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breaking down in New Orleans after Hurricane Katrina has been seared into public memory. In a wave of a severe pandemic, a goal of public health efforts might be to ensure that police and fire departments continued to function, and that services such as housing sanitation, food, electricity, and communications were provided.

Finally, because a pandemic is global, the geographical scope of public health goals needs to be considered. Federal and state governments in the United States are developing national and state responses to the pandemic. Plans are under way to purchase and distribute vaccine and antivirals. Critics in developing countries charge that the available supply of vaccine is being rapidly purchased by developed nations, leaving inadequate supply to other countries (Bertozzi et al., 2009). Furthermore, many nations cannot afford to purchase vaccines for all citizens at increased risk for severe 2009-H1N1 influenza A infection. The world is interconnected, and the United States and other developed countries are affected by the course of the pandemic in less-developed countries. A large number of cases worldwide may increase the chances that the virus will mutate to a lethal variant. Moreover, the United States benefits from other countries sharing surveillance data and virus samples. However, resource-poor countries may be reluctant to engage in such scientific cooperation if they do not receive assistance with their public health efforts in return (Bertozzi et al., 2009).

Balancing Public Health Powers with Liberty and Fairness

Traditional public health laws, promulgated in the late nineteenth and early twentieth centuries, gave great deference to the “police powers” of the state to act in the common good (Colgrove and Bayer, 2005). During a declared public health emergency, public health officials have the authority take actions that would not be permissible in ordinary clinical care, including mandatory examination, isolation, and quarantine. These measures compel individual citizens to forego their basic rights.

In the late twentieth century, greater concern for civil rights was the background for attention to individual liberty during the AIDS epidemic. Mandatory public health measures were recognized as placing heavy burdens on individuals, restricting their liberty, causing economic losses, and sometimes leading to stigmatization (Fidler et al., 2007). Agreement developed that individual liberty may be restricted by public health officials only when several ethical requirements are met (Childress et al., 2002; Gostin, 2008; Gostin et al., 2002, 2003):

  • The threat to public health must be serious and likely.

  • The intervention should be effective in addressing the threat.

  • The intervention should be the least restrictive alternative that addresses the threat.

  • The burdens on those whose freedom is restricted must be acceptable.



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