Pandemic influenza control in Europe and the constraints resulting from incoherent public health laws

Abstract

BackgroundWith the emergence of influenza H1N1v the world is facing its first 21st century global pandemic. Severe Acute Respiratory Syndrome (SARS) and avian influenza H5N1 prompted development of pandemic preparedness plans. National systems of public health law are essential for public health stewardship and for the implementation of public health policy[1]. International coherence will contribute to effective regional and global responses. However little research has been undertaken on how law works as a tool for disease control in Europe. With co-funding from the European Union, we investigated the extent to which laws across Europe support or constrain pandemic preparedness planning, and whether national differences are likely to constrain control efforts.MethodsWe undertook a survey of national public health laws across 32 European states using a questionnaire designed around a disease scenario based on pandemic influenza. Questionnaire results were reviewed in workshops, analysing how differences between national laws might support or hinder regional responses to pandemic influenza. Respondents examined the impact of national laws on the movements of information, goods, services and people across borders in a time of pandemic, the capacity for surveillance, case detection, case management and community control, the deployment of strategies of prevention, containment, mitigation and recovery and the identification of commonalities and disconnects across states.ResultsResults of this study show differences across Europe in the extent to which national pandemic policy and pandemic plans have been integrated with public health laws. We found significant differences in legislation and in the legitimacy of strategic plans. States differ in the range and the nature of intervention measures authorized by law, the extent to which borders could be closed to movement of persons and goods during a pandemic, and access to healthcare of non-resident persons. Some states propose use of emergency powers that might potentially override human rights protections while other states propose to limit interventions to those authorized by public health laws.ConclusionThese differences could create problems for European strategies if an evolving influenza pandemic results in more serious public health challenges or, indeed, if a novel disease other than influenza emerges with pandemic potential. There is insufficient understanding across Europe of the role and importance of law in pandemic planning. States need to build capacity in public health law to support disease prevention and control policies. Our research suggests that states would welcome further guidance from the EU on management of a pandemic, and guidance to assist in greater commonality of legal approaches across states.

Knowledge about the pandemic influenza A (H1N1) and willingness to accept vaccination: a cross-sectional survey

“…National systems of public health law are essential for influenza pandemic control (Martin et al 2010) internationally. Updated scientific information should be diffused to the medical students through teaching/learning modes, as they will be a good source of communication to their families and the community.…”

“…To increase vaccination coverage, there are debates on free and compulsory public measures to limit the dissemination of an infection. Although disease notification responsibility is generally common across Europe (Martin et al 2010), compulsory vaccination is less common. All can agree that while public health policy and pandemic planning may propose measures beneficial to the public health, those measures cannot be applied without legal support (Martin et al 2010).…”

Epidemiologia e políticas públicas

“…In a democratic system based on the respect for human rights, regulatory policies that usually include interventions that infringe upon or restrict individual freedoms must necessarily be based on specific legislation that can ensure the context of the inviolability of rights and the implementation of state power. 14 The role of epidemiology is important in both determining the nexus and causal mechanisms underlying the proposed intervention and assessing the impacts achieved. Technologies typical of epidemiological practices, such as surveillance and monitoring, can be useful in the implementation of these actions.…”

Controlling epidemic viral infection

“…This is tacitly acknowledged by WHO as it is suggested that entry screening should be considered in passengers arriving from countries where there are concerns about the presence or thoroughness of exit screening [20 ]. Substantial difficulties also arise when neighbouring countries have substantially different public health approaches and public health laws [23].…”