Policy and planning for large epidemics and pandemics - challenges and lessons learned from COVID-19.

PURPOSE OF REVIEW: The COVID-19 pandemic is a global catastrophe that has led to untold suffering and death. Many previously identified policy challenges in planning for large epidemics and pandemics have been brought to the fore, and new ones have emerged. Here, we review key policy challenges and lessons learned from the COVID-19 pandemic in order to be better prepared for the future. RECENT FINDINGS: The most important challenges facing policymakers include financing outbreak preparedness and response in a complex political environment with limited resources, coordinating response efforts among a growing and diverse range of national and international actors, accurately assessing national outbreak preparedness, addressing the shortfall in the global health workforce, building surge capacity of both human and material resources, balancing investments in public health and curative services, building capacity for outbreak-related research and development, and reinforcing measures for infection prevention and control. SUMMARY: In recent years, numerous epidemics and pandemics have caused not only considerable loss of life, but billions of dollars of economic loss. The COVID-19 pandemic served as a wake-up call and led to the implementation of relevant policies and countermeasures. Nevertheless, many questions remain and much work to be done. Wise policies and approaches for outbreak control exist but will require the political will to implement them.

Implementing the Epidemic Diseases Act to combat Covid-19 in India: An ethical analysis.

Many states in India have invoked the provisions of the Epidemic Diseases Act, 1897, as a major tool in the fight against the Covid-19 pandemic. The current review attempts to discuss the ethical challenges in implementation of the Epidemic Diseases Act, 1897, to combat Covid-19 in India. Implementation of the Act in India has exposed its major limitations. It remains merely as a "policing" Act with no emphasis on coordinated and scientific responses to outbreaks and without provisions for protecting the rights of citizens. The Epidemic Diseases Act in its current form has the potential to cause more harm than good. Furthermore, the Epidemic Disease (Amendment) Bill, 2020, has not addressed any of these concerns. There is need for a rights-based, people-focused and public health-oriented law in India to deal with epidemics.

The Rights of Elders in Ireland during COVID-19.

This article reflects on COVID-19 restrictions imposed on elders in Ireland through the lens of the right to private and family life (Article 8 ECHR), focusing on stay at home orders and recommendations advising elders to avoid social contact. Furthermore, we examine restrictions on visiting nursing homes given the high death toll in that setting. In our analysis, we zero in on the principles of foreseeability and proportionality, highlighting areas of concern and aspects that we submit should be considered in a proportionality assessment. Ultimately, we argue that it is a mistake to view the COVID-19 pandemic solely as an emergency. In this manner, the solutions suggested through the law - restrictions on movement and visitation bans - are too narrow and fail to address the underlying structures, such as, issues in the healthcare system, the limited home help for elderly and poor conditions in nursing homes.

The Effects of Border Shutdowns on the Spread of COVID-19.

OBJECTIVES: At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, some countries imposed entry bans against Chinese visitors. We sought to identify the effects of border shutdowns on the spread of the COVID-19 outbreak. METHODS: We used the synthetic control method to measure the effects of entry bans against Chinese visitors on the cumulative number of confirmed cases using World Health Organization situation reports as the data source. The synthetic control method constructs a synthetic country that did not shut down its borders, but is similar in all other aspects. RESULTS: Six countries that shut down their borders were evaluated. For Australia, the effects of the policy began to appear 4 days after implementation, and the number of COVID-19 cases dropped by 94.4%. The border shutdown policy took around 13.2 days to show positive effects and lowered COVID-19 cases by 91.7% on average by the end of February. CONCLUSIONS: The border shutdowns in early February significantly reduced the spread of the virus. Our findings are informative for future planning of public health policies.

Buying Time with COVID-19 Outbreak Response, Israel.

Israel's response during the containment phase of the COVID-19 outbreak in early 2020 led to a delay in sustained community transmission and effective mitigation. During February-April 2020, a total of 15,981 confirmed cases resulted in 223 deaths. A total of 179,003 persons reported electronically to self-quarantine and were entitled to paid sick leave.

The Impact of COVID-19 Partial Lockdown on Primary Pollutant Concentrations in the Atmosphere of Rio de Janeiro and São Paulo Megacities (Brazil).

As COVID-19 spread all over the world, most of the countries adopted some kind of restrictions to avoid the collapse of health systems. In Brazil, São Paulo and Rio the Janeiro, the two most populated cities in the country, were the first to determine social distancing. In this study, the impact of the social distancing measures on the concentrations of the three main primary air pollutants (PM10, NO2 and CO) was analyzed. CO levels showed the most significant reductions (up to 100%) since it is related to light-duty vehicular emissions. NO2 also showed reductions (9.1%-41.8%) while PM10 levels were only reduced in the 1st lockdown week. The decrease of pollutants was not directly proportional to the vehicular flux reduction, because it depends on other factors such as the transport of air masses from industrial and rural areas. The differences observed can be explained considering the fleet characteristics in the two cities and the response of the population to the social distancing recommendations.

Policy Lessons From Early Reactions to the COVID-19 Virus in China.

The World Health Organization (WHO) declared the COVID-19 virus outbreak to be a Public Health Emergency of International Concern on January 30, 2020. Although the Chinese central government implemented significant measures to control the epidemic from January 20 within China, the crisis had already escalated dramatically.Between December 1, 2019, and January 20, 2020, a total of 51 days passed before the Chinese central government took full control. Several major factors combined to cause what had been in retrospect a clear break in the governmental information chain between December 1 and January 20. The management of this epidemic also illustrated key organizational limitations of the current Chinese health system, in particular provincial-level senior officials' lack of knowledge and awareness of potential public health risks and insufficient emergency medical material storage and logistics arrangements.We review the specific disease control actions that the Chinese central government took between January 20 and January 27, the major reasons why the governmental information chain had broken before January 20, and key structural health system limitations highlighted as the epidemic expanded.

Improving Cross-Border Preparedness and Response: Lessons Learned from 3 Lassa Fever Outbreaks Across Benin, Nigeria, and Togo, 2017-2019.

Long-standing cultural, economic, and political relationships among Benin, Nigeria, and Togo contribute to the complexity of their cross-border connectivity. The associated human movement increases the risk of international spread of communicable disease. The Benin and Togo ministries of health and the Nigeria Centre for Disease Control, in collaboration with the Abidjan Lagos Corridor Organization (a 5-country intergovernmental organization) and the US Centers for Disease Control and Prevention, sought to minimize the risk of cross-border outbreaks by defining and implementing procedures for binational and multinational public health collaboration. Through 2 multinational meetings, regular district-level binational meetings, and fieldwork to characterize population movement and connectivity patterns, the countries improved cross-border public health coordination. Across 3 sequential cross-border Lassa fever outbreaks identified in Benin or Togo between February 2017 and March 2019, the 3 countries improved their collection and sharing of patients' cross-border travel histories, shortened the time between case identification and cross-border information sharing, and streamlined multinational coordination during response efforts. Notably, they refined collaborative efforts using lessons learned from the January to March 2018 Benin outbreak, which had a 100% case fatality rate among the 5 laboratory-confirmed cases, 3 of whom migrated from Nigeria across porous borders when ill. Aligning countries' expectations for sharing public health information would assist in reducing the international spread of communicable diseases by facilitating coordinated preparedness and responses strategies. Additionally, these binational and multinational strategies could be made more effective by tailoring them to the unique cultural connections and population movement patterns in the region.

On Courtroom Dramas and Plot Twists: Typhus in Eighteenth-Century London.

This article applies the model developed in Charles Rosenberg's seminal article "What is an Epidemic?" to typhus outbreaks in eighteenth-century London. That framework remains valuable for understanding contagious disease in early modernity by helping to highlight the structure of responses to epidemics. So-called "Jail Fever" outbreaks are especially instructive, in part because the most notorious of these epidemics were small affairs when compared to the larger pandemics that Rosenberg explored. Considering that they accounted for relatively few deaths, historians must answer why they caused such a stir. Whereas the raw body count often drives development of narratives about epidemics, eighteenth-century typhus epidemics often hinged more on who died and where than how many. Typhus ravaged poor and working class communities throughout the period. However, even significant spikes in mortality occurring in poor neighborhoods often failed to trigger proclamations of epidemics. Some deaths mattered more than others in this regard, suggesting that qualitative criteria may have played a greater role than quantitative criteria when it came to identifying which events registered as epidemics in the eighteenth century.

Understanding the impact of state vaccination laws on exemption rates.

PURPOSE OF REVIEW: This review summarizes the current state of school-entry vaccination requirements and related exemption policies in the United States and examines recent changes to these policies. RECENT FINDINGS: With recent infectious disease outbreaks in the United States, there has been heightened awareness on unvaccinated individuals, and the state-level policies that allow individuals to be exempted from school-entry vaccination requirements. Between 2015 and 2017, there have been eleven states that have altered their policies regarding school-entry vaccination requirements and related reporting for which no formal evaluations have been published. One policy change during that period, California SB 277, which became law in 2016, reduced the nonmedical exemption and increased the childhood vaccination coverage rate in that state, though with some evidence of exemption replacement through the use of medical exemptions. Through September 2019, five additional state law changes have been enacted. SUMMARY: The large number of heterogeneous changes to state-level policies for school-entry vaccination requirements in recent years need rigorous evaluation to identify best practices for balancing public health authority and parental autonomy while seeking to achieve the highest level of infectious disease prevention for children.

Implementation System of a Biosurveillance System in the Republic of Korea and Its Legal Ramifications.

Laws are fundamental tools that regulate and manage various issues to protect the rights of the people in a society. Legislation on disease surveillance enables agencies to regulate and manage public health, including preventing the spread of infectious diseases. We assessed the Infectious Disease Prevention and Control Act of Korea (IDPCA) through the lens of biosurveillance to understand its effectiveness in protecting public health. In addition, the relevant legislation and regulations of the United States and the World Health Organization were examined. The evaluation concludes that the current IDPCA is limited in terms of providing guidance for early detection of and response to hazards using integrated data and an information-sharing system. Further revision of the laws is needed to enable early detection and warning of potential threats to public health.

Assessing National Public Health Law to Prevent Infectious Disease Outbreaks: Immunization Law as a Basis for Global Health Security.

Immunization plays a crucial role in global health security, preventing public health emergencies of international concern and protecting individuals from infectious disease outbreaks, yet these critical public health benefits are dependent on immunization law. Where public health law has become central to preventing, detecting, and responding to infectious disease, public health law reform is seen as necessary to implement the Global Health Security Agenda (GHSA). This article examines national immunization laws as a basis to implement the GHSA and promote the public's health, analyzing the scope and content of these laws to prevent infectious disease across Sub-Saharan Africa. Undertaking policy surveillance of national immunization laws in 20 Sub-Saharan African countries, this study: (1) developed a legal framework to map the legal attributes relevant to immunization; (2) created an assessment tool to determine the presence of these attributes under national immunization law; and (3) applied this assessment tool to code national legal landscapes. An analysis of these coded laws highlights legal attributes that govern vaccine requirements, supply chains, vaccine administration standards, and medicines quality and manufacturer liability. Based upon this international policy surveillance, it will be crucial to undertake legal epidemiology research across countries, examining the influence of immunization law on vaccination rates and disease outbreaks.

Legal and Policy Responses to Vaccine-Preventable Disease Outbreaks.

Laws and policies are vital tools in preventing outbreaks and limiting the further spread of disease, but they can vary in content and implementation. This manuscript provides insight into challenges in responding to recent vaccine-preventable disease outbreaks by examining legislative changes in California, policy changes on certain university campuses, and the laws implicated in a measles outbreak in Minnesota.

An Assessment of State Laws Providing Gubernatorial Authority to Remove Legal Barriers to Emergency Response.

Legal Perspectives is aimed at informing healthcare providers, emergency planners, public health practitioners, and other decision makers about important legal issues related to public health and healthcare preparedness and response. The articles describe these potentially challenging topics and conclude with the authors' suggestions for further action. The articles do not provide legal advice. Therefore, those affected by the issues discussed in this column should seek further guidance from legal counsel. Readers may submit topics of interest to the column's editor, Lainie Rutkow, JD, PhD, MPH, at lrutkow@jhu.edu. Governors play a fundamental role in emergency preparedness and can help facilitate rapid responses to emergencies. However, laws that operate successfully under normal circumstances can inadvertently create barriers during emergencies, delaying a timely response. State laws could thus limit, or even prohibit, necessary response efforts. To combat this risk, legislatures have passed emergency powers laws in each state granting governors the authority to declare a state of emergency and to exercise certain emergency powers to meet the needs of the emergency. Researchers conducted a 50-state legal assessment, which identified and examined state laws that give governors the discretion to modify existing laws or create new laws to respond effectively to any type of declared emergency. This article outlines the findings of that assessment, which identified 35 states that explicitly permit governors to suspend or amend both statutes and regulations; 7 states in which governors are permitted to amend regulations during a declared emergency but are not explicitly authorized to modify or remove statutes; and 8 states and the District of Columbia that provide no explicit authority to governors to change statutes or regulations during a declared emergency. The article also provides examples of how this power has been used in the past to demonstrate the utility and scope of this authority in a variety of public health threats.