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Last Updated

03 Feb 2003

Source: Washington Post, December 3, 2001.


Laws for an Epidemic

THE PERPLEXITY surrounding five anthrax deaths has done little to quell fears that a more contagious epidemic would create chaos. And the darker side of what has happened with anthrax -- the confused lines of authority, the conflicting medical and public health and containment messages -- has led public health experts and lawyers to contemplate a different type of readiness for a possible "next time." The Centers for Disease Control and Prevention last week released a description of steps the federal government would take in a smallpox epidemic, from the distribution of vaccines to emergency workers to the last-resort use of quarantines or sealed-off "cordons sanitaires." But in the early stages, at least, management of epidemics historically has been local and regional; federal authority to override states in such circumstances is uncertain. With that in mind, several public health lawyers have drafted a model law that states could adopt, giving governors sweeping powers to quarantine, confiscate property, compel vaccination or isolation and otherwise protect the public health in an emergency.

The basic idea is unnerving but hard to gainsay. Stemming the carnage in a true emergency such as a smallpox epidemic would require near-universal citizen compliance, and if government could not compel that compliance in a pinch, it would be rendered essentially helpless. Devising laws for such a worst-case scenario requires careful definitions, especially of what exactly qualifies as a triggering "public health emergency." Carefully spelled-out protections also are owed to people being compelled to accept restrictions on their freedom to save others.

State officials and civil libertarians already have pushed successfully for a round of revisions to a draft law prepared by public health law specialists at Johns Hopkins and Georgetown. In early discussions, for instance, they agreed to give state legislatures the power to override a governor's declaration of emergency and specify for those who resist vaccination the option of remaining in isolation instead. More revisions should, and will, be contemplated as state legislatures take up versions of the draft. Any emergency law should be designed to resist misuse by public officials who, no less than the general population, could be susceptible to panic and invoke such a law without proper cause.

State laws also need clear guidelines on when to yield to federal powers in the case of an epidemic that leaped regional boundaries; the last thing people need in an epidemic is confusion about who is in charge. But emergency laws, important as they are, can be only a small part of the government's strategy in combating such a crisis. As in any public health campaign, the more important element is gaining people's willing cooperation through openness and the timely release of reliable information. If more than a small minority need coercion, the battle is lost from the start.