title: [Structures and concepts for nationwide outbreak management in a federal state].
abstract: With pandemic influenza in 2009/2010 and an EHEC outbreak in 2011, the Federal Republic of Germany experienced two extensive outbreaks in the course of only 3 years. Although both infectiological crises were comparatively successfully coped with, certain aspects have been critically examined. One point of criticism has been the presumption that federal structures may not be well suited for the management of a nationwide outbreak. This has been linked to the request for a central authority with responsibility. In fact, centralized as well as federal structures have advantages and disadvantages during infectiological crises. However, the "first response," i.e., immediate action against the spreading of infectious diseases, has to take place locally anyway. Regional differences, even in the context of a nationwide outbreak, might well demand regional action. After all, the federal structure of the Republic of Germany is deliberately firmly rooted in the German constitution, and there are no indications that this may change in the near future. Suitable concepts and structures should be used so as to benefit from the advantages and avoid the disadvantages of a federal state. The current structures are described, and improvements that may be necessary are discussed. The existing structures are shown to be entirely appropriate in allowing necessary decisions to be made and a fast transmission of information even in a federal state. Occasional shortcomings are seen as mainly due to the inadequate implementation of already existing regulations and partly to the ambition of a few spotlight seekers rather than to actual inadequacies of existing federal structures.
authors.affiliation: Ehemaliger Leiter des Gesundheitsamtes der Stadt Köln, Aachener Str. 1313, 50859, Köln, Deutschland. jleidel@t-online.de
authors.forename: J
authors.initials: J
authors.lastname: Leidel
authors.forename: F
authors.initials: F
authors.lastname: Feil
mesh_terms: D003140:Communicable Disease Control / Q000379:methods / Q000458:organization & administration*; D018563:Disease Notification / Q000379:methods* / Q000706:statistics & numerical data; D004196:Disease Outbreaks / Q000517:prevention & control*; D035082:Federal Government; D005858:Germany / Q000453:epidemiology; D006291:Health Policy; D006801:Humans; D019221:Mandatory Reporting; D017146:Models, Organizational