ACLU stresses public health's role in pandemics

Washington -- Efforts to prepare for a pandemic or other type of mass disease event belong squarely in the realm of public health and not law enforcement, contrary to the direction taken since 9/11 by the federal government, argues a new report by the American Civil Liberties Union.

Instead of focusing on providing resources and guidance to local and state public health agencies, federal policies too often emphasize the need to take tough, coercive actions against the people they are charged with protecting, according to the report, "Pandemic Preparedness: The Need for a Public Health Approach."

Although the message is fading from the headlines, preparing for a coming flu pandemic is still on the minds of health officials. For them, it's not a question of if, but when. Avian influenza remains a prime suspect, but other illnesses also could emerge, they warn.

Many groups, including the AMA, have stepped in to assist with planning and training for a timely and appropriate response to disasters.

Now this report, released Jan. 14, cites federal handling of recent cases of extensively drug-resistant tuberculosis as examples of how the law enforcement approach to protecting the nation's health backfired.

Atlanta attorney Andrew Speaker should have been provided protection and safe transport back to the U.S. when it was suspected that he had XDR-TB while on his honeymoon in Italy. Instead, he was told to stay put. His misguided attempts to reach effective treatment in Denver put many other people at risk, the report said.

In another case, a 27-year-old TB patient was jailed for failing to wear a face mask in public. He was placed in solitary confinement for nearly a year in a facility without a proper ventilation system to protect others from his infectious disease, the report said.

Although the public health approach is neither cheap nor glamorous, it does have a successful track record, the report noted. "The public health community has known for decades about dealing with diseases," said Barry Steinhardt, director of the ACLU Technology and Liberty Program, in releasing the report.

Most people want to do the right thing, Steinhardt said, and if provided the necessary guidance and support will do just that. There should be little need for strong police action as there would likely be few, if any, outliers who are intent upon purposeful harm, he added. "This is not an episode of [the television show] '24.' "

More funds need to be provided to public health, said Michael Greenberger, director of the University of Maryland Center for Health and Homeland Security and a professor at the university's law school. He spoke during a panel discussion following the report's release.

"Little money is offered to state and public health departments," he said, noting that normal tasks can often stretch departments thin.

And when federal plans require each household to stockpile supplies and medications, they aren't taking the elderly, disabled and poor into account, Greenberger said.

Plus, although work is progressing on an effective pandemic flu vaccine, antiquated manufacturing and distribution paths could make supply a problem, Greenberger said. Federal action should focus on these areas.

Hospitals also could benefit from federal aid to help them increase surge capacity, said Monica Schoch-Spana, PhD, senior associate at the Center for Biosecurity at the University of Pittsburgh Medical Center. Emergency departments already are overwhelmed by the normal patient load, she said.

The questions mount when considering other facets of existing plans, said Wendy Parmet, co-author of the ACLU report and the Matthews Distinguished University Professor of Law at Northeastern University in Boston. For example, if people are expected to remain at home to lessen the likelihood of disease spread, there should be job guarantees in place and some form of income. "The biggest reason for people not staying home when SARS was affecting Toronto was loss of income."