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Willingness to Respond to Public Health Emergencies: The Role of Law

posted on Fri, Nov 7 2014 9:07 am by Jon S. Vernick and Lainie Rutkow

As the world is transfixed by the outbreak of Ebola in West Africa, medical and public health responses have come under scrutiny. Issues such as the appropriate isolation of infected individuals and the quarantine of those who have been exposed to the virus (but who may or may not become ill) have been raised not just in African nations, but here in the U.S. as well. 

Recently, the nation watched as the State of Maine attempted to enforce a quarantine order restricting the activities of Kaci Hickox, a nurse who travelled to Sierra Leone to serve as a volunteer with Doctors Without Borders. Ms. Hickox successfully challenged portions of this order. 

Responding to Ebola and other health emergencies represents a challenge for medical personnel as well as the public health system – including the public health legal system. Among other factors, an effective response requires that public health officials have needed authority to act and that first responders are willing to put themselves at risk. The law can affect both outcomes.

Dr. Lainie Rutkow of the Network for Public Health Law’s Eastern Region led an effort to study legal issues that might affect willingness to respond among the public health and emergency medical services (EMS) workforce in a public health emergency. In work published this year in the Journal of Law, Medicine, and Ethics, Rutkow and colleagues determined from a 50-state survey of potentially relevant public health laws that, although all states had the authority to declare an emergency, only about half had the power to specifically declare a public health emergency. Particularly topical given the response to Ebola, just 15 states have legislation providing priority access to health resources, such as medications, for first responders.          

Building on a body of prior work by Dr. Daniel Barnett, who is also part of the project on emergency response willingness, the study also examined how state law might affect response willingness among the EMS workforce. EMS workers are often the very first responders to reach a potentially infectious patient. Analysis of a 2009 survey of EMS workers shows that state laws allowing the declaration of a public health emergency slightly increased response willingness to a hypothetical pandemic flu outbreak – though the differences were not statistically significant.

To ensure the most robust response, policymakers should consider other ways to enhance response willingness through the law. For example, guaranteeing access to personal protective equipment or care for first responders’ families (as appropriate) might enhance willingness to respond.

In an emergency, practitioners and policymakers may not have time to find and read a journal article or lengthy report. This series of brief translational tools — one-page summaries of relevant law and research findings — makes it easier to access vital information.

Just like epidemiology, behavioral sciences, medicine, and many other disciplines, the law is a potentially potent tool for responding to an emergency like Ebola. Like other tools, though, it must be continually sharpened and updated to be most effective.

This blog post was developed by Jon S. Vernick, J.D., M.P., Professor and Co-Director, and Lainie Rutkow, Ph.D., J.D., M.P.H., Associate Professor and Assistant Director -- the Center for Law and the Public’s Health at the Johns Hopkins Bloomberg School of Public Health. Both are affiliated with the Network for Public Health Law – Eastern Region at the University of Maryland’s Francis King Carey School of Law.

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this post does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.

Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not necessarily represent the views of, and should not be attributed to, RWJF.


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