ABSTRACT
This paper summarizes key shifts in judicial decisions relating to public health powers during the pandemic and the implications of those decisions for public health practice. Then, it gives a preview and call for partnership in developing a legal framework for authority that guides public health to better activities, processes, and accountability in service of the public's health.
Subject(s)
COVID-19 , Public Health , Humans , Public Health/legislation & jurisprudence , COVID-19/prevention & control , COVID-19/epidemiology , United States , Pandemics/legislation & jurisprudence , Judicial RoleABSTRACT
The COVID-19 pandemic spurred legal and policy attacks against foundational public health authorities. Act for Public Health - a partnership of public health law organizations - has tracked legislative activity since January 2021. This article describes that activity, highlighting 2023 bills primarily related to vaccine requirements and policy innovations undertaken in the wake of the pandemic. Finally, we preview a legal framework for more equitable and effective public health authority.
Subject(s)
COVID-19 , Pandemics , Public Health , State Government , Humans , COVID-19/prevention & control , COVID-19/epidemiology , United States , Public Health/legislation & jurisprudence , Pandemics/legislation & jurisprudence , Health Policy/legislation & jurisprudence , COVID-19 Vaccines , SARS-CoV-2Subject(s)
International Cooperation , Negotiating , Pandemics , Humans , COVID-19/epidemiology , COVID-19/prevention & control , International Cooperation/legislation & jurisprudence , Pandemics/legislation & jurisprudence , Pandemics/prevention & control , World Health Organization/organization & administrationSubject(s)
Global Health , International Cooperation , Pandemics , Humans , COVID-19/epidemiology , Global Health/legislation & jurisprudence , Global Health/standards , International Cooperation/legislation & jurisprudence , Pandemics/legislation & jurisprudence , World Health Organization/organization & administrationABSTRACT
Public health legal powers are increasingly under pressure from the courts in the United States. During the COVID-19 pandemic, individuals and organizations successfully challenged many community mitigation orders (for example, mask mandates, vaccination mandates, and restrictions on gatherings), demonstrating the legal vulnerability of disease control measures. Analyzing 112 judicial decisions in which the plaintiff prevailed from March 2020 through March 2023, we examined the ways in which courts constrained public health powers during the COVID-19 pandemic. We found that in these 112 decisions, courts shifted how they analyze religious liberty claims and reviewed challenges to the exercise of statutory powers by health officials in novel ways. We discuss implications for public health policy going forward, and we recommend ways in which legislatures and health officials can design policies to maximize their prospects of surviving legal challenges.
Subject(s)
COVID-19 , Health Policy , Public Health , Humans , COVID-19/prevention & control , COVID-19/epidemiology , United States , Health Policy/legislation & jurisprudence , Public Health/legislation & jurisprudence , Policy Making , Pandemics/prevention & control , Pandemics/legislation & jurisprudence , SARS-CoV-2ABSTRACT
What are the insights from historical pandemics for policymaking today? We carry out a systematic review of the literature on the impact of pandemics that occurred since the Industrial Revolution and prior to Covid-19. Our literature searches were conducted between June 2020 and September 2023, with the final review encompassing 169 research papers selected for their relevance to understanding either the demographic or economic impact of pandemics. We include literature from across disciplines to maximise our knowledge base, finding many relevant articles in journals which would not normally be on the radar of social scientists. Our review identifies two gaps in the literature: (1) the need to study pandemics and their effects more collectively rather than looking at them in isolation; and (2) the need for more study of pandemics besides 1918 Spanish Influenza, especially milder pandemic episodes. These gaps are a consequence of academics working in silos, failing to draw on the skills and knowledge offered by other disciplines. Synthesising existing knowledge on pandemics in one place provides a basis upon which to identify the lessons in preparing for future catastrophic disease events.
Subject(s)
Health Policy , Pandemics , Humans , COVID-19/epidemiology , Influenza, Human/epidemiology , Pandemics/economics , Pandemics/legislation & jurisprudence , Pandemics/prevention & controlABSTRACT
Se realizó un estudio exploratorio a través de una encuesta a Comités de Ética en países de América Latina y el Caribede habla hispana, con el fin de relevar su situación frente a emergencias sanitarias y consultar los dilemas éticos enfrentados en las investigaciones para COVID-19. Se obtuvieron respuestas de 106 comités, pertenecientes a 14 países.Solamente el 24% respondió que existía una red de comunicación eficiente y efectiva entre comités, previa a la pandemia. El 45% respondió queno existían en su región comités específicos para evaluar proyectos vinculados a emergencias sanitarias con anterioridad a la pandemia. El porcentaje de CEI que disponía de procedimientos previos para evaluar investigaciones en situaciones de emergencias sanitarias, fue sólo de 7%, si bien el 52% estaba en proceso de elaboración a raíz de la pandemia.El porcentaje de CEI que consideró razonable un tiempo inferior a 5 días para la evaluación de proyectos de investigación, varió en virtud del diseño: 32% para los estudios observacionales y 12% para los ensayos clínicos con drogas o con vacunas.Los tres problemas éticos principales identificados en los estudios para COVID estuvieron relacionados con el consentimiento informado, los aspectos metodológicos y la poca información previa o falta de evidencia para los productos de investigación.Consideramos que debemos reformular la manera de pensar los problemas éticos de las emergencias hacia un abordaje global, con un enfoque preventivo, donde las redes de colaboración entre los CEI deberían convertirse en regla.(AU)
Es va realitzar un estudi exploratori a través d'una enquesta a Comitès d'Ètica a països d'Amèrica Llatina i el Carib de parla hispana, per rellevar la seva situació davant d'emergències sanitàries i consultar els dilemes ètics enfrontats a les investigacions per a COVID-19. S'obtingueren respostes de 106 comitès, pertanyents a 14 països. Només el 24% va respondre que existia una xarxa de comunicació eficient i efectiva entre comitès, prèvia a la pandèmia. El 45% va respondre que no existien a la seva regió comitès específics per avaluar projectes vinculats a emergències sanitàries amb anterioritat a la pandèmia. El percentatge de CEI que disposava de procediments previs per avaluar investigacions en situacions d'emergències sanitàries va ser només de 7%, si bé el 52% estava en procés d'elaboració arran de la pandèmia. El percentatge de CEI que va considerar raonable un temps inferior a 5 dies per a l'avaluació de projectes de recerca va variar en virtut del disseny: 32% per als estudis observacionals i 12% per als assaigs clínics ambdrogues o amb vacunes.Els tres problemes ètics principals identificats als estudis per a COVID van estar relacionats amb el consentiment informat, els aspectes metodològics i la poca informació prèvia o manca d'evidència per als productes de recerca. Considerem que cal reformular la manera de pensar els problemes ètics de les emergències cap a un abordatge global, amb un enfocament preventiu, on les xarxes de col·laboració entre els CEI haurien de convertir-se en regla.(AU)
An exploratory study was carried out through a survey of Ethics Committees in Spanish-speaking Latin American and Caribbean countries, to assess their situation in the face of health emergencies and consult the ethical dilemmas faced in research for COVID-19. Responses were obtained from 106 committees, belonging to 14 countries.Only 24% responded that there was an efficient and effective communication network between committees, before the pandemic. 45% responded that there were no specific committees in their regions to evaluate projects linked to health emergencies before the pandemic. The percentage of RECs that had prior procedures to evaluate research in health emergencies was only 7%, although 52% were in the process of being prepared as a result of the pandemic.The percentage of RECs that reasonably expected less than 5 days to evaluate research projects varied by design: 32% for observational studies and 12% for clinical drug or vaccine trials.The three main ethical problems identified in the studies for COVID were related to informed consent, methodological aspects, and little prior information or lack of evidence for investigational products.We believe that we must reformulate the way of thinking about the ethical problems of emergencies towards a global approach, with a preventive approach, where collaboration networks between the RECs will not become the rule.(AU)
Subject(s)
Humans , Ethics, Medical , Disease Outbreaks/legislation & jurisprudence , Disease Outbreaks/prevention & control , Pandemics/ethics , Pandemics/legislation & jurisprudence , Ethics Committees, Research , Bioethics , Bioethical Issues , Coronavirus Infections/epidemiology , Severe acute respiratory syndrome-related coronavirusSubject(s)
COVID-19 , Information Dissemination , International Cooperation , Pandemics , SARS-CoV-2 , Humans , COVID-19/epidemiology , COVID-19/virology , Information Dissemination/legislation & jurisprudence , International Cooperation/legislation & jurisprudence , Pandemics/legislation & jurisprudence , Pandemics/prevention & controlABSTRACT
Negotiations ought not focus on enforcement and sanctions.
Subject(s)
International Cooperation , International Law , Pandemics , Pandemics/legislation & jurisprudence , Pandemics/prevention & control , International Cooperation/legislation & jurisprudence , World Health Organization , HumansABSTRACT
This Medical News feature examines how the expiration of states' pandemic-related licensure waivers is limiting telemedicine services.
Subject(s)
Licensure, Medical , Pandemics , Telemedicine , Pandemics/legislation & jurisprudence , Telemedicine/legislation & jurisprudence , United StatesABSTRACT
A Pandemic/Disaster Law is needed to condense and organize the current dispersed and multiple legislation. The State must exercise a single power and command appropriate to each situation, with national validity. The production of plans for the use of land and real estate as potential centers for health care, shelter or refuge is recommended. There should be specific disaster plans at least for Primary Health Care, Hospitals and Socio-sanitary Centers. The guarantee of the maintenance of communication and supply routes is essential, as well as the guarantee of the autochthonous production of basic goods. The pandemic has highlighted the need to redefine the training plans for physicians who, in their different specialties, have to undertake reforms that allow a more versatile and transversal training. National research must have plans to be able to respond quickly to questions posed by the various crises, using all the nations resources and in particular, all the data and capabilities of the health sector. Contingency plans must consider ethical aspects, and meet the needs of patients and families with a humanized approach. In circumstances of catastrophe, conflicts increase and require a bioethical response that allows the best decisions to be made, with the utmost respect for peoples values. Rapid, efficient and truthful communication systems must be contained in a special project for this sector in critic circumstances. Finally, we believe that the creation of National Coordination Centers for major disasters and Public Health can contribute to better face the crises of the future. (AU)
Es necesaria una Ley de Pandemias/catástrofes que condense y ordene la dispersa y múltiple legislación actual. El Estado tiene que ejercer un poder y mando único adecuado a cada situación, con vigencia nacional. Se recomienda la confección de planes de utilización de suelo e inmuebles como centros potenciales de asistencia sanitaria, refugio o albergue. Deberán existir planes de catástrofes específicos al menos para la Atención Primaria, Atención Hospitalaria y Centros Sociosanitarios. La garantía del mantenimiento de las vías de comunicación y abastecimiento es esencial, así como la garantía de producción autóctona de materias de primera necesidad. La pandemia ha puesto de manifiesto la necesidad de redefinir los planes de formación de los médicos que en sus distintas especialidades tienen que asumir reformas que permitan un entrenamiento más versátil y transversal. La investigación nacional debe tener planes para poder responder con rapidez a preguntas que planteen las distintas crisis, utilizando para ello, todos los recursos de la nación y en particular todos los datos y capacidades del sector sanitario. Los planes de contingencia deben considerar los aspectos éticos, y cubrir las necesidades de pacientes y familias con un enfoque humanizado. En circunstancias de catástrofe aumentan los conflictos que requieren una respuesta bioética que permita tomar las mejores decisiones, con el máximo respeto a los valores de las personas. La comunicación, rápida, eficiente y veraz debe estar contenida en un proyecto especial para este sector en circunstancias de crisis. Pensamos finalmente que la creación de un Centro coordinador nacional de grandes catástrofes y Salud Pública puede contribuir a enfrentarnos mejor a las crisis del futuro. (AU)
Subject(s)
Humans , Coronavirus Infections/epidemiology , Pandemics/legislation & jurisprudence , Disasters , Severe acute respiratory syndrome-related coronavirus , Primary Health Care , Hospital CareSubject(s)
Health Insurance Exchanges , Insurance Coverage , Pandemics , Patient Protection and Affordable Care Act , Costs and Cost Analysis , Health Insurance Exchanges/economics , Health Insurance Exchanges/legislation & jurisprudence , Health Policy/economics , Health Policy/legislation & jurisprudence , Insurance Coverage/economics , Insurance Coverage/legislation & jurisprudence , Insurance, Health/economics , Insurance, Health/legislation & jurisprudence , Pandemics/economics , Pandemics/legislation & jurisprudence , Patient Protection and Affordable Care Act/economics , Patient Protection and Affordable Care Act/legislation & jurisprudence , Policy , United StatesSubject(s)
COVID-19 , Health Policy , Health Services Accessibility , COVID-19/epidemiology , COVID-19/therapy , Health Policy/legislation & jurisprudence , Health Services Accessibility/legislation & jurisprudence , Humans , Pandemics/legislation & jurisprudence , Pandemics/prevention & control , SARS-CoV-2 , United States/epidemiologyABSTRACT
Background: Does exposure to events that transgress accepted norms, such as killing innocent civilians, prompt the psychological and emotional consequences of moral injury among soldiers? Moral injury is associated with negative emotions such as guilt, shame and anger, and a sense of betrayal and is identified among veterans following exposure to potentially morally injurious events (PMIE). Objective: We experimentally investigate how PMIE characteristics affect the intensity of MI and related negative moral emotions in participants with varied military experience. Method: We conducted three controlled, randomized experiments. Each exposed male respondents with active combat experience (Study 1) and varied military experience (Study 2) to four textual vignettes describing PMIE (child/adult and innocent/non-innocent suspect) that transpire at an Israeli checkpoint in the West Bank. In study 3, we exposed participants to two scenarios, where descriptions of police officers enforcing COVID 19 restrictions confronted lockdown violators. Results: Participants assigned to vignettes describing killing an innocent civilian exhibited more intense levels of shame and guilt than those assigned to vignettes describing killing a person carrying a bomb. Religiosity and political ideology were strong predictors of guilt and shame in response to descriptions of checkpoint shootings. These effects disappeared in Study 3, suggesting that political ideology drives MI in intergroup conflict. Conclusions: Background and PMIE-related characteristics affect the development of moral injury. Additionally, lab experiments demonstrate the potential and limitations of controlled studies of moral injury and facilitate an understanding of the aetiology of moral injury in a way unavailable to clinicians. Finally, experimental findings and methodologies offer further insights into the genesis of moral injury and avenues for therapy and prophylaxis.
Antecedentes: ¿La exposición a eventos que transgreden las normas aceptadas, como matar a civiles inocentes, provocan las consecuencias psicológicas y emocionales del daño moral entre los soldados? El daño moral (DM) se asocia con emociones negativas como la culpa, la vergüenza y la ira, y un sentido de traición y es identificado entre los veteranos después de la exposición a eventos potencialmente dañinos moralmente (EPDM).Objetivo: Investigamos experimentalmente cómo las características de EPDM afectan la intensidad del DM y emociones moralmente negativas relacionadas en participantes con vasta experiencia militar.Método: Realizamos tres experimentos controlados y aleatorizados. Cada varón expuesto respondió con experiencia en combate activo (Estudio 1) y vasta experiencia militar (Estudio 2) a cuatro viñetas textuales que describen EPDM (niño/adulto y sospechoso inocente/no inocente) que suceden en un puesto de control israelí en Cisjordania. En el estudio 3, expusimos a los participantes a dos escenarios, donde las descripciones de los agentes de policía que aplicaban las restricciones de COVID-19 enfrentaron a los infractores del confinamiento.Resultados: Los participantes asignados a viñetas que describen el asesinato de un civil inocente exhibieron niveles más intensos de vergüenza y culpa que los asignados a las viñetas que describen el asesinato de una persona llevando una bomba. La religiosidad y la ideología política fueron fuertes predictores de culpa y vergüenza en respuesta a descripciones de tiroteos en puestos de control. Estos efectos desaparecieron en el Estudio 3, lo que sugiere que la ideología política impulsa al DM en los conflictos intergrupales.Conclusiones: Los antecedentes y las características relacionadas con el EPDM afectan el desarrollo del daño moral. Adicionalmente, los experimentos de laboratorio demuestran el potencial y las limitaciones de los estudios de daño moral y facilitan una comprensión de la etiología del daño moral de una manera no disponible para los clínicos. Por último, los hallazgos y las metodologías experimentales ofrecen perspectivas adicionales en la génesis del daño moral y las vías para la terapia y la profilaxis.
Subject(s)
Military Personnel/psychology , Stress Disorders, Post-Traumatic/psychology , Veterans/psychology , Adult , Anger , COVID-19/epidemiology , Child, Preschool , Guilt , Humans , Israel/epidemiology , Male , Pandemics/legislation & jurisprudence , Shame , Stress Disorders, Post-Traumatic/epidemiology , Surveys and QuestionnairesABSTRACT
Changing collective behaviour and supporting non-pharmaceutical interventions is an important component in mitigating virus transmission during a pandemic. In a large international collaboration (Study 1, N = 49,968 across 67 countries), we investigated self-reported factors associated with public health behaviours (e.g., spatial distancing and stricter hygiene) and endorsed public policy interventions (e.g., closing bars and restaurants) during the early stage of the COVID-19 pandemic (April-May 2020). Respondents who reported identifying more strongly with their nation consistently reported greater engagement in public health behaviours and support for public health policies. Results were similar for representative and non-representative national samples. Study 2 (N = 42 countries) conceptually replicated the central finding using aggregate indices of national identity (obtained using the World Values Survey) and a measure of actual behaviour change during the pandemic (obtained from Google mobility reports). Higher levels of national identification prior to the pandemic predicted lower mobility during the early stage of the pandemic (r = -0.40). We discuss the potential implications of links between national identity, leadership, and public health for managing COVID-19 and future pandemics.