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Public Health Legal Preparedness: A Framework for Action

13 A. Introduction Public health emergencies have occurred throughout history, encompassing such events as plagues and famines arising from natural causes, disease pandemics interrelated with wars (such as the influenza pandemic of 1918-1919), and industrial accidents such as the 1986 Chernobyl disaster, among others. Law and legal tools have played an important role in addressing such emergencies. Three prime U.S. examples are Congressional authorization of quarantine as early as 1796,1 legally mandated smallpox vaccination upheld in a landmark 1905 U.S. Supreme Court ruling,2 and the President’s 2003 executive order adding SARS to the federal government’s list of “quarantinable communicable diseases.”3 The public health emergencies of the present – both actual and potential – pose equally serious threats but do so in the context of greatly magnified expectations that stem directly from the attacks of September 11, 2001, and the immediately following anthrax attacks. These events transformed the environment in which government agencies – public health, emergency management, law enforcement, and others – work to address public health emergencies in the U.S. As a result, public health emergencies now are seen under the intense spotlight of national security concerns. The agencies charged to prepare for, and respond to, public health emergencies at all levels face extraordinary expectations for safeguarding the nation from potentially catastrophic health threats. Other trends have further transformed the operating environment for public health emergency preparedness, including, for example: the rapid emergence of new threats to the public’s health, such as SARS and influenza A (H5N1); the expectations of elected officials and the public for effective emergency response on an accelerated timeline and on a 24/7 “always on” basis; and, certainly not least, expansion in the origins and scope of public health threats from the local and regional levels to the national and global levels. The public health emergencies the nation faces today require urgent and highly complex responses that involve multiple governments, agencies, jurisdictions, and social sectors. They also may require the use of many public health tools rooted in legal authority, such as disease surveillance; control of movement through quarantine and isolation; government use of private property; allocation of vaccines, medicine and medical supplies; and evacuation of populations. The nation needs modern legal tools to enable rapid, effective responses to such highly complex challenges. Many states and communities, like the federal government and partners at every level, have worked hard to strengthen legal preparedness beginning even before the attacks of September and October 2001. Most, if not all, states have updated their public health emergency laws since then. Many have conducted training in legal preparedness and have incorporated legal issues into preparedness exercises. Further, beginning in 2002, legal preparedness has been an explicit focus of CDC’s program of preparedness grants to the states.4 In spite of this progress, continually emerging events – such as the case of a U.S. citizen who traveled internationally in 2007 while infected with a dangerous form of tuberculosis – underscore that much remains to be done. The driving impetus for the 2007 Georges C. Benjamin, M.D., F.A.C.P., is the Executive Director of the American Public Health Association. Anthony D. Moulton, Ph.D., is the Co-Director of the Public Health Law Program at the Office of the Chief of Public Health Practice, Centers for Disease Control and Prevention. Public Health Legal Preparedness: A Framework for Action