By Wendy Parmet | June 30, 2009
THE World Health Organization has announced the obvious: The H1N1 (swine flu) outbreak has become a global pandemic. Fortunately, the virus thus far appears to be far less lethal than many expected and that is wonderful news as our preparation for H1N1 demonstrated some serious flaws in our public health policies.
Over the last five years, the catchphrase for US pandemic policy was “preparedness.’’ At its core, preparedness emphasized the need to keep watch and be ready for a public health catastrophe, such as a highly lethal pandemic.
As a result, policies based on preparedness emphasized not only the need to enhance surveillance, to detect the onset of a new outbreak, but also emergency measures, including coercive emergency laws, that were designed to keep out or contain a dangerous new pathogen.
States were urged to revise their public health laws, to grant health officials clearer authority to impose quarantines and other highly coercive measures. Laws were also passed immunizing drug companies and healthcare workers for medical responses to an epidemic. All these laws, preparedness advocates argued, would facilitate a robust response in the event of a public health emergency.
The H1N1 pandemic reveals the fallacy of relying on public health emergency laws to contain an epidemic. Even with enhanced surveillance, H1N1 had already spread widely in many parts of Mexico and the United States before it had been identified.
Thus as US and WHO officials quickly recognized, neither border closings nor quarantines, both of which figured largely in preparedness efforts, could keep H1N1 out. Nor are school closings as effective or as simple as many had anticipated. In many communities, families struggled with finding child care or losing pay when schools were closed. Meanwhile, the virus continued to spread as children continued to meet with their peers, even when school was out.
Unfortunately, not all nations have admitted that H1N1 cannot be contained. Utilizing the type of coercive powers that were called for in US preparedness efforts, several nations, including China, have quarantined healthy travelers who officials think may have been exposed to H1N1. Not surprisingly, in many cases these quarantines seem to have been motivated more by xenophobia and bigotry (especially toward Mexicans) than by sound public health policy.
If containment doesn’t work, how should we respond to a public health emergency? H1N1 provides a clue. As in many epidemics, deaths are occurring primarily among those with prior health conditions. In many cases, those prior health conditions were either preventable or controllable. Unfortunately, funding for public health efforts to control conditions such as diabetes and asthma were slashed around the country even as more money was put into developing emergency response plans.
In addition, it now seems clear, though it should have all along, that a well-functioning healthcare system is critical to weathering any public health emergency. In part, past preparedness efforts supported that goal by stockpiling antiviral medications and bolstering the US capacity to manufacture vaccines. Still, even though H1N1 did not require treatment in most cases, stockpiles of antiviral medication were quickly depleted. Moreover, preparedness efforts generally neglected the lack of universal health insurance, the shortage of primary-care providers, and overcrowded hospital emergency rooms. Yet these flaws in our healthcare system loomed large this spring and could have proven fatal if H1N1 had been more lethal.
Fortunately, we seem to have missed the big one. But rather than take from that the need to buckle down and enact more emergency laws, we should realize that the best way to prepare for a public health emergency, whether big or small, highly lethal or not, is to have a healthy population with good access to quality healthcare. The best way to prepare for a public health disaster is to focus our attention and our laws on ameliorating our everyday health problems.
Wendy Parmet is a professor of law at Northeastern University School of Law, and author of “Populations, Public Health and the Law.’’