We are pleased to present this symposium featuring commentary from participants in the “Between Complacency and Panic: Legal, Ethical and Policy Responses to Emerging Infectious Diseases” conference held on April 14, 2017, at Northeastern University School of Law. The conference was sponsored by the Center for Health Policy and Law and the American Society for Law, Medicine, and Ethics (ASLME), with support from The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School. Stay tuned for more posts!
By Wendy E. Parmet and Jennifer L. Huer
Public health is often invisible. In contrast to health services, public health interventions usually operate behind the scenes, reducing risks to broad populations. No one can say who was saved, what deaths were prevented.
For public health, this invisibility presents political and budgetary challenges. Without clear beneficiaries, public health has lacked the political support and dollars allocated to health services. This challenge may be even more formidable today as the Trump Administration seeks enormous cuts to public health programs, while questioning settled public health science.
In the face of such challenges, it may be tempting for public health advocates to emphasize the dangers of emerging infectious diseases. Over the last forty years, a multitude of new or previously tamed infectious diseases such as HIV/AIDS, SARS, Ebola, and Zika have emerged, wrecking morbidity and mortality, and causing panic around the globe. During these outbreaks, public health’s importance becomes, at least briefly, all-too-apparent.
Unfortunately, as the history of the HIV epidemic attests, panic doesn’t necessarily preclude neglect. Nor does it guarantee long-term support for public health efforts. Instead, during a disease panic, policymakers often scapegoat already vulnerable populations and impose coercive measures, even when the evidence suggests that such approaches will do little to stem the outbreak. Then, when the epidemic or at the least the panic recedes, public attention often wanes. Support for the long-term, often unglamorous but evidence-based efforts needed to protect the public health from the next threat often fades. For example, the Trump Administration has recently proposed massive budget cuts for programs aimed at protecting against pandemics and bioterrorism.
This cycle of panic and neglect, of over-reaction and underfunding, was the subject of a conference sponsored this past April by the Center for Health Policy and Law at Northeastern University School of Law. Between Complacency and Panic explored ways law and policy can prepare for the next epidemic, protect the interests and rights of vulnerable populations, and address some of the social determinants of health that underlie emerging infectious diseases. This blog symposium shares comments from some of the conference speakers.
The conference keynote speaker, Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, set the stage as he walked attendees through his experiences as five different presidential administrations faced new emerging infectious diseases, starting with the AIDS epidemic in the 1980s. (Dr. Fauci’s presentation can be found on the conference webpage). Dr. Fauci emphasized the need for further research as well as communication at all levels (international, domestic, national, regional), particularly in developing and implementing emergency preparedness plans. In line with a major theme for the conference, he observed that fear and unfair treatment of health workers and patients often grab the attention of the media and public, while overshadowing the work that is and can be done to prevent and treat public health crises, such as Ebola and Zika.
Another theme from the day’s conversations was the expansive universe of public health and all that it touches, as highlighted during the luncheon presentation by Pulitzer Prize-winning journalist and New York Times bestselling author, Laurie Garrett, who offered a riveting and sobering commentary on the interconnectedness between climate change and public health. As Garrett explained, climate change is not only an environmental problem: it is a major public health threat.
Panels throughout the day addressed the need for preventive plans and processes, both at the international and domestic levels, whether through patent law as applied to vaccine development, ethical standards for human challenge trials, legal protections for public health workers, appropriate enforcement of public health measures (e.g., quarantine and isolation), or more proactive responsiveness to the social determinants that affect a population’s health (e.g., stable and safe housing, access to clean water, reproductive rights). We encourage people to visit the conference webpage to view some of the materials presented throughout the day.
In the blog posts that follow in this symposium, conference speakers will continue the conversation. Two posts will focus on the need to reconsider coercive public health responses to infectious diseases, specifically surrounding quarantine. Kaci Hickox, infection preventionist and public health advocate, perhaps most known for being at the center of a quarantine overreach back in 2014, will emphasize the importance of investing in a public health infrastructure that supports the work and rights of public health workers. She writes from personal experience about the need for protection of individual freedom and due process, particularly in an environment that historically enforces fear-based policies and laws. She reminds us that rather than building barriers, we need to fight outbreaks such as Ebola at their source. See her post here.
Similarly, Professor Wendy K. Mariner will comment on recent regulations by the Centers for Disease Control and Prevention (CDC), which broadens its authority to issue quarantine orders. Mariner will argue that the new regulations fail to protect an individual’s right to due process, and grant far too much discretion to CDC officials. She also observes that the new regulations focus entirely on reactive processes, rather than utilizing and enhancing the CDC’s proactive, scientifically-based preventive powers and expertise.
Ana Ayala, Director of the Global Health LL.M. Program at Georgetown Law, will use her post to move the discussion to the international arena, while also emphasizing the need for preventative, rather than reactive, policies to preparing for infectious diseases. Ayala will urge a multidisciplinary approach to building partnerships and projects aimed at “pandemic preparedness.” Her point gets to the heart of the conference, which sought to draw together experts and scholars from across disciplines to discuss and collaborate on these very issues.
Emerging infectious diseases may be unique in their capacity to incite panic. But like other disease threats, they are more apt to strike those who are already vulnerable. And as with chronic diseases and endemic infections, prevention must be multi-faceted, evidence-based and focused on protection rather than blame. Conference speakers made clear that no magic bullet can ensure such an approach, or wholly prepare us for the next epidemic, but we hope that interdisciplinary conversations, and awareness of the dangers of both complacency and panic, can at least put us on the right path.
Stay tuned for more posts in the Emerging Infectious Diseases Blog Symposium!