Global Emergency Legal Responses to the 2014 Ebola Outbreak: Public Health and the Law

Abstract

From their relative obscurity over the past three decades, varied strains of Ebola disease have emerged as a substantial global biothreat. The current outbreak of Ebola, beginning in March 2014 in Guinea, is projected to infect tens of thousands of people before being brought under control. Some estimate the outbreak could exceed 100,000 cases and extend another 12-18 months. Ebola’s spread has the potential to extend across the globe, but is concentrated in several African countries (e.g., Democratic Republic of Congo, Sierra Leone, Liberia, Guinea, Nigeria, and Senegal). Collectively, these countries are home to nearly 290 million people. Among Liberia’s population of 4.1 million, over 1,100 people have already died from Ebola in less than 6 months; by comparison, if this same outbreak and death rate occurred in the United States, over 88,000 Americans would perish.

Ethical considerations surrounding the response to Ebola: the Spanish experience

“…Although we do not know this with certainty, the introduction of quarantine would possibly contribute to the stigmatisation of contacts and their families observed in Spain [ 41 ]. Secondly, quarantine diverts resources which could be used to combat in more effective ways the epidemic or attend to other urgent health needs [ 49 ]. In Spain, high-risk contacts were given the choice of home or hospital quarantine and all of them opted for hospital quarantine, citing among other reasons the fear of infecting family members, in spite of the fact that, apparently, no appropriate justification for quarantine was given to them [ 50 ].…”

Everyday Ethics and Ebola: Planning for the Unlikely

“…This issue is a legitimate area for concern, however, as health care professionals, attorneys, and ethicists differ on the question of whether it is appropriate to use a different standard of care in emergencies. Experts in public health law have published some work directly speaking to legal issues raised by Ebola (Gostin et al 2014;Hodge et al 2014).…”

Ebola Virus Disease: international perspective on enhanced health surveillance, disposition of the dead, and their effect on isolation and quarantine practices

“…The constitutions of Guinea, Sierra Leone, and Liberia allow for a wide range of emergency response measures to protect the public’s health during emergencies [ 7 ]. Though all three constitutions grant certain public rights, such as freedoms of assembly and association, only Guinea’s constitution explicitly preserves those rights during declared public emergencies [ 8 ].…”

“…The EVD outbreak remained rampant in West Africa for 6–8 months before actual surveillance was launched in order to monitor the spread of the disease [ 9 ]. While internationally most countries carried out some level of EVD screening and monitoring, Guinea, Sierra Leone, and Liberia eventually implemented mandatory health checkpoints and house-to-house searches to conduct contact investigations, and developed and enforced strict penalties, including jail time, for those violating public health orders [ 7 ].…”

“…All three countries’ emergency declarations required closures of borders and certain public spaces, such as schools and markets [ 7 ]. Liberia and Sierra Leone banned mass gatherings and closed government offices.…”