# Presentation: 063656

## Quarantine: Law & Collaboration

- Global Government Health Partners Leadership Forum 2004:
- Managing Emerging Biological Threats
- through Professional Collaboration
- June 23, 2004

*"The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.” *

## Presentation Outline

**A.**  Role of quarantine
**B.**  U.S. legal framework
**C.**  Issues and challenges
**D.** Opportunities

## A. Role of Quarantine

- To protect those not infected
- To support and treat the infected
- Criteria: Necessity, proportionality, efficacy

## B. U.S. Legal Framework

- Federal constitution
- Judicial law/case law
- Statutory law
- Legal basis for collaboration

## U.S. Constitution

- Federal govt. has “enumerated powers”
- 	Regulate international & interstate commerce Supremacy clause
- States have “reserved powers”
- 	“Police powers” = “enact laws...that safeguard the health, welfare, and morals of [their] citizens”
- Citizens have civil rights
- 	Speech, travel, liberty, life, religion, property

## Evolution of Statutory Law

- First colonial quarantine laws - in 1660s
- First federal quarantine law - 1796 (federal govt. may help states implement quarantines), later repealed
- Federal quarantine act authorized aid to states – 1878
- Today: Concurrent federal-state jurisdiction (e.g., airports)

## Key Judicial Rulings

- Cases from 1825 to 1902 established federal preemption of state quarantine laws
- 1900 U.S. Circuit Court held San Francisco quarantine unconstitutional because applied unequally (*Jew Ho v. Williamson*)
- Cases in 1960s and later established “strict scrutiny” and “due process” standards for civil detention

## Federal Statutory Law Today

**42 US Code, Sec. 264**
- Prevent spread of disease to U.S. and between states
- For Presidentially declared diseases:
- 		Cholera, diphtheria, infectious TB, plague, smallpox, 	yellow fever, viral hemorrhagic fevers, SARS (2003)
**42 US Code, Sec. 247d**
- Authorizes assistance in federally declared emergencies
**18 US Code, Sec. 1385 (“Posse Comitatus Act”)**
- Prohibits military from imposing quarantine (may only support)

## State Statutory Law Today

- Quarantine laws typically are broad
- Disease-specific laws, e.g., TB
- Extensive updating since 2001
- Draft model state emergency health powers act
- Due process protections
- Group quarantine

## C. Issues & Challenges

- Public health officials: Medical-scientific criteria; public communication
- Public health attorneys: Selection of legal authorities
- Judiciary: Individual rights & community protection; procedural protections
- Elected officials: Emergency declaration; public communication

- Collaboration in Activating Quarantine

## Issues & Challenges

- Public health officials: Monitoring, response coordination, public communication
- Public health legal counsel: Clarification
- Law enforcement: Enforcement/compliance, response coordination
- Elected officials: Public communication, revisedlegal powers, economic response
- Judiciary: Orders, appeals

- Collaboration in Implementing Quarantine: Public Sector

## Issues & Challenges

- Health care providers: Medical care, response coordination
- Employers/employees: Business continuity, employee protection and benefits
- Press: Public communication
- Legal counsel: Liability

- Collaboration in Implementing Quarantine: Private Sector

## Issues and Challenges

- The most critical collaboration?
- Components
- Prior education
- Honesty
- Equity
- Transparency

- Maintaining the public’s trust

## Issues and Challenges

- Search for alternatives to quarantine
- Lessons from SARS
- Voluntary and “work” quarantine in Toronto
- Hybrid voluntary-compulsory quarantine
*“**Shelter in place”*

## Issues & Challenges

- Implications of the draft IHR
- Nations “shall develop...capacity to respond to...public health emergencies of international concern”
- “Core capacity standards” to isolate “suspect or affected travelers”
- Collaboration will be critical to core capacity and response

## D. Opportunities

- To learn from each other’s experiences
- To establish a global exchange on quarantine law and collaboration
**Information**
**Training**
**Best practices**