NCSL Brief: The Public Health Role in Fighting Terrorism

(This is one of a series of briefs written by NCSL, "Protecting Democracy: States Respond to Terrorism.")

The Public Health Role in Fighting Terrorism

By Ann Dietrich, L. Cheryl Runyon and Martha King

The nation's fears that terrorists might use anthrax, smallpox, or chemical, nuclear and radiological weapons have splashed public health issues across headlines with stark new urgency. Lawmakers face the challenge of ensuring that their state's public health system and laws are up-to-date and can serve the public well in the event of another terrorist attack. These are the same public health laws that help states guard against naturally occurring threats, such as influenza, measles, West Nile virus, Hantavirus, toxic substance spills, and natural disasters such as hurricanes, fires and floods.

Public health systems help prevent disease and injury, protect against environmental hazards, promote healthy behaviors, respond to disasters, and help ensure access to health services. These systems were built to counter naturally occurring events. But the additional threats posed by deliberate actions to unleash infectious or other deadly agents on unsuspecting populations are now very real.

An effective public health system includes strong state and local health departments, highly trained professionals, sophisticated disease monitoring and reporting systems, up-to-date laboratories, electronic information systems to communicate rapidly with other emergency responders, resources to treat victims (such as adequate medicines and vaccines), and tools to prevent the spread of disease (such as the ability to isolate contagious or contaminated people).

But according to the Centers for Disease Control and Prevention (CDC), most state and local public health agencies are not fully prepared to serve as the first line of defense against terrorism and other public health threats. Many systems lack some of the key components identified as necessary to respond adequately to natural or man-made threats.

State Actions

Many states have public health laws that predate modern threats and civil rights advances. For example, Massachusetts Senator Richard Moore notes that his state's quarantine law still carries a 1940s-era fine of $10 per violation. Many state laws give broad authority for emergency powers without specifying important details. Emergency health powers in some cases have been revised on a piecemeal basis over the decades, embedding provisions in different sections of statutes, and may be inconsistent or ambiguous.

A number of legislatures and state agencies are beginning to look at the capacity of their state systems. In 2000, Colorado enacted legislation that creates an emergency epidemic response committee to advise the governor about reasonable and appropriate measures to reduce or prevent the spread of a disease, agent or toxin, and to protect the public health. The committee will develop a supplement to the state's disaster plan, which will outline the public health responses to acts of bioterrorism, pandemic influenza and epidemics caused by novel and highly fatal infectious agents.

Federal Actions

The Public Health Improvement Act of 2000 is the first federal program aimed at helping the nation's state and local health departments respond to health threats like drug resistant diseases and terrorist attacks. The act authorizes grants to state and local health departments to update laboratories, improve electronic information networks and emergency response systems, and train staff. It also establishes public health standards for states to measure their performance.

Also, in an effort to help states examine their own public health emergency preparedness, CDC requested legal experts at the Center for Law and the Public's Health (at Johns Hopkins and Georgetown universities) to draft a model state emergency health powers act. The draft act is under review by several national organizations, including the National Association of Attorneys General, the National Governors Association and NCSL, as of December 2001. The final product--whether it is proposed as a model act or a checklist to consider--is intended to help states review their own statutes for key elements to prepare them for possible terrorist attacks or other public health emergencies.

The draft act would give the governor the power to declare an emergency in the event of a public health threat caused by acts of terrorism (chemical, biological, radiological or mass trauma) or a communicable disease that threatens the community. The act proposes that the governor consult with an appointed commission that is charged with developing a state preparedness plan. During a declared emergency, the act would allow the governor to use all available state government resources, suspend laws that hinder a response, direct actions of state personnel (including militia) and work with other states to coordinate aid.

The proposed emergency response measures include broad powers to control both people and property in extraordinary emergency situations. For example, the draft would allow compulsory medical examinations and vaccinations, and would require people to be quarantined, or face a penalty. The public health agency also would control health care facilities, materials, food, medicines, transportation, and other property and services as necessary "to reasonably respond to the emergency." Although the draft act contains certain provisions to protect civil liberties, some critics claim the proposed emergency powers go too far and that the act's language is too vague.

Colorado Representative John Witwer says that such legislation will have serious consequences and should be crafted carefully. "It needs to be thought out beforehand and issues settled," he advises. "Stakeholder input must be part of legislation, as these are the people who will implement it. There will not be time during a disaster to settle issues."

NCSL has formed a working group of legislators and legislative legal staff to advise the authors of the draft model act on its potential usefulness and appropriateness for states.

NCSL is also publishing a Legislator's Guide to Public Health, which will be available in January 2002. It addresses a full range of public health issues, including state readiness to respond to both natural and man-made threats to the public's health.

Contacts for More Information

Cheryl Runyon and Lisa Speissegger
NCSL--Denver
(303) 856-1525, ext. 252 and 199
cheryl.runyon@ncsl.org
lisa.speissegger@ncsl.org

Other NCSL Resources:

Other NCSL Briefs "States Respond to Terrorism"

NCSL's Protecting Democracy Page

NCSL's 2002 Legislative Session Home Page

NCSL's Health Page