U.S. Department of Justice 

Office of Justice Programs 

Bureau of Justice Assistance 
U.S. Department of Justice

Office of Justice Programs 

810 Seventh Street NW. 

Washington, DC 20531 

Alberto R. Gonzales 

Attorney General 

Regina B. Schofield 

Assistant Attorney General 

Domingo S. Herraiz 

Director, Bureau of Justice Assistance 

Office of Justice Programs 

Partnerships for Safer Communities 

www.ojp.usdoj.gov 

Bureau of Justice Assistance 

www.ojp.usdoj.gov/BJA 

NCJ 214333


Written by


Edward P. Richards, Katherine C. Rathbun,


Corina Solé Brito, and Andrea Luna


This document was prepared by the Police Executive Research Forum using funding 

provided by the Bureau of Justice Assistance, Office of Justice Programs, U.S. Department of 

Justice. The opinions, findings, and conclusions or recommendations expressed in this 

document are those of the authors and do not necessarily represent the official position or 

policies of the U.S. Department of Justice. 

The Bureau of Justice Assistance is a component of the Office of Justice Programs, which also 

includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile 

Justice and Delinquency Prevention, and the Office for Victims of Crime. 
The Role of 

Law Enforcement 

in Public Health 

Emergencies 

Special Considerations for an 

All-Hazards Approach 

September 2006 
Acknowledgments 

The U.S. Department of Justice, Office of Justice Programs’ Bureau of 

Justice Assistance (BJA) and the Police Executive Research Forum (PERF) wish 

to acknowledge Clifford L. Karchmer for his contributions during the writing 

of the publication.We also express our gratitude to Nancy Demme of the 

Montgomery County Police Department (Maryland), Stephen Holl of the 

Arlington County Police Department (Virginia),Tom Imrie of the Toronto 

Police Service, and Larry Moser of the Fairfax County Police Department 

(Virginia) for their thoughtful reviews of and significant contributions to this 

publication. 

About PERF 

PERF is a national organization of progressive law enforcement chief 

executives from city, county, and state agencies who collectively serve more 

than half of the country’s population. Established in 1976 by 10 prominent 

police chiefs, PERF has evolved into one of the leading police think tanks.With 

membership from many of the largest police departments in the country and 

around the globe, PERF has pioneered studies in such fields as community and 

problem-oriented policing, racially biased policing, multijurisdictional 

investigations, domestic violence, the police response to people with mental 

illnesses, homeland security, management concerns, use of force, and crimereduction approaches. In addition to PERF’s cutting-edge police and criminal 

justice research, the organization provides a wide variety of management and 

technical assistance programs to police agencies throughout the world.The 

organization also continues to work toward increased professionalism and 

excellence in the field through its training, leadership, and publications 

programs.To learn more about PERF, visit www.policeforum.org. 

About BJA 

BJA supports law enforcement, courts, corrections, treatment, victim 

services, technology, and prevention initiatives that strengthen the nation’s 

criminal justice system. BJA provides leadership, services, and funding to 

America’s communities by emphasizing local control; building relationships 

in the field; developing collaborations and partnerships; promoting capacity 

building through planning; streamlining the administration of grants; increasing 

training and technical assistance; creating accountability of projects; encouraging 

innovation; and ultimately communicating the value of justice efforts to decision 

makers at every level.To learn more about BJA, visit www.ojp.usdoj.gov/BJA. 

iii 
Table of Contents


Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .iii

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

The Role of Law Enforcement . . . . . . . . . . . . . . . . . . . . . .1

Preparing the Department . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Responding to and Managing Incidents . . . . . . . . . . . . . . .3

Continuity of Operations . . . . . . . . . . . . . . . . . . . . . . . . . .5

Protecting Law Enforcement Officers . . . . . . . . . . . . . . . . . . .7

Risks to Law Enforcement From Disease . . . . . . . . . . . . . .7

Casual Contact . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Food- and Water-Borne Diseases . . . . . . . . . . . . . . . . . .8

Blood-Borne Diseases . . . . . . . . . . . . . . . . . . . . . . . . . .9

Immunization and Personal Protective Equipment . . . . . .9

Immunization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Personal Protective Equipment . . . . . . . . . . . . . . . . .11

Major Infectious Diseases . . . . . . . . . . . . . . . . . . . . . . . . .13

Treatment of Infectious Disease . . . . . . . . . . . . . . . . . . . .15

Protecting Officers’ Families . . . . . . . . . . . . . . . . . . . .15

Protecting the Community . . . . . . . . . . . . . . . . . . . . . . . . . . .17

The Role of Law Enforcement in Mass Vaccination 


Law Enforcement’s Role During Voluntary 


Law Enforcement’s Role During Involuntary 


Law Enforcement’s Role in Mass Casualty 


Working With Public and Private Agencies . . . . . . . . . . . .17

and Preventive Measures . . . . . . . . . . . . . . . . . . . . . .18

Restrictions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Restrictions, Including Quarantine . . . . . . . . . . . . . . .20

Special Populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25

Appendix 1: Further Considerations . . . . . . . . . . . . . . . . . . . .27

Appendix 2:Ten Principles of Modern Quarantine . . . . . . . .31

Appendix 3:Available Vaccinations for Diseases . . . . . . . . . . .33

Appendix 4: Standard Definitions of Key Terms . . . . . . . . . . .35

Appendix 5:What Is a Pandemic? . . . . . . . . . . . . . . . . . . . . . .37

v 
Introduction


Recently, increases in cases of avian flu in both 

humans and animals have raised concern about the 

threat of another flu pandemic.The Centers for 

Disease Control and Prevention (CDC) characterizes a flu 

pandemic as the emergence of a virus for which most people 

have little or no immunity, causes serious illness, and then 

spreads easily person-to-person worldwide.The CDC states 

that a pandemic may come and go in waves (lasting 6–8 

weeks each—perhaps longer), which could lead to high 

levels of illness, death, social disruption, and economic loss. 

The death toll of the 1968–1969 flu pandemic was more 

than 700,000 worldwide.1 

On May 2, 2006, the White House released the Implementation 

Plan for the National Strategy for Pandemic Influenza, which 

reiterates the importance of state and local preparedness; clarifies 

roles and responsibilities; and includes information, guidance, and 

recommendations for preparedness.While preparedness may seem 

largely a public health responsibility, law enforcement has a very critical 

role in the response to these incidents. Chapter 8 of the Implementation 

Plan (“Law Enforcement, Public Safety, and Security”) states: 

“If a pandemic influenza outbreak occurs in the 

United States, it is essential that governmental entities 

at all levels continue to provide essential public safety 

services and maintain public order. It is critical that all 

stakeholders in State and local law enforcement and 

public safety agencies, whose primary responsibility 

this is, be fully prepared to support public health 

efforts and to address the additional challenges they 

may face during such an outbreak.”2 

The Role of Law Enforcement3 

Public health emergencies pose special challenges for law 

enforcement, whether the threat is manmade (e.g., the anthrax 

1. U.S. Department of Health and Human Services, www.pandemicflu.gov/


general/#impact.


2. www.whitehouse.gov/homeland/nspi_implementation.pdf, p. 153. 

3. For the purposes of this document, the term “law enforcement” refers generally to sworn 

personnel serving state, city, and county jurisdictions (e.g., police officers, sheriffs’ deputies, and 

state troopers). Specific references to other types of law enforcement officials, such as federal 

agents, park rangers, animal control officers, and others will be noted. 

1 
The Role of Law Enforcement in Public Health Emergencies 

terrorist attacks) or naturally occurring (e.g., flu pandemics). Policing 

strategies will vary depending on the cause and level of the threat, as 

will the potential risk to the responding officers. In a public health 

emergency, law enforcement will need to quickly coordinate its 

response with public health and medical officials, many of whom they 

may not have worked with previously. 

Depending on the threat, law enforcement’s role may include 

enforcing public health orders (e.g., quarantines or travel restrictions), 

securing the perimeter of contaminated areas, securing health care 

facilities, controlling crowds, investigating scenes of suspected biological 

terrorism, and protecting national stockpiles of vaccines or other 

medicines. 

In a large-scale incident, such as a pandemic, law enforcement 

resources will quickly become overwhelmed, and law enforcement 

officials will have to balance their resources and efforts between these 

new responsibilities and everyday service demands.All of this may 

have to be accomplished with a greatly diminished workforce, as 

officers and their families may become infected and ill, and some 

personnel may determine that the risk of continuing to report to work 

is just too great to themselves or their families.A department’s ability 

to respond effectively to any emergency—public health or 

otherwise—greatly depends on its preparedness, and this is directly 

linked to the law enforcement agency’s planning and its partnerships. 

This document will help state and local law enforcement officials 

and policymakers to understand communicable diseases (including 

terminology and methods of transmission) and the threat they pose to 

public health and safety.4 The document outlines key concerns that law 

enforcement officials must address in preparation for a virus-caused 

pandemic and other public health emergencies and identifies issues 

that may arise in the department’s “all-hazards” approach.The document 

has three main sections: 

• Preparing the department (e.g., maintaining operational 

continuity). 

• Protecting the officers (e.g., educating them about


transmission, vaccination, and treatment).


• Protecting the community (e.g., maintaining public order). 

In addition, five appendixes provide background information and 

additional resources. 

4.This document does not deal with law enforcement’s role in controlling disease outbreaks 

in crops and farm animals. 

2 
Preparing the Department


Law enforcement plans for a large-scale public health 

emergency must be applicable to all types of public 

health hazards.The value of developing an all-hazards 

plan is that it can be activated regardless of whether the 

public health emergency is intentional (e.g., an act of 

biological terrorism) or naturally occurring (e.g., avian flu). 

More important, an all-hazards plan provides a basis for better 

protection of officers from the risks that arise in routine 

policing. By incorporating an all-hazards approach into routine 

activities, and developing the needed partnerships with key 

stakeholders now, a department can move seamlessly into 

higher states of readiness as risks change, rather than having 

to shift into an emergency mode that has different operating 

parameters than routine police work. 

An important objective of this all-hazards planning is to facilitate 

informed discussion on the issues and to encourage law enforcement 

officials to think about the implications of a public health emergency, 

how the necessary response fits into their existing emergency 

operations plans, and additional partnerships that may be needed. 

In short, what law enforcement should have in place, before a 

major outbreak of illness or chemical contamination occurs, is an 

all-hazards control plan, which encompasses every aspect of what must 

be done as soon as an event that threatens major loss of life looms on 

the horizon. 

Responding to and Managing Incidents 

Both the National Incident Management System (NIMS) and the 

National Response Plan (NRP)5 have had a significant impact on how 

state and local entities are updating their emergency response plans. 

Many cities have opted to model their emergency response plans after 

the NRP.The NRP is effectively an all-hazards plan composed of 15 

Emergency Support Function (ESF) annexes that spell out the response 

roles of primary and secondary agencies (e.g., the U.S. Department of 

Justice (DOJ), the American Red Cross).Although many plans were 

written with input from local law enforcement representatives, some 

may not have been, and it is critical that law enforcement personnel 

review their planned roles to be familiar with local government’s 

expectations in the case of a critical incident. 

5.Available at www.dhs.gov/dhspublic/interapp/editorial/editorial_0566.xml. 

3 
The Role of Law Enforcement in Public Health Emergencies 

ESF #8 of the NRP, titled “Public Health and Medical Services 

Annex,” discusses the elements involved in providing for “public health 

and medical care needs (to include veterinary and/or animal health 

issues when appropriate) for potential or actual Incidents of National 

Significance and/or during a developing potential health and medical 

situation.”6 

This ESF details how to provide support in these areas: 

• Assessment of public health/medical needs (including 

behavioral health). 

• Public health surveillance. 

• Provision of medical care personnel. 

• Acquisition of medical equipment and supplies. 

The primary agency for this ESF is the U.S. Department of Health 

and Human Services (HHS); DOJ is listed as one support agency. Under 

the Concept of Operations, the plan states,“Personnel representing an 

ESF #8 organization are expected to have extensive knowledge of the 

resources and capabilities of their respective organization and have 

access to the appropriate authority for committing such resources 

during the activation.”7 

The support roles listed for DOJ, which may be passed on to local 

law enforcement as state and local agencies plan, include: 

• Assist in victim identification, coordinated through the Federal 

Bureau of Investigation (FBI). 

• Provide state, local, and tribal governments with legal advice 

concerning identification of the dead. 

• Provide HHS with relevant information of any credible threat 

or other situation that could threaten public health. 

• Provide communication, transportation, and other logistical 

support. 

• Provide security for the strategic national stockpile and 

quarantine enforcement assistance, if required. 

Local law enforcement agencies should help devise their jurisdiction’s 

plans. If officers have an opportunity to take part in the planning, it is 

more likely that the expectations set for the department will be met—in 

any type of emergency. For example, ESF #8 states that in a public 

health emergency, the U.S. Postal Service will assist “in the distribution 

6. U.S. Department of Homeland Security. (2004). National Response Plan. ESF #8-1. 

7. U.S. Department of Homeland Security. (2004). National Response Plan. ESF #8-3. 

4 
Preparing the Department 

and transportation of medicine and pharmaceuticals and medical 

information to the general public affected by a major disaster or 

emergency as needed.”8 Here, for example, there may be an underlying 

expectation that local law enforcement will help the Postal Service 

with this task in some communities.This is just one of the many 

expectations that law enforcement agencies need to be aware of when 

preparing an all-hazards plan. 

Continuity of Operations 

The second component of an all-hazards disease control plan 

for law enforcement agencies to consider is how to protect the 

department and ensure operational continuity.All agencies need to 

prepare to work with a significantly reduced workforce—with 

estimates of possible workforce reductions from 10 to 40 percent—or 

more—as employees will either be caring for others, sick with the 

disease, or in some cases may be too concerned to report to work. 

In planning for staff reductions, departments will have to reconsider 

the types of calls that usually require dispatching officers, identifying 

which responsibilities and functions receive priority, and how other, 

lower priority tasks will be handled. For example, departments may 

consider taking reports of property destruction or other property 

crimes over the phone or through the Internet, or employees in 

quarantine may be able to work from home, taking incident reports 

over the telephone, if allowed by department policy. 

There should be contingency planning within the department, 

especially in units that are essential to maintaining core operations 

(e.g., dispatch, executive office, and patrol). Some departments have 

begun such planning by conducting assessments to determine from 

where personnel will be drawn to maintain core functions. Support 

staff—including human resources and benefits, payroll, and personnel 

and materials acquisition staff—must be maintained even at the height 

of an event. Cross training of support staff to fill key functions within 

payroll and materials management will ensure the availability of 

resources for primary response personnel, including, for example, fuel 

for police vehicles. 

Further, personnel performing functions that may be deemed nonessential during a public health incident (e.g., training and recruiting) 

may have to perform primary response tasks. Reprioritizing calls for 

service may have to occur, and smaller agencies may have to partner 

with larger agencies to provide service during periods of staff reduction. 

Mutual aid agreements that provide for agency interoperability and 

increase staff understanding of specific challenges or hazards present 

in the workplace should be established in advance. 

8. U.S. Department of Homeland Security. (2004). National Response Plan. ESF #8-13. 

5 
Protecting Law Enforcement Officers 

To prepare a law enforcement agency for any type of 

public health emergency (e.g., an epidemic or 

bioterrorist attack), education about and plans for 

infectious disease control need to be a regular part of the 

department’s activities. Officers need basic education about 

infectious disease biology, modes of transmission (such as 

person-to-person and vector borne), and routes of entry of 

communicable diseases (eyes, nose, and so forth).Ways to 

provide this education include forming a partnership with 

a local hospital or an occupational health and safety 

program.9 Departments also could include a substantial 

short course in preventing on-the-job exposure to infectious 

diseases through basic precautionary measures and the 

proper use of personal protective equipment. In time, the 

use of antimicrobial gloves during close personal contact, 

frequent hand washing, and proven disinfection and 

decontamination strategies will become second nature 

through repeated exposure to the teaching points. 

Further considerations in regard to education—and all the other 

forms of protection for officers—appear in appendix 1. 

Risks to Law Enforcement From Disease 

Casual Contact 

The diseases that should most concern law enforcement are those 

that are spread by casual contact between individuals. If a respiratory 

disease, such as influenza or measles, is spreading throughout the 

community, officers will be exposed repeatedly.As the incidence of a 

disease increases in the community, it also will increase among law 

enforcement officers, unless specific measures are taken to prevent 

infection. 

In the simple act of stopping and speaking with someone, an 

officer may inhale pathogens or handle an infected item (e.g., a car 

registration). Physical contact and altercations dramatically increase the 

risk of infection. In addition, officers will face work-specific risks, such 

as controlling crowds at large events, transporting prisoners to jails 

9. For more information on occupational health and safety programs, visit the U.S. 

Department of Labor’s Occupational Safety and Health Administration (OSHA) web site at 

www.osha.gov. 

7 
The Role of Law Enforcement in Public Health Emergencies 

(where respiratory diseases spread quickly), and working closely with 

health care workers who are also at heightened risk for exposure, such 

as ambulance personnel. 

In some situations, public health officials may ask law enforcement 

personnel to locate an infected person who is either knowingly or 

unknowingly spreading a disease. For example, several people have 

recklessly or intentionally spread sexually transmitted diseases 

(typically HIV).10 

Diseases that spread rapidly by direct respiratory contact or other 

means and cause death or severe aftereffects may compel restricted 

movement of individuals. If left unchecked, such high-mortality 

diseases can lead to pandemics, social disorder, and the need for major 

assistance from law enforcement. If not segregated, a single individual 

could infect and cause the death of thousands. In these circumstances, 

the designated officials would decide whether quarantine or isolation 

is needed. Law enforcement and public health officials will need to 

work closely together to decide when to move from voluntary to 

mandatory orders, how quarantine and isolation orders will be 

enforced, and, if necessary, maintained by legitimate instruments of 

force (the roles of law enforcement agencies during quarantines and 

isolations are discussed in a subsequent section).11 

Food- and Water-Borne Diseases 

Generally, the risk of food- and water-borne diseases (spread 

through bacterial contamination of food or drinking water) is the same 

for law enforcement personnel as for the general population.The risk 

of contracting these diseases, however, may increase in situations 

where the civil and social infrastructures have been heavily damaged, 

as in the areas ravaged by Hurricane Katrina and its aftermath.As first 

responders, law enforcement personnel may face more food- and 

water-borne disease than the general population while they are 

assisting in evacuation or rescue and recovery. 

The spread of food- and water-borne infections can be limited if 

infected individuals and the people with whom they have been in 

close contact are prevented from working in food preparation until 

tests indicate they are no longer contagious. Even when infected 

persons have been physically isolated, it is still important that they be 

prevented from preparing food, even for their own families, and from 

working with especially vulnerable populations, such as the elderly or 

very young. In an outbreak of diseases such as typhoid or cholera, law 

10. State v. Gamberella, 633 So.2d 595 (La.App. 1 Cir. Dec 29, 1993). 

11.The official authorized to implement quarantine and isolation measures is usually a 

public health official, but this varies by state.The necessity of issuing mandatory quarantine and 

isolation orders depends on the level of threat. 

8 
Protecting Law Enforcement Officers 

enforcement might be asked to help public health and park authorities 

close—and then enforce closure of—recreational areas such as pools, 

water parks, and beaches to prevent the spread of infection. 

As long as the basic public health infrastructure for water and food 

sanitation is intact, food- and water-borne illnesses do not pose a major 

threat in the United States. If bioterrorists contaminated the water 

supply, flushing extra chlorine through the water supply system would 

easily eliminate the contamination. In the event of a biological terrorist 

attack on the food supply, law enforcement would head up the 

investigation in partnership with public health authorities to identify 

the source and extent of the contamination. 

Blood-Borne Diseases 

In the instance of blood-borne diseases, hepatitis B is in fact 

more infectious than HIV and thus poses the greater threat to law 

enforcement officers—especially if they work in correctional settings 

or are in close contact with intravenous drug users. Minor injuries 

often occur to both suspects and officers during altercations, leading 

to potential exposure to blood-borne pathogens.The risks of hepatitis 

C transmission are not well understood, but they are thought to be 

limited in these situations.12 

However, officers are first on the scene in many traffic accidents— 

another opportunity for exposure to blood-borne pathogens. 

Investigating crime scenes, especially if drugs are involved, can also 

pose particular hazards (e.g., needles that have not been disposed of 

properly or exposure to body fluids). 

Immunization and Personal Protective 

Equipment 

Immunization 

One important protective measure for law enforcement officers 

and support staff is immunization against the basic diseases that might 

pose a threat to their health and to the health of their community.13 

However, there may be some who question mandatory immunization. 

12. Centers for Disease Control and Prevention. 2000, July 28.“Hepatitis C Virus Infection 

Among Firefighters, Emergency Medical Technicians, and Paramedics—Selected Locations, United 

States, 1991–2000.” MMWR Weekly 49(29): 660–665.Available at www.cdc.gov/mmwr/preview/ 

mmwrhtml/mm4929a3.htm. Datta, D.S.,Armstrong, G.L., Roome,A.J.,Alter, M.J. 2003.“Blood 

Exposures and Hepatitis C Virus Infections Among Emergency Responders.” Archives of Internal 

Medicine 163(21): 2605–2610.Available at http://archinte.ama-assn.org/cgi/content/abstract/ 

163/21/2605. 

13. Centers for Disease Control and Prevention, www.cdc.gov/nip/recs/adult-schedule.htm. 

9 
The Role of Law Enforcement in Public Health Emergencies 

The department cannot assume that this resistance will disappear 

when there is a public health emergency. In fact, objections to 

vaccination are likely to increase because personnel may need to be 

vaccinated before there is a clear threat, and the vaccine to be used 

may not have been proved safe or effective. 

The starting point is encouraging employees to be fully immunized 

against common diseases. Offering a voluntary flu vaccine program is 

an example of this type of benefit. It often helps to present the risk 

factors in clear terms: the probabilities associated with taking and not 

taking the preventive treatment, windows of opportunity for getting 

vaccinated once there is exposure, and the downside effects of 

complications that could occur in rare circumstances.This topic 

should also be covered in any educational programs the department 

may offer. 

Several types of vaccines are used only in special situations. One is 

the smallpox vaccine, which is only available through the federal 

government.This vaccine is used to prevent the spread of smallpox by 

a bioterrorist.14 Unlike other immunizations, the smallpox vaccine is a 

disease agent itself and can be very dangerous for a defined period of 

time, during which those immunized may be contagious to their close 

contacts.A number of other vaccines are required for traveling (e.g., 

yellow fever, cholera, and typhoid) or for certain occupational 

exposures.These immunizations might be used during an epidemic, 

but they are not widely used in the United States.The anthrax vaccine 

is traditionally administered to people who work with animals that 

may carry anthrax or in laboratories that work with this bacterium. 

It may, however, be needed by law enforcement in special situations 

(e.g., terrorist dispersal). None of these vaccines are routinely 

administered to law enforcement personnel, but any might be used 

for a preventive purpose in an epidemic situation. 

As an option, departments can mandate inoculation against specific 

diseases (e.g., measles, mumps, rubella, chickenpox, polio, and 

diphtheria) pre-employment for all officers who will come in contact 

with the public. Immunization against most of these diseases 

is required (with few exceptions) for students starting school in every 

state, so most officers born in the United States have some residual 

immunity. Some of these diseases, such as chickenpox, are still 

common and pose a serious threat to adults who are not immune. 

Others, such as rubella, are rarer but are particularly dangerous for 

pregnant women.Without up-to-date immunizations, officers might 

easily spread these diseases.15 

14.Wild smallpox was eradicated worldwide in the 1970s (www.bt.cdc.gov/agent/ 

smallpox/overview/disease-facts.asp). 

15. See appendix 3 for diseases officers may be exposed to while on the job and for which 

vaccinations are available. 

10 
Protecting Law Enforcement Officers 

Recently, there has been much debate about the concept of “tiers 

of vaccination” or determining who should be given priority in receiving 

vaccines during an outbreak of a potentially fatal disease. Operating 

under the assumption that the disease causing the outbreak is new 

(e.g., avian flu) and a vaccine does not yet exist, state and local 

decisionmakers are being tasked with identifying the “priority groups” 

that would comprise the first recipients of these vaccines once they 

have been developed. In most jurisdictions, medical professionals are 

first on the list of recipients (e.g., doctors, nurses, and emergency 

medical service providers) and law enforcement personnel are either 

second or third. 

The vaccine priority given to law enforcement officers may 

depend on their role during public health emergencies, as outlined in 

local and state plans. In jurisdictions where law enforcement officers 

are expected to work side-by-side with public health and emergency 

medical services personnel, vastly exceeding their normal scope of 

duties (and increasing their risk of exposure), they may be given 

higher vaccine priority. 

Personal Protective Equipment 

Providing personal protective equipment (PPE) is one of the most 

important steps for protecting law enforcement personnel and is a 

necessary component of an effective all-hazards disease control plan. 

Moreover, many departments prohibit officers from responding to a 

potentially contaminated scene unless they wear the departmentissued PPE. Some jurisdictions have outfitted all officers with such 

equipment. For example, the Toronto Police Service provides officer 

safety kits, which are worn on the officer’s duty belt. Higher level kits 

are stored in patrol vehicles.Training also must be provided in the 

proper use of PPE, and the law enforcement agency must deliver this 

training in a context that is law enforcement-relevant and suitable to 

the biological hazards personnel may face.16 

16. For additional information on personal protective equipment (PPE), see the U.S. 

Department of Homeland Security’s First Standards for Personal Protective Equipment for First 

Responders, available at www.dhs.gov/dhspublic/display?content=3301; the National Institute of 

Justice’s Law Enforcement and Corrections Standard Testing Program, Guide for the Selection of 

Personal Protective Equipment for Emergency First Responders (Respiratory Protection) (NIJ 

Guide 102–00 Vol. IIb) and Guide for the Selection of Personal Protective Equipment for 

Emergency First Responders (Percutaneous Protection—Garments) (NIJ Guide 102–00 Vol. IIa), 

available at www.ncjrs.gov; for information on training on the use of PPE, see www.cdc.gov and 

www.osha.gov. 

Occupational Health and 

Safety Program 

Tom Imrie, Unit Commander, 

Occupational Health and 

Safety, Toronto Police Service 

The Toronto Police Service 

Occupational Health and 

Safety Program ensures that all 

police officers and some 

civilian staff receive training in 

communicable disease risk 

management and appropriate 

personal protective equipment 

(PPE). PPE has been provided 

to every patrol officer and 

some civilians deemed at risk, 

such as court security officers 

and staff who clean the insides 

of police vehicles. 

Police officers and court 

officers are issued PPE, 

including officer safety kits 

that are contained in pouches 

on an officer’s duty belt.These 

kits include antimicrobial 

gloves, antiseptic towelettes, 

saline solution, and a one-way 

CPR air mask. Higher level 

enhanced kits are stored in the 

trunks of patrol vehicles and 

include N95 masks,a protective 

eye wear, waterless antiseptic 

hand wash, needle debris 

containers, Tyvex or similar 

material coveralls, heavy-duty 

rubber gloves, and biohazard 

storage bags for contaminated 

clothing. The foregoing is 

considered basic equipment 

and is available to all members 

who may be exposed to 

communicable diseases. 

continued on next page 

11 
The Role of Law Enforcement in Public Health Emergencies 

continued from previous page 

Identifying which officers 

need enhanced PPE was one of 

the lessons learned during the 

Severe Acute Respiratory 

Syndrome (SARS) epidemic 

and other events such as 

anthrax hoaxes. 

Through risk assessment, 

the Toronto Police Service 

determined that there was a 

need for officers who could 

respond to natural or manmade 

public health emergencies. In 

preparation, the department 

trained and equipped specific 

forensic identification officers 

in Level 4 Hazmat. The 

equipment provided consists 

of positive pressure selfcontained breathing apparatus 

(SCBA), and full-coverage, 

total-isolation, biohazard containment suits. These officers 

were then trained in the recognition, assessment, and control 

of biological hazards. In a biohazard emergency, their function is to mitigate the 

biological hazards that resulted 

in the emergency through 

appropriate means (e.g., 

containment, isolation, and 

decontamination), and then 

investigate the event including 

packaging and collecting 

evidence. 

continued on next page 

PPE should be planned for and acquired well before an outbreak 

occurs.There are three main classes of PPE that should be made 

available to law enforcement: hand sanitation, protection against blood 

and body fluids (e.g., gloves), and respiratory protection.17 

Hand sanitizing—hand washing, applying alcohol gels (with 60–90 

percent alcohol), and using antibacterial wipes—is the simplest and 

easiest form of personal protection. It can also be one of the most 

effective. Even in an epidemic, liberal use of hand washing and alcohol 

gel can slow the spread of disease. 

The next level of protection is what used to be called “universal 

precautions” (i.e., against blood and body fluids) and includes gloves, 

gowns, and masks.Anyone who might come in contact with another 

person’s blood or body fluids should be wearing latex or vinyl 

antimicrobial gloves. During an epidemic, wearing gloves when body 

contact is likely would prevent germs from getting on hands in the 

first place—preferable to killing germs by hand sanitizing. 

If there is more than a little blood or it is likely to splatter, more 

complete coverage is needed: waterproof gowns, paper masks, and eye 

shields.Although these items are fairly simple to put on correctly, few 

people take them off correctly. If gloves are grossly contaminated, for 

example, they must be washed or cleaned before removing any other 

items. Gowns should be pulled off inside out before the gloves are 

removed.The facemask should then be removed completely, not hung 

around the neck. Goggles should be removed last (using clean hands). 

Wearing waterproof gowns poses two challenges to law enforcement 

personnel. First, it will be difficult to identify them as law enforcement 

personnel because their uniforms will be covered. Second, unless their 

equipment (e.g., batons, pepper spray, and firearms) is worn outside the 

gown, it will not be readily available. If the equipment is worn outside 

the gown, on the other hand, it will have to be decontaminated before 

it can be touched with clean hands. 

Respiratory protection is the most complicated and difficult to use 

properly.A paper mask worn loosely over the mouth and nose is good 

protection against blood splatters and keeps the officer from putting 

contaminated fingers into the mouth or nose.As protection from 

airborne disease, however, it is virtually useless.The basic principle of 

respiratory protection is that all air moving into the respiratory tract 

must pass through the filter of the mask. Individuals need masks that 

fit snugly over the mouth and nose and a pair of goggles that covers 

17. U.S. Food and Drug Administration, www.fda.gov/cdrh/ppe/fluoutbreaks.html. 

12 
Protecting Law Enforcement Officers 

the eyes. If air gets around the mask or through contaminated tears 

and into the nose, there is no protection.18 

Law enforcement personnel who may be required to wear any 

type of respirator, even a simple mask type, should have a physical 

exam beforehand and must be fit-tested to determine that they can 

wear the mask appropriately. Inability to detect specific aromatic 

substances in the air while wearing a respirator, for example, indicates 

a proper fit. Men with facial hair cannot wear this kind of protection 

effectively. People with asthma or other respiratory diseases may not 

be able to tolerate the reduced airflow. 

In general, the more virulent the disease, the smaller the amount of 

infectious agent needed to infect an individual and the more critical 

the use of effective PPE. If a dangerous disease is easily spread through 

inhaled particles (e.g., anthrax or smallpox), the most effective PPE 

available, such as air-purifying respirators or self-contained breathing 

apparatus, will be necessary. Further, all PPE should be disposed of as 

hazardous medical waste would be. 

Major Infectious Diseases 

What should departments do about workers with major infectious 

diseases who nonetheless insist on staying at work? Paid sick leave is 

limited, and taking extra sick days may simply not be possible in some 

departments.There is also the realization that missing work places an 

added burden on those who are still working. 

With major infectious diseases, however, it is critical that no one be 

allowed to work while sick, and this needs to be supported by 

supervisors at all levels within the department. Contagious diseases 

can spread very quickly through a department and most preventive 

measures are not very effective in a work environment. Many diseases 

spread through the air, through hand contact, and on environmental 

surfaces. One person working for a few hours while sick can pass the 

disease to many others. Soon, a significant proportion of the department 

(both sworn and civilian) is likely to be sick, too. For example, during 

the SARS outbreak in Toronto, an employee who came to work sick 

18. Putting the mask on the person who has contracted a respiratory infection is a more 

effective way of controlling the spread of respiratory diseases.This strategy has been used in 

tuberculosis control for decades. If the disease agent is in the respiratory secretions (e.g., 

phlegm), keeping the secretions in the mask instead of coughing them into the air everyone else 

is breathing helps reduce the chance of spread. Fortunately, when trying to keep the germs in 

instead of out, the loose fitting mask is acceptable.There are, however, two problems. If someone 

has a significant respiratory illness, they are less likely to be able to tolerate the mask than a 

healthy individual would be.The other problem is determining who should be wearing a mask. 

Many people cough frequently (it is a natural cleaning mechanism for the lungs and mouth). If 

there is a serious respiratory illness spreading in a community, it may be worthwhile to put a 

mask on anyone who is coughing or on everyone when they must be in close contact with 

others, such as in a car, a holding cell, or waiting room. 

model has been adopted 

The department has similarly 

trained and equipped officers 

who investigate clandestine 

drug labs and “hydroponics 

grow” (i.e., soil-less gardening) 

operations. These officers can 

be deployed to assist in the 

event of natural and manmade 

incidents. They are provided 

with SCBA, Level 1 Hazmat 

suits, and evidence collection 

and packaging materials suitable to the risks present. This 

throughout Canada. 

continued from previous page 

a. Masks certified by the CDC’s 

National Institute for Occupational 

Safety and Health as filtering out at 

least 95 percent of airborne particles 

(www.cdc.gov/niosh/npptl/topics/ 

respirators/disp_part). 

13 
The Role of Law Enforcement in Public Health Emergencies 

exposed 49 people in 1 day.These individuals—who had the potential to 

infect their families and other close contacts—were quarantined and 

thus rendered unable to perform their duties for 10 days. 

This is a particular problem for diseases that have a short incubation 

period (such as measles, mumps, and flu). Everyone who is infected 

from the original sick employee is likely to get sick and be out sick at 

the same time, reducing the size of the workforce. Law enforcement 

disease surveillance programs and plans are important vehicles for 

addressing the issue of working while sick during a public health 

emergency. Effective preparedness requires policymakers to consider 

implementing some form of disease surveillance and reviewing sick 

leave policies and policies on working while infected. Further, other 

issues regarding how and when employees use sick leave; workmen’s 

compensation; and considerations for those who report to work, 

contract the disease, and die all need to be addressed in advance. 

During the SARS outbreak in Toronto, officials decided that officers 

who were quarantined as a result of potential occupational exposure 

would receive full pay for the days they were previously scheduled to 

work. If they were quarantined as a result of nonoccupational exposure, 

however, they were instructed to use sick leave. 

If there is an epidemic, a department may activate its disease 

surveillance program, whereby employees are checked for signs of 

illness before they return to work.This may be as simple as asking 

everyone to monitor their temperatures at specific intervals during 

their shifts and report any symptoms or as complex as having a nurse 

check each person physically before they enter the building. Obviously, 

the level of surveillance and the restrictions on employees returning to 

work depends on the type and severity of the disease. 

In addition, much thought should be given to what ought to be 

done after an employee has been identified as possibly sick.Would he 

or she be sent home or to another predetermined location for isolation? 

The level of the threat will dictate the response, but departments 

should consider the range of possible responses (and secure the 

necessary partnerships and resources for implementing these 

responses). Departments need measures for determining which officers 

are fit for duty. Otherwise, it becomes even more challenging for a 

department to implement an effective disease control strategy, especially 

when leave will not be compensated or will count against the employees’ 

sick leave or earned time off.19 

Medical professionals in Toronto also encountered a situation that 

could translate to law enforcement. It was called a “working quarantine.” 

19. Some union contracts provide for a second independent medical opinion when the 

member does not agree with the findings of the medical official. 

14 
Protecting Law Enforcement Officers 

Nurses who had potentially been exposed still attended work, but 

were required to wear PPE while at work to minimize the risk of 

transmission. If one or more symptoms developed, the nurse was sent 

home.This may be an appropriate option for some essential personnel, 

depending on the level of the threat and the type of contact these 

personnel have with others. 

Further considerations for dealing with employees who want to 

work despite having a major infectious disease appear in appendix 1. 

Treatment of Infectious Disease 

Many epidemic diseases do not have specific treatments. If a 

disease is caused by bacteria (e.g., anthrax or pertussis), antibiotics 

may be curative and can stop the disease from developing in someone 

who has been exposed. Because prophylactic antibiotics have to be 

given quickly to prevent a disease from developing, antibiotics must be 

stockpiled before an outbreak. 

For most viral diseases, however, there are no curative medicines: 

once the person has caught the disease, it must and will run its course. 

This is why the best approach to viral diseases is to prevent them from 

occurring by developing a vaccine against them. 

It may be prudent for law enforcement agencies to arrange for care 

of exposed or symptomatic employees who have no one else to care 

for them.While this would be somewhat difficult to do, it would also 

demonstrate support for employees at a time when some might 

consider not coming to work. Providing care for employees confined 

to their residences or a facility previously secured by the jurisdiction 

(for example, a hotel) also can speed their return to work. 

Protecting Officers’ Families 

Officers are more likely to report to work if their families are 

safe and healthy.Advanced education—to include information on the 

value of sheltering-in-place for the family and items that should be 

stockpiled—and planning (possibly securing a temporary residence for 

officers so they do not bring the disease home) may encourage a larger 

number of officers to report for duty. 

Staff members with a sick relative at home may not report for 

work. Planning for the health of officers’ families presents a unique 

challenge, as workers’ compensation, injury prevention systems, and 

sick and special leave often address only the employee and not family 

situations. Effective disease control requires prevention activities that 

include all of an employee’s close contacts. 

15 
The Role of Law Enforcement in Public Health Emergencies 

For example, preventive measures such as immunization may protect 

individual officers, but department staffing levels may be difficult to 

maintain unless vaccines also are offered to family members, roommates, 

and anyone sharing an intimate or close contact relationship with an 

employee. 

16 
Protecting the Community 

F or years, community-oriented policing and problemsolving initiatives have taken root throughout the 

country.These relationships, now widely recognized 

as an essential component of law enforcement, facilitate 

community participation and ownership of programs and 

provide opportunities for community education on the 

importance of compliance with the law.Where these 

relationships already exist, working with community 

residents before a communicable disease outbreak event 

will be relatively easy. Law enforcement and community 

members can meet for open dialogue about plans, concerns, 

and strategies. Public health officials should consider teaming 

with law enforcement to address these groups. 

If these relationships do not already exist, departments must build 

bridges with their community now, because such bridges will greatly 

enhance all department efforts that involve the community and will 

ensure that the relationships necessary to support an effective and 

coordinated response to a public health emergency are in place. 

Some things for law enforcement to consider when bringing the 

community into disease control planning include informing people 

about the jurisdiction’s plans; including residents in exercises; and 

getting as much input, buy-in, and involvement from community 

stakeholders as possible. Obtaining support prior to the incident can 

facilitate restrictive measures such as voluntary social distancing (and 

sheltering-in-place), quarantine, and isolation. Gaining this compliance 

is extremely important, as once the state of civil order declines past a 

certain point, it can be terribly costly for law enforcement to restore 

public order. 

Working With Public and Private Agencies 

The importance of partnerships to preparedness cannot be 

overstated, yet the terms “partnership” and “collaboration” are so 

common that their importance may be overlooked in the planning 

process. Effective, meaningful partnerships result in coordinated planning, 

information sharing, and formal memorandums of understanding 

(MOUs) and mutual aid agreements. Partnerships help the parties 

identify challenges and capacities within their organizations and 

develop and test response plans and alternatives based on the pooling 

of knowledge and resources. 

17 
The Role of Law Enforcement in Public Health Emergencies 

Partnerships among law enforcement, local hospitals, and public 

health agencies should (1) focus on cross-training personnel, (2) 

educate the community on its role during a public health emergency 

and the basics of communicable disease prevention, and (3) develop 

methods for delivering up-to-date and consistent information to the 

public during an emergency. 

Working collaboratively and sharing information ensures a clear 

understanding of roles and responsibilities and helps departments 

prepare to meet the expectations of other local responders. By gaining 

insight into other agencies’ planning, law enforcement can better 

predict where their resources will be needed, possible shortcomings, 

and the type of activities that will be needed based on the nature and 

location of the threat. 

For example, law enforcement will need to have a clear idea of 

how hospitals plan to handle overflow of patients and how they 

intend to maintain order. Partnerships with the medical examiner or 

coroner’s office will give insight into how deaths will be handled and 

how law enforcement will need to be involved, if different from routine. 

Law enforcement also will need to know the emergency procedures 

for local schools, hospitals, college and university campuses, medical 

centers, and shopping malls. 

Planning can facilitate agreement among partners as to the 

appropriate time to request assistance from the state and federal 

government and the types of assistance that may be needed.While 

partnerships require significant effort to initiate and maintain, they pay 

vital dividends during a crisis: delivering a coordinated response and 

accessing necessary personnel and resources quickly depend on them. 

The Role of Law Enforcement in Mass 

Vaccination and Preventive Measures 

Law enforcement would play two primary roles during a mass 

vaccination or prophylactic distribution campaign.The first—maintaining 

civil order and securing the sites and the supply of the vaccine or 

prophylactic measures—involves a dilemma. If the city activates a small 

number of sites (e.g., one for every 10–50,000 or more people), law 

enforcement may be able to secure all the sites, but there will likely be 

so many people at each site competing for vaccinations or treatment 

that crowd control may be difficult or impossible. On the other hand, if 

the city activates a greater number of sites (so that no one has to wait 

long or travel far), the crowd will be manageable, but there may be so 

many sites that it may be impossible to assign officers to all of them. 

18 
Protecting the Community 

The second role law enforcement might assume is the enforcement 

of restrictions based on vaccination status, including prohibiting travel 

or enforcing quarantine orders for the unvaccinated.The most difficult 

task would be enforcing mandatory vaccination orders, if issued. In the 

face of a serious outbreak, the federal government may enact policies 

to encourage vaccinations or place restrictions on those who refuse. 

Enforcing a mandatory vaccine rule raises questions about whether 

law enforcement would physically detain persons so they could be 

vaccinated against their will, whether these persons would be arrested 

(or held in a custodial status that is permitted under public health law 

but perhaps not criminal law), and how such an order might be 

enforced.Another issue to consider is that officers themselves may 

refuse inoculation with a new and unproven vaccine. Many health 

workers and first responders nationwide refused voluntary smallpox 

vaccinations offered by the Department of Health and Human 

Services in 2003 after two recipients died and others experienced 

unanticipated heart problems and other “serious” and “nonserious 

”20 adverse events.

Further considerations regarding the role of law enforcement in 

mass vaccination and/or treatment measures appear in appendix 1. 

Law Enforcement’s Role During 

Voluntary Restrictions 

Social distancing is the process of limiting contacts between 

individuals to reduce the chance of spreading a disease. Community 

social distancing can include banning public gatherings, closing public 

places such as malls and movie theaters, canceling sporting and 

entertainment events, and closing nonessential workplaces.To be 

effective, as many locations as possible need to be closed to keep 

people at home, or at least out of contact in as many group settings as 

public officials can affect. 

Personal social distancing means eliminating handshaking, increasing 

the physical separation of persons at work, eliminating nonessential 

meetings, using telecommunications for as many business or personal 

interactions as feasible, and other measures to limit personal contact 

with individuals outside the immediate family. Social distancing relies 

heavily on voluntary compliance and can slow the spread of disease if 

the population is compliant. 

20. Centers for Disease Control and Prevention. 2004, February 13.“Update:Adverse Events 

Following Civilian Smallpox Vaccination—United States, 2003.” MMWR Weekly 53(05): 106–107. 

Available at www.cdc.gov/mmwr/preview/mmwrhtml/mm5305a4.htm. 

19 
The Role of Law Enforcement in Public Health Emergencies 

Successful Components 

of Toronto’s Voluntary 

Quarantine 

During a recent conference 

hosted by the Police Executive 

Research Forum (and sponsored by Motorola, Inc., as part 

of the Critical Issues in Policing 

Series), Unit Commander Tom 

Imrie of the Toronto Police and 

Jane Speakman, Public Health 

Attorney for the City of 

Toronto, identified several key 

factors that led to the successful 

at-home, voluntary quarantine 

during the city’s SARS 

outbreak: 

1. Consideration should be 

given to compensation 

for lost time from work. 

2. The government must 

guarantee the delivery of 

essentials such as food and 

medicines to quarantined 

houses. A major grocery 

chain provided delivery 

service in Toronto, but 

some U.S. cities may not 

have similar resources or 

established mutual aid 

agreements with the 

private sector for this 

type of assistance. In a 

pandemic, food will 

become scarce, and some 

form of government 

intervention such as 

rationing may become 

necessary. 

3. The state should provide 

medical evaluation and 

transport for anyone 

continued on next page 

The biggest challenge for law enforcement in trying to enforce 

social distancing and voluntary quarantine will be keeping people in 

their neighborhoods. Because people will still need to shop for food 

and obtain medical care, it may be difficult to enforce social distancing 

unless the public has been educated about how social distancing 

protects their health and safety. 

Isolation works on the principal that a person cannot spread a 

disease if he or she does not come into contact with others. Law 

enforcement can test and practice several approaches to isolation, even 

when an outbreak is not taking place. Holding cells in correctional 

facilities could be used to isolate prisoners while doctors determine 

whether they carry an infection before sending them into the general 

population. Cells could be arranged for single occupants, allowing 

officers to talk to and care for a prisoner without actually entering the 

cell. Eating utensils and the like should be disposable.This isolation 

allows time to check for disease before exposing others to the prisoner. 

While this approach increases the number of isolation locations, 

it is a very limited resource during a major outbreak and should be 

reserved for emergencies where there are only a few cases of a 

dangerous disease. 

Voluntary, at-home quarantine was the primary method used by 

Canadian officials to control SARS.21 Only a few people refused to 

cooperate, requiring the government to obtain legal confinement 

orders.22 The Toronto Police Service sent specially trained and 

equipped officers to locate the named party and transport him or her 

to the hospital named in the order, where the parties were detained 

until quarantine elapsed. 

Specific considerations on social distancing, quarantine, and 

isolation appear in appendix 1. 

Law Enforcement’s Role in Involuntary 

Restrictions, Including Quarantine23 

As the number of persons who must be restricted increases, so too 

does the cost in staff time and other resources needed to support the 

restrictions. In any given community, the number of (and the available 

space in) isolation and quarantine facilities—especially hospitals—is 

very limited. Setting up quarantine in secondary facilities—such as 

21. Canadian SARS Commission, www.sarscommission.ca. 

22. In these cases, a medical officer of health issued the order for quarantine upon application 

to a judge. Evidence of the nature of the disease was presented.This is a reverse onus situation in 

that the person named must comply with the order and show cause after they have complied. 

23.Although quarantine may be practical when dealing with an outbreak of a communicable 

disease, it may not be practical in response to a biological disaster. 

20 
Protecting the Community 

public buildings—only serves to congregate many people in a confined 

space, ensuring that many persons will be infected. Fear of infection 

will make it difficult to keep people in these facilities, requiring 

significant law enforcement personnel and resources to enforce such 

a quarantine. 

The most realistic way to restrict large numbers of persons is to 

persuade them to stay home.The CDC’s Ten Principles of Modern 

Quarantine (see appendix 2) stresses that involuntary quarantine is 

a last resort, seldom necessary, and should be as limited in scope as 

possible.This reflects philosophical concerns about individual liberty 

and pragmatic concerns about maintaining a quarantine that is widely 

resisted. For example, the logistical requirements of enforcing 

a quarantine in cities with complex networks of roads, alleys, 

underground tunnels, sewers, and various transportation links, as 

well as interconnecting buildings, are massive.Although most of the 

Canadians impacted by SARS voluntarily submitted to quarantine, 

it cannot be assumed that this will be the case in the United States, 

which has a very different cultural history of using compliance as a 

law enforcement tool. 

In disaster management and disease control, the legal authority to 

act expands with the threat. Judges will not stop the enforcement of 

quarantine or the detention of individuals if they believe it is necessary 

for public safety.The U.S. Supreme Court has steadfastly upheld the 

broad powers of the state to protect its citizens from threats to public 

health.24 Further, the Court has never questioned law enforcement 

authority to enforce quarantines and other public health measures. 

Nevertheless, many states have amended their traditional public health 

laws to provide citizens with additional due process protections. 

In 2001, recognizing this need to provide guidance for states on 

the authority necessary for public health to enforce protective 

measures, the CDC, the Center for Law and the Public’s Health at 

Georgetown and Johns Hopkins Universities, and representatives from 

various national organizations collaborated to develop a Model State 

Emergency Health Powers Act (MSEHPA).The goal of the Model Act is 

to assist state governments in reviewing emergency public health 

powers to ensure they are adequate to respond to modern disease and 

bioterrorism concerns.The Model Act helps to define elements of an 

emergency and the types of measures that can be enforced, but 

specific guidance on how to enforce these measures and the role and 

authority of public safety in enforcing these measures is not 

included.25 

24. Jacobson v. Massachusetts, 197 U.S. 11, 25 S.Ct. 358 (1905). 

25.The Model Act is available at www.publichealthlaw.net/MSEHPA/ 

MSEHPA2.pdf#search=Model_State_Emergency_Health_Powers_Act.The following states have 

passed MSEHPA in some form:Arizona, Florida, Georgia, Hawaii, Maine, Maryland, Minnesota, 

Missouri, New Hampshire, New Mexico, South Dakota,Tennessee, Utah, and Virginia. 

symptoms. 

of those in 

state,a medical condition, 

other supplies.b 

Although these not 

almost none of the thousands 

needing medical care, or 

for those who develop 

4. The state must keep track 

quarantine, communicating with 

them at least once a day 

to determine their mental 

and need for food or 

are 

routine law enforcement functions, law enforcement personnel may be called upon to 

assist, because cities may not 

have sufficient social service 

and public health personnel to 

provide the services. 

It is critical to note that 

of persons who were voluntarily 

quarantined in Toronto developed SARS. This meant that 

Canadian officials did not have 

to transport many sick persons 

to the hospital or experience 

the secondary cases that would 

continued from previous page 

continued on next page 

a. Many of those quarantined 

during the SARS outbreak reported 

experiencing post-traumatic stress 

disorder (www.sarscommission.ca/ 

report/Interim_Report_2.pdf). 

b.The department itself could 

conduct this type of health check on 

its own members.Two objectives 

would be achieved: the well-being of 

the member is assured and an early 

and safe return to work will be 

achieved through regular contact. 

21 
The Role of Law Enforcement in Public Health Emergencies 

continued from previous page 

have prolonged the quarantine 

for weeks. This lack of secondary cases may in fact be due to 

the efficacy of Toronto’s rapid 

quarantine response, but it also 

might lead some persons to 

question whether the quarantine was necessary at all. This 

sense of ambiguity about what 

happened might complicate 

future voluntary quarantines. 

Irrespective of whether states have formally adopted the provisions 

of the MSEHPA or not, law enforcement has the power to act under 

existing laws, even if a public health emergency has not been declared. 

This is a critical point because states are not likely to declare a public 

health emergency except in the most extreme circumstances. 

An additional complication that law enforcement will face is the 

abundance of both legal and illegal weapons in homes throughout the 

United States. If education is not sufficient to maintain voluntary 

quarantine, and public decisionmakers believe that quarantine must be 

enforced, law enforcement leaders will have to determine the rules of 

engagement and whether ad hoc rules have to be adopted.There will 

be many issues to consider in regard to maintaining quarantine 

by force. For example, how much force should be used? Will the 

department apply its preexisting use-of-force policies/force continua 

to a quarantine? This should be part of the planning process, if only 

to stress the complexities associated with enforcing quarantine. 

Furthermore, arrest and imprisonment are not practical if more than 

a handful of persons resist quarantine: already crowded jails are not 

appropriate for quarantining persons with communicable diseases.26 

Further considerations on involuntary movement restrictions 

appear in appendix 1. 

Special Populations 

Many cities in the United States have large populations of illegal 

aliens who may not cooperate with voluntary disease control measures 

if they believe doing so will put them at risk of identification and 

deportation.They also may be excluded from receiving social support 

services such as food delivery and transportation to medical care.The 

flow of illegal aliens into the United States, estimated at 700,000 a 

year,27 would also pose a major problem for the implementation of a 

widespread quarantine or travel restriction.28 Engaging the formal and 

informal leaders of different community groups to educate them and 

answer questions in advance of an outbreak is the key to convincing 

these community members to comply with quarantine orders. 

Movement restrictions would be especially challenging should an 

outbreak occur in any of the cities on the border with Mexico. U.S. law 

enforcement would face numerous challenges in coordinating 

quarantine enforcement between local and state law enforcement 

26.Although the challenge of housing violators is daunting, this topic is beyond the scope of 

this document.The Bureau of Justice Assistance, however, is currently discussing this challenge 

with appropriate justice system representatives. 

27. U.S. Government Accountability Office, www.gao.gov/new.items/d05646r.pdf. 

28. National Health Care for the Homeless Council, www.nhchc.org/Publications/ 

CA08DataResourceGuide.pdf. 

22 
Protecting the Community 

personnel; cross-border cooperation and coordination in light of 

language and cultural barriers will prove difficult. One step might be to 

reexamine current mutual aid agreements. 

Also problematic is restricting the movement of people engaged in 

criminal and gang activity. It is unknown how they will cooperate with 

voluntary restrictions and quarantine, and it will be almost impossible 

to enforce restriction orders against them. For example, it has been 

postulated that bird smugglers are contributing to the spread of avian 

flu between countries. Given the pervasiveness of criminal enterprises 

in some cities, these groups should be specifically targeted in local or 

state plans. 

Further considerations on special populations appear in appendix 1. 

Law Enforcement’s Role in 

Mass Casualty Planning 

When mass casualties resulting from manmade or natural disasters 

occur, most hospitals and morgues are not at surge capacity and are 

able to assist. During a large-scale public health emergency such as 

might be caused by a pandemic flu, fatalities may continue to occur 

weeks or months after surge capacity has already been attained.The 

traditional sequence—the victim is transported to a medical facility, 

death pronounced, autopsies performed, and victim claimed and 

transported to a funeral home—will likely not occur. 

Although primarily the responsibility of agencies listed in ESF #6 of 

the NRP (“Mass Care, Housing, and Human Services”), law enforcement 

will play a major role in the management of mass casualties.A 

pandemic flu could leave medical examiners and private physicians 

unable to sign multitudes of death certificates and perform autopsies 

when necessary and could overwhelm funeral homes, crematories, and 

cemeteries.These issues would be exacerbated by the lack of 

supportive infrastructure and the need to maintain other medical 

operations while dealing with a crisis. 

In many jurisdictions, unattended deaths (i.e., occurring when the 

individual is not under a doctor’s care or not in a hospital setting) have 

to be investigated by the state or local law enforcement agency. Given 

the number of unattended deaths during a pandemic situation, agencies 

should work with the state medical examiner (or coroner) in advance 

of an actual emergency to determine how best to respond. MOUs with 

these organizations could identify specialized teams of officers and 

paramedics to investigate a fatality and pronounce death. Clearly, some 

type of investigation will be necessary to rule out criminal activity. 

23 
Conclusion


While threats to public health are not new, this is 

the first time in recent history that local and 

state law enforcement officials and policymakers 

have had to consider these threats in such depth. 

Lessons learned from the Hurricane Katrina response demonstrate 

the importance of careful planning in preparing law enforcement 

agencies and communities for any type of hazard. Ensuring the safety 

and welfare of law enforcement personnel and their families is vital to 

ensuring an adequate workforce and implementing a response. Local 

and state agencies must be able to work across jurisdictional lines to 

access necessary resources and assistance. 

Incidents such as the anthrax letters mailed in fall 2001 underline 

the importance of quickly containing a contaminated area, accessing 

needed medicines and vaccines, and having the appropriate PPE 

available to first responders. Community cooperation and buy-in to 

comply with the SARS voluntary quarantine and isolation orders 

required public understanding of public health threats and measures 

for preventing the transmission of infectious disease. 

This document outlines key issues and concerns that law 

enforcement officials need to address in the wake of recent public 

health emergencies and in preparation for future public health 

emergencies, including flu pandemics and bioterrorist incidents. 

It is hoped that law enforcement officials will carefully consider 

issues that may need to be addressed in their department’s all-hazards 

planning process.The public safety and response issues raised herein 

are relatively new to this era of law enforcement and require further 

education and collaboration among departments and other local, state, 

and federal stakeholders.As stated in the Implementation Plan for the 

National Strategy for Pandemic Influenza, “Preparedness for a 

pandemic requires the establishment of infrastructure and capacity, a 

process that can take years. For this reason, significant steps must be 

taken now.” 

25 
Appendix 1: Further Considerations 

1. Education

• What educational materials need to be developed to educate


officers about disease risks, methods of transmission,


prevention, and control?


• Is there benefit to starting or expanding a basic occupational


health program? What would be the scope of the program and


where would it be housed organizationally? Are there local


partners who could assist? What resources would be needed?


• Should certain law enforcement officers receive basic training


in public health investigation techniques so they could assist


in investigations during an outbreak? 


• Should officers, who are in direct contact with the public or


persons at high risk of contracting communicable diseases,


be trained to observe and report potential outbreaks?


2. Personal Protective Equipment (PPE) 

• Bearing in mind the recent debate over the effectiveness of


masks at protecting against airborne viruses, does providing


law enforcement personnel with surgical or N95 masks give


them a false sense of security? 


• Will differences in masks and other PPE raise concern among


law enforcement that members from one jurisdiction are less


protected than members from another? 


• How will law enforcement departments secure enough masks


prior to an outbreak? How many masks should be secured and


who will receive them? 


• What other types of basic PPE should be provided to all 


officers for day-to-day use? Should additional emergency kits


be provided and what should be included in these kits? Who


should receive the kits?


• What is a reasonable amount of PPE to keep on hand? How


does the need compare with other department priorities 


competing for resources?


3. Working While Sick 

• Will officers be encouraged to report possible exposure to


communicable diseases and report symptoms during a 


public health emergency? How? 


27 
The Role of Law Enforcement in Public Health Emergencies 

• Should there be special sick leave policies for these 

emergencies? 

• Should there be a special leave category for officers who have 

been exposed but do not have symptoms? 

• If there is a special leave category, should it only apply to 

communicable diseases to keep leave from being abused? 

• How should isolation or quarantine orders for infected persons 

(i.e., they must stay home) be applied to law enforcement 

officers? 

• How will department physicians or other medical professionals 

be involved in efforts to minimize disease spread within the 

department? 

4. Immunization and Prophylactic Measures 

An outbreak will send a huge number of people to hospitals 

and clinics seeking care and reassurance. Most will not be 

infected, but some may be and could contaminate the 

facilities. 

• What are hospital or clinic plans for handling an overflow 

of patients? Will anyone be allowed to enter the hospital 

or clinic? Who will handle crowd control? What are the 

expectations of law enforcement if crowd control is needed? 

• Will hospital staff conduct triage in the parking lot? Will law 

enforcement maintain order at the triage sites? 

If there is a vaccine or treatment (Tamiflu, for example) 

available, there will be a run on facilities where it is 

rumored to be. 

• How will law enforcement work with other organizations 

to receive, transport, protect, and distribute the vaccines 

or drugs throughout the community or the state? 

• Are the hospitals and pharmacies counting on law 

enforcement support that the department cannot provide? 

If emergency treatment facilities are set up in gyms, arenas, 

and the like, will law enforcement be expected to provide 

security? If private security companies will be enlisted to 

help, what coordination mechanisms exist to ensure 

smooth functioning with law enforcement agencies? 

• Do any such agreements with private security agencies exist? 

• What services can private security provide and what resources 

and protection will be needed from the law enforcement agency? 

28 
Appendix 1: Further Considerations 

5. Controlling the Movement of Exposed/Infected Community 

Members 

• During an event such as an anthrax attack, how is law 


enforcement expected to deal with displaced community


members? 


• Which agencies will supply community members with 


personal protective equipment and evacuate them 


if the area cannot be rapidly decontaminated? 


• How would law enforcement be involved in evacuating a large


urban area? 


• What would law enforcement’s role be in keeping an area


closed for weeks or longer? 


• How would law enforcement determine when people being


evacuated would be allowed to enter the perimeter to remove


personal property?


• Who is responsible for tracking individuals exposed to the


virus who have left the jurisdiction? What resources are 


available through law enforcement cooperative agreements


and possibly from federal and private agencies for assisting in


tracking?


• What about people on airplanes and mass transit coming into


the city? Are local law enforcement agencies prepared to work


with airport and transit security agencies?


6. Involuntary Restrictions on Exposed/Infected Community 

Members 

• Have the local law enforcement and public health agencies


developed plans for activating restrictive measures? Are these


plans detailed as to identifying individuals and backups for


each critical function as well as contact numbers? 


• Have these plans been integrated with the larger jurisdiction’s


plan (e.g., a county and a state plan) to ensure the plans work


in concert?


• Has the plan been tested? 

• Are there policies and procedures for enforcing a quarantine 


or other restrictions? 


• Should law enforcement officers watch quarantined houses 


or patrol quarantined neighborhoods? 


• Is there a hotline for people to report violations? 

• Should violators be arrested? If so, when? 

29 
The Role of Law Enforcement in Public Health Emergencies 

• Is there a preexisting court order that permits use of force or 

detainment of violators? 

• Where should violators be housed? Short-term? Long-term? 

How will they be protected from the communicable disease? 

• Will law enforcement guard these facilities? 

• If the local law enforcement agency is expected to help 

enforce these orders, are mutual aid agreements in place to 

supplement the agency’s workforce? 

Assuming that some may want to contest isolation orders, 

they are entitled to a habeas corpus hearing. 

• Are administrative alternatives to court hearings available? 

• Is law enforcement expected to transport individuals to the 

court? 

• Are there provisions for mobile or ad-hoc hearing facilities? 

Can hearings take place via a video link? Will law enforcement 

take the equipment to the homes of quarantined persons? 

• What if the courts are closed as part of social distancing? 

7. Special Populations

• Has law enforcement worked with community groups (e.g., 

faith-based) to reach out to and educate these populations? 

• How can local law enforcement work with border law 

enforcement to plan for movement restrictions? 

8. Controlling Disease in Animals* 

• What would the role of law enforcement be if avian flu spread 

through the U.S. bird population and policymakers decided to 

destroy domestic fowl? 

• What if the disease spreads to urban birds such as pigeons and 

authorities called in law enforcement officers to help with 

eradication? 

• Have relationships between law enforcement and agricultural 

inspection and regulatory agencies been established? Are 

existing mutual aid provisions appropriate for this kind of 

cooperation and are there policies and protocols drafted to 

help guide agency interactions? 

*Although law enforcement may not generally handle this function, animal control (which 

may comprise civilians, not sworn officers) may fall under the purview of law enforcement in 

some jurisdictions. Officers who undertake this responsibility risk bird-to-human contraction of 

the virus, making it imperative that departments plan for these issues in advance. 

30 
Appendix 2: 

Ten Principles of Modern Quarantine* 

Modern quarantine is a collective action for the common good 

predicated on aiding persons infected or exposed to infectious agents 

while protecting others from the dangers of inadvertent exposure. 

1. Used when exposed to highly dangerous and contagious 

diseases, when resources are available to implement and 

maintain, and when less restrictive means cannot accomplish the 

public health objectives. 

2. Encompasses a wide range of strategies, from passive selfmonitoring for symptoms to use of barriers limiting entry and 

exit to authorized persons. 

3. Used in combination with other interventions and 


countermeasures to ensure that persons in quarantine 


or isolation are among the first to receive all supportive 


interventions available.


4. Ensures rapid isolation of infectious persons and separation from 

those merely exposed. 

5. Lasts only as long as necessary to achieve epidemic control but 

no longer than the disease incubation period. 

6. Does not have to be absolute to be effective; therefore, favors 

voluntary over compulsory approaches. 

7. More likely to involve limited numbers of exposed persons in 

small areas than in a widespread geographic locale. 

8. Requires clear understanding of the roles of jurisdictions and 

legal authorities. 

9. Requires coordination and planning with multiple partners. 

10. Requires education, trust, and participation of the general 

public. 

*Centers for Disease Control and Prevention. October 2004.“Postexposure Prophylaxis, 

Isolation, and Quarantine To Control an Import-Associated Measles Outbreak—Iowa, 2004.” 

MMWR Weekly, 53(41): 969–970. 

31 
Appendix 3: 

Available Vaccinations for Diseases 

The following is an overview of common diseases officers may be 

exposed to while on the job for which vaccinations are available.* In 

all cases, a qualified medical professional should be consulted by 

individuals and departments for advice on vaccinations. 

• Pertussis (whooping cough) vaccine was historically 

administered exclusively to children under age 7.This was 

done because the vaccine was not safe for older children and 

adults.A new pertussis vaccine for older children and adults 

has been created and should quickly become more commonly 

used.Whooping cough is still common in much of the southern 

United States. 

• Hepatitis B vaccine has been available for more than 20 years. 

It was originally provided only to those at high risk for blood 

exposures, such as officers and health care workers. It is now 

given to all children as part of their regular immunizations. 

Officers who were not immunized previously may consider 

receiving the full three-shot series of immunizations.Those 

with partial immunity may also consider receiving a booster 

dose of vaccine.This vaccine is considered safe and effective 

and the consequences of hepatitis B are severe.A substantial 

percentage of people with the disease develop chronic 

hepatitis, which can lead to liver failure and liver cancer. 

• Hepatitis A is another relatively new vaccine that public health 

authorities recommend as standard for people with 

occupational risks. Contaminated food and close association 

spread this disease. Spread through jails, residential schools, 

and shelters is common. Unlike hepatitis B, hepatitis A does 

not cause chronic infection. However, it can cause liver failure 

and death so the vaccine is valuable. Having the vaccine also 

means that one does not need gamma globulin (antibodies 

removed from donated blood) if one is exposed to hepatitis A. 

Gamma globulin shots are painful, expensive, and less safe 

than the vaccine. 

*American Public Health Association. Control of Communicable Diseases in Man, 18th ed. 

2004; Adult Immunization: A Report By the National Vaccine Advisory Committee. 1994; 

Centers for Disease Control and Prevention. Interim Immunization Recommendations for 

Emergency Responders: Hurricane Katrina (www.bt.cdc.gov/disasters/hurricanes/ 

responderimmun.asp); Centers for Disease Control and Prevention. Interim Immunization 

Recommendations for Evacuees of Hurricane Katrina. (www.bt.cdc.gov/disasters/ 

hurricanes/katrina/vaccrecdisplaced.asp); Nothdurft, H.D., J. Zuckerman, M. Stoffel, I. Dieussaert, P. 

Van Damme.“Accelerated Vaccination Schedules Provide Protection Against Hepatitis A and B in 

Last-Minute Travelers,” Journal of Travel Medicine 11(4): 260–262, 2004. 

33 
The Role of Law Enforcement in Public Health Emergencies 

• Influenza (flu) immunization is the one vaccine that must be 

administered every year because the influenza virus changes 

from year to year.The vaccine is not perfect, but health 

officials consider it safe and effective in preventing 

complications and in slowing the spread of the disease. 

Despite the popular myth, flu vaccine does not give recipients 

the flu. If avian flu becomes a threat to humans, the vaccine 

developed will be similar to the annual flu vaccine, just 

tailored to this special strain of flu. Because of the way the flu 

virus changes, the more years a person receives a flu shot, the 

more likely that person is to be resistant to whatever type of 

influenza circles the globe next. 

• Rabies vaccine is recommended for anyone who works in 

animal control (which may fall under law enforcement 

agencies in some jurisdictions). Everyone who works in the 

program should discuss having the three-shot series for 

pre-exposure immunization with their physician.This will help 

protect from unknown exposures and will shorten the series 

to two additional shots after a known exposure. Like the 

hepatitis A vaccine, if an individual has had the previous shots 

and is exposed to rabies, the individual will not have to receive 

the rabies gamma globulin. 

• Tetanus toxoid is also one of the childhood immunizations. 

While not a contagious disease, tetanus is everywhere in our 

environment, and it is not possible to prevent exposure to 

tetanus bacteria.The only way to prevent the disease is by 

immunizing everyone against the bacterial toxin that makes 

people sick. Because the disease is not spread from person to 

person, an individual could refuse immunization and not risk 

spreading the disease to others. However, the risk of the 

disease seems unjustifiable when the immunization is 

considered safe and readily available. 

Officers are at special risk for many of the diseases for which 

immunization is available. If they are not immunized, they are very 

likely to spread these diseases to others in their department or in the 

communities they are supposed to protect. 

34 
Appendix 4: 

Standard Definitions of Key Terms 

Effective collaboration among public health, law enforcement, and 

other coordinating agencies requires all parties to use the same 

definitions of terms.The following introduces the core vocabulary for 

communicable diseases.* 

• Communicable or infectious disease. Diseases caused by 

infectious agents such as bacteria or viruses. Individuals may 

be infected from agents in the environment, infected animals, 

and infected people.These diseases are distinguished from 

genetic diseases, diseases caused by toxic exposures, and 

chronic illnesses such as diabetes and cardiovascular disease. 

The terms “communicable” and “infectious” are used 

interchangeably. Examples: the common cold, salmonella, 

Severe Acute Respiratory Syndrome (SARS). 

• Cordon sanitare.An area that has been closed off to prevent 

the spread of a communicable disease. No one will be allowed 

to enter, and persons in the area may be kept from leaving or 

may be evacuated, depending on the nature of the threat.† 

• Epidemic disease.The occurrence of more cases of disease 

than expected in a given area or among a specific group of 

people over a particular period of time. Synonymous with the 

term “outbreak.” Example: 10 cases of tuberculosis in a week 

in New York City would be within the expected number 

(based on historical data) and would not be considered an 

outbreak.Ten cases of measles in New York City, however, 

would be many more than expected and would be considered 

an epidemic or outbreak. 

• Epizootic. An outbreak or epidemic of disease in animal 

populations.‡ Examples: avian flu in fowl, hoof and mouth 

disease in cattle. 

• Incidence.The rate of new cases in a community over a given 

time interval, such as two cases per day. Examples: 20 cases of 

chickenpox in a week; 20,000 new cases of tuberculosis a year. 

*Unless noted, the definitions cited are from the Centers for Disease Control and Prevention 

Epidemiology Glossary available at www.cdc.gov/Reproductivehealth/EpiGlossary/glossary.htm. 

There also is a glossary in the Implementation Plan for the National Strategy for Pandemic 

Influenza, p. 205, available at www.whitehouse.gov/homeland/nspi_implementation.pdf. 

†Compagnie Francaise de Navigation a Vapeur v. Board of Health of State of Louisiana, 

186 U.S. 380 (1902). 

‡Centers for Disease Control and Prevention, www.cdc.gov/ncidod/dvrd/spb/mnpages/ 

glossary.htm. 

35 
The Role of Law Enforcement in Public Health Emergencies 

• Incubation period.The time between when a person is first 

exposed to a communicable disease and the time when the 

person exhibits symptoms of the disease and becomes capable 

of spreading it to others. Diseases with short incubation periods, 

such as measles or smallpox, can cause fast spreading epidemics 

or pandemics because there will be a constant supply of 

infectious persons as new contacts become infected. Diseases 

with a long incubation period such as tuberculosis spread much 

more slowly, but can also reach high levels in the community. 

• Isolation. Separation of infected individuals from those who 

are not infected. Example: placing a person with infectious 

tuberculosis in a restricted-access hospital room. 

• Outbreak. Synonymous with “epidemic.” The term is 

alternatively used to describe a localized (as opposed to 

generalized) epidemic. 

• Prevalence.The total number of cases of disease in a 

community at a point in time. Example: the total number of 

persons living with HIV in a major city. 

• Pandemic.An epidemic occurring over a very wide area 

(countries or continents) and usually affecting a large 

proportion of the population.The term “panzootic” is used 

to describe a pandemic in animals. Example: winter flu 

pandemic in the northern hemisphere. 

• Quarantine. Preventing a person who has been exposed 

to a communicable disease, but is not yet showing signs of 

infection, from coming in contact with others. Example: 

requiring health care workers exposed to SARS to stay home 

until the incubation period has passed. 

• Restriction. Limiting the activities of an individual infected with a 

contagious disease to prevent the spread of the disease to 

others. Examples: preventing a typhoid carrier from working in a 

restaurant; quarantining a person with infectious tuberculosis. 

• Social distancing. The process of reducing contacts between 

individuals to reduce the chance of the disease spreading. 

Community social distancing can include barring public 

gatherings, closing public places such as malls and movie 

theaters, canceling sporting and entertainment events, and 

closing nonessential workplaces. 

• Surge capacity.The maximum patient load a hospital or 

medical system can handle.§ 

§Agency for Healthcare Research and Quality. 2004. Optimizing Surge Capacity: Hospital 

Assessment and Planning. Bioterrorism and Health System Preparedness, Issue Brief No. 31. 

AHRQ Publication No. 04-P008.Available at www.ahrq.gov/news/ulp/btbriefs/btbrief3.htm. 

36 
Appendix 5: What Is a Pandemic? 

A pandemic is an epidemic occurring over a very wide area (several 

countries or continents) and usually affecting a large proportion of the 

population.This means that control measures have failed and the 

emphasis must shift from preventing the further spread of the disease 

to limiting the damage the pandemic does to the community and its 

economy.The most effective approach for law enforcement to help 

prevent a pandemic is to prepare a rapid-response plan and resources 

to contain any initial outbreak of a disease, in addition to contingency 

planning should the outbreak turn into an epidemic or pandemic.The 

World Health Organization and the Centers for Disease Control and 

Prevention have developed a list of the six phases of a pandemic as 

shown below.According to this table, and at the time the document 

was written, avian flu could be categorized as a Phase 3 disease. 

The Six Phases of a Pandemic* 

Interpandemic Period 

Phase 1: No new influenza virus subtypes have been detected in 

humans.An influenza virus subtype that has caused human 

infection may be present in animals. If present in animals, the risk 

of human infection or disease is considered to be low. 

Phase 2: No new influenza virus subtypes have been detected in 

humans. However, a circulating animal influenza virus subtype 

poses a substantial risk of human disease. 

Pandemic Alert Period 

Phase 3: Human infection with a new subtype but no humanto-human spread, or, at most, rare instances of spread to a close 

contact. 

Phase 4: Small cluster(s) with limited human-to-human 

transmission but spread is highly localized, suggesting that the 

virus is not well adapted to humans. 

Phase 5: Larger cluster(s) but human-to-human spread is still 

localized, suggesting that the virus is becoming increasingly better 

adapted to humans but may not yet be fully transmissible 

(substantial pandemic risk). 

Pandemic Period 

Phase 6: Pandemic: increased and sustained transmission in the 

general population. 

*Centers for Disease Control and Prevention, www.cdc.gov/flu/pandemic/phases.htm. 

37 
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