healthcare and food control, fostering thereby a common vision and sense of urgency, a better communication, as well as a common plan to react quickly.

This need was fulfilled by the EHEC Task Force in June 2011, in which federal agencies [the Robert Koch Institut (RKI), the Federal Office of Consumer protection and Food Safety (BVL) and the Federal Institute for Risk Assessment (BfR)], which already had some relations with international organizations, such as the World Health Organization (WHO), worked in close collaboration with the European Food Safety Authority (EFSA) to monitor and coordinate the actions.

Challenges
The speed to which the outbreak spread itself and the unknown strain of the disease set a certain number of challenges for the authorities in charge :

➢ Rapid exchange of information (as well as implicit knowledge) and coordination among authorities

➢ Avoid measures which could lead to unnecessary economic losses

➢ Avoid panic, which could lead to the overload of emergency department

➢ Making the right prevention, ignoring the source of the outbreak

➢ Avoid spreading misleading information to the public

Outbreak legacy
The outbreak led to several suggestion regarding the reporting system, but they were not all realistic due to collusion with federal and legal system.

➢ Implementation of a real-time Electronic Reporting System of Infectious diseases (through Global Public health Intelligence Network (GPHIN), but first faced issues concerning privacy protection.

➢ Early warning system (like the ones existing in Japan or in the USA). Remained at the state of project (EU’s EO2HEAVEN project).

➢ Task-force (Which currently do not exist anymore)

➢ Establishment of a super central authority (which could have been embodied by the Robert Koch Institut)

Critical point of view

According to Klotter’s last two steps, the crisis led to some improvement, which should be internalized in order to enhance the approach for future cases. As it is stated in the text no solution can be found to solve every crisis, the emphasis should therefore be put on the flexibility of the structure and its ability to adapt itself quickly.
In order to do that we would have let each organization operate its daily routine as long as there were no crisis, that way, we would have avoid the overload with irrelevant information of the federal and international organizations. But as soon as the outbreak occurred, the laboratories would have been accountable directly to the task-force. The time gained that way could have been used to control if the assumptions concerning the vehicle of the disease were correct or not, avoiding thereby any public out cry, like with the Spanish cucumbers. The issue is that German legal framework constrains to include every single authority in the process.