BALANCING PUBLIC HEALTH AND CIVIL LIBERTIES IN FLU PANDEMICS: QUARANTINES AND MANDATES

Abstract

There is a tension, perhaps a conflict, whatever language one might use, between public health measures and the civil liberties of individuals, groups, and communities. Given the experiences of the last century with plagues of influenza, SARS, and HIV, and the emergence of more virulent pathogens as evidenced by Ebola, the models of regulation of infectious diseases would appear to be timely. Flu pandemics present several distinct models of public health measures and civil liberties. What happens when vaccination uptake is low and people refuse to comply with a community mandate to be vaccinated? What happens when individuals become ill and public health authorities prefer to isolate and confine rather than treat? What is the balance between the health of the public and the liberty of the individual? What level of departure or variation from a norm of civil liberty may be permissible? How often and with how much publicity are such departures? Questions about public health measures and civil liberties are alive at federal, state, and local levels with regard to notifiable diseases as is captured in the proverb “It takes a whole village to raise a child,” (Shawn Tracy et al., 2009). And yet, flu pandemics raise questions about the limits of civil liberties that are distinct from those raised by other infectious diseases. Just as vaccines are key to controlling and ending flu pandemics, so too are some graduation of public health measures/eventually severe public health measures such as mandates and quarantines critical to curtailing a pandemic’s peak and duration. The rudiments of a pandemic flu plan outline a stepwise consideration of increasingly sever public health measures that take into account both efficacy and feasibility/acceptability. The first measures are voluntary and/or community-based education, with mandates/quarantines to be considered only at a pandemic’s latter stages, if at all. But as there are no clear rules for when/what events trigger consideration of public health measures, consider an initial case study: consideration of quarantine for an ill individual. At its most basic, quarantine means the restriction of an individual’s movement in order to reduce the risk of pathogen transmission. The quarantine of individuals/households has been an essential tool in the public health response to prior flu pandemics.