The Law Library of Congress, Global Legal Research Center 

(202) 707-6462 (phone) • (866) 550-0442 (fax) • law@loc.gov • http://www.law.gov

Legal Responses to Health 

Emergencies 

Argentina • Australia • Brazil • Canada • China • Egypt 

England • France • Greece • India • Israel • Italy 

Japan • Kenya • Lebanon • Mexico • Nigeria 

Portugal• Russian Federation • Senegal 

South Korea • Spain • Sweden 

European Union 

World Health Organization 

February 2015
This report is provided for reference purposes only. 

It does not constitute legal advice and does not represent the official 

opinion of the United States Government. The information provided 

reflects research undertaken as of the date of writing. 

It has not been updated.
Contents 

Comparative Analysis ......................................................................................................................1 

Argentina..........................................................................................................................................5 

Australia .........................................................................................................................................13 

Brazil ..............................................................................................................................................29 

Canada............................................................................................................................................39 

China ..............................................................................................................................................50 

Egypt ..............................................................................................................................................62 

England ..........................................................................................................................................66 

France .............................................................................................................................................80 

Greece ............................................................................................................................................88 

India ...............................................................................................................................................92 

Israel ...............................................................................................................................................99 

Italy ..............................................................................................................................................114 

Japan ............................................................................................................................................122 

Kenya ...........................................................................................................................................137 

Lebanon........................................................................................................................................152 

Mexico .........................................................................................................................................156 

Nigeria..........................................................................................................................................161 

Portugal ........................................................................................................................................175 

Russian Federation .......................................................................................................................187 

Senegal .........................................................................................................................................197 

South Korea .................................................................................................................................202 
Spain ............................................................................................................................................211 

Sweden .........................................................................................................................................220 

European Union ...........................................................................................................................241 

World Health Organization ..........................................................................................................250 

Bibliography ................................................................................................................................262 
The Law Library of Congress 1

Comparative Summary 

Peter Roudik 

Director of Legal Research*

This report contains discussions of the regulations addressing health emergencies in twenty-five 

jurisdictions. The jurisdictional surveys that are included cover countries from six continents 

and reflect national, regional (European Union, EU), and international (World Health 

Organization, WHO) approaches to the problem. The report is supplemented by an annotated 

bibliography that lists recently published English-language monographs and academic articles on 

issues related to handling public health crises. All surveys included in this report review 

government structures tasked with delivering public health protection, relevant legislative 

frameworks for addressing health emergencies, and the powers of government institutions in 

times of health crises and their ability to mitigate the consequences of such crises. Analyses of 

the regulation of such issues as disease surveillance and notification systems are also provided. 

Individual surveys discuss the role of medical and emergency services personnel in responding 

to public health challenges, the coordination of government activities aimed at minimizing the 

spread of epidemics, and the cooperation of national health-care institutions with the WHO in 

implementing pandemic preparedness measures. Measures taken by national governments in 

response to recent outbreaks of infectious diseases, including the Ebola epidemic in western 

Africa in 2014, are also described. 

I. Introduction 

All the countries surveyed recognize the existence of a threat to public health from a variety of

infectious diseases, mass illnesses resulting from technological catastrophes or the malicious 

distribution of viruses, and the potential use of chemical and biological weapons by terrorists. 

All the reviewed jurisdictions appear to be aware of the importance of maintaining national 

health care infrastructures to combat public health crises and readily available communications 

systems that inform the public on preparedness plans and serve as clearinghouses for 

crisis information. 

In addition to the national governments, the WHO performs a critical role in confronting health 

crises. The WHO coordinates international health work and provides technical and policy 

assistance to national governments and medical authorities in support of programs to promote 

health, prevent and control health problems, control or eradicate diseases, and strengthen 

national health systems. It also keeps communicable and noncommunicable diseases and other 

health problems under constant surveillance, sets safety standards, issues regulations that are 

binding on member states, collects and disseminates health data, and carries out statistical 

analyses and comparative studies concerning various diseases. 

The EU survey reflects measures aimed at improving the coordination of Member States’ 

actions. While public health emergencies occurring within the EU fall primarily within the 

* This comparative summary was originally prepared by Giovanni Salvo and Karel Wennink, former Foreign Law

Specialists, in August 2003; it was updated for the purposes of the present report. 
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domain of the individual Member States, the legal acts of the EU pertaining to public health 

complement the national policies of the EU members, coordinate their actions, and facilitate 

communication and the exchange of information among Member States. Addressing existing 

deficiencies in managing health crises, the EU has passed new legislation expanding the list of 

threats beyond communicable diseases to include biological, chemical, environmental, and other 

events that may pose a risk. Three newly established institutions demonstrate the EU’s response 

to health care challenges that emerged with recent epidemics and terrorist attacks: the European 

Center for Disease Prevention and Control, modeled after the United States Centers for Disease 

Control and Prevention; the Early Warning and Response System; and the Health Security 

Committee, which developed into a full-fledged institution in charge of information exchange 

and response planning from an informal discussion forum on public threats. 

The Nordic states take a regional approach toward tackling health crises through cooperative 

preparedness efforts. These countries have mutual obligations to help each other when necessary 

and may send their patients to other countries for better treatment. The Baltic states likewise 

take special actions against contagious diseases jointly. In another example of the regional 

approach toward managing health care emergencies, members of the Association of Southeast 

Asian Nations (ASEAN), together with China and Japan, adopted a joint resolution on standard 

border controls in 2003 during the SARS (Severe Acute Respiratory Syndrome) epidemic to 

counter the spread of the disease, and also distributed standardized health declaration cards to all 

travelers at airports. In 2009, following the A/H1N1 (swine flu) virus epidemic, and in 2014, 

because of the Ebola virus threat, national governments issued guidelines and took measures 

similar to those suggested by the US Centers for Disease Control and Prevention, another 

example that demonstrates the increasing interconnectedness of health care management 

authorities in various countries.

II. Structure of Public Health Crisis Management Systems

In the countries surveyed, the systems of health care and health crisis management are governed 

by statutory and regulatory measures that reflect general constitutional principles concerning the 

protection of the public and the health of an individual. Responsibilities for dealing with health 

crises are distributed among the central or federal governments and regional and municipal 

authorities to prevent, monitor, and respond to public health emergencies. This distribution 

prevails regardless of the cause of the health emergency. In the case of terrorism, the 

intervention of other government authorities may be required. In Germany the legislative power 

for public health remains with the states; however, the German Federation has concurrent 

legislative power over measures to combat most public health threats. Decision-making powers 

and the authority to declare emergencies appear to be concentrated in the hands of specified 

officials, who are assisted by civil servants from the agencies involved. The participation and 

cooperation of different agencies and of special units, if they exist, appear to be a common 

feature in the countries surveyed where the minister responsible for health issues plays a leading 

role. The appointment of a special commissioner may be an option in certain cases. 

Reporting systems for notifiable diseases have been widely adopted so that authorities with 

decision-making powers can monitor the situation in order to take the appropriate measures. 

Almost every country reviewed has its own classification of infectious and contagious diseases, 
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depending on disease severity, as well as relevant national action plans to respond to an outbreak 

of such diseases. 

III. Powers of Public Health Authorities

In the majority of the countries surveyed, the Ministry of Health is the central authority in public 

health crises and takes appropriate emergency measures to confront such crises. In many 

countries, separate agencies dealing with epidemic surveillance and sanitary control are 

subordinated to the Ministry of Health for the duration of a crisis. While in the majority of the 

countries reviewed such agencies are usually responsible for planning, coordinating, and 

implementing the response to a crisis, in some countries (e.g., Brazil and Russia) they have the 

actual power to mobilize resources. In Canada, the Prime Minister and provincial premiers have 

the authority to declare emergencies for all types of crises, including public health crises. In 

England, the Secretary of State has broad powers with respect to a health crisis. The power to 

proclaim a state of emergency is vested in the president in Nigeria and Kenya, according to 

their constitutions. 

In several countries, depending on the type of health crisis, other departments (such as the 

Departments of Agriculture, Justice, Interior, and Environment), in cooperation with the Ministry 

of Health, may be involved in the decision-making process. This cooperation is often in addition 

to the involvement of other agencies’ special units, where existing. Public health services at any 

level are primarily entrusted with the bulk of the measures needed to prevent and control a health 

crisis. These measures are often preventive in nature, including the power to enter private homes 

and coercive powers to carry out precautionary measures, including the right to quarantine 

infected individuals, conduct mandatory inoculations, and examine and monitor diseased 

persons. In Japan, provincial governors may order the hospitalization of patients, whereas the 

report on England indicates that public authorities do not have the power to force a quarantined, 

diseased person to undergo treatment. 

A number of reports point out that during a simultaneous outbreak of an infectious disease in 

several countries, as was the case with SARS in 2003, avian flu in 2005, and the A/H1N1 virus 

in 2009, or when a threat comes from a disease outbreak outside of the country, as during the 

2014 Ebola epidemic, health authorities can impose stricter controls on travelers coming from 

high-risk areas and require air carriers to provide detailed information regarding their 

passengers’ itineraries. Heath authorities exercise control with the help of health questionnaires, 

sanitary monitoring, and the mandatory hospitalization of infected persons. Measures necessary 

to curb a public health crisis may include compulsory health procedures, such as vaccinations, 

disinfection, quarantine, and travel restrictions. Most of the reports illustrate that measures taken 

during health crises are, in many instances, in conflict with the constitutional and legal rights of 

individuals, such as those concerning the inviolability of person and home, freedom of 

movement, the use of property, peaceful assembly, and the ability to conduct business. In most 

of the surveyed countries, the constitution permits intrusions into these constitutionally 

guaranteed fundamental rights to the extent that the intrusive measures are specifically 

authorized in statutory provisions and are in the public interest, such as for the protection of 

public health. In Brazil, the government may issue a compulsory license for the use of a patent if 

a patent holder does not comply with a request for its use, in order to secure the reserve of 

medicines needed to fight a public health crisis. 
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The failure to comply with measures taken in a crisis generally results in administrative or 

criminal sanctions. Medical personnel who fail to provide assistance in emergency health 

situations, or to act on or report a case, may be more severely penalized. These sanctions are not 

only set forth in the body of the legislation authorizing the specific measures, but are also 

included in the criminal codes of a majority of the countries surveyed. 

IV. Transparency of Public Health Crisis Management System

Recognizing that a well-informed public is better prepared to deal with an emergency and 

minimize its impact, education and the disclosure of public health information appear to be 

important components of the response to public health crises. The need for transparency is 

emphasized in many of the surveys. The duty to supply information concerning public health 

finds its basis (with some exceptions) in the countries’ constitutions or special laws. 

V. Cooperation with the WHO 

Recognizing the important role of the WHO in helping its Member States to confront and 

overcome health crises, the countries surveyed generally cooperate with the WHO. All of the 

countries have agreed to implement the WHO International Health Regulations of 2005 and are 

making efforts to comply with the requirements prescribed by that document. 
The Law Library of Congress 5

Argentina 

Graciela Rodriguez-Ferrand 

Senior Foreign Law Specialist

SUMMARY The strengthening of Argentina’s Epidemic Surveillance System has been a government 

priority for the last fifteen years and, although the public health in the country at large has 

improved, many more resources need to be devoted to reach a higher level of health, 

especially regarding epidemic prevention and control. In 2002 the declaration of a health 

emergency required the adoption of urgent measures to ensure the supply of medicines to 

the population. Following the outbreak of swine flu in Mexico in April 2009, the 

government declared a health emergency, taking immediate action to ensure the supply of 

medicines to the population. The current alert on the Ebola virus outbreak is under strict 

surveillance by health authorities in the country, who are following the World Health 

Organization’s international epidemiology protocols. 

I. Government Structure 

Argentina’s political organization was established by the National Constitution1 as a Federal 

Republic consisting of twenty-three provinces and the autonomous city of Buenos Aires. The 

federal state is headed by a President, who appoints a cabinet and holds the country’s executive 

power. The legislative power is exercised by a bicameral Congress with a Lower Chamber 

(Cámara de Diputados) and an Upper Chamber (Cámara de Senadores). 

Under the National Constitution, each province has its own provincial constitution, legislation, 

and resolutions. However, provincial legislation may not violate any of the individual rights 

protected under the National Constitution. The provinces have delegated to the federal 

legislature the power to enact laws of national scope governing civil, commercial, and 

other matters.2

 

Although not stated explicitly, the National Constitution guarantees the right to health as a 

derivative of the right to life.3 Several provisions also guarantee the right to health, including the 

right to a healthy environment,4

 the right of consumers to the protection of their health,5 and in a 

broader sense, the right to protect collective rights.6 The constitutional guarantee of health 

1

 CONSTITUCIÓN DE LA NACIÓN ARGENTINA, Dec 15, 1994, http://infoleg.mecon. gov.ar/infolegInternet/anexos/0-

4999/804/norma.htm. 

2 Id. arts. 121–129. 

3

 Daniel Sabsay & Pablo Manili, Constitución de la Nación Argentina y Normas Complementaria, Análisis 

Doctrinal y Jurisprudencial 1234 (2009). 

4

 Constitución de la Nación Argentina art. 41, para. 1. 

5

 Id. art. 42, para. 1. 

6 Id. art. 43, para. 2. 
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protection may be defined as the right of all individuals to be protected by the state with regard 

to the prevention and treatment of diseases and the maintenance of health.7

II. Structure of Public Health Crisis Management System 

The health system has a decentralized structure where many responsibilities have been 

transferred to the provinces. The Law on Ministries of 1999,8 as amended by Decree 355/2002,9

restructured the Ministry of Health (MH), creating two new subdivisions: the Secretariat for 

Health and Care and the Secretariat for Health Policy and Regulation. The Secretariat for Health 

and Care has an office of the Undersecretary of Prevention and Promotion Programs, which 

comprises the National Directorate of Health Programs and the Directorate of 

Epidemiology (DE). 

Under the Law on Ministries, the MH is assigned the responsibility of assisting the President in 

all health matters, including 

 executing plans, programs, and projects related to health; 

 medical aspects of immigration and the defense of borders, ports, airports, and international 

means of transportation; 

 coordinating national, provincial, and municipal health services; 

 participating in the control of food safety in coordination with the Ministry of Production; 

 intervening in the assignment and control of subsidies to solve health emergencies, either 

unforeseen or not covered by the system in place; 

 preparing health statistics and ensuring access to health information for the population; 

 developing epidemiology research studies to improve the efficiency and quality of 

health services; 

 managing international health relations, not only with other countries, but also with 

international health organizations; 

 planning health campaigns to eradicate endemic diseases, rehabilitate the ill, and detect and 

prevent nontransmissible diseases; 

 epidemic control and surveillance, including the management of the disease 

notification system; 

 planning national vaccination and immunization programs; and 

 

7

 SABSAY AND MANILI, supra note 3, at 1235. 

8

 Law 25233, Law of Ministries, Dec. 10, 1999, http://www.infoleg.gob.ar/infolegInternet/anexos/60000- 

64999/61394/norma.htm (in Spanish). 

9

 Decree 355/2002, amending Law 25,233, Law of Ministries, Feb. 21, 2002, http://www.infoleg.gob.ar/infoleg 

Internet/anexos/70000-74999/72483/texact.htm (in Spanish). 
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 establishing integrated programs to cover specific pathologies affecting groups determined to 

be at risk because of their geographic location.10

In the provinces, health services are provided by a network of provincial primary and secondary 

care services and by the private sector. The MH establishes basic regulations for the delivery of 

health services and the operation of health facilities, but most provinces also have an extensive 

set of regulations. The MH is represented in each province through a Federal Health Council, 

which constitutes the link between the national MH and the provinces in all healthrelated matters.11

The Federal Health Plan 2010–2016, released by the MH, provides for general guidelines on 

public health in the country. However, the guidelines are only indicators, since provinces have 

autonomy in setting their own health policies for the protection of their population. The Federal 

Health Council, which is made up of the ministers of health of all the provinces and 

municipalities in the country, facilitates the coordination of health policies and services between 

the National Health Authority and the provinces. 12

In 2011, the MH and the Ministry of Planning signed an agreement to integrate hospitals, 

primary health care centers, integrated community centers, and other health care centers 

throughout the country into the National Fiber Optics Network,13 which became operative in 

August 2014.14

III. Powers of Public Health Authorities 

The DE and its National Epidemiological Surveillance System are responsible for the registration 

of diseases subject to obligatory reporting, as established by Law 15465.15 The Law includes a 

list of diseases that is updated periodically as needed.16 The reporting is required not only in 

confirmed cases but also in suspected cases.17 Physicians and veterinarians and, when 

applicable, laboratory technicians and pathologists, dentists, OB/GYNs, and kinesiologists,18 are 

 

10 Id. art. 23 ter. 

11 Pan American Health Organization [PAHO], Argentina, in II SALUD EN LAS AMERICAS, 2007: PAÍSES 53, 

http://www.paho.org/hia/archivosvol2/paisesesp/Argentina%20Spanish.pdf. 

12 PAHO, Argentina, in SALUD EN LAS AMERICAS, EDICIÓN DE 2012, at 35–36, http://www.paho.org/saludenlas 

americas/index.php?option=com_docman&task=doc_view&gid=186&Itemid. 

13 Id. at 37. 

14 Manzur y DeVido Pusieron en Marcha la red federal de Infraestructura Cibersalud, Ministerio de Salud, Aug. 5, 

2014, http://www.msal.gov.ar/prensa/index.php/noticias/noticias-de-la-semana/2150-manzur-y-de-vido-pusieron-enmarcha-la-red-federal-de-infraestructura-cibersalud. 

15 Law 15465, on Required Reporting of Diseases, Sept. 29, 1960, http://www.infoleg.gob.ar/infolegInternet/anexos/ 

195000-199999/195093/norma.htm, regulated by Decree 3640/64, May 19, 1964, http://www.infoleg.gob.ar/ 

infolegInternet/anexos/195000-199999/195289/norma.htm (in Spanish). 

16 Decree 2771/79, Nov. 1, 1979, art. 2, available on the Legisalud website, at http://test.e-legis-ar.msal.gov.ar/ 

leisref/public/showAct.php?id=4140&word (in Spanish). 

17 Id. art. 3. 

18 Id. art. 5. 
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all under obligation to report the listed diseases.19 Noncompliance with this obligation is 

punishable by a fine and temporary suspension of the professional license to practice for one to 

three months.20 The sanctions are determined by the MH or its provincial counterparts when the 

offense falls under their jurisdiction.21

The Advisory Commission on Epidemic Surveillance was also created within the jurisdiction of 

the DE to provide guidance on procedural and operational aspects of epidemic surveillance 

actions.22 The Advisory Commission on Epidemic Surveillance provides technical advice to the 

provinces contributing to the organization and development of the National Epidemiological 

Surveillance System, of which it is a part.23

The DE also promotes the control of transmissible and nontransmissible diseases and health risks 

and regulates all activities related to environmental health, including training, research, and 

control in situ upon request of the different jurisdictions.24 This system is organized by levels 

and is comprised of the DE at the national level and epidemiology directorates, departments, and 

units within ministries of health at the provincial level. The system compiles information on 

reportable diseases and laboratory data weekly.25

The provincial Federal Health Department is in charge of controlling epidemic diseases; this 

includes diseases subject to quarantine and those that, by their character, danger, or scope, may 

become a national threat.26 To this end, the Federal Health Department reports the presence of 

any such diseases by means of a uniform national procedure and, together with the provincial 

authorities, carries out epidemic research related to these diseases.27 Such reporting and 

communication are confidential. The manner in which the information is reported allows the 

Federal Health Department to identify and locate the individuals affected and the source of 

infection.28 However, the National Health Authority is the only government body with the 

power to report on this subject abroad.29

 

19 Id. art. 4. 

20 Law 15465, art. 16. 

21 Id. art. 18. 

22 Ministry of Health, Manual de Normas y Procedimientos de Vigilancia y Control de Enfermedades de 

Notificación Obligatoria (rev. ed. 2007), http://www.snvs.msal.gov.ar/descargas/Manual%20de%20Normas 

%20y%20Procedimientos%202007.pdf. 

23 Id. 

24 Dirección de Epidemiología: Acciones, MINISTERIO DE SALUD, http://www.msal.gov.ar/index.php/component/ 

content/article/43-funciones/28-funciones (last visited Oct. 23, 2014). 

25 MINISTRY OF HEALTH, supra note 22, at 6–8. 

26 Decree-Law 4143/58, Health Assistance, Apr. 2, 1958, arts. 2 & 7, BOLETÍN OFICIAL, Apr. 16, 1958. 

27 Id. 

28 Law 15465, on Required Reporting of Diseases, Sept. 29, 1960, arts. 7, 8. 

29 Id. art. 11. 
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Once the National Health Authority receives the required information or report, it provides all 

the means necessary to perform clinical and laboratory tests, provide assistance to the sick, and 

protect public health, including ordering quarantines and other preventive measures.30

The Comisión Nacional de Actividades Espaciales (National Commission on Space Activities) 

concluded an agreement with France’s Nationale d’études Spatiales (National Space Studies 

Center) to develop a panoramic epidemiology system, which allows the prediction and early 

warning of diseases through the cross-referencing of a combination of satellite-gathered data on 

such things as vegetation, clouds, rain, rivers, and forests, with traditional data. 31 

Through the Directorate of Health Emergencies, the MH manages catastrophic and emergency 

situations and provides necessary medical supplies and health assistance throughout the country. 

The Directorate of Health Emergencies has a permanent communications unit on call for 

emergencies in coordination with the Federal Emergency System. However, it has been reported 

that the Federal Emergency System has not been efficiently used in spite of the considerable 

amount of funds assigned for its operational budget.32 Since its creation in 1972, the Directorate 

of Health Emergencies has assisted both in Argentina and abroad in a number of disasters and 

health emergencies, providing medicine, medical assistance, and transportation when the 

seriousness of the situation required treatment in a more sophisticated medical facility.33 The 

Directorate of Health Emergencies coordinates with the National Directorate for Trauma, 

Emergencies, and Disasters within the jurisdiction of the Undersecretary of Prevention and 

Promotion Programs to implement assistance at the national, provincial, and municipal level in 

cases of emergencies or disasters requiring federal intervention.34 The National Directorate for 

Trauma, Emergencies, and Disasters is the authority in charge of the evacuation and reception of 

victims and the referral of patients, whether individually or in mass, in cases of natural, 

technological, or other disasters.35 

The Border Health Program is in charge of maintaining health and epidemic control at the 

borders and in the international transportation terminals, according to international standards and 

in compliance with the International Health Regulation.36 

 

30 Id. art. 14. 

31 Nora Bär, La Argentina Desarrolla una Red de Vigilancia Epidemiológica Satelital, LANACIÓN (July 14, 2003), 

http://www.lanacion.com.ar/nota.asp?nota_id=511256. 

32 Daniel Gallo, El Sistema Federal de Emergencias No se Utiliza, LA NACIÓN (Apr. 7, 2013), http://www.lanacion. 

com.ar/1570410-el-sistema-federal-de-emergencias-no-se-utiliza. 

33 For historical data on emergencies in Argentina and abroad covered by the Directorate of Health Emergencies, see 

Historia, DINESA (June 13, 2011), http://www.msal.gov.ar/dinesa/index.php/sobre-dinesa/historia. 

34 Servicios, DINESA (June 13, 2011), http://www.msal.gov.ar/dinesa/index.php/actividades/servicios. 

35 Decree 1106/2000 of the Ministry of Health, Nov. 27, 2000, Annex II, http://www.infoleg.gob.ar/infolegInternet/ 

anexos/65000-69999/65187/norma.htm; DP’12 – DOCUMENTO PAIS 2012: RIESGO DE DESASTRES EN LA ARGENTINA

183–84, http://www.msal.gov.ar/salud-y-desastres/images/stories/4-biblio-recursos/pdf/2014-04_documentopais.pdf. 

36 Decree 1343/2007, Oct. 4, 2007, sched. annexed to art. 2, Secretaria de Politicas Regulaciónes e Institutos, 

Objetivos 6; Subsecretaria de Politicas, Regulación y Fiscalización, Objetivos 14; Dirección Nacional de Registro, 

Fiscalización y Sanidad de Fronteras, Acciones 5, 9, 11, http://www.infoleg.gob.ar/infolegInternet/anexos/130000-

134999/133099/texact.htm.
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As a result of the 2003 worldwide SARS alert, the MH took a number of measures to prevent 

and eventually control the disease.37 The Secretariat for Health Policy and Regulation of the MH 

ordered the strict control over any vessel and its crew entering the country.38 

The Criminal Code sanctions with imprisonment of three to fifteen years anyone who knowingly 

propagates a dangerous and contagious illness to human beings.39 If the propagation is due to 

negligence or violation of the public authorities’ regulations or directives but does not result in 

the death or infection of someone else, a fine may be imposed. If the propagation does result in 

death or infection, the offender is subject to imprisonment for six months to five years.40 

Anyone who violates the measures adopted by the designated authorities to prevent the 

introduction or containment of an epidemic is subject to imprisonment for six months to two 

years. This crime is punishable even when an epidemic does not occur. If the wrongdoer is a 

public officer or professional, the sanction will include a special disqualification from his/her 

post for a period double the length of the penalty.41

IV. Transparency of Public Health Crisis Management System 

The Statistics and Health Information Directorate is the agency in charge of the collection and 

analysis of health data on a permanent basis. Its objectives include the identification of health 

factors that allow the early detection of diseases to prevent their spread and alert 

the population.42 

The DE publishes an epidemiological bulletin entitled Boletín Epidemiológico Periódico, which 

is available on the MH webpage.43 This weekly report includes the latest news on health issues, 

the current situation on specific illnesses threatening the population, outbreaks of new diseases in 

the country and abroad, and the epidemic surveillance data provided by the provinces.44 

V. Management of Health Emergencies 

In September 2002, the MH, together with its provincial counterparts, implemented a 

surveillance system called unidades centinela (health watch units) to closely monitor specific 

 

37 See MINISTERIO DE SALUD, PLAN DE CONTINGENCIA NACIONAL – SÍNDROME RESPIRATORIO AGUDO GRAVE 

(SRAG) (Apr. 2003), available on the Federación Médica de la Provincia de Buenos Aires website, at http://www. 

femeba.org.ar/fundacion/quienessomos/Novedades/sragministerioabril.pdf. 

38 Id. annex D.1.A, at 21. 

39 CÓDIGO PENAL DE LA NACIÓN ARGENTINA, as amended (1984 revised text), art. 202, http://www.infoleg.gov.ar/ 

infolegInternet/anexos/15000-19999/16546/texact.htm#22. 

40 Id. art. 203. 

41 Id. arts. 205, 207. 

42 DIRECCIÓN DE ESTADÍSTICAS E INFORMACIÓN DE SALUD, SISTEMA DE INFORMACIÓN DE SALUD 9 (rev. ed. Sept. 

2004), http://www.deis.gov.ar/publicaciones/Archivos/sis2005.pdf. 

43 BOLETÍN EPIDEMIOLÓGICO PERIÓDICO, http://www.msal.gov.ar/saladesituacion/epidemiologia_ boletines.php. 

44 Id. 
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health threats like pneumonia.45 Since 2001, the National Health Statistics Program has been 

equipped with the proper hardware and software to make the health information collected 

accessible to all in a timely manner.46

In March 2002, the President declared a National Health Emergency47 as part of an overall 

public, social, economic, financial, and monetary emergency declared by Law 25561.48 The 

social and economic situation in the country was so serious that the provision of medicine and 

other health and medical supplies, especially those imported, was undermined, causing a genuine 

crisis and collapse of the national health system. The critical situation of the health sector 

constituted an exceptional circumstance, rendering it impossible to provide health services 

according to regular procedures.49 Under the National Health Emergency, the MH was 

empowered to take all necessary measures to guarantee the provision of medicine to the 

population, and to establish the procedures and priorities for its distribution.50 The MH instituted 

exceptional procedures to acquire such medicine, authorized special funding for its acquisition,51

and imposed price controls to avoid excessive price increases.52 The MH also developed a 

system that prioritized medical attention during the emergency.53

On April 29, 2009, as part of the measures taken by the Argentine government to control the 

swine flu outbreak that originated in Mexico, all flights incoming from Mexico were suspended 

until May 5, 2009.54 At the same time health control points were set up at all points of entry to 

the country, and sensors to detect fever among the travelers were set up in international 

airports.55 Flights from Mexico resumed on May 15, 2009,56 but measures to check the body 

temperature of arriving passengers at international airports remained in effect for some time.57

 

45 Id. 

46 BOLETÍN DEL PROGRAMA NACIONAL DE ESTADÍSTICAS EN SALUD, http://www.deis.gov.ar/Publicaciones/ 

arbol_tematico.asp (last visited Oct. 29, 2014; click on “Boletín del Programa Nacional de Estadísticas en Salud” 

under “Búsqueda Avanzada”). 

47 Decree 486/02 on National Health Emergency of March 12, 2002, http://infoleg.mecon.gov.ar/infoleg 

Internet/anexos/70000-74999/72887/texact.htm (in Spanish). 

48 Law 25561 on National Emergency of Jan. 6, 2002, http://www.infoleg.gob.ar/infolegInternet/verNorma.do; 

jsessionid=A917C3C78C096E7D9B12CFD246CC3D4A?id=71477 (in Spanish). 

49 Id., intro. 

50 Id. arts. 2, 3. 

51 Id. art. 9. 

52 Id. art. 10. 

53 Id. arts. 18–20. 

54 Resolution 201/2009 of the Secretaría de Transporte, Apr. 29, 2009, http://www.infoleg.gov.ar/infolegInternet/ 

anexos/150000-154999/152904/norma.htm; Resolution 214/2009 of May 4, 2009, http://www.infoleg.gov.ar/ 

infolegInternet/anexos/150000-154999/152973/norma.htm. 

55 Por la Gripe Porcina, el Gobierno suspende los vuelos con México, CLARÍN.COM (Apr. 28, 2009), http://www. 

clarin.com/diario/2009/04/28/um/m-01907438.htm. 

56 Mariano Obarrio, Se reanudan hoy los vuelos a México, LANACION (May 15, 2009), http://www.lanacion.com. 

ar/nota.asp?nota_id=1128307. 

57 Id. 
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VI. Current Crisis 

On August 7, 2014, the MH issued an epidemiological warning (alerta epidemiológica) in the 

country because of the Ebola virus outbreak in Africa.58 The warning provides specific 

instructions and a health protocol to follow in suspicious and confirmed Ebola cases.59 It further 

provides information about symptoms to the population at large and specific information for 

travelers entering the country.60 On August 20, 2014, the MH published a comprehensive update 

on the evolution of the Ebola virus in the world, providing an update of the reinforcement 

prevention, notification and detection measures in compliance with WHO standards.61

On September 10, 2014, Argentina announced that the Malbrán Institute of Health in Buenos 

Aires had developed a biological molecular method for detecting the Ebola virus in less than 

twenty-four hours.62 The Minister of Health announced that Argentina was the first country in 

Latin America that had a diagnosis method for Ebola that had been validated by the WHO. 

Health authorities have been working in training health staff, acquiring equipment for patients’ 

isolation, and developing and updating a protocol for handling Ebola cases. Currently there are 

three hospitals in the country already selected and ready to treat Ebola patients.63

 

58 DIRECCIÓN DE EPIDEMIOLOGÍA, MINISTERIO DE SALUD DE LA NACIÓN, SEMANA EPIDEMIOLÓGICA 32 (Aug. 7, 

2014), http://www.msal.gov.ar/images/stories/epidemiologia/inmunizaciones/11-08-2014-alerta-6-enfermedadvirus_ebola-.pdf. 

59 Id. at 2, 3. 

60 Información sobre la Enfermedad del Virus del Ébola, MINISTERIO DE SALUD, http://www.msal.gov.ar/index. 

php/component/content/article/47-epidemiologia/448-informacion-sobre-ebola (last visited Nov. 14, 2014). 

61 Subsecretaría de Política, Regulación y Fiscalización, Ministerio de Salud de la Nación, Refuerzo de los Planes de 

Contingencia de Salud Pública ante el Riesgo de Ébola: Puntos de Entrada Argentinos (Aug. 20, 2014), 

http://www.msal.gov.ar/images/stories/epidemiologia/ebola/pdf/10-11-2014-plan-contingencia-puertos-entrada.pdf. 

62 Argentina Desarrolló un Método para Diagnosticar Casos de Ebola, TELAM (Sept. 10, 2014), http://www.telam. 

com.ar/notas/201410/81135-argentina-metodo-diagnostico-ebola.html. 

63 Id. 
The Law Library of Congress 13

Australia 

Kelly Buchanan 

Chief, Foreign, Comparative, and 

International Law Division I

SUMMARY Under Australia’s federal system, states and territories have primary responsibility for 

matters related to health care and emergency management. The federal government 

provides various funding, policy leadership, and coordination assistance in the context of 

national responses to public health emergencies. It also has quarantine powers and powers 

related to border management that can be utilized where there is an epidemic or threat of 

an epidemic. National agreements, as well as the National Health Security Act 2007 (Cth), 

establish structures and processes for preventing and responding to national health 

emergencies, with different entities providing oversight and coordination at the national 

level, and states and territories applying their own laws, jurisdictional responses, and 

coordination processes. This includes a national notification and surveillance system 

under which state and territory authorities report on instances of certain diseases to a 

central authority, which then makes information available for analysis and discussion. In 

the event of a public health threat, state and territory public health laws provide a range of 

powers to enable action to be taken by authorities. This can include ordering medical 

examinations, treatment, and detention of individuals. 

 The Australian government, along with state and territory governments, has taken a range 

of actions in response to the 2014 Ebola virus disease (EVD) epidemic in West Africa. 

This includes enhanced screening of passengers at airports, stopping the processing of visa 

applications from citizens of affected countries, issuing national guidance to public health 

units and laboratories, and the development of detailed state and territory response plans. 

As of October 2014, around twenty people who arrived in Australia from EVD-affected 

countries had been placed on home quarantine.

I. Introduction 

Australia has a federal system of government with powers divided under the Constitution 

between the Commonwealth government and the country’s six states and two mainland selfgoverning territories.1

 The matters over which the Commonwealth Parliament has legislative 

powers are listed in sections 51 and 52 of the Constitution.2 Most of these legislative powers are 

concurrent, meaning that they are shared with state and territory parliaments. Where there is a 

conflict between state and federal laws, the federal law will override the state law to the extent of 

the inconsistency.3

 

1 See generally Making Laws, PARLIAMENTARY EDUCATION OFFICE, http://www.peo.gov.au/learning/closerlook/governing-australia/making-laws.html (last visited Oct. 28, 2014). 

2

 AUSTRALIAN CONSTITUTION ss 51 & 52, http://www.comlaw.gov.au/Details/C2013Q00005. 

3 Id. s 109. 
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Section 96 of the Constitution provides the Commonwealth Parliament with the power to grant 

financial assistance to any state “on such terms and conditions as the Parliament thinks fit.”4

 In 

practice, this may include tying grants to the implementation of certain policies by the states.5

Often such policies are the subject of agreements between the state and federal governments, 

such as through the mechanisms of the Council of Australian Governments (COAG).6 In 

addition, state and territory parliaments may refer matters within their legislative powers to the 

Commonwealth Parliament.7

Section 51(ix) of the Constitution provides that the federal government has legislative powers 

with respect to quarantine. In addition, the commerce and trade powers under section 51 are 

interpreted broadly, enabling the Commonwealth Parliament to make laws in a range of healthrelated areas.8

 In general, however, all other matters related to human health fall within the 

residual powers of the states. 

Public hospitals are owned and operated by state and territory governments, which also fund and 

deliver various health programs and services. However, as a result of long-term funding and 

policy arrangements, the federal government partially funds public hospitals and “is primarily 

responsible for health service funding; regulation of health products, services and workforce; and 

national health policy leadership.”9

 Various national agreements impact funding, policy, and 

implementation arrangements within the health sector.10 

II. Structure of Public Health Crisis Management System

A. Federal Laws and National Agreements 

In addition to the states and territories having residual legislative powers in relation to health 

care, the management of emergencies is also not generally a matter for which the federal 

government may give directions to states and territories under the Constitution. Therefore, 

“cooperative and collaborative mechanisms” between these levels of government are needed for 

the strategic coordination of responses to national emergencies, including public health crises.11 

 

4 Id. s 96. 

5

 Christopher Reynolds, Public and Environmental Health Law 44–45 (2011). 

6 See About COAG, COUNCIL OF AUSTRALIAN GOVERNMENTS, https://www.coag.gov.au/about_coag (last visited 

Oct. 28, 2014). 

7

 Australian Constitution s 51(xxxvii). 

8

 REYNOLDS, supra note 5, at 40–41. 

9

 Australian Bureau of Statistics, Health Care Delivery and Financing, in 1301.0 – YEAR BOOK AUSTRALIA, 2012,

http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/1301.0~2012~Main%20Features~Health%20care

%20delivery%20and%20financing~235 (last updated Jan. 21, 2013). 

10 See Health and Ageing, COUNCIL OF AUSTRALIAN GOVERNMENTS, https://www.coag.gov.au/health_and_ageing

(last visited Oct. 28, 2014). 

11 National Health Emergency Response Arrangements § 3.2 (Nov. 2011), available on the website of the Australian 

Government Department of Health, at http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-responsearrangement-nov11-l (last visited Oct. 29, 2014). For historical information regarding Australia’s approach to 

responding to infectious disease outbreaks see Nigel Brew & Kate Brunton, Australia’s Capacity to Respond to an 
Legal Responses to Health Emergencies: Australia 

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1. National Health Security Act and Agreement 

All of the states and territories signed the National Health Security Agreement in 2008,12 which 

supports the National Health Security Act 2007 (Cth) and National Health Security Regulations 

2008 (Cth).13 These enactments give effect to the World Health Organization’s International 

Health Regulations (2005).14 These regulations required Australia to “develop multi-level 

capacities in the health sector to effectively manage public health threats and to develop, 

strengthen and maintain the capacity to detect, report and respond to public health events.”15 

The objectives of the National Health Security Act include 

(a) to provide a national system of public health surveillance to enhance the capacity of 

the Commonwealth and the States and Territories to identify, and respond to, public 

health events of national significance which include: 

(i) the occurrence of certain communicable diseases; or 

(ii) certain releases of chemical, biological or radiological agents; or 

(iii) the occurrence of public health risks; or 

(iv) the occurrence of overseas mass casualties; and 

(b) to provide for the sharing of information with: 

(i) the World Health Organization; and 

(ii) countries affected by an event relating to public health or an overseas mass 

casualty; and 

(c) to support the Commonwealth and the States and Territories in giving effect to the 

International Health Regulations (other than as mentioned in paragraphs (a) and (b)).16

The National Health Security Agreement is primarily concerned with strengthening Australia’s 

public health surveillance and reporting system. It sets out the responsibilities of entities at the 

national and state levels of government with regard to surveillance and reporting of 

communicable diseases and responding to significant public health events. 

2. National Health Emergency Response Arrangements 

The Australian government’s 2011 National Health Emergency Response Arrangements, 

referred to as the NatHealth Arrangements, “articulate the strategic arrangements and 

mechanisms for the coordination of the Australian health sector in response to emergencies of 

 Infectious Disease Outbreak (Research Paper No. 3 2004-5, Nov. 16, 2004), AUSTRALIAN PARLIAMENTARY 

LIBRARY, http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/ 

pubs/rp/rp0405/05rp03. 

12 See National Health Security Agreement, available on the website of the Australian Government Department of 

Health, at http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-nhs-agreement.htm (last visited 

Oct. 29, 2014). 

13 National Health Security Act 2007 (Cth), http://www.comlaw.gov.au/Details/C2014C00121; National Health 

Security Regulations 2008 (Cth), http://www.comlaw.gov.au/Details/F2013C00171. 

14 WHO, International Health Regulations (2d ed. 2005), http://www.who.int/ihr/publications/9789241596664/en/

(last visited Oct. 28, 2014). 

15 National Health Security Agreement, supra note 12, recital B. 

16 National Health Security Act 2007 (Cth) s 6. 
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national consequence.”17 The document provides a governance structure for coordination, 

command or control, and information flows during national health emergencies. 

Emergencies of national consequence are those that “require consideration of national level 

policy, strategy and public messaging or inter-jurisdictional assistance, where such assistance is 

not covered by existing arrangements.”18 The NatHealth Arrangements may be triggered to 

coordinate a national response to health impacts arising from, for example, natural disasters, acts 

of terrorism, biosecurity threats, and emergent or re-emergent communicable diseases. They 

operate in the broader context of Australia’s national security framework, which includes various 

strategic plans and arrangements related to both conventional and nonconventional threats.19 

They may also be utilized for an international health emergency affecting Australian interests 

or nationals.20

B. State and Territory Responsibilities 

The National Health Security Agreement recognizes that state and territory governments have 

“primary responsibility for the public health response” to public health events within their own 

jurisdictions,21 while the Commonwealth government has “primary responsibility for 

international border surveillance and public health events occurring at international borders.”22 

Where there is a “Public Health Event of National Significance,” a “national health sector 

response will occur at the request of an affected, or potentially affected, State or Territory.”23 

Such a response will be coordinated at the national level in accordance with Commonwealth and 

state and territory legislation, as well as any established national plans or protocols, and each 

state and territory will also “undertake its own jurisdictional coordinating processes.”24

According to the NatHealth Arrangements, 

[s]tate and territory health authorities have well established emergency management 

legislation, and well rehearsed and integrated emergency management arrangements. 

Jurisdictional health authorities have existing command and control structures for the 

management of health facilities, public health units and pathology laboratory services. 

Additionally, in some jurisdictions ambulance services also come under the health 

authority response arrangements. 

 

17 National Health Emergency Response Arrangements, supra note 11, “Authority.” 

18 Id., “Introduction.” 

19 Id. 

20 Id. § 3.3.2. 

21 National Health Security Agreement, supra note 12, art. 3. 

22 Id. art. 22. 

23 Id. art. 14. 

24 Id. art. 20. 
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Each state and territory is responsible for determining its own internal coordination 

mechanisms to give effect to the NatHealth Arrangements, both as an affected 

jurisdiction in requesting national coordination and as an unaffected jurisdiction that may 

provide resources and assistance.25

C. Key National Coordination Entities 

1. Australian Health Protection Committee 

The Australian Health Protection Committee (AHPC) was established in 2006 by the Australian 

Health Ministers’ Advisory Council (AHMAC). Along with a second new committee, the 

Australian Population Health Development Committee, the AHPC replaced the previous 

National Public Health Partnership.26 It is responsible for “high level cross jurisdictional 

collaboration in public health protection, planning, preparedness, response and recovery in 

relation to public health emergencies arising from man made emergencies or natural disasters.”27 

Its membership includes the Commonwealth Chief Medical Officer and the Chief Health Officer 

of each state and territory, as well as health disaster officials, clinical experts, and representatives 

from the federal Department of Health, Australian Defence Force, and the Emergency 

Management Australia division of the Attorney-General’s Department.28

The roles of the AHPC include, among others, 

 advising and making recommendations to AHMAC on health protection matters; to 

mitigate emerging health threats related to infectious diseases, the environment, 

natural disasters and disasters related to human endeavour in a context of prevention, 

preparedness, response and recovery; 

 advising on national health protection priorities and coordinating the allocation of 

health resources to these priorities; 

 national coordination of emergency operational activity in health responses to 

disasters and health protection issues of national significance; 

 enabling development and adoption by states and territories of national health 

protection policies, guidelines and standards[.]29

The AHPC has various standing committees, including the Communicable Diseases Network 

Australia (CDNA), National Health Emergency Management Subcommittee (NHEMS), and the 

 

25 National Health Emergency Response Arrangements, supra note 11, § 4.2. 

26 The National Public Health Partnership, NATIONAL PUBLIC HEALTH PARTNERSHIP (archived by the Victoria 

Department of Health), http://www.health.vic.gov.au/archive/archive2014/nphp/ (last updated Feb. 22, 2010). 

27 National Health Emergency Response Arrangements, supra note 11, § 4.3. 

28 Presentation, Dr. Robyn Walker, Department of Health and Ageing, RACMA Annual Conference 2011, slide 5 

(Oct. 12, 2011), Royal Australasian College of Medical Examiners website, http://files.racma.com.au/ 

conference_racma2011_Walker-135.pdf. For information on Emergency Management Australia, see Our 

Organisation, AUSTRALIAN EMERGENCY MANAGEMENT, AUSTRALIAN GOVERNMENT ATTORNEY-GENERAL’S 

DEPARTMENT, http://www.em.gov.au/AboutAGD/Ourorganisation/Pages/default.aspx (last visited Oct. 28, 2014). 

29 Principal Committees, AUSTRALIAN HEALTH MINISTERS’ ADVISORY COUNCIL, http://www.ahmac.gov.au/site/ 

membership.aspx#other (last visited Oct. 28, 2014). 
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Public Health Laboratory Network (PHLN). The AHPC and these three standing committees 

receive secretariat support from the Office of Health Protection within the Department 

of Health.30

a. National Health Emergency Management Subcommittee 

According to the NatHealth Arrangements, 

[t]he National Health Emergency Management Subcommittee (NHEMS) addresses the 

operational aspects of disaster medicine and health emergency management in an all 

hazards context with a focus on preparedness and response. The NHEMS reports to the 

AHPC. In an emergency the AHPC may task NHEMS to provide advice on operational 

aspects of the response.31

b. Communicable Diseases Network Australia 

The CDNA was established in 1989. It “provides national public health co-ordination on 

communicable disease surveillance, prevention and control, and offers strategic advice to 

governments and other key bodies on public health actions to minimise the impact of 

communicable diseases in Australia and the region.”32 The committee meets every two weeks to 

review information and developments related to communicable diseases surveillance. Its 

ongoing projects include developing a national communicable disease framework and 

developing national guidelines for the Series of National Guidelines (SoNGs). Such guidelines 

are endorsed by the AHPC and “provide nationally consistent advice and guidance to public 

health units in responding to a notifiable disease event.”33 The CDMA also provides advice on 

the inclusion and removal of conditions on the Nationally Notifiable Diseases List.34

c. Public Health Laboratory Network 

The PHLN was first established as part of the previous 1996 National Communicable Diseases 

Surveillance Strategy in order to complement the CDNA.35 It is a “collaborative group of 

pathology and veterinary laboratories, nominated by state and territory health departments,”36

with the central role of providing “leadership and consultation in all aspects of public health 

 

30 About the Office of Health Protection (OHP), AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH,

http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-about.htm (last updated Sept. 25, 2014). 

31 National Health Emergency Response Arrangements, supra note 11, § 6.5.1. 

32 About Communicable Diseases Network Australia, AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH,

http://www.health.gov.au/internet/main/publishing.nsf/content/cda-cdna-cdna.htm (last updated Nov. 4, 2013). 

33 Series of National Guidelines (SoNGs), AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH,

http://www.health.gov.au/internet/main/publishing.nsf/Content/cdnasongs.htm (last updated Oct. 14, 2014). 

34 About Communicable Diseases Network Australia, supra note 32. 

35 Overview of the Public Health Laboratory Network (PHLN), AUSTRALIAN GOVERNMENT DEPARTMENT OF 

HEALTH, http://www.health.gov.au/internet/main/publishing.nsf/content/cda-cdna-phln-phln.htm (last updated 

Feb. 26, 2014). 

36 National Health Emergency Response Arrangements, supra note 11, § 6.5.1. 
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microbiology and communicable disease control.”37 During an emergency of national 

consequence, the AHPC may seek advice on laboratory diagnostic and surveillance aspects of 

the emergency from the PHLN.38

d. Australian Medical Assistance Teams 

The AHPC also oversees multidisciplinary civilian medical assistance teams situated throughout 

the country. The Australian Medical Assistance Teams (AUSMATs), which are designed to be 

self-sufficient and have field deployment capabilities, include various volunteer health 

professionals such as doctors, nurses, paramedics, firefighters, environmental health staff, 

radiographers, and pharmacists.39 AHPC may deploy AUSMATs to affected Australian 

jurisdictions or overseas to assist in the event of health emergencies.40

2. Department of Health and Health Emergency Management Branch 

According to the NatHealth Arrangements, the federal Department of Health provides leadership 

and national health sector coordination in the event of an emergency of national consequence. 

This may include “provision of expert health advice and national policy development, logistical 

coordination of extra jurisdictional health sector resources (human, equipment and peripherals) 

and linkages to international health authorities and bodies.”41 The federal budget for the 

Department of Health includes a specific outcome related to “Biosecurity and 

Emergency Response.”42

The Department of Health’s Office of Health Protection aims to “protect the health of the 

Australian community through effective national leadership and coordination and building of 

appropriate capacity and capability to detect, prevent and respond to threats to public health and 

safety.”43 It consists of several branches, including the Health Protection Policy Branch, Health 

Emergency Management Branch (HEMB), and Immunisation Branch. 

HEMB is the designated National Focal Point under the National Health Security Act 2007 (Cth) 

and the International Health Regulations (2005).44 It undertakes a range of activities related to 

 

37 Overview of the Public Health Laboratory Network (PHLN), supra note 35. 

38 National Health Emergency Response Arrangements, supra note 11, § 6.5.1. 

39 AUSMAT, NATIONAL CRITICAL CARE AND TRAUMA RESPONSE CENTRE, http://www.nationaltraumacentre. 

nt.gov.au/what-we-do/disaster-management/ausmat (last visited Oct. 28, 2014); Australian Medical Assistance 

Team, SA HEALTH, http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/ 

protecting+public+health/emergency+management/australian+medical+assistance+team (last modified 

Oct. 21, 2014). 

40 National Health Emergency Response Arrangements, supra note 11, § 6.5.1. 

41 Id. § 4.1. 

42 Australian Budget 2014–15 Health Portfolio Budget Statements, Outcome 9: Biosecurity and Emergency 

Response (2014), http://www.health.gov.au/internet/budget/publishing.nsf/Content/2014-2015_Health_PBS_ 

sup2/$File/2014-15_Health_PBS_2.09_Outcome_9.pdf. 

43 About the Office of Health Protection (OHP), supra note 30. 

44 Id. 
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providing “effective surveillance of current and emerging communicable disease threats” and to 

monitoring and implementing “effective and sustained responses to national health emergencies 

and risks.”45 For example, it is responsible for managing the National Incident Room (NIR),46

which “provides a centralised hub from which responses to national health emergencies are 

coordinated.”47 The branch also manages the National Medical Stockpile (NMS),48 administers 

the Security Sensitive Biological Agents Regulatory Scheme, publishes the Communicable 

Diseases Intelligence journal, and manages surveillance systems for nationally notifiable 

diseases, among other activities.49 

D. Notification and Surveillance System 

Public health legislation in each state and territory mandates that certain diseases be reported by 

health care providers to the relevant state or territory health department, while the National 

Health Security Act 2007 (Cth) requires the establishment and maintenance of a National 

Notifiable Disease List.50 Diseases may be added to this list “if the Commonwealth Minister, 

having consulted State and Territory Ministers, considers that an outbreak would be a public 

health risk.”51 Diseases may also be added in an emergency where there is not time to 

undertake consultation.52 

The federal government operates the National Notifiable Diseases Surveillance System.53 Where 

a nationally-notifiable disease is reported at the state or territory level, “[c]omputerised, deidentified unit records of notifications are supplied to the Australian Government Department of 

Health on a daily basis, for collation, analysis and publication on the Internet, (updated 3 times 

per week), and in the quarterly journal Communicable Diseases Intelligence.”54 The Office of 

 

45 Id. 

46 National Incident Room, AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH, http://www.health.gov.au/ 

internet/main/publishing.nsf/Content/health-pubhlth-strateg-bio-factsht_inc_room.htm (last updated Mar. 4, 2011). 

47 Dr. Robyn Walker, supra note 28, slide 9. 

48 National Medical Stockpile, AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH, http://www.health.gov.au/ 

internet/main/publishing.nsf/Content/health-pubhlth-strateg-bio-factsht_stckpile.htm (last updated May 14, 2014). 

49 About the Office of Health Protection (OHP), supra note 30. 

50 National Health Security Act 2007 (Cth) pt 2 div 5; National Health Security (National Notifiable Disease List) 

Instrument 2008 (Cth), http://www.comlaw.gov.au/Details/F2008L00800. 

51 National Health Security Agreement, supra note 12, definition of NNDL; National Health Security Act 2007 

(Cth) s 11(2). 

52 National Health Security Act 2007 (Cth) s 12. 

53 For information on the history and development of the surveillance system, see Megge Miller et al., Evaluation of 

Australia’s National Notifiable Disease Surveillance System, AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH,

http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-2004-cdi2803a.htm (last updated Oct. 30, 2004). 

54 Introduction to the National Notifiable Diseases Surveillance System, AUSTRALIAN GOVERNMENT DEPARTMENT 

OF HEALTH, http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-nndss-nndssintro.htm (last 

updated Mar. 11, 2014). 
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Health Protection is the “primary data collection and coordination centre for many 

communicable diseases.”55

Under the National Health Security Agreement, where there are one or more cases of certain 

diseases listed in the National Notifiable Disease List this will be considered a “Public Health 

Event of National Significance” and must be reported to the National Focal Point. The relevant 

diseases are 

 smallpox, 

 poliomyelitis due to wild-type poliovirus; 

 human influenza caused by a new subtype; 

 severe acute respiratory syndrome (SARS); 

 pneumonic plague; 

 yellow fever; 

 viral haemorrhagic fevers; 

 cholera; 

 rabies.56

The reporting requirement may also be triggered by any other potential “Public Health Event of 

National Significance or Public Health Emergency of International Concern” depending on the 

circumstances.57 Events that constitute a Public Health Emergency of International Concern are 

defined in Annex 2 of the International Health Regulations (2005).58 

Notification requirements that may be imposed on others, such as the captains of ships or aircraft 

entering Australia, are included in the Quarantine Act 1908 (Cth).59 The Department of 

Agriculture is notified of ill passengers before a plane lands or a ship docks. In addition, 

information about where a person has traveled and whether they are feeling ill upon entering 

Australia may be required.60 Further information on powers that may be exercised under the 

Quarantine Act 1908 (Cth) is provided below. 

Under the National Health Security Act 2007 (Cth), where a state or territory authority places a 

traveler who enters, and is in transit, under public health observation while in Australia, the 

National Focal Point must be notified and provided with certain details.61 

 

55 Communicable Diseases Information, AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH, http://www.health. 

gov.au/internet/main/publishing.nsf/Content/ohp-communic-1 (last updated Oct. 23, 2014). 

56 National Health Security Agreement, supra note 12, definition of “Public Health Event of National Significance 

to be Reported to the NFP.” 

57 Id. 

58 Id., definition of “Public Health Emergency of International Concern.” 

59 Quarantine Act 1908 (Cth) s 22, http://www.comlaw.gov.au/Details/C2014C00612. See also Fact Sheet: 

Reporting an Illness or Death, AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH, http://www.health.gov.au/ 

internet/main/publishing.nsf/Content/ohp-quarantine-factsheet (last updated Feb. 17, 2014). 

60 Quarantine, AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH, http://www.health.gov.au/internet/main/ 

publishing.nsf/Content/ohp-quarantine.htm (last updated Aug. 20, 2014). 

61 National Health Security Act 2007 (Cth) s 17. 
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III. Powers of Public Health Authorities 

A. Vaccinations 

As a general rule, there are no diseases for which vaccination is compulsory for persons living in 

Australia. However, unless an appropriate medical or philosophical exemption has been 

obtained, children must be assessed as fully immunized in order for parents to be eligible for the 

federal Family Tax Benefit Part A supplement and other payments.62 A national childhood 

immunization register records vaccinations given to children under seven years of age.63 Parents 

may be required to keep a nonimmunized child home from school or day care if certain cases of 

vaccine-preventable diseases occur at that facility.64

Furthermore, where cases of quarantinable diseases arise, quarantine officers have the power to 

require a person who is subject to quarantine to submit to vaccination or prophylaxis if this is 

considered necessary to prevent the spread of the disease or is specified in the International 

Health Regulations.65 The Quarantine Act 1908 (Cth) was amended in 2008 to meet certain 

requirements under the International Health Regulations (2005) for vaccinations and other health 

measures related to travelers.66 

B. State and Territory Public Health Legislation 

As noted above, state and territory governments have various powers under their respective 

public health and emergency management laws. For example, in New South Wales, the largest 

state in the country, the Public Health Act 2010 (NSW) provides that, where a state of 

emergency exists under the State Emergency and Rescue Management Act 1989 (NSW), the 

relevant Minister may take actions or give orders that could include directing all persons in a 

specified group or area to submit to medical examination.67 

Furthermore, where a situation exists that is considered a threat to public health, the Minister 

may take actions to reduce the risk, segregate or isolate people in an area, and prevent access to 

 

62 AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH, THE AUSTRALIAN IMMUNISATION HANDBOOK, App. 4: 

“Commonly Asked Questions about Vaccination” (10th ed. 2013), http://www.health.gov.au/internet/ 

immunise/publishing.nsf/Content/appendix4. See also Immunising Your Children, AUSTRALIAN GOVERNMENT 

DEPARTMENT OF HUMAN SERVICES, http://www.humanservices.gov.au/customer/subjects/immunising-your-children

(last updated Oct. 24, 2014). 

63 Australian Childhood Immunisation Register, AUSTRALIAN GOVERNMENT DEPARTMENT OF HUMAN SERVICES,

http://www.humanservices.gov.au/customer/services/medicare/australian-childhood-immunisation-register (last 

updated July 4, 2014). 

64 The Australian Immunisation Handbook, supra note 62. 

65 Quarantine Act 1908 (Cth) s 75. 

66 Quarantine Amendment (National Health Security) Act 2008 (Cth), http://www.comlaw.gov.au/Details/ 

C2008A00068. 

67 Public Health Act 2010 (NSW) s 8, http://www.legislation.nsw.gov.au/maintop/view/inforce/act+127+2010+ 

cd+0+N. 
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an area.68 In individual cases, if a certain condition is suspected and a person is considered to be 

a risk to public health, the Director-General of the New South Wales health department may 

direct that the person undergo a medical examination and associated tests.69 Other public health 

orders are also available to authorized medical practitioners where a person has a condition and 

is behaving in a way that may be a risk to public health. This might including ordering the 

person to refrain from certain conduct, submit to supervision, or undergo specified treatment.70 

Where such an order is contravened, the person may be arrested and detained.71

In New South Wales, the above public health orders may be made with respect to persons who 

have the following conditions: avian influenza in humans; Middle East respiratory syndrome 

coronavirus; Severe Acute Respiratory Syndrome (SARS); tuberculosis; typhoid; viral 

haemorrhagic fevers; Acquired Immune Deficiency Syndrome (AIDS); and Human 

Immunodeficiency Virus (HIV) infection.72

Similar public health orders and other powers related to notifiable diseases are available under 

the public health legislation of Queensland, the third largest state. For example, a judge may 

issue a detention order for a person with a “controlled notifiable condition” whose condition or 

behavior constitutes an “immediate risk to public health.”73 The person subject to the order must 

remain at the place of detention for the period stated in the order and undergo ordered medical 

examination or treatment.74

C. Federal Quarantine Law 

The Quarantine Act 1908 (Cth) is administered jointly by the Department of Health and the 

Department of Agriculture. Under the federal statute, in the event of an emergency a 

proclamation may be issued declaring that “any or all measures of quarantine prescribed by or 

under any State Act” must cease to have effect for a period of time.75 In addition, the 

Commonwealth government may enter into arrangements with states and territories with respect 

to a range of quarantine-related matters.76

The federal government may declare by proclamation the existence of an epidemic or the danger 

of an epidemic caused by a quarantinable disease. During the period that the proclamation is in 

force the relevant Minister may “give such directions and take such action as he or she thinks 

 

68 Id. s 7. 

69 Id. s 61. 

70 Id. s 62. 

71 Id. s 71. 

72 Id. sch 1, categories 4 & 5. 

73 Public Health Act 2005 (Qld) s 129, https://www.legislation.qld.gov.au/LEGISLTN/CURRENT/P/ 

PubHealA05.pdf. 

74 Id. s 132. 

75 Quarantine Act 1908 (Cth) s 2A. 

76 Id. s 11. 
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necessary to control and eradicate the epidemic, or to remove the danger of the epidemic, by 

quarantine measures or measures incidental to quarantine.”77 Authorized persons may also 

exercise such powers in order to implement a coordinated response to a declared epidemic.78 

Failure to comply with a direction given under these provisions is an offense punishable by up to 

ten years’ imprisonment.79 

In the legislation, quarantine is defined to include measures 

(a) for, or in relation to: 

(i) the examination, exclusion, detention, observation, segregation, isolation, 

protection, treatment and regulation of vessels, installations, human beings, 

animals, plants or other goods or things; or 

(ii) the seizure and destruction of animals, plants, or other goods or things; or 

(iii) the destruction of premises comprising buildings or other structures when 

treatment of these premises is not practicable; and 

(b) having as their object the prevention or control of the introduction, establishment or 

spread of diseases or pests that will or could cause significant damage to human beings, 

animals, plants, other aspects of the environment or economic activities.80

The Quarantine Act 1908 (Cth) provides that persons who may be subject to quarantine include 

“every person infected with a quarantinable disease or quarantinable pest,” or who a quarantine 

officer reasonably suspects is infected, as well as persons who have been in contact with or 

exposed to infection from any person or goods subject to quarantine.81 Quarantinable diseases 

are listed in the Quarantine Proclamation 1998 (Cth),82 and are also reflected in the National 

Notifiable Disease List.83 

Where a vessel or installation has on board a case of communicable disease, and a quarantine 

officer certifies that quarantine measures are needed to stop the spread of the disease, such 

measures may be taken in relation to the vessel itself as well as any persons or goods on board. 

Those suffering from the disease, which need not be a quarantinable disease, may be ordered 

into quarantine.84

Persons ordered into quarantine may be detained on board the vessel in which they arrived in 

Australia, on the premises on which they are found, or removed and detained in a quarantine 

 

77 Id. s 2B(1) & (2). 

78 Id. s 3. 

79 Id. ss 2B(3) & 3(9). 

80 Id. s 4(1). 

81 Id. s 18(1). 

82 Quarantine Proclamation 1998 (Cth) reg 21, http://www.comlaw.gov.au/Details/F2014C00294. 

83 National Health Security (National Notifiable Disease List) Instrument 2008 (Cth) div 2.3. 

84 Quarantine Act 1908 (Cth) s 35. 
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station or other approved place.85 Persons arriving in Australia may also be placed under 

“quarantine surveillance” as an alternative to detention.86 

Various enforcement powers are included in Part VIA of the Quarantine Act 1908 (Cth). These 

include powers in relation to premises and vehicles, and search and seizure powers. 

In July 2014, the Minister for Agriculture announced that the Biosecurity Bill 2014 would be 

advanced to replace the Quarantine Act 1908 (Cth).87 The Bill was previously introduced in 

2012 but lapsed when Parliament adjourned in 2013.88 The passage of the Bill would be “the 

biggest change to [Australia’s] biosecurity system in more than one hundred years.”89 Among 

the changes would be new powers to allow the Commonwealth government to respond to 

biosecurity risks and to “help state and territory governments manage a nationally significant 

pest or disease outbreak.”90 

IV. Transparency of Public Health Crisis Management System 

As noted above, the Department of Health, through the National Notifiable Diseases Surveillance 

System, provides online, publicly-available information on notifiable diseases that is updated 

three times per week. Summary data is available online for each state and territory, and all 

diseases, dating back to 1991.91 A quarterly journal that provides detailed information on 

different diseases and related activities is also published by the Department of Health.92 The 

National Health Security Act 2007 (Cth) contains provisions related to information 

confidentiality, disclosure, and use.93

 

85 Id. s 45(1). 

86 Id. s 34. 

87 Press Release, Hon. Barnaby Joyce MP, Historic Biosecurity Bill 2014 to Safeguard Australia (July 7, 2014), 

http://www.maff.gov.au/Pages/Media%20Releases/biosecurity-bill-2014.aspx; Biosecurity Bill 2014, AUSTRALIAN 

GOVERNMENT DEPARTMENT OF AGRICULTURE, http://www.agriculture.gov.au/bsg/biosecurity-reform/newbiosecurity-legislation (last updated Oct. 1, 2014). 

88 Biosecurity Bill 2012, http://www.comlaw.gov.au/Details/C2012B00222. See also Chapter 2 – Managing 

Biosecurity Risk: Human Health, AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH, http://www.health.gov. 

au/internet/main/publishing.nsf/Content/ohp-biosecurity-2-human-health.htm (last updated Feb. 20, 2013). 

89 Hon. Barnaby Joyce MP, supra note 87. 

90 Id. 

91 National Notifiable Diseases Surveillance System, AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH,

http://www9.health.gov.au/cda/source/cda-index.cfm (last updated Oct. 29, 2014). 

92 Communicable Diseases Intelligence – Current Issue – June 2014, AUSTRALIAN GOVERNMENT DEPARTMENT OF 

HEALTH, http://www.health.gov.au/cdi (last updated Aug. 25, 2014). See also Surveillance Systems Reported in 

Communicable Disease Intelligence 2014, AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH, 

http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-surv_sys.htm (last updated 

June 30, 2014). 

93 National Health Security Act 2007 (Cth) pt 2 div 8. 
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V. Response to Ebola Virus Epidemic in West Africa 

Australian federal and state and territory governments have taken a range of actions in response 

to the 2014 Ebola virus disease (EVD) epidemic in several countries in West Africa. This 

includes the appointment of an infectious disease expert to oversee the response.94 State and 

territory Chief Health Officers provide weekly updates on their preparedness plans at meetings 

of the AHPC. Australia’s Chief Medical Officer stated in October 2014 that 

[n]ationally and at a local level we have alerted doctors, hospital, paramedics and other 

health professionals on what to do if they suspect a patient has Ebola. 

All States and Territories have their own response plans which include designating 

specific hospitals to treat suspected cases and ensuring there are adequate facilities and 

equipment, including personal protection, available. 

In addition the Communicable Diseases Network of Australia has produced a series of 

special guidelines for hospitals, public health units, clinicians and GPs. The guidelines 

give step by step guidance on identifying and dealing with a suspected case and they are 

continually under review as new information and experiences from overseas 

are received.95

Enhanced airport screening of passengers traveling to Australia from affected countries started in 

August 2014, and airport border agencies have been provided with guidance by the Department 

of Health “to identify and quarantine any passengers presenting Ebola symptoms in flights or at 

airports.”96 Travelers who have been in EVD-affected countries are asked a series of questions 

by a Biosecurity Officer “to assess their risk of exposure to EVD.”97 Passengers may then be 

referred to state health authorities for assessment if required.98 As at late October, more than 

nine hundred passengers had been screened at ten Australian airports.99 Twenty-four people had 

undergone a full screening process, “including being referred to human quarantine officers.”100 

 

94 Sophie Scott & Brigid Anderson, Infectious Disease Expert Professor Lyn Gilbert Appointed to Oversee 

Australia’s Response to Ebola Threat, ABC NEWS (Oct. 23, 2014), http://www.abc.net.au/news/2014-10-

23/infectious-diseases-expert-named-as-australias-ebola-tsar/5837000. 

95 Press Release, Australian Government Department of Health, Ebola Health Protection Update (Oct. 17, 2014), 

http://www.health.gov.au/internet/main/publishing.nsf/Content/mr-yr14-dept-dept010.htm. 

96 Press Release, Australian Health Protection Principal Committee, Australia is Well Prepared to Deal with Ebola 

(Aug. 15, 2014), http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-ebola.htm//$File/AHPPCStatement.pdf. 

97 Ebola Outbreak in West Africa, SMARTRAVELLER.GOV.AU, http://www.smartraveller.gov.au/zwcgi/view/travelbulletins/Ebola (last updated Oct. 25, 2014). 

98 Press Release, Hon. Barnaby Joyce MP, Appropriate Biosecurity Measures at Airports to Help Manage Ebola 

Risk (Oct. 17, 2014), http://www.maff.gov.au/Pages/Media%20Releases/appropriate-biosecurity-measures-airportsebola-risk.aspx. 

99 Sarah Scopelianos & Tim Leslie, Explained: Australia’s Plan to Tackle Ebola, ABC NEWS http://www.abc.net. 

au/news/2014-10-30/ebola-explained-australia-response/5826378 (last visited Oct. 31, 2014). 

100 Dan Harrison, Australia Shuts Borders to Ebola-Affected Countries, THE SYDNEY MORNING HERALD (Oct. 28, 

2014), http://www.smh.com.au/federal-politics/political-news/australia-shuts-borders-to-ebolaaffected-countries20141027-11ciut.html. 
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On October 27, 2014, the Minister of Immigration announced in Parliament that Australian 

immigration authorities had stopped processing visa applications from citizens from EVDaffected countries.101 People from these countries who had previously received permanent 

immigration visas are required to submit to a twenty-one day quarantine period before leaving 

West Africa, as well as being checked on arrival in Australia.102 Temporary visas previously 

granted to people who had not yet traveled to Australia were canceled.103 

In terms of national guidance and response coordination, the CDNA issued a new SoNG on EVD 

for public health units in August 2014, which has been updated several times and endorsed by 

the AHPC.104 In addition, the PHLN has prepared the National High Security Quarantine 

Laboratory Guideline for Management of Quarantinable Viral Haemorrhagic Fevers105 and 

guidelines on laboratory procedures for samples collected from patients with suspected EVD.106 

The Department of Health provides updates on its website regarding actions being taken by the 

federal government to “prevent the spread of EVD to Australia in partnership with the States and 

Territories.”107 For example, it states that “EVD is a quarantinable disease in Australia, and as 

such can be controlled and eradicated through a range of quarantine measures, including 

enforcing appropriate disinfection measures on aircraft and ships or port facilities.”108

At the state and territory level, detailed EVD response plans have been prepared or updated and 

published by health departments, such as the Victorian Ebola Virus Disease Response Plan109

 

101 Federal Government to Stop Processing Visa Applications from Countries Affected by Ebola, ABC NEWS (Oct. 

27, 2014), http://www.abc.net.au/news/2014-10-27/government-visa-applilcations-ebola/5845048. 

102 Interview, Hon. Scott Morrison MP with Chris Uhlman, ABC AM Programme (Oct. 27, 2014), 

http://www.minister.immi.gov.au/media/sm/2014/sm218747.htm; Scopelianos & Leslie, supra note 99. 

103 Harrison, supra note 100. 

104 Australian Government Department of Health, Ebola Virus Disease (EVD): CDNA National Guidelines for 

Public Health Units (version 1.3, Oct. 24, 2014), http://www.health.gov.au/internet/main/publishing.nsf/Content/ 

ohp-ebola.htm/$File/EVD-SoNG.pdf. 

105 National High Security Quarantine Laboratory Guideline for Management of Quarantinable Viral 

Haemorrhagic Fevers, AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH, http://www.health.gov.au/internet/ 

main/publishing.nsf/Content/ohp-nhsql-qvhf.htm (last updated Aug. 14, 2014). 

106 Laboratory Procedures and Precautions for Samples Collected from Patients with Suspected Viral 

Haemorrhagic Fevers (Oct. 2014), AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH, http://www.health.gov. 

au/internet/main/publishing.nsf/Content/cda-pubs-other-vhf.htm (last updated Oct. 17, 2014). 

107 Ebolavirus Disease (Ebola) Outbreaks in West Africa, AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH,

http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-ebola.htm (last updated Oct. 31, 2014). 

108 Ebolavirus Disease (EVD) Outbreaks in West Africa – Important Information for Travellers, Patients and 

Consumers, AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH, http://www.health.gov.au/internet/main/ 

publishing.nsf/Content/ohp-ebola-info-patients.htm (last updated Oct. 17, 2014). 

109 VICTORIA DEPARTMENT OF HEALTH, VICTORIAN EBOLA VIRUS DISEASE RESPONSE PLAN (version 1, Sept. 15, 

2014), http://docs.health.vic.gov.au/docs/doc/F379C2BD968364E8CA257D540008B3CA/$FILE/Victorian%20 

Ebola%20Virus%20Disease%20Response%20Plan_September%202014.pdf. 
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and the New South Wales Contingency Plan for Viral Haemorrhagic Fevers.110 These are read 

alongside the SoNG issued by the CDNA as well as state and territory legislation. 

During October, nineteen people from four families were placed on home quarantine in 

Queensland for twenty-one days after arriving from affected countries on humanitarian visas.111 

In addition, in September a person in Queensland who had previously traveled to an EVD 

affected country “was isolated, overseen by infectious disease experts with necessary tests 

quickly initiated.”112 

The federal government has stated that a team of twenty health care workers is available to be 

dispatched to Australia’s regional neighbors should they request assistance in the event of an 

EVD outbreak.113 As at late October 2014, Australia was facing criticism from the affected 

countries and the United Nations with regard to the new visa restrictions,114 and from the 

Australian Medical Association and others for not sending AUSMATs or other Australian health 

professionals to those countries to provide medical assistance.115 

 

110 Health Protection NSW, NSW Contingency Plan for Viral Haemorrhagic Fevers (updated Oct. 22, 2014), 

http://www.health.nsw.gov.au/Infectious/alerts/Documents/NSW-VHF-Plan-Web.pdf. 

111 Paul Osborne, Aust Closes Door on Ebola-Affected Countries, THE AUSTRALIAN (Oct. 27, 2014), 

http://www.theaustralian.com.au/news/latest-news/woman-tests-negative-for-ebola-in-brisbane/story-fn3dxiwe1227103069235?nk=59548baedb63759428ccdeece45558ba. 

112 Press Release, Hon. Peter Dutton MP, Australia’s World Class Preparedness Against Ebola (Sept. 11, 2014), 

http://www.health.gov.au/internet/ministers/publishing.nsf/content/health-mediarel-yr2014-duttonpd075.htm. 

113 Press Release, Hon. Peter Dutton MP, Ebola – The Facts: Australia is Ready and Able to Assist Neighbouring 

Countries Across the Region Should Ebola Appear Here (Oct. 22, 2014), http://www.health.gov.au/internet/ 

ministers/publishing.nsf/Content/health-mediarel-yr2014-dutton090.htm. 

114 Greg Dyett, Australia Criticised Over Ebola Visa Decision, SBS (Oct. 29, 2014), http://www.sbs.com.au/ 

news/article/2014/10/29/australia-criticised-over-ebola-visa-decision; Matt Siegel, Australian Ebola ‘Tsar’ 

Questions Government’s West Africa Visa Ban, REUTERS (Oct. 29, 2014), http://www.reuters.com/article/ 

2014/10/29/us-health-ebola-australia-idUSKBN0II0CU20141029. 

115 AMA Head Attacks Australia’s Response to Ebola as Shambolic, THE AUSTRALIAN (Oct. 26, 2014), 

http://www.theaustralian.com.au/in-depth/ebola-crisis/ama-head-attacks-australias-response-to-ebola-asshambolic/story-fnpqlos3-1227102521941. 
The Law Library of Congress 29

Brazil 

Eduardo Soares 

Senior Foreign Law Specialist

SUMMARY In Brazil, health is a fundamental right under the Constitution and the government has 

responsibility for the regulation and control of health activities and services, as well as 

sanitary and epidemiologic surveillance.

A Unified Health System, defined as a body of actions and health services provided by 

public organs and institutions at all government levels, is in charge of executing 

epidemiologic surveillance proceedings, including those for the purpose of recommending 

and adopting preventive measures and the control of diseases.

The Brazilian Penal Code provides for punishing whoever causes an epidemic or fails to 

comply with public health regulations, and Brazil is currently in the process of 

incorporating the revised International Health Regulations into its domestic legal system. 

 Recently, the Ministry of Health updated a Contingency Plan for the Ebola Disease 

designed to guide government actions to prevent and a possible epidemic in the country. 

I. Constitutional Principles – Health 

The Brazilian Constitution states that health is a right of all and a duty of the government, 

guaranteed by social and economic policies aimed at reducing the risk of disease and at the equal 

and universal access to actions and services for its promotion, protection, and recovery.1

It further states that health activities and services are of public importance and it is the 

government’s responsibility to provide, in accordance with the law, for their regulation, 

supervision, and control. Such activities and services must be carried out directly or through 

third parties and also by individuals or legal entities.2

 Public health activities and services are 

part of a regionalized and hierarchical network and constitute a unified3

 system.4

According to the Constitution, the Unified Health System (Sistema Único de Saúde, SUS) is 

responsible, inter alia, for the execution of actions regarding sanitary and epidemiologic 

surveillance, as well as those relating to the health of workers.5

 

1

 CONSTITUIÇÃO FEDERAL [C.F.] art. 196, http://www.planalto.gov.br/ccivil_03/Constituicao/Constituicao.htm. 

2 Id. art. 197. 

3 Id. art. 198. 

4

 Article 198 of the Constitution also provides the organizational directives that must be followed by the unified 

health system. 

5 Id. art. 200(II). 
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II. Unified Health System 

The SUS was established by Law No. 8,080 of September 19, 1990,6 and, pursuant to article 4, is 

composed of the body of actions and health services provided by public organs and institutions at 

the federal, state, and municipal levels of direct and indirect administration,7

 and by the 

foundations maintained by the government. Federal, state and municipal public institutions of 

quality control, research, and production of supplies and medications, including blood and blood 

products and health equipment, are also part of the SUS.8

 The private sector can participate in 

the SUS in a complementary manner.9

The SUS’s duties encompass, among other things, epidemiologic surveillance,10 which is defined 

as a group of actions that provide for the knowledge, detection, or prevention of any change in 

the determining and conditioning factors of individual or collective health, for the purpose of 

recommending and adopting measures to prevent and control diseases.11 Law No. 8,080 also 

provides for the organization of the SUS at the federal, state, and municipal levels;12 the 

attributes of each organization;13 and their competencies.14

A. National Agency of Sanitary Surveillance 

Pursuant to the authority in Law No. 8,080,15 on January 26, 1999, the government issued Law 

No. 9,782, which further defined the National System of Sanitary Surveillance (Sistema 

Nacional de Vigilância Sanitária), and created the National Agency of Sanitary Surveillance 

(Agência Nacional de Vigilância Sanitária, ANVISA).16

ANVISA is a federal agency (autarquia sob regime especial) linked to the Ministry of Health the 

institutional purpose of which is to foster the protection of the health of the population by 

exercising sanitary control over the production and marketing of products and services subject to 

 

6

 Lei No. 8.080, de 19 de Setembro de 1990, http://www.planalto.gov.br/ccivil_03/Leis/L8080.htm. 

7

 Direct Administration is considered to be the body of public administrative services exercised directly by the 

government (federal, state, and municipal) through government organs, such as ministries and secretaries, which are 

integrated into the structure of the Executive. Indirect Administration is the body of acts and services rendered by 

decentralized administrative agencies (autarquias) or public entities created by law, in the exercise of their own 

activities or government functions, through delegation by the government. MARIA HELENA DINIZ, 1 DICIONÁRIO 

JURÍDICO 123–24 (São Paulo, Editora Saraiva 2005). 

8

 Lei No. 8.080, art. 4(§1). 

9 Id. art. 4(§2). 

10 Id. art. 6(I)(b). 

11 Id. art. 6(§2). 

12 Id. art. 9. 

13 Id. art. 15. 

14 Id. art. 16. 

15 Id. arts. 6(§1), 15–18. 

16 Lei No. 9.782, de 26 de Janeiro de 1999, art. 3, http://www.planalto.gov.br/ccivil_03/Leis/L9782.htm. 
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sanitary surveillance, including the environments, processes, supplies and technologies related to 

them, as well as the control of ports, airports and borders.17 

The activities of epidemiologic surveillance and vector control related to ports, airports, and 

borders must be executed by the ANVISA under the technical and normative guidance of the 

Ministry of Health.18 In addition, the agency is in charge of regulating, controlling, and 

inspecting products and services that pose a threat to public health.19 Law No. 9,782 details the 

goods and products subordinated to the control and inspection of the ANVISA.20 Decree No. 

3,029 of April 16, 1999 approved the agency’s bylaws.21

B. Secretariat of Health Surveillance

On August 7, 2013, Decree No. 8,06522 granted to the Ministry of Health the authority to 

implement the national health policy,23 including the coordination and supervision of the SUS;24

responsibility for taking general preventive measures; and responsibility for the surveillance and 

sanitary control of borders, ports, and airports.25

 

The Secretariat of Health Surveillance (Secretaria de Vigilância em Saúde, SVS)26 is one of the 

many organs within the organizational structure of the Ministry of Health and is composed of 

 Department of Surveillance of Transmissible Diseases (Departamento de Vigilância das 

Doenças Transmissíveis);27 

 Department of Surveillance of Non-Transmissible Diseases and Health Promotion 

(Departamento de Vigilância de Doenças e Agravos não Transmissíveis e Promoção 

da Saúde);28 

 Department of Management of Health Surveillance (Departamento de Gestão da Vigilância 

em Saúde);29 

 

17 Id. art. 6. 

18 Id. art. 7(§3). 

19 Id. art. 8. 

20 Id. 

21 Decreto No. 3.029, de 16 de Abril de 1999, http://www.planalto.gov.br/ccivil_03/decreto/D3029.htm. 

22 Decreto No. 8,065, de 7 de Agosto de 2013, http://www.planalto.gov.br/ccivil_03/_Ato2011-

2014/2013/Decreto/D8065.htm#art7. 

23 Id. Anexo I, art. 1(I). 

24 Id. art. 1(II). 

25 Id. art. 1(VI). 

26 Id. art. 2(II)(e). 

27 Id. art. 2(II)(e)(1). 

28 Id. art. 2(II)(e)(2). Article 42 of Decree No. 8,065 defines the competence of the Department of Surveillance of 

Non-Transmissible Diseases and Health Promotion. 
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 Department of Surveillance, Prevention and Control of Sexually Transmitted Diseases, 

Acquired Immunodeficiency Syndrome and Viral Hepatitis (Departamento de Vigilância, 

Prevenção e Controle das Doenças Sexualmente Transmissíveis, Síndrome da 

Imunodeficiência Adquirida e Hepatites Virais);30 and 

 Department of Environmental Health Surveillance and Worker’s Health (Departamento de 

Vigilância em Saúde Ambiental e Saúde do Trabalhador).31

The SVS is responsible for coordinating the management of the National System of Health 

Surveillance (Sistema Nacional de Vigilância em Saúde), composed of 

 National Subsystem of Epidemiologic Surveillance of Transmissible and Non-Transmissible 

Diseases (Subsistema Nacional de Vigilância Epidemiológica, de Doenças Transmissíveis, e 

de Agravos e Doenças Não Transmissíveis);32 

 National Subsystem of Environmental Health Surveillance, including Working Environment 

Conditions (Subsistema Nacional de Vigilância em Saúde Ambiental, incluindo Ambiente de 

Trabalho);33 

 National System of Laboratories of Public Health (Sistema Nacional de Laboratórios de 

Saúde Pública);34

 Health Surveillance Information Systems (Sistemas de Informação de Vigilância 

em Saúde);35 

 Programs for the Prevention and Control of Diseases of Public Health Relevance, including 

the National Program of Immunizations (Programas de Prevenção e Controle de Doenças de 

Relevância em Saúde Pública, incluindo o Programa Nacional de Imunizações);36 and 

 National Policy on Worker’s Health (Política Nacional de Saúde do Trabalhador).37

The SVS’s duties include, inter alia, preparation and disclosure of information and analysis of 

health situations enabling the establishment of priorities, monitoring the sanitary situation of the 

country, assessing the impact of actions taken for the prevention and control of diseases, and 

 29 Id. art. 2(II)(e)(3). Article 43 of Decree No. 8,065 defines the competence of the Department of Management of 

Health Surveillance. 

30 Id. art. 2(II)(e)(4). Article 44 of Decree No. 8,065 defines the competence of the Department of Surveillance, 

Prevention and Control of Sexually Transmitted Diseases, Acquired Immunodeficiency Syndrome and 

Viral Hepatitis. 

31 Id. art. 2(II)(e)(5). Article 45 of Decree No. 8,065 defines the competence of the Department of Environmental 

Health Surveillance and Worker’s Health. 

32 Id. art. 40(I)(a). 

33 Id. art. 40(I)(b). 

34 Id. art. 40(I)(c). 

35 Id. art. 40(I)(d). 

36 Id. art. 40(I)(e). 

37 Id. art. 40(I)(f). 
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assisting the Ministry of Health with the development of policies.38 The SVS also coordinates 

activities related to preventing and controling diseases39 and participates in preparing and 

implementing norms, instruments, and methods to strengthen the capacity of the SUS in all three 

levels of government in the field of health surveillance.40

C. Department of Surveillance of Transmissible Diseases 

The Department of Surveillance of Transmissible Diseases is responsible, among other things, for 

 Proposing norms related to (a) procedures for the prevention and control of transmissible diseases; 

(b) notification of transmissible diseases; (c) epidemiologic investigation; and (d) 

epidemiologic surveillance at ports, airports, borders and customs terminals;41

 Establishing preventive measures and control of risk factors and diseases;42 

 Supplementary or complementary coordination of epidemiologic measures and control of 

diseases in exceptional situations, when (a) the capacity of a State is surpassed; (b) there is the 

involvement of more than one State; or (c) there is a risk of national dissemination;43 

 Regulation and definition of technical instruments related to information systems regarding 

the mandatory notification of diseases and diseases under surveillance;44 

 Analysis, surveillance, supervision and orientation in the execution of actions for the 

prevention and control of diseases that are part of a list of diseases requiring mandatory 

notification, or that may become important for public health;45 

 Monitoring the epidemiologic behavior of diseases under surveillance;46

 Preparing the national list of diseases requiring mandatory notification;47

 Preparing a basic mandatory vaccination plan;48 

 Coordination of investigations related to outbreaks and epidemics;49 and 

 

38 Id. art. 40(II). 

39 Id. art. 40(III), (IV). 

40 Id. art. 40(VII). 

41 Id. art. 41(I). 

42 Id. art. 41(II). 

43 Id. art. 41(III). 

44 Id. art. 41(IV). 

45 Id. art. 41(V). 

46 Id. art. 41(VI). 

47 Id. art. 41(VII). 

48 Id. art. 41(VIII). 

49 Id. art. 41(IX). 
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 Regulation and supervision of the National System of Laboratories of Public Health with 

respect to health surveillance.50

1. Epidemiologic Surveillance Guide 

In 1975, the Ministry of Health created the National System for Epidemiologic Surveillance 

(Sistema Nacional de Vigilância Epidemiológica, SNVE).51 The SNVE was established by Law 

No. 6,259 of October 30, 1975, which was regulated by Decree No. 78,231 of August 12, 1976.52 

Law No. 6,259 provided for the organization of epidemiologic surveillance actions,53 created the 

national program of immunizations,54 and made mandatory the communication of the presence 

of selected diseases.55

In 1977, the Ministry of Health prepared the first Epidemiologic Surveillance Manual (Manual 

de Vigilância Epidemiológica), which gathered all technical norms being used for the 

surveillance of each disease within the ambit of specific control programs.56 The manual is still 

being published by the Ministry of Health and its last updated version was issued in 2009.57

With the promulgation of Law No. 8,080 on September 19, 1990, the SUS incorporated the 

SNVE, which further defined epidemiologic surveillance58 and re-organized the health system in 

the country.59

2. Rapid Response Center 

In 1990, the government merged two agencies in charge of public health and created the National 

Health Foundation (Fundação Nacional de Saúde, FUNASA),60 an entity responsible for health 

promotion and protection,61 promoting sanitation solutions for prevention and control of 

 

50 Id. art. 41(X). 

51 MINISTÉRIO DA SAÚDE, GUIA DE VIGILÂNCIA EPIDEMIOLÓGICA 17, 18 (7a Edição, Brasília, DF, 2009), 

http://bvsms.saude.gov.br/bvs/publicacoes/guia_vigilancia_epidemiologica_7ed.pdf. 

52 Decreto No. 78.231, de 12 de Agosto de 1976, http://www.planalto.gov.br/ccivil_03/decreto/1970-

1979/D78231.htm. 

53 Lei No. 6.259, de 30 de Outubro de 1975, art. 2, http:// www.planalto.gov.br/ccivil_03/Leis/L6259.htm. 

54 Id. art. 3. 

55 Id. art. 7. 

56 MINISTÉRIO DE SAÚDE, supra note 51. 

57 Id. 

58 Lei No. 8.080, de 19 de Setembro de 1990, art. 6(§2), http://www.planalto.gov.br/ccivil_03/Leis/L8080.htm. 

59 Id. 

60 Lei No. 8.029, de 12 de Abril de 1990, art. 14, http://www.planalto.gov.br/ccivil_03/LEIS/L8029cons.htm#art14. 

61 Decreto No. 7.335, de 19 de Outubro de 2010, Anexo I, art. 2, http://www.planalto.gov.br/ccivil_03/_Ato2007-

2010/2010/Decreto/D7335.htm#art6. 
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diseases, and preparing and implementing actions to promote and protect health related actions 

established by the National Sub-System of Environmental Health Surveillance.62

 

On August 31, 2000, FUNASA created the Rapid Response Center for Epidemiologic 

Emergencies (Núcleo de Resposta Rápida em Emergências Epidemiológicas, NUREP)63 to act in 

the following cases: 

 Epidemics that go beyond the limits of a state 

 Epidemics of emerging diseases 

 Introduction into the country of an infectious agent that had been eradicated or did not 

previously exist 

 Epidemics of diseases that are part of the International Sanitary Regulation 

 Epidemics characterized by an expansion to areas without previous occurrences 

 Floods, droughts, and other calamities and/or disasters relevant to public health when 

insufficient action is demonstrated by a municipality or state64

NUREP is also responsible for planning, mobilizing resources, coordinating and implementing 

actions that reduce or eliminate risks to public health;65 maintaining information systems 

regarding human resources and logistics available for mobilization;66 and preparing procedural 

manuals for interventions in emergency situations.67

III. Patent Breach 

In cases of national emergency or public interest, the government may issue a compulsory 

license for the use of a patent if the owner of the patent or its licensee does not comply with a 

request for its use.68 The national emergency must have been declared by an act of the executive 

branch of the federal government, and the compulsory license must be temporary and nonexclusive, and may not cause prejudice to the rights of the owner.69

On October 6, 1999, Decree No. 3,201 was issued to regulate the issuance of compulsory 

licenses in cases of national emergency and public interest.70 The decree further: (1) determines 

 

62 Id. 

63 MINISTÉRIO DE SAÚDE , Portaria No. 473, de 31 de Agosto de 2000, art. 1, http://www.jusbrasil.com.br/diarios/ 

1420127/pg-105-secao-1-diario-oficial-da-uniao-dou-de-04-09-2000. 

64 Id. art. 1. 

65 Id. art. 2(I). 

66 Id. art. 2(II). 

67 Id. art. 2(III). 

68 Lei No. 9.279, de 14 de Maio de 1996, art. 71, http:// www.planalto.gov.br/ccivil_03/Leis/L9279.htm. 

69 Id. 

70 Decreto No. 3.201, de 6 de Outubro de 1999, http://www.planalto.gov.br/ccivil_03/decreto/D3201.htm. 
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that in cases of public interest the compulsory license is for noncommercial public use only;71 (2) 

defines “national emergency” as an imminent public danger, even if it is only in part of the 

country;72 (3) defines “public interest” as the facts related, inter alia, to public health and 

environmental protection, as well as those of fundamental importance to the technological or 

socio-economic development of the country;73 and (4) regulates the procedures that must be 

observed for the issuance of a compulsory license.74

IV. Right to Privacy 

According to the Brazilian Constitution, everyone is equal before the law, with no distinction 

whatsoever, and Brazilians and foreigners residing in the country are guaranteed the inviolate 

right to life, liberty, equality, security, and property.75 

As part of the fundamental rights and guarantees established in the Constitution, personal 

intimacy, private life, honor, and reputation are inviolable, and the right to compensation for 

pecuniary or moral damages resulting from violations of such rights is guaranteed.76 In addition, 

the Constitution provides that an individual’s home is inviolable, and no one may enter it without 

the dweller’s consent, except in cases of a flagrant crime (flagrante delito) or disaster, or to 

provide help, or during the day with a court order.77

The Brazilian Medical Code of Ethics78 provides that a medical doctor must keep secret all 

information that he or she has access to while performing his duties, except in cases provided by 

law.79 However, a physician is authorized to disclose information acquired while exercising his 

or her profession in cases of justified motive (justa causa), legal obligation, or written 

authorization of the patient.80 

 

 

71 Id. art. 1. 

72 Id. art. 2(§1). 

73 Id. art. 2(§2). 

74 Id. art. 5. 

75 C.F. art. 5. 

76 Id. art. 5(X). 

77 Id. art. 5(XI). 

78 FEDERAL COUNCIL OF MEDICINE, Resolução CFM No. 1.931, de 17 de Setembro de 2009, 

http://www.portal.cfm.org.br/index.php?option=com_content&view=category&id=9&Itemid=122. 

79 Id. ch. I, no. XI. 

80 Id. art. 73. 
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V. Criminal and Civil Sanctions 

The Brazilian Penal Code punishes by up to fifteen years in prison whoever is condemned of 

causing an epidemic by propagating pathogenic germs.81 If death occurs, the punishment 

is doubled.82 

The breach of government determinations designed to prevent the introduction or propagation of 

a contagious disease is punished by up to one year in prison and the payment of a fine,83 and 

Medical doctors that fail to communicate to health authorities the presence of diseases under the 

mandatory notification system are punished by up to two years in prison and the payment of a fine.84

In addition to the criminal sanctions established in the Penal Code, Law No. 6,437 of August 20, 

1977 lists the situations that characterize infringement of federal sanitary laws85 and their 

respective penalties.86

VI. International Health Regulations 

Brazil is a member of the World Health Organization (WHO)87 and the Pan American Health 

Organization (PAHO),88 and follows the International Health Regulations (IHR) adopted by the 

WHO in 1969 and later amended in 1973 and 1981. 

In 1995, the 48th World Health Assembly called for a substantial revision of the Regulations 

adopted in 1969.89 After extensive work, on May 23, 2005, IHR (2005) was adopted by the 58th 

World Health Assembly and on June 15, 2007, it entered into force.90 

The purpose and scope of the IHR (2005) are “to prevent, protect against, control and provide a 

public health response to the international spread of disease in ways that are commensurate with 

and restricted to public health risks, and which avoid unnecessary interference with international 

traffic and trade.”91 

 

81 CÓDIGO PENAL, Decreto-Lei No. 2.848, de 7 de Dezembro de 1940, art. 267, http://www.planalto.gov.br/ 

ccivil_03/Decreto-Lei/Del2848compilado.htm. 

82 Id. art 267(§1). 

83 Id. art 268. 

84 Id. art. 269. 

85 Lei No. 6.437, de 20 de Agosto de 1977, art. 10, http://www.planalto.gov.br/ccivil_03/Leis/L6437.htm. 

86 Id. art 2. 

87 WORLD HEALTH ORGANIZATION, http://www.who.int/countries/bra/en/. 

88 PAN AMERICAN HEALTH ORGANIZATION, http://www.paho.org/hq/index.php?option=com_wrapper&view= 

wrapper&Itemid=2005&lang=en. 

89 WHO, International Health Regulations (2d ed. 2005), http://www.who.int/ihr/ publications/9789241596664/en/. 

90 Id. at 1. 

91 Id. 
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IHR (2005) was incorporated into Brazil’s domestic legal system through Legislative Decree No. 

395/2009.92 

VII. Recent Developments

On August 8, 2014, the Ministry of Health updated the Contingency Plan for Emergency in 

Public Health – Disease for Ebola Virus (Plano de Contingência para Emergência em Saúde 

Pública – Doença Pelo Vírus Ebola),93 which was designed to guide specific actions against a 

possible introduction of the Ebola virus in the country. 

The Plan defines responsibilities on the federal level and establishes the necessary organization 

in order to respond to emergency situations related to this disease in Brazil, aiming at the 

integration of actions and prevention and control.94

The objectives of the Plan are as follows: 

 Define the operating strategy of the Ministry of Health in line with the definitions of the Response 

Plan for Public Health Emergencies 

 Establish a coordinated response within the scope of the Unified Health System 

 Activate Emergency Operation Centers in Public Health to manage a coordinated response 

 Adopt measures to prevent the spread of the Ebola virus on an eventual introduction of the virus in 

the country 

 Establish the use of standard protocols and procedures to respond to Ebola95  

 

92 Decreto Legislativo No. 395, de 2009, http://www2.camara.leg.br/legin/fed/decleg/2009/decretolegislativo-395-9-

julho-2009-589324-publicacaooriginal-114307-pl.html. 

93 Ministério da Saúde, Secretaria de Vigilância em Saúde, Departamento de Vigilâncias das Doenças Transmissíveis, 

Plano de Contingência para Emergência em Saúde Pública, Doença pelo Vírus Ebola Versão 5 (Brasília, DF, 2014), 

http://www.ribeiraopreto.sp.gov.br/ssaude/doencas/ebola/plano_contingencia.pdf. 

94 Id. at 4. 

95 Id. 
The Law Library of Congress 39 

Canada 

Tariq Ahmad 

Legal Research Analyst

SUMMARY Emergency measures and emergency management at the federal level in Canada are 

regulated by the Emergency Act and the Emergency Management Act. However, there is 

a relatively high trigger for the federal government to take the lead in a health emergency. 

Therefore, most health emergencies or crises are dealt with at the municipal and provincial 

level in coordination with the federal government. Most provinces and territories have 

passed various “health acts” that govern the powers and duties of health officials during a 

health emergency. 

I. Structure of Public Health Crisis Management System 

Legislative competence in relation to public health matters is shared by all levels of government 

in Canada.1

 The Constitution Act, 1867,2 which defines much of the structure and operations of 

the Government of Canada, “does not explicitly include ‘health’ as a legislative power assigned 

either to Parliament (in section 91) or to the provincial legislatures (in section 92).”3

In the 1982 case of Schneider v. The Queen, the Supreme Court of Canada stated that 

“health” is not a matter which is subject to specific constitutional assignment but instead 

is an amorphous topic which can be addressed by valid federal or provincial legislation, 

depending in the circumstances of each case on the nature or scope of the health problem 

in question.4

Under Section 91 of Canada’s Constitution Act, the federal government derives its jurisdiction to 

directly or indirectly regulate on public health-related issues principally from its powers to 

legislate on 

 quarantine and the establishment and maintenance of marine hospitals; 

 criminal matters; 

 public debt and property; 

 

1 Background, PUBLIC HEALTH AGENCY OF CANADA (PHAC), http://www.phac-aspc.gc.ca/about_apropos/backcont-eng.php (last updated Oct. 9, 2014). 

2

 Constitution Act, 1867, 30 & 31 Victoria, c. 3 (U.K.), §§ 91, 92, http://laws-lois.justice.gc.ca/eng/const/page1.html. 

3

 Martha Butler & Marlisa Tiedemann, Library of Parliament, Legal and Social Affairs Division, The Federal Role 

in Health and Health Care § 1, Pub. No. 2011-91-E (Sept. 2011; revised Sept. 2013), http://www.parl.gc.ca/ 

Content/LOP/ResearchPublications/2011-91-e.htm. 

4

 Schneider v. The Queen, (1982) 2 S.C.R. 112, p. 142. 
Legal Responses to Health Emergencies: Canada 

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 taxing powers; 

 power to pass laws for the peace, order, and good government of Canada; and 

 census and statistics matters.5

Section 92 of the Act assigns responsibility to the provinces and territories for 

 matters relating to the establishment, maintenance, and management of hospitals, asylums, 

charities, and charitable institutions; 

 matters in their province of a local or private nature; and 

 municipal institutions.6

As stated by the Standing Senate Committee on Social Affairs, Science, and Technology, “[d]ue 

to this lack of clarity in the constitutional division of powers in relation to health and public 

health, both levels of government may legislate in these areas.”7

Canada’s public health emergency management system has been described as a “bottom up 

system,”8 where the “initial and ongoing responsibility for investigation and response to public 

health events, including infectious disease outbreaks, occurs at the local/municipal level.”9 

Therefore, “depending on the severity, complexity, extent and nature of the public health issue, 

provincial, territorial and federal systems may be engaged to provide assistance and resources as 

requested and/or required by local authorities and facilities managing the situation.”10 All levels 

of government have various forms of legislation to protect and manage public health in a time 

of crisis. 

A. Federal Laws 

At the federal level, the Public Health Agency of Canada (PHAC) is primarily responsible for the 

promotion of health, prevention and control of chronic diseases, prevention and control of 

infectious diseases, and preparation and response to public health emergencies.11 The PHAC 

operates under the Minister of Health and Health Canada. It was established by the 2006 Public 

Health Agency of Canada Act12 “for the purpose of assisting the Minister of Health in exercising 

 

5

 Constitution Act, 1867, § 91. 

6 Id. § 92. 

7

 STANDING SENATE COMMITTEE ON SOCIAL AFFAIRS, SCIENCE, AND TECHNOLOGY, CANADA’S RESPONSE TO THE 

2009 H1N1 INFLUENZA PANDEMIC (Dec. 2010), http://www.parl.gc.ca/content/sen/committee/403/soci/rep/ 

rep15dec10-e.pdf. 

8 Responding to an Infectious Disease Outbreak: Progress Between SARS and Pandemic Influenza H1N1, PHAC, 

http://www.phac-aspc.gc.ca/ep-mu/rido-iemi/index-eng.php#in (last updated Apr. 11, 2012). 

9 Id. 

10 Id. 

11 Mandate, PHAC, http://www.phac-aspc.gc.ca/about_apropos/what-eng.php (last updated June 16, 2011). 

12 Public Health Agency of Canada Act, S.C. 2006, c. 5, http://lois-laws.justice.gc.ca/eng/acts/P-29.5/FullText.html. 
Legal Responses to Health Emergencies: Canada 

The Law Library of Congress 41 

or performing the Minister’s powers, duties and functions in relation to public health.”13 This 

statute also established the office of the Chief Public Health Officer “and the related powers, 

duties and functions.”14

Federal legislation also mandates public health surveillance activities under the Department of 

Health Act, the Public Health Agency of Canada Act, and the Statistics Act.15 The Department 

of Health Act gives the Minister of Health “the power, subject to the Statistics Act, to collect, 

analyze, interpret, publish and distribute information related to public health.”16

The federal government’s power to act in a public health emergency is largely governed by two 

pieces of legislation: the Emergencies Act17 and the Emergency Management Act.18 The 

Emergencies Act gives the government of Canada the authority to “invoke exceptional yet 

incident-specific powers to deal with emergencies,”19 including public welfare emergencies. The 

Emergency Management Act “sets out the leadership role and responsibilities of the Minister of 

Public Safety and Emergency Preparedness, including “coordinating emergency management 

activities among government institutions and in cooperation with the provinces and 

other entities.”20

The federal government works in collaboration with provinces and territories “to support 

communities when disasters strike.”21 According to the website of Public Safety Canada, “[t]o 

this end, An Emergency Management Framework for Canada was revised and approved by 

Federal/Provincial/Territorial Ministers in 2011. The Framework establishes a common 

approach for a range of collaborative emergency management initiatives in support of safe and 

resilient communities.”22 The Framework divides emergency management into four 

interdependent components, which are meant to provide greater clarity of risks “and contribute[] 

 

13 List of Acts and Regulations, PHAC, http://www.phac-aspc.gc.ca/about_ apropos/act-reg-lois/list-liste-eng.php

(last updated May 7, 2013). 

14 Id. 

15 Evaluation Directorate, Public Health Agency of Canada/Health Canada, Evaluation of the Surveillance Function 

at the Public Health Agency of Canada, App. F. Federal, Provincial and Territorial Authorities for Public Health 

Surveillance, (Jan. 14, 2013), http://www.phac-aspc.gc.ca/about_apropos/ evaluation/reports-rapports/2012-2013/sffs/app-ann-f-eng.php. 

16 Id. 

17 Emergencies Act, R.S.C., 1985, c. 22, http://laws-lois.justice.gc.ca/eng/acts/E-4.5/. 

18 Emergency Management Act, S.C. 2007, c. 15, http://laws-lois.justice.gc.ca/eng/acts/E-4.56/. 

19 Emergencies Act, ALBERTA MUNICIPAL AFFAIRS, http://apsts.alberta.ca/online-courses/bem/chapter-4-

legislation/federal-legislation/emergencies-act/ (last visited Nov. 13, 2014). 

20 Emergency Management, PUBLIC SAFETY CANADA, http://www.publicsafety.gc.ca/cnt/mrgnc-mngmnt/indexeng.aspx (last updated Mar. 4, 2014). 

21 Id. 

22 Id. 
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to a safer, prosperous, sustainable, disaster resilient society in Canada.”23 The components, as 

explained in the Framework, include the following: 

Prevention and Mitigation – to eliminate or reduce the risks of disasters in order to 

protect lives, property, the environment, and reduce economic disruption. 

Prevention/mitigation includes structural mitigative measures (e.g. construction of 

floodways and dykes) and non-structural mitigative measures (e.g. building codes, landuse planning, and insurance incentives). Prevention and mitigation may be considered 

independently or one may include the other. 

Preparedness – to be ready to respond to a disaster and manage its consequences 

through measures taken prior to an event, for example emergency response plans, mutual 

assistance agreements, resource inventories and training, equipment and exercise 

programs. 

Response – to act during or immediately before or after a disaster to manage its 

consequences through, for example, emergency public communication, search and 

rescue, emergency medical assistance and evacuation to minimize suffering and losses 

associated with disasters. 

Recovery – to repair or restore conditions to an acceptable level through measures taken 

after a disaster, for example return of evacuees, trauma counseling, reconstruction, 

economic impact studies and financial assistance. There is a strong relationship between 

long-term sustainable recovery and prevention and mitigation of future disasters. 

Recovery efforts should be conducted with a view towards disaster risk reduction.24

Canada’s federal legislation also includes the Quarantine Act,25 the purpose of which is “to 

protect public health by taking comprehensive measures to prevent the introduction and spread 

of communicable diseases.”26 The Canada Border Services Agency (CBSA) assists the PHAC in 

the administration of the Quarantine Act and the Quarantine Regulations.

27 The Act is by and 

large a border-control statute that is applied at entry and departure points. 

B. Provincial Laws 

Public health activities, including public health crisis management at the provincial and 

territorial levels, are governed by Public Health Acts (or their equivalent) and related regulations. 

These Acts usually have provisions on reporting requirements, prevention, inspection powers, 

emergency measures, and the powers and duties of health officials. 

 

23 PUBLIC SAFETY CANADA, AN EMERGENCY MANAGEMENT FRAMEWORK FOR CANADA (2d ed. Jan. 2011), 

http://www.public safety.gc.ca/cnt/rsrcs/pblctns/mrgnc-mngmnt-frmwrk/index-eng.aspx. 

24 Id. 

25 Quarantine Act, S.C. 2005, c. 20, http://laws-lois.justice.gc.ca/eng/acts/Q-1.1/FullText.html. 

26 Id. § 4. 

27 CANADIAN BORDER SERVICES AGENCY, MEMORANDUM D19-9-3 (Jan. 16, 2009), http://www.cbsa-asfc.gc.ca/ 

publications/dm-md/d19/d19-9-3-eng.html. 
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Provinces and territories also have Emergency Management Acts in their respective jurisdictions 

that provide the legal basis for establishing emergency management organizations (EMOs) and 

creating provincial/territorial-level emergency management plans to help coordinate a provincial 

response to an emergency.28 

II. Powers of Public Health Authorities 

A. Federal 

1. Emergency Powers 

At the federal level, the Emergencies Act authorizes the government of Canada to take special 

temporary measures through a declaration of a “public welfare emergency,” which the Act 

defines as an emergency caused by a real or imminent disease in human beings, animals, or 

plants (among others) “that results or may result in a danger to life or property, social disruption 

or a breakdown in the flow of essential goods, services or resources, so serious as to be a national 

emergency.”29 However, the federal government’s power to issue a declaration of a public 

welfare emergency can only be triggered after a relatively high threshold is met. According to 

the Act, 

[t]he Governor in Council may not issue a declaration of a public welfare emergency 

where the direct effects of the emergency are confined to, or occur principally in, one 

province unless the lieutenant governor in council of the province has indicated to the 

Governor in Council that the emergency exceeds the capacity or authority of the province 

to deal with it.30 

Therefore, it has been argued that the Emergencies Act essentially “restrains, even denies, 

federal statutory authority to tackle a disease outbreak while it remains small, manageable, and 

confined to one province. Rather, federal authority begins only once the outbreak has spread, 

reaching the out-of-control quality of an epidemic.”31

While an emergency declaration is in effect, the government has the power to issue orders and 

regulations on the following matters: 

 

28 Emergency Management Ontario Ministry of Community Safety and Correctional Services, Province of Ontario 

Emergency Response Plan (2008), http://www.emergencymanagementontario. 

ca/english/emcommunity/response_resources/plans/provinicial_emergency_response_plan.html. 

29 Emergencies Act § 5. Section 3 defines a “national emergency” as “an urgent and critical situation of a temporary 

nature that”: “(a) seriously endangers the lives, health or safety of Canadians and is of such proportions or nature as 

to exceed the capacity or authority of a province to deal with it, or (b) seriously threatens the ability of the 

Government of Canada to preserve the sovereignty, security and territorial integrity of Canada.” Id. § 3. 

30 Id. § 14(2). “Governor in Council” is another phrase for the Federal Cabinet. 

31 Amir Attaran & Kumanan Wilson, A Legal and Epidemiological Justification for Federal Authority in Public 

Health Emergencies, 52 MCGILL L.J. 381, 385 (2007), http://lawjournal.mcgill.ca/userfiles/other/5670367-

1219616683_Attaran__Wilson.pdf. 
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(a) the regulation or prohibition of travel to, from or within any specified area, where 

necessary for the protection of the health or safety of individuals; 

(b) the evacuation of persons and the removal of personal property from any specified 

area and the making of arrangements for the adequate care and protection of the 

persons and property; 

(c) the requisition, use or disposition of property; 

(d) the authorization of or direction to any person, or any person of a class of persons, to 

render essential services of a type that that person, or a person of that class, is 

competent to provide and the provision of reasonable compensation in respect of 

services so rendered; 

(e) the regulation of the distribution and availability of essential goods, services 

and resources; 

(f) the authorization and making of emergency payments; 

(g) the establishment of emergency shelters and hospitals; 

(h) the assessment of damage to any works or undertakings and the repair, replacement or 

restoration thereof; 

(i) the assessment of damage to the environment and the elimination or alleviation of the 

damage, and 

(j) the imposition [of fines] for contravention of any order or regulation made under 

this section.32

2. Quarantine 

The Quarantine Act “authorizes the Minister of Health to establish quarantine stations and 

quarantine facilities anywhere in Canada, and to designate various officers, including quarantine 

officers, environmental health officers, and screening officers.”33 The Act also “authorizes 

measures that can be taken in respect of international travellers, or other persons at an entry or 

departure point, who have or might have a communicable disease (one that poses a risk of 

significant harm to public health).”34 It also authorizes procedures “that can be taken in respect 

of conveyances arriving in or departing from Canada, and cargo on those conveyances, which 

could be the source of a communicable disease.”35

 

 

32 Emergencies Act § 8(1). 

33 List of Acts and Regulations, PHAC, supra note 13. 

34 Id. 

35 Id. 
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B. Provincial Powers 

1. Emergency Powers 

Given the limitations on the federal government to deal with health-related emergencies, 

responsibility for this matter is largely left to the provinces. All the provinces and territories 

have their own legislation dealing with emergencies and emergency management. While 

“[t]here is considerable variation among the provinces and territories with respect to the content, 

provisions, and the limits of authority defined in the respective legislation,”36 the laws are more 

or less the same in terms of powers and organizational structure.37 For example, they empower 

“the province or territory, municipalities, individuals, private corporations and/or organizations 

to formulate emergency plans to prepare for and respond to emergencies or disasters.”38 Other 

common features of these laws include provisions 

 establishing Emergency Management Organizations with assigned powers and duties, 

 defining the roles and responsibilities of municipalities and their relationship with 

the provinces, 

 providing “extraordinary power to local government if required,” 

 in some jurisdictions requiring local governments “to create and maintain an emergency 

measures/management organization and program/plan,” 

 enabling “provision of Disaster Financial Assistance to victims of all disasters,” and 

 “provid[ing] exemption from civil liability to all emergency service workers.”39

2. Quarantine and Other Powers 

Health officials in the provinces and territories have extensive powers under various “health 

acts” to protect the public against pandemics and public health emergencies. For example, 

section 22 of Ontario’s Health Protection and Promotion Act40 provides that a medical officer of 

health may, through a written order, “require a person to take or to refrain from taking any action 

that is specified in the order in respect of a communicable disease” if this officer has “reasonable 

and probable grounds” to believe 

 

36 Id. 

37 John Lindsay, Emergency Management in Canada: Near Misses and Moving Targets, https://www.training. 

fema.gov/emiweb/edu/Comparative%20EM%20Book%20-%20Chapter%20-%20Emergency%20 

Management%20in%20Canada%20-%20Near%20Misses%20and%20Moving%20Targets.doc (last visited 

Nov. 28, 2014).

38 NOVA SCOTIA EMERGENCY MANAGEMENT OFFICE, BASIC EMERGENCY MANAGEMENT § 1.6.3 (Jan. 2011), 

http://0-fs01.cito.gov.ns.ca.legcat.gov.ns.ca/deposit/b10645214.pdf. 

39 Id. 

40 Health Protection and Promotion Act, R.S.O. 1990, c. H.7, http://www.e-laws.gov.on.ca/html/statutes/english/ 

elaws_statutes_90h07_e.htm#BK26.
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The Law Library of Congress 46 

(a) that a communicable disease exists or may exist or that there is an immediate risk of 

an outbreak of a communicable disease in the health unit served by the medical 

officer of health; 

(b) that the communicable disease presents a risk to the health of persons in the health 

unit served by the medical officer of health; and 

(c) that the requirements specified in the order are necessary in order to decrease or 

eliminate the risk to health presented by the communicable disease.41 

Such an order can include, but is not limited to, 

(a) requiring the owner or occupier of premises to close the premises or a specific part of 

the premises; 

(b) requiring the placarding of premises to give notice of an order requiring the closing 

of the premises; 

(c) requiring any person that the order states has or may have a communicable disease or 

is or may be infected with an agent of a communicable disease to isolate himself or 

herself and remain in isolation from other persons; 

(d) requiring the cleaning or disinfecting, or both, of the premises or the thing specified 

in the order; 

(e) requiring the destruction of the matter or thing specified in the order; 

(f) requiring the person to whom the order is directed to submit to an examination by a 

physician and to deliver to the medical officer of health a report by the physician as 

to whether or not the person has a communicable disease or is or is not infected with 

an agent of a communicable disease; 

(g) requiring the person to whom the order is directed in respect of a communicable 

disease that is a virulent disease to place himself or herself forthwith under the care 

and treatment of a physician; 

(h) requiring the person to whom the order is directed to conduct himself or herself in 

such a manner as not to expose another person to infection.42

In British Columbia, similar protective measures are stipulated under the province’s Public 

Health Act, which includes “quarantine and isolation measures, and closures of public places to 

help prevent the spread of a disease or health hazard.”43 Under the Act, medical health officers 

are “empowered to quarantine and isolate individuals who pose a significant risk of spreading 

serious communicable diseases to others.”44 The Act also allows a quarantine order to be made 

to a group of people “to expedite the prevention of disease.”45 Medical health officers “can have 

a person who is spreading disease detained until a court order can be obtained, or during a wide 

 

41 Id. § 22(1) & (2). 

42 Id. § 22(4). 

43 Public Health Act – Frequently Asked Questions, MINISTRY OF HEALTH, http://www.health.gov.bc.ca/phact/ 

faq.html (last visited Nov. 13, 2014). 

44 Id. 

45 Id. 
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spread emergency, the Provincial Health Officer can take command of directing the public 

health response.”46

III. Transparency of Public Health Crisis Management System 

In the Emergency Management Framework for Canada, the federal, provincial, and territorial 

governments agreed to the principle of maintaining “clear communications” with the “aim to be 

as open as possible regarding the work each does in emergency management.”47 The Framework 

states that, prior to an emergency, emphasis must be on public education in respect to emergency 

management in order to “enhance awareness of hazards, risks and vulnerabilities; strengthen 

prevention, mitigation and preparedness measures; and provide information on all aspects of 

emergency management.”48 Communications during and after an emergency must explain the 

necessary “response actions” in order to “minimize impacts and to maintain safety 

and security.”49

The independent SARs Commission report, which investigated the 2003 outbreak of SARs in 

Ontario, criticized the “lack of transparency in the adjudication system” during the outbreak and 

concluded that the lack of transparency “led to confusion over roles and responsibilities” of local 

Medical Officers of Health in the case review of new probable cases of the disease.50 

IV. Cooperation with the World Health Organization (WHO) 

Canada is a member of WHO and is therefore bound by the International Health Regulations 

(2005) (IHR). Health Canada “leads Canada’s relationship with WHO, while the Department of 

Foreign Affairs, Trade and Development (DFATD) provides Canada’s assessed contribution—

about [Can]$14 million [approximately US$12.34 million] per year.”51 The PHAC operates as 

“the focal point for coordinating the implementation of the IHR in Canada.”52 

According to the DFATD website, “Canada works closely with WHO to reduce global diseases 

such as polio, HIV/AIDS, tuberculosis and malaria, and to improve maternal, newborn and child 

health including nutrition.”53 The website also states that Canada is a strong supporter of WHO 

 

46 Id. 

47 An Emergency Management Framework for Canada, supra note 23. 

48 Id. 

49 Id. 

50 THE HONOURABLE MR. JUSTICE ARCHIE CAMPBELL, THE SARS COMMISSION INTERIM REPORT: SARS AND 

PUBLIC HEALTH IN ONTARIO 50 (Apr. 15, 2004), http://www.health.gov.on.ca/en/common/ministry/publications/ 

reports/campbell04/campbell04_2.aspx. 

51 World Health Organization, FOREIGN AFFAIRS, TRADE AND DEVELOPMENT CANADA, http://www.acdicida.gc.ca/acdi-cida/acdi-cida.nsf/en/NAD-321114340-LFU (last updated Aug. 1, 2013). 

52 Responding to an Infectious Disease Outbreak, PHAC, supra note 8. 

53 Id. 
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initiatives, such as the Global Polio Eradication Initiative, the Stop TB Partnership, and the 

Partnership for Maternal, Newborn and Child Health.54

Canada also works with WHO to “support national health programs such as those in Haiti and 

the Polio Eradication Signature Project in Afghanistan and with WHO’s regional offices such as 

the Pan American Health Organization.”55

There are twenty-six WHO Collaborating Centres operating in Canada.56 

V. Recent Developments 

As of the date of this report there have been no instances of persons with the Ebola virus in 

Canada.57 The PHAC has stated that it is working with all levels of government to prevent the 

disease from spreading in the country. Canadian health authorities have also stated that they 

have taken the following steps: 

 “[E]nforcing the Quarantine Act at all international points of entry into Canada. This will 

help us to identify any sick travellers arriving, and to apply public health measures 

as appropriate.”58

 The National Microbiology Laboratory in Winnipeg and provincial laboratories are ready to 

detect the virus and respond quickly. Experts at Quebec’s lab are able to diagnose Ebola and 

labs in British Columbia, Alberta, Ontario, and Nova Scotia will be next.59

 Canadian hospitals “have infection control systems to limit the spread of infection and 

protect health-care workers.”60

In early October 2014, the federal Health Minister announced that the government would be 

taking the additional step of taking “targeted temperature” screenings at Canadian airports. The 

PHAC also increased the number of staff “at Canadian airports to help with the screening of 

travelers from Ebola-affected regions.”61 On October 30, 2014, the Canadian federal 

 

54 Id. 

55 Id. 

56 WHO Collaborating Centres Global Database, WHO, http://apps.who.int/whocc/List.aspx?cc_code=CAN (last 

visited Nov. 13, 2014). 

57 Canada’s Response to Ebola, GOVERNMENT OF CANADA, http://healthycanadians.gc.ca/diseases-conditionsmaladies-affections/disease-maladie/ebola/response-reponse-eng.php (last modified Nov. 12, 2014). 

58 Id. 

59 Ebola Preparedness Plan Ready, Canada’s Health Officials Say, CBCNEWS (Oct. 1, 2014), 

http://www.cbc.ca/news/health/ebola-preparedness-plan-ready-canada-s-health-officials-say-1.2783655. 

60 Id. 

61 Helen Branswell, Canada to Step Up Border Checks for Ebola, THE CANADIAN PRESS (Oct. 9, 2014), 

http://www.cp24.com/news/canada-to-step-up-border-checks-for-ebola-1.2046410#ixzz3HjzdnJio. 
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government announced that it was “suspending visa applications for residents and nationals of 

countries with ‘widespread and persistent-intense transmission’ of Ebola virus disease.”62

 

62 Rob Gillies, Canada Restricts Visas Amid Ebola Scare, ASSOCIATED PRESS (Oct. 31, 2014), https://news.yahoo. 

com/canada-restricts-visas-amid-ebola-scare-213729168.html. 
The Law Library of Congress 50

People’s Republic of China 

Laney Zhang 

Senior Foreign Law Specialist

SUMMARY China’s public health crisis system has been under restructuring since 2003. With the 

outbreak of a public health crisis, the emergency headquarters set up by the State Council 

is responsible for leading and commanding the nationwide response to the crisis. The 

provincial emergency headquarters are responsible for leading and commanding the 

response to the crisis within their own jurisdictions. 

 The State Council and its health department, formerly the Ministry of Health and since 

2013 the National Health and Family Planning Commission, have the power to declare a 

crisis involving a statutory infectious disease and draft and implement public health crisis 

contingency plans. The measures that may be taken when a crisis occurs include the 

evacuation or isolation of people, the blockade of infectious disease epidemic areas, and 

the compulsory quarantine and treatment of suspected carriers and people in close contact 

with them. 

 

 In 2010, the ban on the entry into China of aliens with HIV/AIDS or leprosy was lifted. 

According to the current rules, aliens with serious mental disorders, infectious pulmonary 

tuberculosis, or other infectious diseases that may significantly endanger the public health 

may be prohibited from entering China. 

I. Legislative and Regulatory Framework 

The public health crisis system of the People’s Republic of China (PRC or China) has been 

significantly restructured primarily as a result of the Severe Acute Respiratory Syndrome 

(SARS) crisis of 2002–2003. Although a statutory and regulatory framework to handle public 

health emergencies had been in place prior to the SARS crisis, major laws, regulations, and 

government measures have been amended or newly enacted since then to curb 

health emergencies. 

A. PRC Constitution on States of Emergency 

On March 14, 2004, the Constitution of the People’s Republic of China was amended1

 to expand 

the power of the National People’s Congress, President, and State Council to declare martial law 

 



 This is a revised and updated version of a report authored by Wendy Zeldin, Senior Legal Research Analyst of the 

Law Library of Congress, in 2003. 

1

 XIANFA (1982, as amended on Mar. 14, 2004) (P.R.C.); for the Chinese text, see Announcement of the National 

People’s Congress of the People’s Republic of China: Amendments to the Constitution of the People’s Republic of 

China, NPCSC GAZETTE (Special Issue, 2004) 1–27 (Mar. 15, 2004). For an English translation, see 16 THE LAWS 

OF THE PEOPLE’S REPUBLIC OF CHINA [LAWS OF PRC] (2004) 59–91 (Beijing, Law Press 2005). See also Cao 

Kangtai (Head of the State Council Legislative Affairs Office), Wei Jianli Jinji Zhuangtai Zhidu Tigong Xianfa Yiju

[Providing a Constitutional Basis for Establishing an Emergency System], FAZHI RIBAO [LEGAL DAILY], Mar. 25, 

2004, available at http://www.people.com.cn/GB/14576/15157/2410102.html (in Chinese). 
Legal Responses to Health Emergencies: China 

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to include declaring states of emergency in cases of serious natural disasters, industrial accidents, 

public health crises, social unrest, and terrorist attacks.2

 

B. Emergency Response Law and National System of Contingency Plans for Emergencies 

For the purpose of preventing and reducing emergent hazards such as natural disasters, industrial 

accidents, public health crises, and public security hazards, the first PRC Law on Emergency 

Response (Emergency Response Law) was promulgated and entered into force in 2007.3 

Since the passage of the Emergency Response Law, the country has established a national 

system of contingency plans for emergencies, as provided by the Law on Emergency Response.4

 

The Law requires the government at all levels, including the State Council and its departments, 

to formulate contingency plans for emergencies, which these government bodies are to apply 

according to their level of authority.5

 The central government has set up a webpage on its 

official website where it publishes the contingency plans for emergencies formulated by the State 

Council, its departments, and the provinces. The webpage also publishes special project plans.6

 

As part of the national system of contingency plans for public emergencies, the National 

Contingency Plan for Public Health Emergencies was formulated on February 26, 2006,7 in 

accordance with the Health Emergency Regulations, as discussed in Part III(B), below. 

C. Regulations on Contingent Public Health Emergencies 

A major set of provisions specifically addressing public health emergencies comprise the 

Regulations on Contingent Public Health Emergencies (Health Emergency Regulations), 

promulgated by the State Council on May 9, 2003.8 The Regulations define “public health 

emergencies” as “major epidemic situations of infectious diseases, broad-spectrum diseases with 

an unknown cause, major food and occupational poisoning incidents, and other serious public 

health incidents that occur unexpectedly and cause or may cause grave harm to public health 

in society.”9 

 

2

 XIANFA arts. 67, 80, 89. 

3

 Tufa Shijian Yingdui Fa [Law on Emergency Response] (promulgated by the National People’s Congress (NPC) 

Standing Committee on Aug. 30, 2007, effective Nov. 1, 2007), 2007 ZHONGHUA RENMIN GONGHE GUO FAGUI 

HUIBIAN [FAGUI HUIBIAN] [COMPILATION OF THE LAWS AND REGULATIONS OF THE PEOPLE’S REPUBLIC OF CHINA], 

81–97, English translation available at Westlaw China (by subscription). 

4

 Law on Emergency Response art. 17. 

5 Id. 

6 Guojia Tufa Gonggong Shijian Yuan Tixi [National System of Contingency Plans for Public Emergencies], 

CENTRAL PEOPLE’S GOVERNMENT OF THE PEOPLE’S REPUBLIC OF CHINA, http://www.gov.cn/yjgl/2005-08/31/ 

content_27872. htm (last visited Oct. 16, 2014). 

7 Guojia Tufa Gonggong Weisheng Shijian Yingji Yu’an [National Contingency Plan for Public Health Crises], 

XINHUA NEWS AGENCY (Feb. 26, 2006), http://www.gov.cn/yjgl/2006-02/26/content_211654.htm. 

8

 Tufa Gonggong Weisheng Shijian Yingji Tiaoli [Regulations on Contingent Public Health Emergencies] (Health 

Emergency Regulations) (promulgated by the State Council, May 9, 2003), available at Westlaw China. 

9 Id. art. 2. 
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D. Law on the Prevention and Treatment of Infectious Diseases 

Prior to the 2003 Health Emergency Regulations, the primary legislation addressing the 

prevention and treatment of infectious diseases, including the reporting and releasing of 

information in epidemic situations, was the PRC Law on the Prevention and Treatment of 

Infectious Diseases (Infectious Diseases Law), which was enacted in 1989. The Law was 

significantly revised in August 2004.10 Effective on December 1, 2004, the new version doubled 

the length of the former Infectious Diseases Law from forty-one articles to eighty articles.11

The Infectious Diseases Law divides contagious diseases into three categories, each requiring the 

implementation of different preventive and control measures. Category A covers bubonic plague 

and cholera; category B includes such diseases as SARS, anthrax, AIDS, typhoid, and viral 

hepatitis; and category C contains such diseases as influenza, leprosy, mumps, and 

schistosomiasis.12 The 2004 amendment to the Law added infectious SARS and highly 

pathogenic avian influenza to category B, thereby increasing the total number of infectious 

diseases to thirty-seven.13 Three category B diseases—infectious SARS, pulmonary anthrax, and 

highly pathogenic avian influenza—are designated to be treated with preventive and control 

measures applicable to category A diseases.14 

E. Other Relevant Laws, Regulations, and Government Measures 

The prevention, control, and elimination of epidemic diseases among animals are under the 

general supervision of the State Council’s Ministry of Agriculture and regulated under the PRC 

Law on Prevention of Epidemics in Animals. The Law was enacted in 1997 and amended in 

2007.15 Under the Law, animal epidemics are grouped into three categories, the first of which 

includes epidemics that menace human beings and animals so seriously that urgent and intensive 

compulsory measures are required for their prevention, control, and elimination.16 

Some other major laws and regulations for addressing public health crises include the PRC Food 

Safety Law17 and various laws and regulations on quarantine. Under the Food Safety Law, the 

 

10 Chuanran Bing Fangzhi Fa [Infectious Diseases Law] (promulgated by the NPC Standing Committee, Aug. 28, 

2004, effective Dec. 1, 2004), 6 NPCSC GAZETTE 16–23 (Sept. 15, 2004). For an English translation, see 16 LAWS 

OF CHINA (2004) 127–55. 

11 Id. 

12 Id. art. 3. 

13 Id. 

14 Id. art. 4. 

15 Dongwu Fangyi Fa [Law on Prevention of Epidemics in Animals] (promulgated by the NPC Standing Committee, 

July 3, 1997, amended Aug. 30, 2007, entered in force Jan. 1, 2008), 2001 FAGUI HUIBIAN 1009–22, English 

translation available at Westlaw China. 

16 Id. art. 4. 

17 Shipin Anquan Fa [Food Safety Law] (promulgated by the NPC Standing Committee, Feb. 28, 2009, effective 

June 1, 2009), http://www.gov.cn/flfg/2009-02/28/content_1246367.htm, English translation available at

Westlaw China. 
Legal Responses to Health Emergencies: China 

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State Council is to organize the formulation of a national food safety emergency response plan; 

the government at or above the county level must also make food safety emergency response 

plans for its own administrative region.18

The central government departments also established the following measures to specifically 

manage information reporting, transportation administration, and border quarantine when public 

health crises occur: 

 Ministry of Health: Measures for the Administration of Information Reporting in Monitoring 

Public Health Emergencies and Epidemic Infectious Disease Situations (November 7, 2003; 

revised August 24, 2006);19

 General Administration of Quality Supervision, Inspection and Quarantine: Provisions on the 

Emergent Response to the Entry-Exit Inspection and Quarantine of Frontier and Port Public 

Health Emergencies (November 7, 2003);20 and 

 Ministry of Health and Ministry of Transportation: Provisions on Traffic Preparedness and 

Response to Public Health Emergencies (March 4, 2004; effective May 1, 2004).21

In 2007, the State Council passed the Regulations on Open Government Information. Effective 

from May 1, 2008, information concerning public emergency contingency plans, early warnings, 

and responses to emergency situations are included in the “key information” that the government 

at and above the county level must disclose to the public.22 

II. Structure of Public Health Crisis Management System 

A. Central and Local Institutions 

The State Council is the highest executive organ and has the power, among others, to direct and 

administer public health work.23 In 2013, the Ministry of Health merged with the newly 

established National Health and Family Planning Commission (NHFPC), a department under the 

 

18 Id. art. 70. 

19 Tufa Gonggong Weisheng Shijian yu Chuanrangbing Yiqing Jiance Xinxi Baogao Guanli Banfa [Measures for the 

Administration of Information Reporting on Monitoring Public Health Emergencies and Epidemic Situation of 

Infectious Diseases], MOH Order No. 37, http://www.moh.gov.cn/mohzcfgs/pgz/200901/38689.shtml. 

20 Guojing Kou’an Tufa Gonggong Weisheng Shijian Churujing Jianyan Jianyi Yingji Chuli Guiding [Provisions on 

Emergent Response to the Entry-Exit Inspection and Quarantine of Frontier and Port Public Health Emergencies], 

http://www.aqsiq.gov.cn/zwgk/jlgg/zjl/zjl20032004/200610/t20061027_12228.htm. 

21 Tufa Gonggong Weisheng Shijian Jiaotong Yingji Guiding [Provisions on Traffic Preparedness and Response to 

Public Health Emergencies], available at Westlaw China. 

22 Zhengfu Xinxi Gongkai Tiaoli [Regulations on Open Government Information] (promulgated by the State 

Council, Apr. 5, 2007, effective May 1, 2008) art. 10, 2007 FAGUI HUIBIAN 98, 99, English translation available at 

http://www.epa.gov/ogc/china/open_government.pdf (last visited Oct. 20, 2014). 

23 XIANFA art. 89, item 7, in part. 
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State Council.24 The NHFPC is in charge of most health-related matters at the national level. It 

supervises and administers contagious disease prevention and various aspects of hygiene, 

organizes and oversees international cooperation and exchanges involving health care, and 

mobilizes national health care personnel and technical resources to assist local governments and 

other concerned departments in dealing with outbreaks of epidemics and disease and in taking 

emergency measures to prevent and control them.25 A health emergency office, the Public 

Health Emergency Command Center, is set up in the NHFPC to address public 

health emergencies.26

Once a public health crisis has been identified, the State Council sets up emergency 

headquarters, over which it exercises unified leadership and command. The national 

headquarters set up for a crisis is to be composed of relevant departments of the State Council 

and the Armed Forces, with the competent leader of the State Council as the general director in 

charge. The NHFPC and other relevant departments of the State Council carry out related tasks 

within the scope of their duties and responsibilities.27 

Provincial-level governments are also required to set up emergency headquarters on the outbreak 

of a public health crisis, with principal provincial leaders as the general directors in charge of 

handling contingencies in their region. The provincial headquarters are to direct the response to 

the crisis within their respective jurisdictions. The health departments of local governments at 

and above the county level are responsible for investigating and managing health crises and 

organizing medical treatment.28

B. Decision Making 

With the outbreak of a public health crisis, the emergency headquarters set up by the State 

Council is responsible for leading and commanding the nationwide response to the public health 

crisis.29 The provincial emergency headquarters are responsible for leading and commanding the 

response to the crisis within their own jurisdictions.30

In the case of the SARS crisis, a National SARS Prevention and Control Headquarters was 

established by the State Council, with the Vice Premier and Minister of Health as the 

 

24 Guojia Weisheng he Jihuashengyu Weiyuanhui Zhuayo Zhize Neishe Jigou he Renyuan Bianzhi Guiding 

[Responsibilities, Internal Organs, and Personnel of the National Health and Family Planning Commission] (issued 

by the State Council by Guo Ban Fa [2013] No. 50, June 9, 2013), http://www.gov.cn/zwgk/2013-06/18/content_ 

2428241.htm. 

25 Id.

26 Id. 

27 Health Emergency Regulations art. 3. 

28 Id. art. 4. 

29 Id. art. 3. 

30 Id. art. 4. 
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chairpersons. Ten special teams (e.g., on prevention and control, quarantine, and rural areas) and 

a General Office were component units.31 

C. Reporting and Releasing Information About Emergencies 

The state, according to the Health Emergency Regulations, is to establish a system for reporting 

emergencies. Under the system, the following circumstances may trigger a provincial-level 

government emergency report to the NHFPC, which must be submitted within one hour after the 

provincial-level government learns of the emergency: (1) the outbreak and spread, or potential 

outbreak and spread, of an infectious disease; (2) the occurrence or discovery of a broadspectrum disease with an unknown cause; (3) the loss of infectious disease bacteria and viruses; 

and (4) the occurrence or potential occurrence of major food and occupational poisoning 

incidents.32 The NHFPC is to promptly report to the State Council any emergency “that may 

cause significant social repercussions.”33 The Health Emergency Regulations also require that 

notifications of health emergencies be transmitted from monitoring and medical organizations to 

local health departments to the local government to higher-level health departments (including 

the NHFPC), with each organization or department required to transmit the information within 

two hours of receiving it.34 

The Health Emergency Regulations also require the reporting and release of information from 

the NHFPC to other departments under the State Council, to the health departments of 

provincial-level governments, and to the Armed Forces; from the health departments of 

provincial-level governments35 to their counterparts in the neighboring provinces; from 

provincial health departments to lower-level health departments within the same jurisdiction; and 

from the governments at the county level and above to their health departments.36

In addition, any entity or individual in China has the right to report to the government on the 

potential danger of a public health emergency, as well as the right to report to a higher level if a 

local government fails to carry out its duties and responsibilities or carry them out according to 

regulations. A reporting hotline is also to be established.

37

 

 

31 Local SARS headquarters and work mechanisms were also established. Speech of Mr. Gao Qiang, Executive 

Vice Minister, Ministry of Health, People’s Republic of China, WHO Global Meeting on SARS, Kuala Lumpur, 17 

June [2003], WHO, GLOBAL ALERT AND RESPONSE (GAR), http://www.who.int/csr/sars/conference/june_2003/ 

materials/presentations/qiang/en/ (last visited Oct. 21, 2014). 

32 Health Emergency Regulations art. 19. 

33 Id. 

34 Id. art. 20. 

35 The “provincial level” includes provinces, autonomous regions, and municipalities (e.g., Beijing, Shanghai, 

Tianjin, Chongqing) under the direct control of the central government. 

36 Id. art. 23. 

37 Id. art. 24. 
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III. Powers of Public Health Authorities

A. Declaring a Statutory Infectious Disease Outbreak 

When an acute infectious disease is newly identified, the health department under the State 

Council, formerly the Ministry of Health (MOH) and since 2013 the NHFPC, has the power to 

declare it a statutory infectious disease in accordance with the Infectious Disease Law.38 Only 

the State Council itself may declare such a disease to be a category A disease.39 The NHFPC has 

the power to declare the addition of a disease to category B or C.40 The MOH or NHFPC may 

also, upon approval by the State Council, decide to apply the preventive and control measures 

applicable to category A diseases to certain category B diseases and other infectious diseases 

whose outbreak has occurred from unknown causes.41 Such a decision was made, for example, 

in the 2009 H1N1 influenza A crisis.42 

B. Drafting and Implementing Contingency Plans 

Under the Health Emergency Regulations, the health department under the State Council, 

currently the NHFPC, is to draft a national contingency plan for emergencies and submit it to the 

State Council for approval. On the basis of the national plan, provincial-level governments are 

to draw up contingency plans for their respective administrative regions.43 

When a public health emergency occurs, health departments are to organize experts to evaluate 

and classify it and propose whether a contingency plan should be implemented. Specialized 

technical organizations designated by health departments at and above the provincial level or by 

other relevant departments are responsible for investigating emergencies; verifying relevant 

evidence; and addressing, managing, and assessing such emergencies.44 

With State Council approval, the NHFPC implements a contingency plan nationwide or across 

provinces. The decision to implement a contingency plan in a province is made by the provincial 

government, not the health authorities, and must be reported to the State Council.45 

 

 

38 Id. art. 30. 

39 Id. 

40 Infectious Diseases Law art. 3. 

41 Id. art. 4. 

42 Weishengbu Gonggao 2009 Nian Di Ba Hao [MOH Announcement [2009] No. 8, Apr. 30, 2009], http://www. 

gov.cn/jrzg/2009-05/01/content_1302001.htm. 

43 Health Emergency Regulations art. 10. 

44 Id. arts. 26, 29. 

45 Id. art. 27. 
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C. Measures 

1. Evacuation, Isolation, and Blockade 

Emergency headquarters have the power to evacuate or isolate people and to blockade areas of 

epidemic infectious disease.46 Suspected carriers and people in close contact with infected 

patients who need to be quarantined and treated or put under medical observation must cooperate 

with the health department or relevant organizations. Compulsory implementation will be 

carried out with the assistance of the police.47

2. Assembling Personnel and Facilities 

Emergency headquarters have the power to assemble personnel, materials in reserve, transport 

vehicles, and relevant facilities and equipment to deal with emergencies.48 Relevant departments 

of the State Council and local governments at and above the county level are to ensure the 

production and supply of medical and rescue equipment, medicine, medical instruments, and 

other needed materials.49 

3. On-Site Control 

Emergency headquarters may adopt measures to control food and water sources. Government 

health departments are to adopt measures to control the crisis and provide emergency 

vaccinations, medicines for preventive purposes, and community-based protection measures to 

people who are vulnerable to infections or harm.50

4. Right of Entry 

Specialized technical organizations designated by the NHFPC or other relevant departments of 

the State Council have the right to enter an emergency scene to conduct investigations, 

samplings, technical analyses, and tests. The cooperation of the relevant units and individuals 

is mandatory.51

5. Formulating Standards

The NHFPC is to formulate technical standards, specifications, and control measures “as soon as 

possible” for newly discovered infectious diseases, broad-spectrum diseases with an unknown 

cause, and major food and occupational poisoning incidents.52

 

46 Id. art. 33. 

47 Id. art. 44. 

48 Id. art. 33. 

49 Id. art. 32. 

50 Id. art. 34. 

51 Id. art. 36. 

52 Id. art. 37. 
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D. Sanctions 

The Health Emergency Regulations contain administrative sanctions (e.g., written criticism, 

warnings, demotions, dismissal) for impermissible acts committed by government officials 

involved in public health emergencies. These include, for example, covering up, delaying 

reporting, or lying about public health emergencies or instructing others to do so; refusing to 

cooperate with higher-level government investigations or carry out contingency-related 

responsibilities; and dereliction of duty. Officials will be dismissed if their acts cause infectious 

disease contamination, spread, or harm to public health. Medical institutions that refuse to 

receive and treat patients or fail to promptly adopt control measures are subject to administrative 

sanctions and may face revocation of their license; officials involved will be disciplined. 

Responsible units or individuals who fail to carry out reporting duties, obstruct technical or other 

personnel, refuse to cooperate in investigations, etc., may incur administrative or disciplinary 

sanctions. If any of the above acts result in a crime, the perpetrator will be investigated for 

criminal responsibility.53

IV. Transparency of Public Health Crisis Management System 

The Infectious Diseases Law explicitly makes it illegal for responsible officials and antiepidemic 

health personnel to conceal the outbreak of contagious diseases or instruct others to do so.54 It 

also requires the NHFPC and, under its authorization, provincial-level health departments to 

promptly release information on and publicly announce an epidemic.55 The Health Emergency 

Regulations reinforce the Law. Information on public health emergencies is to be released in a 

“timely, accurate, and comprehensive way,” and no unit or individual is allowed to cover up, 

delay reporting, or lie about public health emergencies or instruct others to do so.56

Despite such provisions, the transparency of the public health crisis management system may be 

problematic considering that the media is controlled by the Communist Party through 

government agencies, and that the government may treat infectious diseases as a matter of 

national security requiring secrecy.57 Furthermore, the military’s health departments supervise 

and control the prevention and treatment of infectious disease in the People’s Liberation Army.58 

For example, in the SARS crisis, the independent administration of the military hospitals made it 

possible for such hospitals in Beijing to keep secret the number of SARS patients being held in 

 

53 Id. arts. 45–51. 

54 Infectious Diseases Law art. 37. 

55 Id. art. 38. 

56 Health Emergency Regulations arts. 21, 25. 

57 Sin-ming Shaw, China’s Glasnost Moment?, 25 CHINA REVIEW 9 (Summer 2003); DAVID COWHIG, OPENNESS 

MANDATED BY PRC LAW, SECRECY IS ILLEGAL: BUT IS NON-GOVERNMENT INFORMATION JUST PUNISHABLE 

RUMOR, available at http://bulldog2.redlands.edu/dept/AsianStudiesDept/cowhig.pdf (last visited Oct. 20, 2014). 

Cowhig states that perhaps the best example of such government secrecy with regard to health crises is the top secret 

documents kept by the MOH and the Henan provincial health bureau on the spread of HIV/AIDS throughout Henan 

during the early to mid-1990s. He notes that some Chinese officials have even contended that health secrecy—for 

example, keeping secret the incidence of AIDS—protects a locality’s collective privacy. 

58 Infectious Diseases Law art. 6. 
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them, resulting in a major underreporting of cases. Even after the actual number of cases was 

made known, officials were reportedly not forthcoming with statistics from the PRC’s nearly two 

hundred army hospitals.59 

Although the 2004 amendment to the Infectious Diseases Law continues to provide that military 

departments in charge of health are to supervise and control the prevention and treatment of 

infectious disease in the People’s Liberation Army,60 it now places a reporting requirement on 

military hospitals. Military hospitals, some of which are open to the public, must report on the 

epidemic infectious disease situations they encounter when providing medical services to the 

general public in accordance with relevant NHFPC regulations.61 

V. Cooperation with the World Health Organization 

The PRC is a member of the World Health Organization (WHO), has a WHO representative in 

Beijing, and is part of the WHO Western Pacific Region. At least sixty-four Chinese health 

research institutions have been designated as WHO collaborating centers.62 During the early 

stages of the SARS crisis, the PRC was dilatory in notifying the WHO of cases and admitting 

inspectors, and was criticized for its lack of transparency. However, the PRC did issue WHOcompatible health rules for international trade and travel, disinfected conveyances, and required 

health documents for travelers. Despite its initial failure to cooperate, a senior WHO official 

later praised the PRC for its “excellent work” in preventing and treating SARS and said that the 

government accepted advice from international experts and made changes in combating 

the disease.63 

Although the PRC’s delay in responding to SARS was partially attributed to concerns about 

economic repercussions, the PRC first treats an infectious disease as a medical problem requiring 

a medical response. Thus, the delay may have been due in part to (former) bureaucratic 

procedures that required classification of an infectious disease as a category B disease before 

local health authorities were required to report it to the central government. It may also have 

been unclear whether the disease fell under the WHO’s International Health Regulations (IHR) 

framework that makes reporting to the WHO mandatory. Before May 2003, compliance with the 

IHR was up to the discretion of the Member States; the WHO lacked any enforcement powers 

and had to rely on persuasion and recommendations to encourage Member States to notify the 

WHO within twenty-four hours of infectious disease outbreaks. Moreover, only three diseases 

(plague, cholera, and yellow fever) and no other emerging infectious diseases were covered 

under the IHR. It was not until late May 2003, during its 56th session, that the WHO adopted a 

resolution on SARS confirming the WHO’s authority to verify disease outbreaks from all 

 

59 Gordon Chang, SARS Crisis: New Disease, New Leaders, Same Old Regime, 3:8 CHINA BRIEF 5 (Apr. 22, 2003). 

60 2004 Infectious Diseases Law art. 6(3). 

61 Id. art. 30(2). 

62 See WHO COLLABORATING CENTERS GLOBAL DATABASE, http://apps.who.int/whocc/ReportDetails.aspx?id=1

(last visited Oct. 21, 2014). The site lists sixty-four institutions as collaborating centers. 

63 WHO Official: China’s SARS Prevention Work ‘Excellent,’ XINHUA NEWS AGENCY (June 12, 2003), available at 

http://www1.china.org.cn/archive/2003-06/12/content_1066811.htm; WHO Experts: China’s SARS Surveillance 

Network Unique, XINHUA NEWS AGENCY (May 13, 2003), available at http://china.org.cn/english/China/64578.htm. 
Legal Responses to Health Emergencies: China 

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available official and nonofficial sources and to determine an outbreak’s severity through on-thespot investigations.64 

VI. Recent Developments 

A. Entry Ban Lifted for Foreigners with HIV/AIDS 

On April 24, 2010, the State Council issued a decree to amend the implementation measures of 

the Frontier Health and Quarantine Law.65 The measures were first approved by the State 

Council in 1986 and amended in 1994. Under the old measures, foreigners suffering from 

“mental disorder, leprosy, AIDS, venereal diseases, contagious tuberculosis, or other infectious 

diseases” could be prevented from entering China. The new measures amended this section 

only, removing the ban on aliens with HIV/AIDS or leprosy, while leaving intact the entry ban 

on those with “serious mental disorder, infectious pulmonary tuberculosis, or other infectious 

diseases that may endanger the public health in a major way.”66 

B. Application of the International Health Regulations 

On May 14, 2007, the Chinese government declared that the International Health Regulations 

(IHR), which would enter into force on June 15, 2007, applied to the entire territory of the 

People’s Republic of China, including the two special administrative regions of Hong Kong and 

Macau. The then MOH of China was designated as China’s “national focal point,” pursuant to 

Paragraph 1 of Article 4 of the IHR. The IHR also designated the local health administrative 

authorities as the health authorities responsible for the implementation of the IHR in their 

respective jurisdictions, and the General Administration of Quality Supervision, Inspection and 

Quarantine of China and its local offices as the competent authorities at the points of entry 

referred to in Article 22 of the IHR.67

In this declaration, China vowed to revise its Frontier Health and Quarantine Law to meet the 

needs of applying the IHR. In the later amendment to the Law on December 29, 2007, the only 

 

64 Mely Caballero-Anthony, SARS:A Matter of National Security, ASIA TIMES (Apr. 19, 2003), http://www.atimes. 

com/atimes/Southeast_Asia/ED19Ae01.html (last visited Oct. 24, 2014); Strategies to Fight World Health Threats, 

Such As SARS, Receive International Backing, WORLD HEALTH ORGANIZATION (May 23, 2003), http://www.who. 

int/mediacentre/news/notes/2003/npwha3/en/. 

65 Guowuyuan Guanyu Xiugai Zhonghua Renmin Gongheguo Guojing Weisheng Jianyi Fa Shishi Xize de Jueding 

[State Council Decree in Amending the Implementation Measures of the PRC Frontier Health and Quarantine Law] 

(State Council Decree [2010] No. 574, Apr. 24, 2010), http://www.gov.cn/flfg/2010-04/27/content_ 1594506.htm. 

66 Id. 

67 Zhongguo Zhengfu Shengming: Guoji Weisheng Tiaoli Shiyong yu Zhongguo Quanjing [Chinese Government 

Declaration: The International Health Regulations Apply to the Entire Territory of China], CENTRAL PEOPLE’S 

GOVERNMENT OF THE PEOPLE’S REPUBLIC OF CHINA (May 14, 2007), http://www.gov.cn/jrzg/2007-05/14/content_ 

614312.htm. 
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provision amended was the one on cross-border transportation of corpses.68 Nevertheless, the 

Law provides that in the event of any conflicts between it and the IHR, the IHR prevails.69

 

68 Guojing Weisheng Jianyi Fa [Frontier Health and Quarantine Law] (promulgated by the NPC Standing 

Committee, Dec. 2, 1986, amended Dec. 29, 2007), 2007 FAGUI HUIBIAN 384–88, English translation available at

Westlaw China. 

69 Id. art. 24. 
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Egypt 

George Sadek 

Senior Legal Analyst

SUMMARY Law No. 137 of 1958, as amended by Law No. 55 of 1979, regulates the powers of public 

health authorities in Egypt in the event of an infectious disease outbreak. Additionally, 

Presidential Decree No. 268 of 1975 defines the Ministry of Health’s mission and 

objectives. The World Health Organization has worked closely with the Egyptian Ministry 

of Health (MOH) to establish a cooperation strategy to prevent and control public health 

crises. The MOH posted on its official website an action plan to combat infectious diseases 

in public places, including schools and medical facilities. While no cases of Ebola have 

been reported in Egypt, the MOH has issued a precautionary announcement to Egyptians. 

I. Structure of Public Health Crisis Management System 

Egypt is a low-income, developing country with a per capita GDP of about LE47,050 

(approximately US$6,600).1

 The country is divided into twenty-seven governorates. The major 

provider of health care services is the Ministry of Health (MOH). Health services offered by the 

MOH are free of charge to all Egyptian citizens. Those services are subsidized by the Egyptian 

government. The MOH supervises a nationwide health care system that includes outpatient 

clinics and urban hospitals.2 The current structure of the health care system was developed 

during the 1960s under the administration of President Nasser, who adopted socialist 

economic policies.3

II. Powers of Public Health Authorities 

Law No. 137 of 1958, as amended by Law No. 55 of 1979 (Combating Contagious Diseases), 

defines the term “infectious disease” and regulates the powers of public health authorities in the 

event of an infectious disease outbreak.4

 Article 6 of the Law allows health authorities in any 

province of the country to require all individuals, including adults, to be vaccinated against any 

infectious diseases.5

 Article 10 grants the Minister of Health the power to issue necessary 

 

1 The World Factbook: Egypt, CENTRAL INTELLIGENCE AGENCY, https://www.cia.gov/library/publications/theworld-factbook/geos/eg.html (last updated June 22, 2014). 

2

 Ravi P. Rannan-Eliya, Claudio Blanco-Vidal & A.K. Nandakumar, The Distribution of Healthcare Resources in 

Egypt: Implications for Equity (Boston, Harvard School of Public Health, 2000), https://www. 

hsph.harvard.edu/ihsg/publications/pdf/No-81.PDF. 

3 HASSOUNA ALI & ABOU ALI, LEGAL ANALYSIS OF THE HEALTH SECTOR POLICY REFORM PROGRAM ASSISTANCE 

IN EGYPT, Technical Report No. 5, vol. IV (USAID Partnerships for Health Reform Project, Aug. 1996), 

http://pdf.usaid.gov/pdf_docs/Pnach250.pdf.

4

 Law No. 137 of 1958, al-Jarīdah al-Rasmīyah, vol. 27, 11 Sept. 1958, amended by Law No. 55 of 1979 

(Combating Contagious Diseases), al-Jarīdah al-Rasmīyah, vol. 47, 22 Nov. 1979. 

5 Id. art. 6. 
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decisions to monitor and quarantine specific individuals, including individuals coming from 

abroad if they are suspected of carrying an infectious disease.6

 Furthermore, article 12 requires 

that any individuals suspected of carrying an infectious disease be reported to health authorities.7 

Article 14 also authorizes health authorities to adopt all measures deemed necessary to curb a 

public health crisis.8 Finally, article 15 permits members of law enforcement agencies to inspect 

houses and places where individuals infected with infectious diseases might be located.9 

In addition to Law No. 137 of 1958, there is another law governing the area of public health. 

Presidential Decree No. 268 of 1975 defines the mission and objectives of the MOH. Article 1 

of the decree provides that the Ministry’s main mission is to protect the health of all Egyptian 

citizens through preventive and curative services at a centralized level.10 

The MOH has an array of objectives, which include the following: (1) shaping national health 

care policies; (2) recording health care data and conducting economic health studies; (3) 

providing centralized health services, including central laboratories, pharmaceutical services, and 

manpower training; (4) monitoring the quality of medicine; (5) offering effective management 

during public health crises; (6) administrating health services and units; and (7) coordinating 

with domestic medical units on the local level in all governorates.11

The administrative structure of the MOH consists of the following departments: (1) health care 

and nursing, (2) protective affairs and disease, (3) birth control, (4) treatment, (5) training and 

research, (6) technical support, and (7) provincial health affairs.12 

III. Transparency of Public Health Crisis Management System 

According to an action plan to combat infectious disease issued by the MOH, the Ministry is 

required to report any outbreak of infectious diseases in public places. The Ministry is also 

responsible for warning the public about the outbreak and decontaminating the affected places.13 

 

 

6 Id. art.10. 

7 Id. art 12. 

8 Id. art 14. 

9 Id. art 15. 

10 Presidential Decree No. 268 of 1975, al-Jarīdah al-Rasmīyah, vol. 2615, 23 Mar. 1975. 

11 Id. art. 2; see also, Objectives of the Ministry of Health, MINISTRY OF HEALTH [MOH], http://www.mohp.gov. 

eg/sites/minister/vision/default.aspx (in Arabic; last visited Oct. 16, 2014). 

12 The Administrative Structure of the Ministry of Health, MOH, http://www.mohp.gov.eg/about/orgchart/ 

default.aspx (in Arabic; last visited Oct. 16, 2014). 

13 Health Action Plan to Combat the Outbreak of Infectious Diseases, AL-WATAN (Oct. 10, 2012), http://www. 

masress.com/elwatan/59802. 
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IV. Cooperation with the World Health Organization 

Egypt is a member of the World Health Organization (WHO), to which Egypt is obligated to 

report any outbreak, emergence, or reemergence of infectious diseases.14 The WHO has also 

worked closely with the Egyptian MOH to establish a cooperation strategy to assist in the 

prevention of infectious disease outbreaks. The WHO’s local field office in Cairo, Egypt, has 

contributed to the Cairo Agenda for Action on Aid Effectiveness. According to a WHO progress 

report, the organization is currently working with health-related sectors, including the Ministry 

of Agriculture, to prevent an outbreak of the H5N1 influenza virus. It is also sharing expertise 

with the MOH to prevent and control the spread of hepatitis.15 

V. Response to the Outbreak of Infectious Diseases 

The MOH has posted on its official website an action plan to combat infectious diseases in 

public places, including schools and medical facilities.16 According to a WHO report, the MOH 

is responsible for providing all necessary immunizations and vaccinations to control and prevent 

the spread of infectious diseases. This strategy has led to a decline in the number of people 

infected with such diseases as H1N5 and hepatitis.17 

In an effort to monitor any possible outbreak, the Egyptian health authorities have joined the 

regional rotavirus surveillance network and launched a national rotavirus surveillance program. 

The MOH has also established similar surveillance programs for other viruses such as measles, 

rubella, haemophilus influenza type B, hepatitis, and tuberculosis.18

Finally, the MOH has established an active program to control any outbreak of infectious 

diseases in health care facilities. The Ministry has provided health care facilities across the 

country with necessary guidelines to deal with such public health crises.19 

VI. Response to the Ebola Virus Outbreak 

While no cases of Ebola have been reported in Egypt, in response to this global health threat the 

MOH has issued an announcement urging people to take the following precautionary measures: 

 

 

14 WORLD HEALTH ORGANIZATION [WHO], COUNTRY COOPERATION STRATEGY FOR WHO AND EGYPT 2010–2014 

(2010), http://www.who.int/countryfocus/cooperation_strategy/ccs_egy_en.pdf?ua=1. 

15 WHO, COUNTRY COOPERATION STRATEGY AT A GLANCE: EGYPT (Mar. 23, 2013), http://www.who.int/country 

focus/cooperation_ strategy/ccsbrief_egy_en.pdf. 

16 MOH, GUIDELINES ON COMBATING THE OUTBREAK OF INFECTIOUS DISEASES (2d ed. 2008), http://www.mohp.

gov.eg/programs/InfectFight/DocLib/part11.pdf (in Arabic). 

17 Law No. 137 of 1958, al-Jarīdah al-Rasmīyah, vol. 27, 11 Sept. 1958, p. 15. 

18 Id. p. 16. 

19 Presidential Decree No. 268 of 1975, al-Jarīdah al-Rasmīyah, vol. 2615, 23 Mar. 1975. 
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 Wash hands frequently with soap and water 

 Avoid touching any animals, especially sick ones 

 Avoid touching any sick person or coming in contact with his/her bodily fluids 

 Avoid touching surfaces that have come in contact with the body fluids of a sick person20 

 Avoid making unnecessary trips to West African countries where Ebola is active21 

The Ministry has also required international airports to report suspicious cases to the airport 

medical centers and determined that passengers entering Egypt from countries with suspected 

infectious disease outbreaks should be quarantined and have their temperature taken.22 

 

20 MOH, IMPORTANT GUIDANCE ON THE EBOLA VIRUS, MOH, http://www.mohp.gov.eg/DocLib/ ebola7.pdf (in 

Arabic; last visited Oct. 16, 2014). 

21 Press Release, MOH, Health: Tightening Quarantine Measures for the Port of Egypt on Those Arriving from 

Guinea Following the Outbreak of the Ebola Epidemic, Apr. 3, 2014, http://www.mohp.gov.eg/DocLib/ebola6.pdf. 

22 Id. 
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England 

Clare Feikert-Ahalt 

Senior Foreign Law Specialist

SUMMARY The public health crisis system in England is based on broadly drafted modernized 

legislation and regulations. It operates on a local level with primary health care providers 

using national guidelines to draft emergency plans. Designated agencies or departments 

are responsible for coordinating local efforts if the crisis becomes national or spills over 

into more than one local area. Multiagency groups help to coordinate the response. 

Cooperation and coordination is emphasized as essential to manage public health crises. 

The legislation regarding infectious diseases has recently been amended to take into 

account modern-day challenges and scientific knowledge. 

I. Structure of Public Health Crisis Management System 

A. Government Responsibilities 

The Secretary of State has a legal duty to protect public health in England from disease and other 

dangers.1

 The Secretary has established a number of bodies and programs to meet this duty. The 

National Resilience Capabilities Programme (NRCP) is the core framework through which the 

government is preparing for emergencies across all parts of the United Kingdom.2 This program 

aims to ensure that the UK has a well-prepared infrastructure that is able to address rapidly and 

effectively a wide range of emergencies. The program is divided into a number of different 

groups, one of which includes infectious diseases in humans.3 The Department of Health is the 

lead organization in planning for this type of emergency. 

The Department of Health, the National Health Service (NHS), Public Health England, and local 

government authorities4

 are the main organizations responsible for addressing public health 

crises and, under the NRCP, infectious diseases. These organizations are responsible for 

 

1

 Health and Social Care Act 2012, c. 7, § 11, http://www.legislation.gov.uk/ukpga/2012/7/contents/enacted, 

inserting § 2A into the National Health Service Act 2006, c. 41, http://www.legislation.gov.uk/ukpga/2006/ 

41/contents. 

2

 HM GOVERNMENT, EMERGENCY RESPONSE AND RECOVERY: NON STATUTORY GUIDANCE ACCOMPANYING THE 

CIVIL CONTINGENCIES ACT 2004, Oct. 2013, ¶ 3.4.2, https://www.gov.uk/government/uploads/system/uploads/ 

attachment_data/file/253488/Emergency_Response_and_Recovery_5th_edition_October_2013.pdf. 

3 Id. 

4

 “Local Authority” is defined in section 1 of the Public Health (Control of Disease) Act 1984, c. 22, as district 

councils, county councils, county borough councils in Wales, the Common Council of the City of London, the SubTreasurer of the Inner Temple and the Under-Treasurer of the Middle Temple, and the Council of the Isles of Scilly; 

see also UK Resilience, Pandemic Flu, CABINET OFFICE (Apr. 2008), http://www.cabinetoffice.gov.uk/ukresilience/ 

pandemicflu.aspx. 
Legal Responses to Health Emergencies: England 

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different aspects of planning for public health crises.5

 Public Health England, an Executive 

Agency of the Department of Health, is the national public health agency and responsible for 

fulfilling “the Secretary of State’s duty to protect the public’s health from infectious diseases and 

other public health hazards.”6

B. Department of Health 

The Department of Health is involved on an organizational level in the prevention and control of 

infectious diseases by developing policies and setting standards. It is the lead government 

department involved in planning for a human influenza pandemic.7

 Responsibility for the 

functions of the Department of Health rests with the Chief Medical Officer, the government’s 

principal medical advisor.8

 

There are a number of bodies that advise the Department of Health and the NHS on the control 

and prevention of infectious disease. One of these is Public Health England, an executive 

agency of the Department of Health.9

 Public Health England’s role is to “protect and improve 

the nation’s health and wellbeing, and reduce health inequalities”10 and its general duty is to 

fulfil the Secretary of State’s statutory duty to protect public health.11 It works in a number of 

areas to discharge these functions, such as providing the government, the NHS, public health 

professionals, and the public with scientific advice; supporting local government with advice on 

how to protect health; and ensuring that effective local and national arrangements are in place to 

respond to health protection concerns and emergencies.12 Public Health England is responsible 

for the Secretary of State’s duties under the Health and Social Care Act 2012. It replaced the 

 

5

 PUBLIC HEALTH ENGLAND, PANDEMIC INFLUENZA RESPONSE PLAN 2014, ¶¶ 1, 2, 2.3, 3.1, https://www.gov.uk/ 

government/ uploads/system/uploads/attachment_data/file/344695/PI_Response_Plan_13_Aug.pdf. Health is one 

area that has been devolved to the administrations in Northern Ireland, Scotland and Wales. However, in public 

health crises, the Department of Health takes responsibility for the response of the entire United Kingdom. 

6 Id. at 6. 

7 Id.; CABINET OFFICE, DEPARTMENTS RESPONSIBILITIES FOR PLANNING, RESPONSE, AND RECOVERY FROM 

EMERGENCIES, 2011, at 6, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/61354/ 

lead-government-department-march-2010.pdf. For more information on the role and responsibilities of lead 

government departments, see CABINET OFFICE: CIVIL CONTINGENCIES SECRETARIAT, THE LEAD GOVERNMENT 

DEPARTMENT AND ITS ROLE – GUIDANCE AND BEST PRACTICE, 2004, https://www.gov.uk/government/uploads/ 

system/uploads/attachment_data/file/61355/lead-government-departments-role.pdf. 

8

 Chief Medical Officer, Professor Dame Sally Davies, DEP’T OF HEALTH, https://www.gov.uk/government/people/ 

sally-davies (last visited October 21, 2014). 

9 About Us, PUBLIC HEALTH ENGLAND, https://www.gov.uk/government/organisations/public-health-england/about

(last visited October 21, 2014). 

10 DEP’T OF HEALTH AND PUBLIC HEALTH ENGLAND, FRAMEWORK AGREEMENT BETWEEN THE DEPARTMENT OF 

HEALTH AND PUBLIC HEALTH ENGLAND, Nov. 2013, at 1, https://www.gov.uk/government/uploads/system/ 

uploads/attachment_data/file/259756/DH-PHE_FRAMEWORK_AGREEMENT_FINAL_VERSION_FOR_ 

PUBLICATION_accessible.pdf. 

11 Id. ¶ 2.1. 

12 Id. ¶ 2.2. 
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Health Protection Agency as a “category 1” responder13 under the Civil Contingencies Act 2004 

in respect of health hazards and emergencies caused by infectious diseases, chemicals, poisons, 

and radiation.14 Public Health England operates in a number of ways to both respond to and help 

prevent health emergencies, such as by providing advice to the public on how to remain healthy 

and avoid hazards, conducting surveillance to detect any threats, and preparing plans to ready the 

nation for any future threats to its health.15 Its functions are described as combining “public 

health and scientific knowledge, research and emergency planning within one organization.”16

C. National Health Service 

The National Health Service (NHS) is responsible for the diagnosis and treatment of individuals 

with infectious diseases, as well as for improving and protecting the health of the population.17 

Regarding the latter two functions, the NHS has a broad array of responsibilities to prevent and 

control infectious diseases that include implementing health programs, preventing the spread of 

the disease, surveying the local community, and monitoring any emergence or transmission of 

infectious disease. 

Under the Civil Contingences Act the NHS must demonstrate the ability to effectively respond to 

an emergency, including infectious disease outbreaks.18 This type of preparation in England is 

known as emergency preparedness, resilience, and response (EPRR).19 To manage its EPRR 

responsibilities, the NHS has established commissioning boards and clinical commissioning 

groups.20 It has also established local health resilience partnerships to coordinate the work and 

planning for EPRR across all health bodies.21

 

13 Category 1 responders are designated by the Civil Contingencies Act; they are “likely to be at the core of the 

response to most emergencies [and] are subject to the full range of civil protection duties in the Act.” They 

currently include the police, fire and rescue, health bodies, the Maritime and Coastguard Agency, local authorities 

and the Environment Agency. HM GOVERNMENT, EMERGENCY RESPONSE AND RECOVERY: NON STATUTORY 

GUIDANCE ACCOMPANYING THE CIVIL CONTINGENCIES ACT 2004, 2013, ¶ 3.2 & Glossary at 217, 

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/253488/Emergency_Response_and_

Recovery_5th_edition_October_2013.pdf. See also Part I(I), infra. 

14 Id. ¶ 3.2.22. 

15 Dep’t of Health and Public Health England ¶ 6.5. 

16 Id. ¶ 6.7. 

17 National Health Services Act 2006, c. 41, §§ 1 and 7, http://www.legislation.gov.uk/ukpga/2006/41/contents. 

18 Civil Contingencies Act 2004, c. 36, § 2 and sched. 1, http://www.legislation.gov.uk/ukpga/2004/36/contents. 

19 NHS ENGLAND, NHS ENGLAND CORE STANDARDS FOR EMERGENCY PREPAREDNESS, RESILIENCE AND RESPONSE 

(EPRR) (July 2014), http://www.england.nhs.uk/wp-content/uploads/2014/07/eprr-core-standards-0714.pdf. 

20 NHS COMMISSIONING BOARD, NHS COMMISSIONING BOARD EMERGENCY PREPAREDNESS FRAMEWORK 2013, 

¶ 1.4, http://www.england.nhs.uk/wp-content/uploads/2013/03/eprr-framework.pdf. As of April 1, 2013, this 

guidance superseded both The NHS Emergency Planning Guidance 2005 and the Arrangements for Health 

Emergency Preparedness, Resilience and Response from April 2013.

21 NHS ENGLAND, supra note 19. 
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D. Local Authorities 

Local authorities have a number of statutory obligations and powers to control the spread of 

infectious diseases under the Public Health (Control of Disease) Act 1984.22 The types of 

infectious diseases that trigger the local authorities’ powers under the Public Health (Control of 

Disease) Act are known as notifiable diseases and are specified in the Act and the regulations 

made under the Act.23 Additional infectious diseases have been added to the list through 

regulations, and the Secretary of State has discretion to add more, although the inclusion of any 

further disease is dependent upon the impact of the disease.24 Diseases subject to the WHO’s 

International Health Regulations are contained in the list. Doctors and health care providers also 

have the duty to report other diseases that pose a significant risk to human health.25 

All incidents of notifiable diseases must be reported to an officer appointed by the local 

authority.26 There are no requirements in the legislation as to whom should be appointed, but 

typically the post goes to the local Consultant in Communicable Disease Control. Doctors and 

health care providers are under a legal duty to complete the notification form immediately on 

suspecting or diagnosing a notifiable disease. Lab confirmation of the suspected disease is not 

needed in order for notification to occur.27 Once notified, the proper officer must report the case 

to Public Health England within three days, or twenty four hours for urgent cases.28

To ensure that health needs are met on a local level, local authorities can order that a disease not 

provided for in the Public Health (Control of Disease) Act or in regulations issued by the 

Secretary of State be labeled a notifiable disease within its designated area.29 The order must 

specify the provisions in the Public Health (Control of Disease) Act that apply to the disease and, 

unless the situation is an emergency, be approved by the Secretary of State.30

 

22 Public Health (Control of Disease) Act 1984, c. 22, §§ 1–2, http://www.legislation.gov.uk/ukpga/1984/ 

22/contents. 

23 Id. § 10. Current notifiable disease are acute encephalitis, acute infectious hepatitis, acute meningitis, acute 

poliomyelitis, anthrax, botulism, brucellosis, cholera, diphtheria, enteric fever (typhoid or paratyphoid fever), food 

poisoning, hemolytic uremic syndrome (HUS), infectious bloody diarrhea, invasive group A streptococcal disease, 

legionnaires’ disease, leprosy, malaria, measles, meningococcal septicemia, mumps, plague, rabies, rubella, severe 

acute respiratory syndrome (SARS), scarlet fever, smallpox, tetanus, tuberculosis, typhus, viral hemorrhagic fever 

(VHF), whooping cough, and yellow fever. 

24 Health Protection (Notification) Regulations 2010, SI 2010/695, http://www.legislation.gov.uk/uksi/2010/ 

659/made. 

25 Guidance: Notifiable Diseases and Causative Organisms: How to Report, PUBLIC HEALTH ENGLAND (May 1, 

2010), https://www.gov.uk/notifiable-diseases-and-causative-organisms-how-to-report. 

26 Health Protection (Notification) Regulations 2010, ¶¶ 2–3, http://www.legislation.gov.uk/uksi/2010/659/made. 

27 Id.; see also PUBLIC HEALTH ENGLAND, supra note 5. 

28 Public Health England, supra note 5. 

29 Public Health (Control of Disease) Act 1984, c. 22, § 16(1). 

30 Id. § 16(2). 
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E. Civil Contingencies Secretariat 

The Civil Contingencies Secretariat (CCS) assists the government in preparing for public health 

crises. The CCS was established in 2001 as part of the Cabinet Office to improve the UK central 

government’s ability to prepare for and handle emergencies.31 The CCS assists relevant 

organizations, both within the government and outside of it, in planning and preparing responses 

to emergency situations. The work of the CCS concentrates on four main areas: risk assessment, 

preparation and planning, response and recovery, and building a resilient society. 32

F. Department for Environment and Rural Affairs 

The Department of Environment, Food and Rural Affairs (DEFRA) plays an important role in 

any health crisis related to a disease that can be transmitted from animals to humans.33 The 

Minister of Agriculture has wide-ranging powers, which are discussed in Part II(E), below. 

G. Port Health Authorities 

Port health authorities also exist throughout England.34 During an emergency, their primary 

function is to control infectious diseases at ports of entry into the country.35 The port health 

authorities may be part of a local authority, or in some cases they may be a single authority that 

conducts the functions across a number of local authorities. The port health authorities work 

closely with a number of other government bodies.36

H. Collection of Public Health Information 

Diseases surveillance in the UK is based on statutory reporting required of doctors and other 

health workers who diagnose or suspect notifiable diseases.37 Statutory reporting requirements 

are contained in the Public Health (Control of Disease) Act and the Health Protection 

(Notification) Regulations 2010. The Act requires registered medical practitioners who become 

aware or suspect that a patient is suffering from a notifiable disease to submit a certificate 

containing the patient’s details to the local authority.38 Laboratories that confirm the diagnosis 

 

31 Cabinet Office and National Steering Committee on Warning & Informing the Public, Improving the UK’s Ability 

to Absorb, Respond to and Recover from Emergencies, http://www.cabinetoffice.gov.uk/ukresilience/ ccs.aspx (last 

updated Sept. 18, 2014). 

32 Id. 

33 About Us, DEP’T FOR ENV’T, FOOD & RURAL AFFAIRS, https://www.gov.uk/government/organisations/departmentfor-environment-food-rural-affairs/about (last visited Nov. 5, 2014). 

34 Public Health (Control of Disease) Act 1984, §§ 1–2. 

35 HM GOVERNMENT, supra note 2, ¶ 3.2.26. 

36 Id. ¶ 3.2.26. 

37 Health Protection (Notification) Regulations 2010, ¶¶ 2–3. 

38 Public Health (Control of Disease) Act 1984, § 11. An example of a reporting form is available online at 

Notifiable Diseases: Form for Registered Medical Practitioners, PUBLIC HEALTH ENGLAND (Feb. 17, 2010), 

https://www.gov.uk/government/publications/notifiable-diseases-form-for-registered-medical-practitioners. 
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of a notifiable disease are under a legal duty to inform Public Health England with the details of 

each case of a notifiable disease.39 Public Health England then collates this information and 

publishes reports with an analysis of any trends.40

I. Decisions and Decision Makers 

In the United Kingdom, the decision makers are determined according to the structure provided 

by the Civil Contingencies Act 2004.41 All responder organizations designated as category 1 

under this statute follow a nationally recognized structure of three different levels of command—

operational, tactical, and strategic.42 Operational (also known as bronze) command refers to 

people managing the working elements of the response in such settings as hospital wards or the 

scenes of major incidents.43 Tactical (also known as silver) command is responsible for 

managing an organization’s response to an incident. Tactical command must ensure that plans 

are in place to achieve objectives set by strategic command and that operational command 

provides an efficient, coordinated response.44 Strategic (also known as gold) command has 

overall command of the organization’s resources. This level of command liaises with partners to 

develop strategy and policies and allocates funding to help address incidents.45 

For incidents and emergencies involving several organizations and agencies, a Strategic 

Coordinating Group may be convened to coordinate.46 The NHS’s emergency response teams 

take the form of area Commissioning Boards. In cases of wide-reaching emergencies, the 

Commissioning Board national team can assume command of all of the resources of the NHS 

across England, and the regional Commissioning Boards take action based on the commands of 

that team.47

J. Crisis Triggers 

In addition to regional procedures for outbreaks of infectious diseases, a general health crisis in 

England is referred to under the broader term “major incident.” The NHS defines the term as 

[a]ny occurrence that presents serious threat to the health of the community, disruption to 

the service or causes (or is likely to cause) such numbers or types of casualties as to 

 

39 Health Protection (Notification) Regulations 2010, ¶ 5. 

40 Notifiable Diseases: Current Weekly Report, PUBLIC HEALTH ENGLAND, https://www.gov.uk/government/ 

publications/notifiable-diseases-current-weekly-report (last updated Nov. 5, 2014). 

41 Civil Contingencies Act 2004, c. 36, sched. 1, http://www.legislation.gov.uk/ukpga/2004/36/contents. 

42 NHS Commissioning Board, NHS Commissioning Board Command and Control Framework for the NHS During 

Significant Incidents and Emergencies, Jan. 7, 2013, ¶ 5.1, http://www.england.nhs.uk/wpcontent/uploads/2013/01/comm-control-frame.pdf. 

43 Id. ¶ 5.2. 

44 Id. ¶ 5.2. 

45 Id. ¶ 5.2. 

46 Id. ¶ 5.3. 

47 Id. ¶ 6.1.18. 
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require special arrangements to be implemented by hospitals, ambulance trusts or other 

acute or community provider organisations.48

In addition to health crises, major incidents include chemical, biological, radiological, or nuclear 

incidents; train crashes; and incidents involving terrorism. 

II. Powers To Prevent the Spread of Disease 

A. Legal Overview 

The government was criticized at the turn of the century for not having a clear, coherent 

legislative and regulatory framework for an effective public health crisis system that could deal 

with major health risks, particularly the risk of human pandemic diseases.49 A 2003 report from 

the House of Lords recommended that the roles and responsibilities of the groups involved in the 

fight against infectious disease be more clearly defined.50 The result of this report was the 

development of the NHS’s Emergency Planning Guidance, first published in 2005.51 This 

guidance provides general principles on how NHS organizations should handle major incidents, 

which are defined to encompass “big bang” incidents, such as casualties arising from a terrorist 

attack, and “rising tide” incidents, such as an infectious disease epidemic.52 

The primary piece of legislation that addresses public health emergencies is the Public Health 

(Control of Disease) Act 1984.53 This Act served to consolidate a number of pieces of 

legislation from the nineteenth century, much of which was “directly derived from Victorian 

antecedents.”54 The laws were based on the scientific knowledge and social circumstances of 

those times and, therefore, did not address modern risks, such as contamination from chemicals 

or radiation. This Act was reformed in 2009 after the Law Reform Commission recommended 

that public health legislation was overdue for review,55 noting that the scientific understanding of 

disease contagion at the time the laws were drafted were not congruent with today’s scientific 

knowledge. Additional powers to detain individuals suffering from diseases caused concern that 

the Law would not stand up to a challenge brought under the Human Rights Act 1998, as it 

 

48 Id. ¶ 1.4. 

49 A STRONG BRITAIN IN AN AGE OF UNCERTAINTY: THE NATIONAL SECURITY STRATEGY, Cm. 7953, 2010–11, 

¶ 3.38, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/61936/national-securitystrategy.pdf. 

50 HOUSE OF LORDS, SELECT COMMITTEE ON SCIENCE AND TECHNOLOGY, FIGHTING INFECTION, FOURTH REPORT, 

H.L. 138, 2002–03, http://www.publications.parliament.uk/pa/ld200203/ldselect/ldsctech/138/138.pdf. 

51 National Health Service: Department of Health, Emergency Preparedness Division, NHS Emergency Planning 

Guidance 2005: Underpinning Materials, ¶ 2.2.4, http://webarchive.nationalarchives.gov.uk/20130107105354/ 

http:/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_081303.pdf. 

52 Id. 

53 Public Health (Control of Disease) Act 1984, c. 22, http://www.legislation.gov.uk/ukpga/1984/22/contents. 

54 THE LAW COMMISSION: NINTH PROGRAMME OF LAW REFORM, March 2005, H.C. 535, http://lawcommission. 

justice.gov.uk/docs/lc293_9th_Programme.pdf. 

55 Id. ¶ 4.4. 
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would be “difficult [for the government] to argue that exercise of these powers is ‘necessary’ or 

even effective in disease control.”56 The Law Reform Commission expressed “fear . . . that the 

effectiveness of the British response to a major outbreak of contagious disease could be 

significantly impaired by the defects in the law.”57 

As a result of these concerns, the government enacted the Health and Social Care Act 2008, 

which repealed a large number of provisions in the Public Health (Control of Disease) Act 

1984.58 The amendments aimed to bring the provisions concerning infections up to date and take 

into account other concerns, such as radiation and chemical contamination. The updated 

provisions of the 1984 Act provide two areas under which regulations may be made in relation to 

diseases. The first relates to in-country provisions and the second to England’s 

international borders.59

B. Current Laws and Regulations 

Under the Health and Social Care Act 2008, the Secretary of State may make regulations 

(referred to as “health protection regulations”) to prevent, protect against, control, and provide a 

public health response to an incident or to the spread of infection or contamination in England, 

even if the threat originated from outside the country.60 The Law provides examples of powers 

that the Secretary of State may exercise by regulation, including 

 imposing or enabling restrictions or requirements on individuals in the event of, or in 

response to, a threat to public health; or 

 providing local authorities with functions to monitor public health risks.61 

The restrictions may include keeping a child away from school, prohibitions or restrictions on 

events or gatherings, a “special restriction or requirement” or “Part 2A order,” 62 or requirements 

 

56 Robyn Martin, The Exercise of Public Health Powers in Cases of Infectious Disease: Human Rights Implications, 

14(1) MED. LAW REV. 132, 136 (2006), http://medlaw.oxfordjournals.org/content/14/1/132.full. pdf+html. See also

THE LAW COMMISSION, supra note 54, ¶ 4.6. 

57 THE LAW COMMISSION, supra note 54, ¶ 4.10. 

58 Health and Social Care Act 2008, c. 14, http://www.legislation.gov.uk/ukpga/2008/14/contents. See also DEP’T 

OF HEALTH, REVIEW OF PARTS II, V AND VI OF THE PUBLIC HEALTH (CONTROL OF DISEASE) ACT 1984: REPORT ON 

CONSULTATION (Nov. 2007), http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Consultations/ 

Responsestoconsultations/DH_080384.

59 Public Health (Control of Disease) Act 1984, c. 22, Part 2A, as inserted by the Health and Social Care Act 2008, 

c. 14, § 129, http://www.legislation.gov.uk/ukpga/2008/14/section/129. The Health Protection (Notification) 

Regulations 2010, 2010/659, form part of the in-country regulations. 

60 Id. § 45C, as inserted by Health and Social Care Act 2008, c. 14, § 129. 

61 Id. 

62 “Special restriction or requirement” is defined in the Act as meaning: “a restriction or requirement which can be 

imposed by a justice of the peace by virtue of section 45G(2), 45H(2) or 45I(2) of the PHA.” Id. § 45C(6)(a). 

Special restrictions may only be imposed in response to a “serious and imminent threat to public health, or . . . 

contingent on there being such a threat at the time when it is imposed.” Id. § 45D(4). Part 2A orders are 

described below. 
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with regard to the handling and treatment of dead bodies.63 Any restriction imposed under the 

provisions of this Act must be proportionate with the aim that it is trying to achieve,64 in order to 

comply with human rights principles adopted in the UK. 

The Secretary of State may not make regulations requiring that a person receive medical 

treatment, including vaccinations, as was the case under previous legislation. However, special 

requirements and restrictions may, if there is a serious and imminent threat to public health, 

require “medical examinations, removal to or detention in a hospital or other establishment, or 

isolation or quarantine.”65 

The statute limits the powers and penalties the regulations may confer. The regulations can 

 confer functions on local authorities and other persons; 

 create offenses, although these cannot be punishable with imprisonment or a fine of more 

than £20,000 (approximately US$35,000); 

 enable courts to order that anyone convicted of an offense under the regulations take or pay 

for remedial action; 

 make regulations that apply to different areas of the country;66 

 provide for the execution and enforcement of restrictions or requirements imposed; 

 provide for a system of appeals from and reviews of decisions made under the regulations; 

 allow or prohibit charges to be levied; 

 permit or require the payment of incentive payments, compensation, and expenses; and/or 

 provide for the resolution of disputes.67

To prevent the spread of infection or contamination, the Public Health (Control of Disease) Act 

provides that Justices of the Peace may impose restrictions and requirements on individuals, 

premises, groups, and objects through orders, known as “Part 2A Orders.” Only local authorities 

may apply to a Justice of the Peace for a Part 2A Order, and these orders may, in certain 

circumstances, be made without notifying the individual affected by the Order.68 Once made, an 

individual affected by the order, the local authorities, or any other body that is responsible for 

enforcing or executing the order may apply to have it revoked or varied.69 

 

63 Id. § 45C. 

64 Id. § 45D. 

65 Id. §§ 45D–E. Health and Social Care Act 2008, Explanatory Notes, ¶ 408, http://www.legislation.gov.uk/ukpga/ 

2008/14/notes/contents. 

66 Public Health (Control of Disease) Act 1984, c. 22, § 45P, as inserted by the Health and Social Care Act 2008, 

c. 14, § 129. 

67 Id. § 45F. 

68 Id. § 45M. 

69 Id. 
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Such an order may require that an individual 

 submit to medical examination; 

 be removed to a hospital or other suitable establishment; 

 be detained in a hospital or other suitable establishment (unless otherwise stated, for a 

maximum period of twenty-eight days);70

 be kept in isolation or quarantine (unless otherwise stated, for a maximum period of twentyeight days);71

 be disinfected or decontaminated; 

 wear protective clothing; 

 provide information or answer questions about their health or other circumstances; 

 have their health monitored and the results reported; 

 attend training or advice sessions on how to reduce the risk of infecting or 

contaminating others; 

 be subject to restrictions on where they go or with whom they have contact; and 

 abstain from working or trading. 

The Justice of the Peace may issue the order only if he/she is satisfied that a person may be 

infected or contaminated, could present significant harm to human health, and there is a risk the 

person may infect or contaminate others.72 The Justice of the Peace may also order that the 

suspected infected or contaminated person provide information about the identity and location of 

other individuals that may be infected or contaminated who pose a risk to others, to enable 

“contact tracing” of these individuals.73 

Justices of the Peace have similar powers to make orders in relation to premises or things that 

may be infected or contaminated when they could present significant harm to human health and 

there is a risk that they may infect or contaminate humans.74

For items (things), the order may impose a number of restrictions or requirements, including that 

the thing be seized; retained; isolated; quarantined; disinfected; decontaminated; destroyed; 

disposed of; or, in the case of dead bodies, cremated or buried.75 For premises, the order may 

impose restrictions or requirements, including that the premises be closed, disinfected, 

 

70 Id. § 45L. 

71 Id. 

72 Id. § 45G. 

73 Id. 

74 Id. §§ 45H–I. 

75 Id. § 45H. 
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decontaminated, or destroyed. For conveyances or other moveable structures, the order may 

require that they be detained.76 

To enable contact tracing to help prevent the spread of infection or contamination, the order may 

require the owner or person in control of the thing or premises to provide information or answer 

questions about the thing or premises.77

The Justice of the Peace may also issue additional orders to include “such other restrictions or 

requirements as the justice considers necessary for the purpose of reducing or removing the risk 

in question.”78 The order may be conditional; for example, if a person refuses to be 

decontaminated, he/she must remain in isolation until the risk of contamination or infection 

has passed. 

C. Aircraft and Ships 

The Secretary of State has the authority to make regulations to prevent the spread of infection or 

other contamination through vessels, aircraft, trains, or other conveyances leaving or arriving at 

any place, or to give effect to any international arrangement regarding the spread of infection or 

contamination.79 The regulations may cover issues such as 

 detaining conveyances; 

 requiring the medical examination, detention, isolation, or quarantine of individuals; 

 inspecting, analyzing, retaining, isolating, quarantining, or destroying “things” (objects); 

 disinfecting, decontaminating, or using other sanitary measures for conveyances, persons, 

or things; 

 prohibiting or regulating the arrival or departure of conveyances and the entry and exit of 

persons or things; 

 imposing duties on masters, pilots, train managers, and other persons on board conveyances 

and on owners and managers of ports, airports, and other points of entry; or 

 requiring persons to provide information or answer questions (including information or 

questions relating to their health).80

 

76 Id. § 45I. 

77 Id. §§ 45H–I. 

78 Id. § 45K; Health and Social Care Act 2008, c. 14, Explanatory Notes, ¶ 419, http://www.legislation.gov.uk/ 

ukpga/2008/14/contents. 

79 Id. § 45B. 

80 Id. 
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D. Sanctions and Fines for Failing to Comply with Requirements 

Failing to comply with the requirements of an order without a reasonable excuse can result in a 

fine of up to £20,000 (approximately US$35,000). Where the court is satisfied that the “failure 

or willful obstruction constituting the offence has caused premises or things to become infected 

or contaminated or otherwise damaged them in a material way” by an individual convicted of an 

offense under the Act, the court may require the individual to take or pay for remedial action.81 

The police may take individuals that contravene an order of detention, isolation, or quarantine 

into custody and return them to the place specified in the order.82

E. Animals and Disease 

England’s experience with Bovine Spongiform Encephalopathy (BSE) and foot and mouth 

disease has caused it to introduce numerous pieces of legislation to prevent the spread of such 

diseases and halt any impact they might have on public health. The Animal Health Act 198183

(the 1981 Act) contains broad provisions ranging from requiring the disinfection and cleansing 

of places where animals reside or visit, to prohibiting animal movement and imports, to requiring 

vaccinations and the slaughter of animals. 

The Minister of Agriculture has wide-ranging powers under the 1981 Act and can issue orders 

setting standards for the declaration of infected areas that state who can declare an area as 

infected, as well as the effect, consequence, and duration of such a declaration.84 The Minister 

can make orders prescribing the seizure, detention, or disposal of diseased animals, or those 

suspected of being diseased. To prevent and reduce the risk of spreading any animal disease to 

humans, the Minister can make an order providing that any provision of the 1981 Act will apply 

to a specified disease.85 

Enforcement of the 1981 Act falls to the police, who can arrest and detain any person suspected 

of, or found committing, an offense under the Act. Punishment is either imprisonment and/or a 

fine. If a person infects an animal with a disease specified in the 1981 Act, he/she is guilty of an 

offense and can be fined and/or imprisoned for up to two years, as well as disqualified from 

keeping or dealing with any animals.86

F. Vaccines 

The UK currently does not have the capability to produce large numbers of vaccines; most are 

purchased from France and Belgium.87 Certain strategic vaccines and drugs are being 

 

81 Id. § 45O. 

82 Id. § 45N. 

83 Animal Health Act 1981, c. 22, as amended, http://www.legislation.gov.uk/ukpga/1981/22/contents. 

84 Id. § 17, as amended. 

85 Id. § 29, as amended. 

86 Id. § 28A–B. 

87 HOUSE OF LORDS, supra note 50, ¶ 4.8. 
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stockpiled; however, owing to concerns that information on these items may prove useful to 

terrorists, the government has not publicly disclosed any further details. During the outbreak of 

the swine flu in 2009, the government stated it had enough antivirals on hand to treat thirty-three 

million people in the UK—half of the population.88 

III. Transparency of Public Health Crisis Management System 

A. Disclosing Information to the Public 

There is a duty under the Civil Contingencies Act 200489 for those connected with the public 

health crisis system to disclose information to the public, and the NHS has noted that this is 

based upon the “belief that a well-informed public is better able to respond to an emergency, and 

to minimise the impact of the emergency on the community and on NHS services.”90 The NHS 

follows the Civil Contingencies Act Ten Step Cycle91 of communications, which helps to 

provide for effective communication.92 The Civil Contingencies Act 2004 places two duties on 

responders to public health crises. The first duty is to warn and inform the public of any likely 

risks and threats that NHS organizations may address, and of any planned responses to these 

risks and threats. The second duty is the organization’s response to a crisis. The NHS notes that 

when making information available to the public in crises, the communications must be “simple 

and easily digestible.”93 

B. Methods of Dissemination 

There is no formal emergency broadcast system in England for public health crises, but there are 

long-standing protocols as to how information should be disseminated. The NHS has 

implemented a web-based cascade system known as the Central Alerting System that issues 

“patient safety alerts, important public health messages and other safety critical information and 

guidance to the NHS and others.”94 The NHS notes that the media will play a key role in 

disseminating information to the public and that there must be clear guidelines for providing 

clear and accurate information through these means.95 

 

 

88 Statement on Swine Flu/AH1N1, DEP’T OF HEALTH, http://webarchive.nationalarchives.gov.uk/+/www.dh. 

gov.uk/en/MediaCentre/Pressreleasesarchive/DH_098573?PageOperation=email (last updated Apr. 27, 2009).

89 Civil Contingencies Act 2004, c. 36, http://www.legislation.gov.uk/ukpga/2004/36/contents. 

90 NHS COMMISSIONING BOARD, supra note 20, ¶ 12.12.

91 GOV.UK, CIVIL CONTINGENCIES ACT (2004): DUTY TO COMMUNICATE WITH THE PUBLIC, 2007, https://www.gov. 

uk/government/uploads/system/uploads/attachment_data/file/60906/10_step_cycle.pdf. 

92 NHS COMMISSIONING BOARD, supra note 20, ¶ 12.27(h). 

93 Id. 

94 Central Alerting System, NHS, https://www.cas.dh.gov.uk/Home.aspx (last visited October 29, 2014). 

95 NHS COMMISSIONING BOARD, supra note 20, ¶ 12.25. 
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C. Effectiveness of the Communications System 

The BSE crisis, followed by the foot and mouth epidemic, led to a massive loss of public 

confidence in “official pronouncements about infectious disease issues” from government 

institutions.96 This loss of confidence was exacerbated by the government repeatedly stating that 

certain events pose no risk to the public’s health.97 National Audit Office examinations of 

debriefs to the media also found that there was a lack of coordination and consultation in 

disseminating this information, resulting in inappropriate health advice being given to 

the public.98 

The communication system during the swine flu outbreak in 2009 appeared to operate 

effectively, with statistics on individuals who were tested for the flu, as well as those who tested 

positive, available on the Internet from reliable government pages and distributed via 

the media.99

IV. Cooperation with the WHO 

England complies with the WHO’s International Health Regulations. The provisions from these 

regulations were implemented in the Public Health (Control of Disease) Act,100 as supplemented 

by regulations. 

V. Recent Developments 

Public Health England has helped to provide enhanced screening for Ebola at England’s main 

ports of entry (Heathrow, Gatwick, and St. Pancras). “Targeted Passengers” are those identified 

by the Border Force officers as those who have travelled from Sierra Leone, Guinea and Liberia. 

These passengers must have their temperature taken and complete a questionnaire that includes 

information about their current health, travel history, and any contact with Ebola patients. The 

results of these tests and questions will determine whether the person will be permitted to 

continue their journey with advice or receive additional checks and possibly be transferred to 

a hospital.101

 

96 HOUSE OF LORDS, supra note 50, ¶ 7.20. 

97 Most notably, during government announcements in the midst of the BSE crisis, the government reassured the 

public that British beef was safe to eat, with the Agriculture Minister feeding his daughter a beef burger to 

demonstrate the point. In the BSE case, the government later asserted that its statement about British beef being safe 

to eat did not mean that there was no risk involved. 

98 COMPTROLLER & AUDITOR GENERAL, NATIONAL AUDIT OFFICE, FACING THE CHALLENGE: NHS EMERGENCY 

PLANNING IN ENGLAND, H.C. 36, 2002–03, at 37, http://www.nao.org.uk/wp-content/uploads/2002/11/020336.pdf. 

99 DEPARTMENT OF HEALTH ET AL., UK PANDEMIC INFLUENZA COMMUNICATIONS STRATEGY 2012, at 15, 

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213268/UK-Pandemic-InfluenzaCommunications-Strategy-2012.pdf. 

100 Public Health (Control of Disease) Act 1984, c. 22, http://www.legislation.gov.uk/ukpga/1984/ 22/contents. 

101 Press Release, Public Health England, Department of Health and NHS England, Enhanced Ebola Screening 

Process Begins (Oct. 14, 2014), https://www.gov.uk/government/news/public-health-england-enhanced-ebolascreening-process. 
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France 

Nicolas Boring 

Foreign Law Specialist*

SUMMARY At the national level in France, the management of a public health crisis caused by a 

communicable disease is primarily the responsibility of the Ministry of Health, which is 

aided in its task by public establishments under its supervision such as the Institut de 

Veille Sanitaire, France’s national health monitoring institute. At the local level, the 

prefects, who are the state representatives, have also been given specific powers in times 

of epidemic crisis. A reserve health corps was created in 2007. 

France drew up its first comprehensive national plan for the prevention and control of an 

influenza pandemic in 2004, and last updated it in 2011. The plan is aimed at protecting 

the French population, as well as French citizens living abroad, against a pandemic threat 

and limiting the social and economic consequences of a pandemic. 

Recently, the government has taken steps to prevent or limit the spread of the Ebola virus 

in France. These steps include screenings at airports in at-risk countries, the preparation 

of specialized wards in hospitals, and the dissemination of information to both health care 

professionals and the general public.

I. Introduction 

Public health crises can take many forms, such as disease epidemics; large-scale incidents of 

food or water contamination; and harmful exposure to chemical, radiological, or biological 

agents. Their causes may be natural, accidental, or deliberate. How France deals with a crisis 

and which public authorities are involved depends on the nature of the crisis. This report first 

focuses on the operational management of a public health crisis caused by a communicable 

disease. It then addresses, as examples, the 2009 national plan for the prevention and control of 

an influenza pandemic, and measures recently taken in the context of the current Ebola crisis. 

The administrative division of France plays a role in how the government prepares for and 

manages a health crisis. France is divided into twenty-two regions, and there are ninety-six 

départements within metropolitan France. Each département has a préfet (prefect), who is the 

representative of the central government. For purposes of emergency planning, France is also 

divided into seven zones of defense, each under the responsibility of a zone prefect who will 

manage emergency crises exceeding the boundaries of the département.

1

 The region prefects are 

also given specific powers in times of epidemic crisis.2 Finally, France has incorporated into its 

 

*

 This is a revised and updated version of a report authored in 2009 by Nicole Atwill, Senior Legal Specialist at the 

Law Library of Congress (retired). 

1

 CODE DE LA DEFENSE art. R.1211-4, http://www.legifrance.gouv.fr/affichCode.do?cidTexte=LEGITEXT 

000006071307&dateTexte=20141028. 

2

 CODE DE LA SANTE PUBLIQUE art. L.3131-8, http://www.legifrance.gouv.fr/affichCode.do?cidTexte=LEGITEXT 

000006072665&dateTexte=20141028. 
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national law the 2005 International Health Regulation adopted by the World Health 

Organization’s (WHO’s) Fifty-eighth World Health Assembly on May 23, 2005,3

 which also has 

an impact on the management of public health crises. 

II. Structure of Public Health Crisis Management System 

The operational management of a public health crisis caused by a communicable disease 

principally involves the Ministry of Health; the Ministry of Interior; the Institut de Veille 

Sanitaire (InVS), which is France’s national health monitoring institute; the préfets (prefects), 

who are the state representatives in the départements; and the mayors. A reserve health corps 

was also created in 2007. 

A. Directorate General of Health 

The Ministry of Health is divided into several directorates. Among them, the Direction Générale 

de la Santé (DGS, the General Directorate of Health) sets forth health policies and, as a guarantor 

of health security, may take any measures to prevent or respond to public health crises—in 

particular, a crisis related to communicable diseases. Following audits and reports prepared after 

the SARS (severe acute respiratory syndrome) and other health crises, the DGS was reorganized 

in 2007 to reinforce its action on prevention, to better manage emergencies and health threats, 

and to improve its governance and performance.4

 

The Health Code provides that when an epidemic threatens the country or part of the country and 

local means are insufficient to stop it, the Minister of Health may, by means of a ministerial 

regulation, set forth all appropriate measures and allocate duties to prevent the spread of such 

disease. The decree may give authority to the prefects to implement one or more of the needed 

measures.5

 The measures taken are regularly reviewed by the High Council for Public Health 

(Haut Conseil de la Santé Publique), which checks whether they are appropriate.6 Created in 

2004, this Council comprises six specialized commissions: transmissible diseases; chronic 

diseases; risks linked to the environment; patient safety; education and promotion of health; and 

lastly, evaluation and strategy.7

 One of its missions is to provide the necessary expertise for the 

 

3

 Décret No 2007-1073 du 4 juillet 2007 portant publication du règlement sanitaire international (2005) adopté par la 

cinquante-huitième Assemblée mondiale de la santé le 23 mai [Decree No. 2007-1073 of July 4, 2007, on the 

publication of the International Health Regulations (2005) Adopted by the Fifty-eighth Health Assembly on May 23, 

2005], JOURNAL OFFICIEL DE LA RÉPUBLIQUE FRANÇAISE [J.O.] [OFFICIAL GAZETTE OF FRANCE], July 7, 2007, 

p. 11570, http://www.legifrance.gouv.fr/affichTexte.do;jsessionid=AA3B324B58F8360A41FC03636B303E8A. 

tpdjo06v_3?cidTexte=JORFTEXT000000467563&categorieLien=id. 

4

 Décret No 2007-840 du 11 mai 2007 relatif à l’organisation de l’administration centrale du Ministère chargé de la 

santé et modifiant le code de la santé publique [Decree No. 2007-840 of May 11, 2007, on the Organisation of the 

Central Administration of the Ministry of Health, and Amending the Health Code], J.O., May 13, 2007, p. 11240, 

http://www.legifrance.gouv.fr/affichTexte.do;jsessionid=DF0736163CBBEC68BCF10AE49A507B8E.tpdjo06v_3?

cidTexte=JORFTEXT000000427036&categorieLien=id. 

5

 CODE DE LA SANTE PUBLIQUE art. L.3131-1. 

6 Id. art. L.3131-2. 

7 Organisation [Organization], HAUT CONSEIL DE LA SANTÉ PUBLIQUE [HIGH COUNCIL FOR PUBLIC HEALTH], 

http://www.hcsp.fr/Explore.cgi/Hcsp#73 (last visited Oct. 28, 2014). 
Legal Responses to Health Emergencies: France

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management of health risks and to evaluate the policies and strategies regarding health 

prevention and safety.8

 

B. Institut de Veille Sanitaire (InVS) 

The InVS’s general mission is to constantly monitor the state of the public health. The InVS is 

under the supervision of the Minister of Health. It was created by Law 98-535 of July 1, 1998, 

Relating to the Reinforcement of Health Monitoring.9 Its mission was extended by Law 2004-

806 of August 9, 2004, on Public Health Policy to meet new challenges that were highlighted by 

health crises and emerging risks.10

The InVS is, in particular, charged with the following: 

 Detecting any threat to public health and alerting the competent public authorities; 

 Gathering, analyzing, and developing information on health risks, their causes, and 

their evolution; 

 Taking part in collecting and processing data on the state of public health; 

 Carrying out or supporting any action (investigation, study, assessment, etc.) likely to 

contribute to the monitoring of public health; and 

 Helping to manage health crises by proposing to the health authorities the necessary 

measures and actions to take.11 

The InVS monitors all fields of public health, including infectious diseases, environmental 

health, occupational health, chronic diseases, and international and tropical diseases. It 

participates in international and European cooperation programs, such as the monitoring of AIDS 

or tuberculosis, or setting forth monitoring systems. It is headed by a General Director. Its 2013 

operational expenses were approximately €60 million12 and it has about 425 employees, 

mainly scientists.13

 

8

 Code de la Sante Publique art. L.1411-4. 

9

 Loi 98-535 du 1er juillet 1998 relative au renforcement de la veille sanitaire et du controle de la sécurité sanitaire 

des produits destinés à l’homme [Law 98-535 Relating to the Reinforcement of Health Monitoring and of the 

Control of the Health Safety of Products Destined for Man], J.O., July 2, 1998, p. 10056, http://legifrance.gouv. 

fr/affichTexte.do;jsessionid=20D3E80627BA733894E9F14916C2B1F6.tpdjo16v_2?cidTexte=JORFTEXT0000005

73437&categorieLien=id. 

10 Loi No 2004-806 du 9 août 2004 relative à la politique de santé publique [Law No. 2004-806 of August 9, 2004, 

on Public Health Policy], J.O., Aug. 11, 2004, p. 14277, http://www.legifrance.gouv.fr/affichTexte.do?cidTexte= 

JORFTEXT000000787078&categorieLien=id. 

11 Id. art. 15; CODE DE LA SANTE PUBLIQUE art. L1413-2. 

12 As of October 29, 2014, the exchange rate for dollars to Euros was US$1.27:€1.00. 

13 INSTITUT DE VEILLE SANITAIRE, RAPPORT ANNUEL [ANNUAL REPORT] 2013 at 68–69, http://www.invs.sante.fr/ 

publications/rapport_annuel/2013/sources/index.htm. 
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To perform its mission, the InVS has access to a network of seventeen regional centers called 

Cellules interrégionales d’épidémiologie (CIRE, Inter-regional Epidemiological Units). These 

CIRE fall under the authority of General Director of the InVS, but are integrated into local 

Agences régionales de santé (ARS, Regional Health Agencies).14 ARS were created in 2009 to 

centralize and better coordinate the various government health-related resources at the regional 

level.15 The CIRE investigate and assess potential health safety warning signs,16 and provide 

each ARS with methodological support and independent expertise regarding such 

warning signs.17

In addition to the CIRE, the InVS works with a great number of other organizations that 

contribute to the monitoring of public health, particularly doctors and hospitals.18 Medical 

doctors and laboratories (both public and private) must report to their local ARS diseases that 

necessitate urgent local, national, or international intervention, and diseases that require 

monitoring for the evaluation of public health policies.19 A list of the diseases that must be 

reported is published in the Code of Public Health and is regularly updated.20 Information must 

be sent to the ARS and InVS in a manner that protects the patients’ privacy,21 and all those who 

have access to this information, in whatever capacity, are required to observe the confidentiality 

of the information.22 A violation of the confidentiality requirement is punishable by one year of 

imprisonment and a fine of €15,000 (approximately US$17,000).23 The Public Health Code does 

not provide for a penalty when a doctor fails to report a listed disease. However, failure to report 

may be prosecuted under the provisions governing the risks caused to another24 or the omission 

to render assistance25 when such failure results in the contamination of other individuals either 

 

14 Missions des CIRE [Missions of the CIRE], INSTITUT DE VEILLE SANITAIRE (Apr. 21, 2011), http://www.invs. 

sante.fr/Regions-et-territoires/Missions-des-Cire. 

15 Loi No. 2009-879 du 21 juillet 2009 portant réforme de l’hôpital et relative aux patients, à la santé et aux 

territoires [Law No. 2009-879 of July 21, 2009, Reforming Hospitals and Regarding Patients, Health, and 

Territories] (July 21, 2009), http://www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000020879475& 

categorieLien=id; Présentation générale [General Presentation], AGENCE RÉGIONALE DE SANTÉ, http://www.ars. 

sante.fr/Presentation-generale.89790.0.html (last visited Oct. 29, 2014). 

16 Missions des CIRE, supra note 14. 

17 Qui sommes nous? Organisation [Who Are We? Organization], INSTITUT DE VEILLE SANITAIRE (Sept. 1, 2014), 

http://www.invs.sante.fr/L-Institut/Qui-sommes-nous. 

18 RAPPORT ANNUEL, supra note 13, at 12. 

19 CODE DE LA SANTE PUBLIQUE arts. L.3113-1 & R.3113-1 to R.3113-4. 

20 Id. arts. D.3113-6 & D.3113-7. 

21 Id. arts. L.3113-1 & R.3113-2. 

22 Id. art. R.3113-5. 

23 CODE PENAL [CRIMINAL CODE] art. 226-13, http://www.legifrance.gouv.fr/affichCode.do?cidTexte=LEGITEXT 

000006070719&dateTexte=20141029. 

24 Id. art. 223-1. This article provides that “directly exposing another to a risk of immediate death or of wounds 

likely to result in mutilation or permanent infirmity by the manifestly deliberate violation of a special obligation of 

safety or prudence imposed by law or regulation,” is punishable by one year of imprisonment and a fine of €15,000. 

Id. (translation by the author). 

25 Id. art. 223-6. 
Legal Responses to Health Emergencies: France

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because they have been in contact with the contaminated subject or have been exposed to the 

same source of contamination. 

The InSV works in close cooperation with the European Center for Disease Prevention and 

Control.26 It is part of the Early Warning and Response System that was set up in 1998 under 

Decision 2119/98/EC of the European Parliament and of the Council.27 This alert system 

establishes permanent communication between the EU Member States’ public health authorities, 

enabling them to coordinate their efforts for the prevention and control of 

communicable diseases.28 

In February 2001, the WHO opened an office in France to help developing countries detect and 

control epidemics and emerging diseases.29 InSV also participates in international epidemic 

surveillance organizations such as the WHO’s Early Alerting and Reporting project30 and the 

EpiSouth network, which aims to improve communicable diseases surveillance, communication, 

and training among the countries of the Mediterranean and the Balkans.31 

C. Ministry of Health 

In cases of severe health threats, especially epidemiological threats, necessitating emergency 

measures, the minister in charge of health has the authority to impose any proportional measures 

to prevent and mitigate the dangers to public health.32 The Minister of Health may also give 

authority to local prefects to take any measures necessary to apply the minister’s decisions.33

D. Prefects 

The prefect directly represents the Prime Minister and each minister in the département. He is, 

therefore, responsible for most central functions, including internal order, civil safety, security, 

 

26 Activités Européennes [European Activities], INSTITUT DE VEILLE SANITAIRE (Aug. 12, 2013), http://www.invs. 

sante.fr/Europe-et-international/Activites-europeennes/Projets-europeens-et-contribution-de-l-InVS-a-l-ECDC. 

27 Decision No. 2119/98/EC of the European Parliament and of the Council of 24 September 1998 Setting Up a 

Network for the Epidemiological Surveillance and Control of Communicable Diseases in the Community, 1998 O.J. 

(L 268) 1, http://eur-lex.europa.eu/legal-content/EN/TXT/HTML/?uri=CELEX:31998D2119&from=EN. 

28 Id. art. 1. 

29 La France et la gouvernance mondiale de la santé [France and International Governance on Health], MINISTÈRE 

DES AFFAIRES ETRANGÈRES ET DU DÉVELOPPEMENT INTERNATIONAL [MINISTRY OF FOREIGN AFFAIRS AND 

INTERNATIONAL DEVELOPMENT] (May 2014), http://www.diplomatie.gouv.fr/fr/politique-etrangere-de-lafrance/sante-securite-alimentaire/sante/article/la-france-et-la-gouvernance. 

30 Activités Internationales [International Activities], Veille Sanitaire Internationale [International Health 

Surveillance], INSTITUT DE VEILLE SANITAIRE (July 16, 2014), http://www.invs.sante.fr/Europe-et-international/ 

Activites-internationales/Veille-sanitaire-internationale. 

31 Id.; EPISOUTH, http://www.episouth.org/home.php (last visited Oct. 29, 2014). 

32 Code de la Santé Publique art. L.3131-1. 

33 Id. 
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and health in his département.

34 In a time of crisis of any type, he coordinates all civilian 

services involved in the management of such a crisis within his département.

35 Prefects are 

authorized to requisition all property or services, in particular the services of any health 

professionals, if necessary to face a health crisis.36

E. Reserve Health Corps 

Law 2007-294 of March 5, 2007, established a reserve health corps to help deal with disasters, 

emergencies, and serious health threats.37 The Law was incorporated into the Health Code. The 

reserve corps comprises health professionals, former health professionals, and other individuals 

whose professional duties, experience, or level of training satisfy the requirements set forth by 

the Ministry of Health.38 The contract to serve in the reserve may provide for carrying out 

international missions.39 

III. National Plan for the Prevention and Control of the Influenza Pandemic 

In 2004, France drew up its first comprehensive national plan for the prevention and control of 

an influenza pandemic. Its latest version was published in October 2011,40 and the French 

government has published an English-language version.41 The plan is adaptable and aimed at 

protecting the French population, as well as French citizens living abroad, against a pandemic 

threat and limiting the social and economic consequences of a pandemic.42

The plan sets action guidelines for four different stages of an epidemic’s progression in a 

territory.43 Responses in the first stage focus on slowing down the introduction of the virus into 

the territory, thus allowing the government to prepare for the following stages by making 

vaccines available (if possible), distributing relevant health care products and equipment, and 

 

34 Missions, PRÉFECTURES, MINISTÈRE DE L’INTÉRIEUR [MINISTRY OF THE INTERIOR] (Oct. 10, 2011), 

http://www.interieur.gouv.fr/Le-ministere/Prefectures/Missions. 

35 Id. 

36 Code de la Santé Publique art. L.3131-8. 

37 Loi 2007-294 du 5 mars 2007 relative à la préparation du système de santé à des menaces sanitaires de grande 

ampleur [Law 2007-294 of March 5, 2007, on Preparing the Health System to Deal with Large-Scale Health 

Threats], J.O., Mar. 6, 2007, p. 4224, http://legifrance.gouv.fr/affichTexte.do;jsessionid=C911448ACC0CBA 

39980BD487A5EA824B.tpdjo14v_3?cidTexte=JORFTEXT000000461266&categorieLien=id. 

38 Code de la Sante Publique art. L.3132-1. 

39 Id. 

40 PLAN NATIONAL DE PRÉVENTION ET DE LUTTE «PANDÉMIE GRIPPALE» [NATIONAL “INFLUENZA PANDEMIC”

PREVENTION AND RESPONSE PLAN] (Oct. 2011), http://www.sante.gouv.fr/IMG/pdf/Plan_Pandemie_ 

Grippale_2011.pdf. 

41 NATIONAL “INFLUENZA PANDEMIC” PREVENTION AND RESPONSE PLAN (Oct. 2011), http://www.sante.gouv. 

fr/IMG/pdf/PlanPandemieGrippale-Version_Anglais.pdf. 

42 Id. at 4. 

43 Id. at 11. 
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preparing health care facilities for a possible influx of patients.44 Health checks at the border 

may be part of the government’s response at this stage.45 Similarly, in the second stage, the 

authorities act to slow down the propagation of the virus in the territory so as to gain time for the 

scaling-up of the health care system and/or the preparation of a vaccine.46 Barrier measures, 

such as closing nurseries and schools; encouraging the public to use individual means of 

transport; or restricting collective activities such as performances, sports events, or other major 

gatherings, may be implemented at this stage.47 In the third stage, during which the number of 

affected patients peaks, the authorities try to limit the pandemic’s effect—not only from a health 

care aspect through the treatment of patients, but also from an economic aspect through measures 

to mitigate the effects of absenteeism and other pandemic-related disturbances.48 Finally, stage 

four marks both a transition back to a normal situation, and preparation for a potential 

second wave.49

IV. Responding to the Ebola Crisis 

The first case of Ebola infection in Guinea was identified by a French laboratory on March 23, 

2014. This prompted French authorities to inform the European Commission and the European 

Health Security Committee, and to monitor the epidemiological situation in African countries 

where the virus is present in collaboration with the WHO and the European Center for Disease 

Control.50 An interministry task force, including a prefect and representatives from the Ministry 

of Health and the Ministry of Foreign Affairs, was set up to coordinate the French response to 

the Ebola threat.51 The InVS is continuously monitoring the epidemiological situation, both in 

France and internationally, and special measures were put into place for the early detection and 

isolation of any person who might be contagious on French territory.52 Screening processes have 

been set up at the airports of at-risk countries to assess travelers going to France, and 

informational brochures have been given to airlines to be distributed to passengers traveling 

between France and at-risk countries.53 French citizens are encouraged to postpone any travel to 

at-risk countries.54 If a person infected with the Ebola virus is detected in France, that person is 

 

44 Id. at 39. 

45 Id. 

46 Id. at 47. 

47 Id. at 50. 

48 Id. at 55–61. 

49 Id. at 65. 

50 Nous agissons contre Ebola [We Are Acting Against Ebola], MINISTÈRE DES AFFAIRES SOCIALES, DE LA SANTÉ ET 

DES DROITS DES FEMMES [MINISTRY OF SOCIAL AFFAIRS, HEALTH, AND WOMEN’S RIGHTS], http://ebola.sante.gouv. 

fr/nous-agissons-contre-ebola/ (last visited Oct. 30, 2014). 

51 Press Release, Premier Ministre [Prime Minister], Le Gouvernement renforce l’organisation interministérielle face 

à la crise Ebola [The Government Reinforces the Interministry Organization Against the Ebola Crisis] (Oct. 17, 

2014), http://www.gouvernement.fr/sites/default/files/document/document/2014/10/17.10.2014_communique_de_ 

presse_de_manuel_valls_premier_ministre_-_crise_ebola.pdf. 

52 Nous agissons contre Ebola, supra note 50. 

53 Id. 

54 Id. 
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to be transported to a specialized health care facility, where that person will be treated in 

isolation.55 The government has published a list of hospitals that have been set up and certified 

by an ARS to treat Ebola patients.56 The government has also provided information to medical 

professionals on the symptoms of the Ebola virus, on the procedures to protect themselves from 

infection, and on the procedures to alert the health authorities if they come across a potential 

Ebola patient.57

 

55 Id. 

56 Id.; Liste des établissements de santé de référence habilités pour la prise en charge des patients cas possibles ou 

confirmés de maladie à virus Ebola [List of Reference Health Care Establishments Certified to Take Charge of 

Possible or Confirmed Ebola Virus Patients], MINISTÈRE DES AFFAIRES SOCIALES, DE LA SANTÉ ET DES DROITS DES 

FEMMES [MINISTRY OF SOCIAL AFFAIRS, HEALTH, AND WOMEN’S RIGHTS] (Sept. 25, 2014), http://ebola.sante. 

gouv.fr/IMG/pdf/2014_09_25_-_listingesr_maj_modifidferta-2-2.pdf. 

57 Id. 
The Law Library of Congress 88

Greece 

Theresa Papademetriou 

Senior Foreign Law Specialist

SUMMARY The Ministry of Health and Social Solidarity is in charge of public health issues in Greece, 

such as those related to communicable diseases, weather-related disasters, and others. 

Two major centers play a central role in coordinating, planning, and fighting the spread of 

communicable diseases: (a) the National Health Operations Center, and (b) the Center for 

the Control and Prevention of Communicable Diseases. In response to the Ebola crisis, 

Greece established a comprehensive plan to fight the virus that involved setting-up a 

special unit for potential victims and staffing entry points with medical experts to detect 

suspected cases, among other measures. As a Member of the European Union and the 

World Health Organization, Greece complies with European Union and World Health 

Organization legislation on issues related to public health crises and is in constant 

collaboration with both entities. 

I. Introduction 

In Greece, public health issues fall within the domain of the Ministry of Health and Social 

Solidarity. The mission of the Ministry is to promote the health care of citizens; provide a high 

level of medical, pharmaceutical, and hospital services; and work towards the prevention of 

diseases, in compliance with European Union (EU) legislation and regulations issued by the 

World Health Organization (WHO).1 Greece is required to comply with EU Decision No. 

1082/2013 on Serious Cross-Border Threats to Health2

 and is also in close contact with the 

European Centre for Disease Prevention and Control, established by the EU.3 In addition, 

Greece participates in the Early Warning and Response System established in 1998 in order to 

provide notification of alerts concerning serious public health threats with cross-border 

implications.4

 The Ministry of Health and Social Solidarity also participates in the Health 

Security Committee, established at the EU level.5

As a WHO member, Greece ratified the revised 2005 International Health Regulations, which 

entered into force in June 2007 and require WHO Members to provide notification of all events 

that may constitute a public health emergency of international concern.6

 In February 2014, 

 

1

 HELLENIC REPUBLIC, MINISTRY OF HEALTH, http://www.moh.gov.gr/articles/ministry/organogramma/45-

armodiothtes-toy-ypoyrgeioy-ygeias-kai-koinwnikhs-allhleggyhs (in Greek; last visited Nov. 26, 2014). 

2

 Decision No. 1082/2013/EU of the European Parliament and of the Council of 22 October 2013 on Serious CrossBorder Threats to Health and Repealing Decision No. 2119/1998/ EC, 2013 O.J. (L 293) 1, http://eur-lex.europa.eu/ 

LexUriServ/LexUriServ.do?uri=OJ:L:2013:293:0001:0015:EN:PDF. 

3

 EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL, http://ecdc.europa.eu/ (last visited Nov. 12, 2014). 

4

 Decision No. 1082/2013, supra note 2, art. 8. 

5 Id. art. 17, para. 3. 

6

 Law No. 3991/2011 Kyrose tou Anatheorimenou Diethnous Ygeionomikou Kanonismou, tou Pagkosmiou 

Organismou Ygeias [Ratification of the Revised International Health Regulations Adopted by WHO], EPHEMERIS 
Legal Responses to Health Emergencies: Greece 

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WHO designated the University of Thessaly in Central Greece as a WHO collaboration center in 

order to have support in training activities related to ship inspections and the management of 

public health events at points of entry.7

In 1992, Greece established the Center for the Control and Prevention of Communicable 

Diseases,8

 which plays a critical role in preventing, controlling, and fighting epidemics, chronic 

diseases, intentional or accidental disasters from chemical or biological agents, and public health 

issues associated with a large influx of illegal migrants.9

 

II. National Agencies Responsible for Public Emergencies 

At the domestic level, Greece has established two major agencies in order to effectively address 

public health crises, including natural disasters, communicable diseases, weather-related events, 

illegal migration, and others. 

A. National Health Operations Center 

The National Health Operations Center (NHOC) (in Greek, EKEPY) was established in 2004, 

during Greece’s preparations for the Olympic Games. Its headquarters are located in Athens, 

while four divisions operate in other areas of Greece. The tasks of the NHOC are to assist the 

public in case of communicable diseases, natural disasters, and weather-related events such as 

floods or fires, as well as healthcare management associated with illegal migration.10 It operates 

at the national level under the aegis of the Minister of Health and Social Solidarity and at the EU 

level by collaborating with similar institutions in the EU. 

 TES KYVERNESEOS TES HELLENIKES DEMOKRATIAS [E.K.E.D.] 2011, A:162. http://www.et.gr/index.php/2013-01-

28-14-06-23/search-laws (ratifying the WHO International Health Regulations (2d ed. 2005), 

http://www.who.int/ihr/publications/9789241596664/en/). 

7 New WHO Collaborative Centre for IHR – Points of Entry in Greece (University of Thessaly), WHO PAGNET 

(July 22, 2014), https://extranet.who.int/pagnet/?q=content/new-who-collaborative-centre-ihr-points-entry-greeceuniversity-thessaly. 

8

 Law Νο. 2071/1992, Eksychronismos kai Organosi Systematos Ygeias [Modernization and Organization of the 

Health System] art. 26, Ε.Κ.Ε.D. 1992, A:123, http://www.et.gr/idocs-nph/search/pdfViewerForm.html?args=5C7 

QrtC22wF7YkbUtryc43dtvSoClrL8PD8wzczkG7N5MXD0LzQTLWPU9yLzB8V68knBzLCmTXKaO6fpVZ6Lx3

UnKl3nP8NxdnJ5r9cmWyJWelDvWS_18kAEhATUkJb0x1LIdQ163nV9K--td6SIudHO7dAghsLGact9Nmzq9fl 

479MbV5oRL_W94Evroqqu. 

9

 Law No. 3370/2005, art. 5, Organosi kai Leitourgia of Health Services kai Alles Diatakseis [Organization and 

Operation of Health Services and Other Provisions], E.K.E.D. 2005 A:178, http://www.et.gr/idocsnph/search/pdfViewerForm.html?args=5C7QrtC22wHrZvzjsKBkq3dtvSoClrL8gb8ZK5B_4Hl5MXD0LzQTLWPU

9yLzB8V68knBzLCmTXKaO6fpVZ6Lx3UnKl3nP8NxdnJ5r9cmWyJWelDvWS_18kAEhATUkJb0x1LIdQ163nV

9K--td6SIuUjEQ4m-Pl5_5Ndr9ctGV0KgaYdWP7N74CbAY8Bm2sX_. 

10 DR. PANOS EFSTATHIOU, HELLENIC NATIONAL HEALTH OPERATIONS CENTER, NHOC EMERGENCY PLANS AND 

ACTIONS, http://www.preventionweb.net/files/11564_PANOSEFSTATHIOU.pdf (last visited Nov. 26, 2014). 
Legal Responses to Health Emergencies: Greece 

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The NHOC exercises supervision over the Center for the Control of Communicable Diseases, the 

Hellenic National Center for Emergency Care, and the health districts, which include 

Greek hospitals.11 

B. Center for the Control and Prevention of Communicable Diseases 

The Center for the Control and Prevention of Communicable Diseases12 (abbreviated in Greek as 

KEEL and, as of 2005, as KEELPNO13) was established in 1992 and is located in Athens.14 The 

mission and tasks assigned to KEELPNO are determined by Implementing Decree No. 

358/199215 and include the control and prevention of contagious and noncontagious diseases 

and, if possible, their cure. KEELPNO also makes suggestions and recommendations on 

national policy concerning diseases to the Ministry of Health and Social Solidarity. In addition, 

KEELPNO informs the public and disseminates information and circulars to groups that are at 

high risk of being infected by a disease.16 KEELPNO has been designated as the national 

authority to closely communicate with the European Center for Disease Control and Prevention, 

in particular in the area of developing surveillance responses to health threats, providing 

scientific opinions and scientific and technical assistance, collecting data and identifying 

emerging health threats, and conducting public information campaigns.17

III. National Response to the Ebola Crisis 

In the wake of the Ebola outbreak in West Africa, KEELPNO announced that there is a “very 

low” risk of the Ebola virus reaching Greece. However, KEELPNO officials have been on the 

alert and are monitoring the outbreak.18 

In order to respond to the Ebola crisis in a coordinated manner, Greece established a multifaceted 

national plan agreed upon jointly by the Ministers of Health and Social Solidarity, of Public 

 

11 Id. 

12 Emergency Operations Centre of HCDCP, HELLENIC CENTER FOR DISEASE CONTROL AND PREVENTION, 

http://www.keelpno.gr/en-us/managementofpublichealthissuesoperationcenter.aspx (last visited Nov. 26, 2014). 

13 Law No. 3370/2005, art. 20. 

14 Law Νo. 2071/1992, art. 26, E.K.E.D. 1992, A:123, http://www.et.gr/idocs-nph/search/pdfViewerForm.html? 

args=5C7QrtC22wF7YkbUtryc43dtvSoClrL8PD8wzczkG7N5MXD0LzQTLWPU9yLzB8V68knBzLCmTXKaO6f

pVZ6Lx3UnKl3nP8NxdnJ5r9cmWyJWelDvWS_18kAEhATUkJb0x1LIdQ163nV9K--td6SIudHO7dAghs 

LGact9Nmzq9fl479MbV5oRL_W94Evroqqu. 

15 Presidential Decree No. 358/1992, Organosi Leitourgia kai Armodiotites tou Kentrou Loimodon Limokseon 

[Organization, Operation and Responsibilities of the Center of Communicable Diseases], E.K.E.D. 1992, A:179, 

http://www.et.gr/idocs-nph/search/pdfViewerForm.html?args=5C7QrtC22wF7YkbUtryc43dtvSoClrL8tvm 

GnUriqnd5MXD0LzQTLWPU9yLzB8V68knBzLCmTXKaO6fpVZ6Lx3UnKl3nP8NxdnJ5r9cmWyJWelDvWS_1

8kAEhATUkJb0x1LIdQ163nV9K--td6SIuQILCNmEB2x4MHVk-Xgell4tEqkB5I8OkTDDIYS6ToMB. 

16 Id. art. 3. 

17 Competent Bodies, EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL, http://www.ecdc.europa.eu/ 

en/aboutus/Competent%20bodies/Pages/Competent_bodies.aspx (last visited Nov. 26, 2014). 

18 Greek Disease Control Center Sees ‘Very Low’ Risk of Ebola Spread but Cautions Travelers, EKATHIMERINI 

(Aug. 1, 2014), http://www.ekathimerini.com/4dcgi/_w_articles_wsite1_1_01/08/2014_541879. 
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Order, and of Shipping designed to deal with Ebola patients; ensure that travelers who may have 

Ebola and enter Greece either by air, sea, or land are monitored; keep the public informed; and 

assuage fears among the citizens. To this effect, an intensive care isolation unit specifically 

equipped to deal with Ebola patients has been established in a hospital in Athens. In addition, a 

specially trained team of health workers constantly update their training and knowledge of the 

disease in compliance with guidelines issued by EU and Greek officials.19

On October 10, 2014, officials from the Ministry of Health and Social Solidarity, in 

collaboration with experts from KEELPNO and the NHOC, announced a number of 

precautionary measures to combat a possible Ebola epidemic in Greece. Priority among the 

measures was to secure Greece’s entry points with an additional thirty medical experts from 

KEELPNO to provide early diagnoses of any suspicious cases. Airlines were also instructed to 

distribute questionnaires to visitors traveling from West African countries (via direct flights or in 

transit) in order to identify persons who may have come into contact with Ebola patients. In 

addition, Greek and English-language posters have already been placed in Greek airports 

providing information about the Ebola virus.20 

 

19 Greece Adopts Preventive Measures Against Ebola Virus, CHANIA POST (Oct. 11, 2014), http://www.chaniapost. 

eu/?p=7899; Ioanna Zikakou, Greek Government Takes Steps to Tackle Ebola Virus, GREEK REPORTER (Oct. 11, 

2014), http://greece.greekreporter.com/2014/10/11/greek-government-takes-steps-to-tackle-ebola-virus/. 

20 CHANIA POST, supra note 19; Zikakou, supra note 19. 
The Law Library of Congress 92 

India 

Tariq Ahmad 

Legal Research Analyst*

SUMMARY India’s Central Government and state governments are empowered to regulate healthrelated matters. The Epidemic Diseases Act is the main legislative framework at the 

central level for the prevention and spread of dangerous epidemic diseases. The Act 

empowers the central government to take necessary measures to deal with dangerous 

epidemic disease at ports of entry and exit. The Act also empowers the states to take 

special measures or promulgate regulations to deal with epidemics within their state 

jurisdictions. In such emergencies the states delegate some of these powers to the deputy 

commissioners in the districts, typically through state health acts or municipal corporation 

acts. Thus, responsibility for directly addressing the crisis rests with the deputy 

commissioner at the district level. 

I. Structure of Public Health Crisis Management System 

India is a union of twenty-eight states and seven territories, with a constitutional division of 

legislative responsibilities between the central government and the states. Both the central 

government (also known as the Union government) of India and the state governments are 

constitutionally empowered to legislate on matters of public health. The Union law may deal 

with port quarantine, including in connection with seamen’s and marine hospitals.1 The law may 

also deal with interstate migration and quarantine. State law may provide for matters relating to 

public health and sanitation, hospitals, and dispensaries.2 The central government and state laws 

may also provide for the prevention of the transmission from one state to another of infectious or 

contagious diseases or pests affecting humans, animals, or plants.3 There are several central laws 

managing the prevention of contagious diseases. 

A. Union Laws 

1. Epidemic Diseases Act 

The preamble to the 1897 Epidemic Diseases Act states that its objective is to provide for better 

prevention of the spread of dangerous epidemic diseases.4

 The Epidemic Diseases Act 

empowers the state governments and the central government to take measures as may be 

warranted or necessary to control the further spread of disease. Thus, any state government, 

 

*

 This report updates a report originally prepared in 2003 by former Senior Foreign Law Specialist Krishan S. 

Nehra, which was previously updated in 2009. 

1

 INDIA CONST. 7th Sched., List I, Entries 28 & 81. 

2

 Id. List II, Entry 6. 

3

 Id. List III, Entry 29. 

4

 Epidemic Diseases Act, No. 3 of 1897, pmbl. 
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when satisfied that any part of its territory is threatened with an outbreak of a dangerous disease, 

may adopt or authorize all measures, including quarantine, to prevent the outbreak of the 

disease.5

 Similarly, the central government, when satisfied that there is an imminent threat of an 

outbreak of an epidemic disease and that the provisions of the law at that time are insufficient to 

prevent such an outbreak, may take measures and prescribe regulations allowing for the 

inspection of any ship or vessel leaving or arriving at any port and for the detention of any 

person arriving or intending to sail.6 

Any person who disobeys any regulation or order made under the 1897 Act may be charged with 

an offense under section 188 of the Indian Penal Code.7

 The person in violation of the provision 

is liable, upon conviction, to a sentence of simple imprisonment for one month, a fine, or both. 

Notwithstanding anything contained in the Code of Criminal Procedure, such offense, at the 

discretion of the trial magistrate, may be tried summarily. No suit or legal proceeding lies 

against any person or authority for anything done, or in good faith intended to be done, under 

this Act. 

Some critics have observed that the Epidemic Diseases Act of 1897 “is a century-old blunt act” 

that needs a “substantial overhaul to counter the rising burden of infectious diseases both new 

and old.”8 Some of the issues that require revisiting, they argue, are the “definition of epidemic 

disease, territorial boundaries, ethics and human rights principles, empowerment of officials, 

[and] punishment.”9 It appears that India’s National Centre for Disease Control (NCDC) is 

developing a “Public Health Emergencies Act,” which is “expected to take care of public health 

emergency situations in the country arising as a result of disasters and bio-terrorism incidents 

besides dangerous epidemic diseases including newly emerging infectious diseases.”10 In recent 

years, the Epidemic Disease Act 1897 was invoked by a number of states in India to deal with 

the pandemic H1N1 (“swine flu”) influenza and other communicable diseases.11

2. Quarantine of Visitors 

For people entering India from abroad, a health officer appointed by the central government is 

posted at the port of entry.12 Upon being satisfied that a ship or aircraft is in compliance with the 

health regulations, the health officer grants pratique to the vessel or aircraft for landing. The 

 

5

 Id. § 2. 

6 Id. § 2A. 

7

 INDIAN PENAL CODE, No. 45 of 1860. 

8

 Binod K. Patro, Jaya Prasad Tripathy & Rashmi Kashyap, Epidemic Diseases Act 1897, India: Whether Sufficient 

to Address the Current Challenges?, 18(2) J. MAHATMA GANDHI INST. MED. SCI. 109, 111 (2013), http://www.jm 

gims.co.in/article.asp?issn=0971-9903;year=2013;volume=18;issue=2;spage=109;epage=111;aulast=Patro#ref4. 

9 Id. 

10 Centre for Epidemiology and Parasitic Diseases, NATIONAL CENTRE FOR DISEASE CONTROL, http://nicd.nic.in/ 

index2.asp?slid=496&sublinkid=143 (last visited Nov. 10, 2014).

11 T. Dikid et al., Emerging & Re-emerging Infections in India: An Overview, 138(1) INDIAN J. MED. RES. 19–31 

(July 2013), http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767269/. 

12 Aircraft Act, No. 22 of 1934; Indian Aircraft (Public Health) Rules, 1954, R. 2(8). 
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health officer may demand to see the aircraft journey log book, which shows the places the 

aircraft visited.13 He may also inspect the aircraft, its passengers, and its crew, and subject them 

to medical examinations after their arrival.14 The officer must follow specific precautions with 

regard to communicable diseases15 that require a period of quarantine (such as yellow fever, 

plague, cholera, smallpox, typhus, and relapsing fever) and other infectious diseases that do not 

require a period of quarantine.16 

Except in the case of an emergency constituting a grave danger to public health, an aircraft 

should not, on account of an infectious disease that does not require a period of quarantine, be 

prevented by the health officer of an airport from discharging or loading cargo, fuel, or water. 

However, where any person is required under the rules to be disembarked and isolated for any 

period, the officer may cause him to be removed to a hospital or another approved place and 

detain him in quarantine.17 If necessary, the officer may require the person to report to him at 

specified intervals during the period of surveillance.18 The health officer may also remove, cause 

to be removed, or order the removal of any person, other than someone proceeding on an 

international voyage, who, in the opinion of the officer, is likely to spread any quarantinable or 

infectious disease.19 

When it is brought to the attention of the health officer, he may prohibit the embarkation on any 

aircraft of any person showing symptoms of any quarantinable disease and any person whom the 

health officer considers likely to transmit infection because of his close contact with a person 

showing symptoms of a quarantinable disease.20 When a case of typhus or relapsing fever occurs 

at the airport, the person on an international voyage who is considered liable by the officer to 

spread such a disease must be disinfected.21 Upon request, the health officer must issue to the 

commander of an aircraft a certificate specifying the health measures taken with respect to the 

aircraft, the parts of the aircraft treated, the methods employed, and the reasons why the measure 

have been applied.22 

Regulations require that airline staff report any suspected cases or passengers who in their 

opinion, from observations made in flight, may be suffering from symptoms of a 

quarantinable disease. 

 

13 Id. R. 6(2). 

14 Id. R. 8(1). 

15 Id. R. 9–29. 

16 Id. R. 30–32. 

17 Id. R. 56. 

18 Id. R. 58. 

19 Id. R. 61. 

20 Id. R. 36(1). 

21 Id. R. 39. 

22 Id. R. 54. 
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With respect to Ebola, in early August 2014, the Health Ministry announced that authorities 

would begin screening “travellers who originate from or transit through affected nations, and 

track them after their arrival in India.”23 Passengers are informed through in-flight 

announcements that “mandatory self-reporting is required at immigration.”24 The government 

also “set up facilities at airports and ports to manage travellers showing symptoms of the 

disease.”25 The surveillance system will track travelers for four weeks and persons who develop 

symptoms will be advised to self-report. On August 26, 2014, six Indian nationals were isolated 

after returning from Liberia but all tested negative for the virus.26

Similar quarantine restrictions are provided under the Indian Port Health Rules 1955,27 pursuant 

to the Indian Port Act,28 for passenger ships, cargo ships, and cruise ships. 

B. State Laws 

In order to prevent the outbreak of smallpox, states have enacted laws in their territories for the 

vaccination of children under thirteen years of age.29 For example, the Punjab Vaccination Act 

makes primary vaccination and revaccination of children compulsory throughout the state. 

Where the state’s Superintendent of Vaccination has reasons to believe that a child was not 

vaccinated, he may serve notice on the guardian of the child, requiring him to bring the child for 

vaccination. Upon failure to comply with the notice, a district magistrate may summon the 

guardian and demand an explanation for noncompliance with the Superintendent’s notice. If the 

explanation is not satisfactory, the district magistrate may require him to produce the child for 

vaccination and also produce a certification of such vaccination within the period specified.30 

II. Powers of Public Health Authorities 

Every state in India is divided into districts, and the deputy commissioner of each district is not 

only head of the district administration but also acts as revenue collector and as district 

magistrate, responsible for the maintenance of law and order in his jurisdiction.31 He is the key 

official, and acts as a liaison between the people and the government. 

 

23 Nita Bhalla, India Goes on Alert for Ebola, with Thousands of Nationals in West Africa, REUTERS (Aug. 8, 2014), 

http://in.reuters.com/article/2014/08/08/ebola-india-virus-west-africa-idINKBN0G80OA20140808. 

24 Id. 

25 Id. 

26 Sneha Shankar, Ebola Alert: Six Indians Isolated at Delhi Airport Test Negative, More People Expected to Arrive 

and Be Tested, INTERNATIONAL BUSINESS TIMES (Aug. 26, 2014), http://www.ibtimes.com/ebola-alert-six-indiansisolated-delhi-airport-test-negative-more-people-expected-arrive-1669216. 

27 Indian Port Health Rules, 1955. 

28 Indian Ports Act, No. 15 of 1908, http://www.mumbaiport.gov.in/writereaddata/linkimages/6177609667.pdf. 

29 E.g., Punjab Vaccination Act, No. 49 of 1953. 

30 Id. §§ 13–14. 

31 Introduction, DISTRICT ADMINISTRATION SANGRUR, http://sangrur.nic.in/html/dcrole.html (last visited 

Nov. 17, 2014). 
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In order to meet a health crisis, following the outbreak of an epidemic, the Epidemic Diseases 

Act gives wide ranging powers to the states.32 The states, in such emergencies, delegate some of 

these powers to the deputy commissioners in the districts typically through state health acts or 

municipal corporation acts. Thus, responsibility for addressing the crisis rests with the 

deputy commissioner. 

A. State and Municipal Governments 

If at any time a state government is satisfied that the state or any part of it is threatened with the 

outbreak of a dangerous disease and that ordinary provisions of the law in force at the time are 

insufficient for the purpose of addressing the outbreak, it may take, require, or empower any 

person to take such measures and, by public notice, prescribe such temporary regulations as may 

be necessary to be observed by the public or by any person or class of persons for the prevention 

of the outbreak or spread of such disease.33 

A state government may also take measures and prescribe regulations for the inspection, 

vaccination, and inoculation of persons traveling by road or rail, including their segregation in a 

hospital, temporary accommodation, or otherwise, if such persons are suspected by the 

inspecting officer of being infected with any such disease.34 

A state government, by general or special order, may also empower a deputy commissioner to 

exercise, in relation to his district, all the powers under section 2 of the 1897 Act that are 

exercisable by the state government in relation to the state, other than to determine the manner in 

which and by whom any expenses are to be defrayed. Many of these powers are prescribed in 

Municipal Corporation Acts35 governing “major municipal areas,”36 or Public Health Acts37 that 

also provide municipal-level commissioners or collectors with quarantine or other powers, 

including the following: 

 Removal of a person to separate premises for medical treatment: “Persons suffering from 

such a disease may be removed to any hospital or place for medical treatment, based on an 

order from the Commissioner or the Collector.”38

 

32 Epidemic Diseases Act, No. 3 of 1897, § 2(1). 

33 Id. § 2(2). 

34 Id. § 2(3). 

35 See, e.g., Delhi Municipal Corporation Act, 1957, http://mcdonline.gov.in/tri/sdmc_mcdportal/publications/ 

DMC%20Act.v.11..pdf; and Chennai City Municipal Corporation Act, 1919 (Tamil Nadu Act IV of 1919), 

http://www.chennaicorporation.gov.in/images/chennai_city_municipal_corporation_act.pdf. 

36 Monica Dasgupta, Public Health in India: Dangerous Neglect, XL(49) ECON. & POL. WEEKLY 11 (Dec. 3, 2005), 

available at http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1410508&#. 

37 See, e.g., Madras Public Health Act, No. 3 of 1939, available at http://www.sanchitha.ikm.in/sites/default/files/ 

MadrasPublicHealth_%20Act1939..pdf. 

38 “Municipal Acts of Delhi, Gujarat, West Bengal, Tamil Nadu and Manipur,” Table 1 :Existing Legal 

Frameworks, INDIAN J. PUB. HEALTH, http://www.ijph.in/viewimage.asp?img=IndianJPublicHealth_ 

2010_54_1_11_70539_t1.jpg (last visited Nov. 10, 2014). 
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 Cleansing or disinfecting any building or part of any building or any articles: “The cleansing 

and disinfection of any building or part of it or of any articles in such building which are 

likely to retain infection, may be required to be cleansed and disinfected based on an order of 

the Commissioner or Collector to prevent or check the spread of any dangerous disease.”39

 Taking special measures in case of the outbreak of dangerous or epidemic diseases: “In case 

of an outbreak, the Commissioner or Collector may take special measures and by public 

notice, give directions to be observed by the public or by any class or section of the public, as 

he thinks necessary to prevent the spread of the disease.”40

B. Political and Civil Rights 

By its very nature, the ambit of section 2 of the Epidemic Diseases Act is wide enough to allow a 

state or a lower functionary in the administration, in dealing with an emergency caused by the 

outbreak of a dangerous disease, to seek or require the cooperation of the public or corporate 

bodies in the public or private sectors. If the desired cooperation is not forthcoming, a regulation 

may be imposed. Failure to obey or comply with restrictions imposed by such a regulation 

constitutes a punishable violation.41 

Powers of segregation or quarantine that the central government and state governments enjoy 

may impinge on the political and civil rights of the public. Fundamental rights, as guaranteed by 

the Constitution of India, are justiciable. The judiciary does not shy away from enforcing these 

rights or voiding orders that constitute violations of such rights. Quarantine is a measure that 

adversely affects the fundamental right “to move freely throughout the territory of India.”42 

However, this right is to be enjoyed subject to reasonable restrictions that the state may impose 

in the interest, among others, of the general public.43 As noted above, section 4 of the Epidemic 

Diseases Act includes a protection clause that gives state immunity such that “[n]o suit or other 

legal proceeding” can be brought against “any person for anything done or in good faith intended 

to be done under this Act.”44

The right to privacy, as such, is not a fundamental right in India. The Supreme Court of India 

has found that the right of privacy is an essential component of the right to life, but that it is not 

absolute and may be restricted to prevent crime or disorder, or to protect health, morals, or the 

rights and freedom of others.45 

During the SARS epidemic in 2003, there was concern over the severity of quarantine 

enforcement measures, the discrimination that patients faced, and the lack of privacy and 

 

39 Id. 

40 Id. 

41 Epidemic Diseases Act § 3. 

42 INDIA CONST. art. 19(1)(d). 

43 Id. art. 19(2), (4). 

44 Epidemic Diseases Act § 4. 

45 ‘X’ v. Hospital ‘Z’, 1998 S.C.C. 296, para. 28. 
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The Law Library of Congress 98

confidentiality. There were also reports of shaming of colleagues and neighbors who had been 

placed in quarantine.46

III. Transparency of Public Health Crisis Management System 

Within the democratic system, the judiciary in India ensures transparency in government actions 

and executive orders. The public frequently seeks judicial review of executive orders and 

regulations. The Parliament of India has also enacted a Freedom of Information Act, requiring 

transparency in government actions.47 The Act entitles the public, by filing a written or 

electronic application, to obtain information from any public authority.48 

IV. Cooperation with the World Health Organization (WHO) 

In 1997 the WHO set up the National Polio Surveillance Project to help provide technical 

support for the government with surveillance of polio, mass vaccination campaigns, and 

routine immunizations.49

In 2008, WHO, in collaboration with the NCDC, started a pilot project to prevent humans from 

contracting rabies in five Indian cities. The project “includes training of health professionals in 

animal-bite management and raising public awareness about the need to seek post-exposure 

treatment, notably through posting messages on buses and in other public places.”50

Besides those projects, the WHO is available to provide assistance in all emergencies—for 

example, earthquakes, epidemics, or disasters resulting from terrorism of any sort that may create 

a health emergency in the country. The WHO’s Regional Office annually conducts ten-day, 

intercountry training courses on epidemic preparedness and response to develop regional 

capacity in early detection and response to disease outbreaks. Specifically, the WHO is assisting 

the National Centre for Disease Control (NCDC) (formerly the National Institute of 

Communicable Diseases) in the preparation, printing, and distribution of CD Alert, a monthly 

newsletter published by NCDC. The WHO has also been assisting the NCDC in cooperating 

more closely with neighboring health systems in south and southeast Asian countries through 

workshops and other meetings.51

 

46 Sanjay Nagral, Editorial, SARS: Infectious Diseases, Public Health and Medical Ethics, 11(3) INDIAN J. MED.

ETHICS (2003), http://ijme.in/index.php/ijme/article/view/861/2020. 

47 Freedom of Information Act, No. 5 of 2003. 

48 Id. § 6. 

49 Surveillance, at the Heart of India’s Polio Success Story, WHO COUNTRY OFFICE FOR INDIA, 

http://www.searo.who.int/india/topics/poliomyelitis/surveillance/en/. For more information on WHO-India 

cooperation, see WHO COUNTRY OFFICE FOR INDIA , COUNTRY COOPERATION STRATEGY INDIA 2012–2017 at 29 

(2012), http://www.who.int/countryfocus/cooperation_strategy/ccs_ind_en.pdf?ua=1. 

50 Patralekha Chatterjee, India’s Ongoing War Against Rabies, 87(12) BULLETIN OF THE WORLD HEALTH 

ORGANIZATION 890–91 (Dec. 2009), http://www.who.int/bulletin/volumes/87/12/09-021209/en/. 

51 K.S. Jayaraman, India Upgrades Its Disease Surveillance Network, NATURE (Aug. 17, 2009), http://www.nature. 

com/news/2009/090817/full/news.2009.825.html. 
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Israel 

Ruth Levush 

Foreign Law Specialist

SUMMARY Israel’s Ministry of Health (MOH) is generally responsible for public health crisis 

management. The Minister of Health is authorized to classify specific diseases as 

“communicable diseases,” and to declare a public health crisis caused by such diseases. 

The Minister may resort to special powers to limit and fight communicable diseases. The 

Minister’s powers include the authority to order quarantine and decontamination of 

property. Despite the apparent infringement on the basic rights of protection of privacy, 

confidentiality of medical information, human dignity, and freedom, the law permits the 

restriction of these rights for the purpose of eliminating public health catastrophes such as 

epidemics and chemical or biological attacks. 

 In responding to intentional contamination, the Home Front Command (HFC) of the Israeli 

Defense Forces is charged with making the first response. The HFC regularly publishes 

information on threats and on measures that should be taken against contamination. 

Although data on the spread of communicable diseases is freely available, many aspects of 

counter biochemical and radiological terrorism are classified out of concern that their 

disclosure would endanger the public. 

 Israel develops and implements special plans for preventing the spread of communicable 

diseases as warranted. For example, Israel’s MOH has issued a special memorandum on 

preparedness for and the prevention of Ebola. Previously, a special directive was issued 

by the MOH General Manager on May 4, 2009, regarding preparation for A/H1N1 2009 

influenza. In 2007 the MOH issued a report titled Pandemic Influenza Preparedness Plan 

for the Health System. The Plan includes specific requirements for reporting and 

monitoring, as well as a means of responding to a pandemic health crisis in cooperation 

with the World Health Organization and its regulations. 

I. Introduction 

Israel’s systems of health crises preparedness, disease reporting and surveillance, and alert and 

response management are under the responsibility of the Ministry of Health (MOH). 

The MOH’s jurisdiction extends to managing the medical aspects of Israel’s preparedness for, 

and response to, public health crises, including the operation of hospitals and clinics, 

identification and reporting of health crises, purchase and allocation of vaccines and medications, 

and distribution of information to the public. Other aspects of addressing health crises, including 

activating an emergency status, ordering quarantines, maintaining public order, and determining 

the closing and opening of schools, are handled by the Ministry of Defense through the 

Homeland Security Command. 

The MOH issues new requirements on the spread, prevention, and treatment of disease 

periodically as needed. Most recently, in August 2014, the MOH published special guidelines on 
Legal Responses to Health Emergencies: Israel 

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preparedness for and prevention of the spread of the Ebola virus.1

 In 2007 the MOH issued a 

detailed report titled Pandemic Influenza Preparedness Plan for the Health System.

2

 

This report describes the structure of the public health crisis management system in Israel, 

procedures for the determination of pandemics, and the special powers granted to public health 

authorities for disease and pandemic prevention. It also discusses the impact of these powers on 

human rights in Israel as well as the legal requirement for transparency in the public health crisis 

management system. The report includes information on special prevention programs including 

preparedness for chemical or biological attacks on the homeland. 

II. Structure of Public Health Crisis Management System 

Israel’s public health crisis system is regulated by law and subsidiary legislation. The MOH is 

responsible for collecting information and making decisions for the protection of the public and 

for implementing these decisions and policies.3

 Health services are usually dispensed through 

companies called health insurance establishments (HIEs) that are partially subsidized by the 

state.4

 Every resident has a right to health services provided in a manner that protects human 

dignity, privacy, and medical confidentiality.5

A. Declaring a Disease “Communicable” 

The statutory framework for dealing with communicable diseases is based on Public Health 

Ordinance No. 40 of 1940,6 as amended. A “communicable disease” is defined by the Ordinance 

as any disease listed in the second appendix to the Ordinance, or one declared by the Head of 

Health Services or a designee as a communicable disease. The declaration must be made in the 

official gazette and must specify the area and the period for its application. The list appended to 

the Ordinance may be amended by the Minister of Health, who is authorized to add or delete 

diseases from the list through publication in the official gazette.7 

The list currently includes diseases of international importance requiring immediate notification 

by the treating physician to the MOH regional office or other MOH offices in accordance with 

the World Health Organization (WHO)’s International Health Regulations (2005), such as 

 

1

 State of Israel Ministry of Health [MOH], Memorandum No. 13/14 by Head of Public Health Services (Aug. 7, 

2014), http://www.health.gov.il/ hozer/BZ13_2014.pdf (in Hebrew). 

2

 MOH, PANDEMIC INFLUENZA PREPAREDNESS PLAN FOR THE HEALTH SYSTEM (updated to June 7, 2007), 

http://www. health.gov.il/Subjects/emergency/preparation/DocLib/tora/BIO_TORA_PANDEMIC_FLU.pdf. 

3

 For information about the Ministry’s vision and activities, see About the Ministry, MOH, http://www.health. 

gov.il/English/About/Pages/default.aspx (last visited Oct. 14, 2014). 

4

 National Health Insurance Law, 5754-1994, SEFER HAHUKIM [SH] [Book of Laws] (official gazette) No. 1469 

p. 156 (5754-1994). 

5 Id. § 3. 

6

 Public Health Ordinance No. 40 of 1940, ITON RISHMI [IR] (official gazette during the tenure of the Provisional 

Council of State) 1st Supp. 191 (1940). 

7 Id. §§ 11–11(A). 
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smallpox, Ebola virus, SARS, and yellow fever. Other diseases listed as requiring immediate 

individual notification similar to that required for diseases of international importance include 

AIDS and HIV infection; acute hepatitis A, B, and C; West Nile virus; and malaria.8

 

The inclusion of a disease in the list of communicable diseases empowers health authorities in 

Israel to resort to special measures, including quarantine, to fight the spread of the disease.9

B. Declaration of a Serious Health Danger 

Public Health Ordinance No. 40 of 1940, as amended, authorizes the Minister of Health to 

declare the threat or existence of a serious danger to public health in Israel or in neighboring 

countries. With the publication of the declaration in the official gazette, the head of health 

services at the MOH may issue regulations regarding any person or HIEs activities, such as 

house-to-house visits, the provision of medical assistance, medications, housing 

accommodations, ventilation, and other measures to prevent the spread of the disease.10 

III. Determination of Pandemics 

A. Data Collection: Disease Reporting and Monitoring 

1. Reporting 

Under the 1940 Public Health Ordinance, doctors treating infected patients, patients’ relatives, 

and possessors of property where infected patients have stayed must inform the regional 

government doctors of such cases either immediately or within twelve hours of learning that the 

patients have contracted a communicable disease.11 

Under the 1994 National Health Law, as amended, HIEs must provide the MOH with medical 

data necessary for the fulfilment of the Ministry’s obligations under the Law upon the Ministry’s 

request. Noncompliance with such a request may cause delay in the provision of governmental 

subsidies. The Law specifies that medical information will be dispensed only to the extent 

necessary for the implementation of the Ministry’s obligations and for the protection of the 

privacy of the insured and medical confidentiality.12 

 

 

8

 Public Health Ordinance (Change of List of Communicable Diseases) Decree (5771-2010), KOVETZ HATAKANOT

(Subsidiary Legislation) 5771 No. 6951 pp. 262–72. 

9

 Public Health Ordinance No. 40 of 1940, §§ 13–19. 

10 Id. § 20. For a discussion of powers provided to public health authorities following the declaration of a serious 

health danger, see Part IV, infra. 

11 Public Health Ordinance No. 40 of 1940, § 12. 

12 National Health Insurance Law §§ 40–41. 
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2. Monitoring 

The Israel Center for Disease Control (ICDC) was established under the MOH in 1994. The 

ICDC was designed to provide the Ministry with up-to-date information on health issues. The 

ICDC deals with a large spectrum of health areas and cooperates closely with other departments 

in the MOH, the Central Bureau of Statistics, HIEs, other health care providers, as well as with 

research institutions and universities.13 

According to information posted on the website of the International Association of National 

Public Health Institutes, 

[t]he ICDC main objectives are to identify health areas which lack essential data, establish 

new health-related databases, provide ongoing professional support for users of existing 

databases, undertake applied research in specific areas of public health, carry out national 

health surveys, report on the health status of the population, present policy alternatives to 

decision-makers in MOH, and carry out unusual morbidity surveillance. . . . 

The ICDC took active part in monitoring the pandemic influenza in Israel on [sic] winter 

2009-2010, including syndromic surveillance, serologic surveillance, distribution of 

weekly reports, regular updates of the pandemia guidelines according to the WHO and 

other agencies, distribution of the updated guidelines on a daily basis, and activating a 

hotline for medical teams.14 

The MOH’s 2007 Pandemic Influenza Preparedness Plan for the Health System (the Plan),15 for 

example, provides for a system of monitoring that relies on information received from the ICDC. 

According to the Plan, the monitoring of influenza is based on a combination of both laboratory 

and clinical observations. Laboratory monitoring of influenza is conducted in the MOH’s 

Central Laboratory for Viruses. Samples are received from selected monitoring clinics on a 

weekly basis. All influenza tests among hospitalized patients and during disease breakouts are 

sent to the ICDC. The results of influenza tests conducted in two selected hospitals are also 

routinely delivered to the ICDC. The 2007 Plan further calls for the preparation of additional 

monitoring clinics and pediatric screening during influenza season and throughout the year as 

needed.16 Clinical monitoring is conducted by the MOH Department of Epidemiology, the 

department for information and digitalization, and the ICDC. The ICDC periodically collects 

and integrates daily data determined to be indicative of influenza.17 

The 2007 Plan provides for a specific monitoring program following the issuance of WHO phase 

4 and 5 epidemic alerts, which correlate to both limited and significant human-to-human 

 

13 Israel National Disease Control Center, MOH, http://www.health.gov.il/English/MinistryUnits/HealthDivision/ 

Icdc/Pages/default.aspx. 

14 Israel Center for Disease Control, THE INTERNATIONAL ASSOCIATION OF NATIONAL PUBLIC HEALTH INSTITUTES, 

http://www.ianphi.org/membercountries/memberinformation/israel.html (last visited Oct. 20, 2014). 

15 Pandemic Influenza Preparedness Plan for the Health System, supra note 2. 

16 Id. at 19–28. 

17 Id. 
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contagiousness. The program calls for the operation of additional monitoring clinics, distributed 

geographically, and for the testing of a higher number of samples from persons meeting the 

disease case definition as determined by WHO. In addition, during phases 4 and 5 of the 

epidemic, a comprehensive epidemiological investigation will be conducted in every case in 

order to identify all relevant contacts and consider treatment by medication, isolation, and 

quarantine, as needed.18 

According to the 2007 Plan, during a pandemic, when contamination is spread worldwide, there 

is no need for additional monitoring. Samples will be transferred only to the ICDC, which will 

conduct weekly integration of all the data it receives and disseminate its report to the MOH, 

health clinics, hospital doctors, and the community at large.19 

3. Declaration of a Crisis 

The 1940 Public Health Ordinance authorizes the Minister of Health to declare in Israel’s official 

gazette that public health is severely threatened by the existence of a communicable disease in 

Israel or in neighboring countries. The authorization applies “if it seems that part of the country 

is subject to a danger of a terrible epidemic disease, local or communicable, or is infected with 

such a disease, such as the plague, cholera, yellow fever, smallpox, typhus, or another disease 

declared by the Minister of Health in publication in the official gazette, as a dangerous 

communicable disease.”20 The Ordinance does not describe the decision-making process to be 

followed by the Minister prior to declaring a disease communicable. 

In the case of H1N1 influenza, several cases have been identified in Israel. The declaration 

concerning H1N1 influenza,21 however, followed alert announcements by the WHO. Such a 

declaration forms the basis of the extensive powers granted to the Minister of Health and the 

Ministry’s designees.22 

IV. Powers of Public Health Authorities 

A. General Powers 

The Head of Medical Services of the MOH, and a government doctor or a supervisor appointed 

by the Minister of Health or the Minister of the Environment, whichever is relevant, are provided 

the authority to 

 

18 Id. at 25. 

19 Id. at 26. 

20 Public Health Ordinance No. 40 of 1940, § 20 (in Hebrew; translation by author, R.L.). 

21 Declaration of a Dangerous Communicable Disease, YALKUT HAPIRSUMIM (Notices – Official Gazette) No. 5945 

p. 3536 (2009); for procedures to be followed by health teams, see MOH, General Memorandum by the General 

Manager Regarding Preparedness for 2009 A/H1N1 Influenza (July 1, 2009), http://www.health. 

gov.il/hozer/mk30_2009b.pdf. 

22 For a discussion of these powers, see Part IV, infra. 
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 inspect and decontaminate areas suspected of being contaminated with 

communicable diseases; 

 examine persons found in suspected contaminated areas; and 

 quarantine or transfer infected persons to a hospital.23 

Specific powers are provided to the Head of Medical Services and to government doctors 

to order 

 the decontamination, reconstruction, repair, or closure of all home water supplies; 

 the purification or protection of all private or public water supplies; and 

 the removal and destruction of all garbage from private or public premises.24

Additional powers include the vaccination of residents of an area suspected of being 

contaminated in order to stop the spread of the disease.25 

Any person under an obligation to report communicable diseases, including relatives who stay 

with the infected person, building managers, and treating physicians, is authorized to carry out 

temporary quarantine actions ordered by the government doctor.26 

B. Quarantine Powers 

Under the Quarantine Ordinance (New Version) 5741-1981 the General Manager of the MOH is 

authorized to order a “quarantine service to prevent the penetration of diseases into Israel via 

land, sea or air, and their transfer from Israel to other countries.”27

In accordance with the Quarantine Regulations,28 the MOH is authorized to require a medical 

examination of every vessel in Israel’s waters, to prohibit its contact with the shore or any other 

vessel, and to impose quarantine and sanitary measures to be followed upon arrival.29 Vessels 

suspected of being infected may port only in the ports of Haifa and Tel-Aviv, while those 

confirmed infected, only in the Haifa port.30 

 

23 Public Health Ordinance No. 40 of 1940, §§ 13–16. 

24 Id. 

25 Id. § 19. 

26 Id. § 13. 

27 Quarantine Ordinance (New Version) 5741-1981, §1, 35 DINEI MEDINAT YISRAEL (NUSACH CHADASH) (the 

revised, updated, and binding Hebrew text of legislation enacted before the establishment of the State of Israel) 

p. 747 (translated by author, R.L.). 

28 Quarantine Regulations, 3 HUKE ERETZ ISRAEL [HEI] [Laws of Palestine] 2170, as amended. 

29 Id. § 5. 

30 Id. § 6. 
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The Quarantine Regulations specify the procedures to be taken when a vessel arrives at an Israeli 

port, including the requirement that a health certificate filled out by the vessel’s doctor be 

submitted. The health certificate must include information on events that occurred during travel 

that are related to public health. The health certificate should specify the health status of the 

ship’s country of origin and all the ports it visited, especially if these places were infected with 

the diseases listed in the Regulations.31 Vessels arriving without a health certificate or with an 

inappropriate health certificate will be subjected to quarantine.32 Goods and passenger luggage 

may be subjected to decontamination and possible elimination by burning.33 Passengers in 

vessels confirmed as infected will be subjected to quarantine.34 

Although the Regulations specifically deal with vessels, it is reasonable that similar procedures 

are applicable to other modes of transportation, such as airplanes, under the general authorization 

by the Quarantine Ordinance (New Version) 5741-1981. 

C. Forced Hospitalization and Seclusion 

The 1940 Public Health Ordinance authorizes the head of the MOH or a government physician to 

force the hospitalization or seclusion of every person who is infected with a communicable 

disease. This may be done when the conditions of the residence are not suitable for prevention 

of the spread of the disease. Every person who was in contact with the infected person during 

the disease’s incubation period may also be subjected to forced hospitalization.35 

D. Powers During Periods of Emergency 

As discussed above, the Minister of Health is authorized to publish a declaration that recognizes 

a dangerous communicable disease as existing or threatening public health. Once such a 

declaration has been published, the Head of Medical Services is authorized to order, by decrees, 

directives, or other means, any measures found necessary for preventing or containing the 

disease, including home visits; the provision of medical help; the distribution of medication; and 

the provision of clean, ventilated, and decontaminated places of residence.36 The authorization 

encompasses the entire country, or designated parts, and applies to all vessels within the 

territorial waters of Israel.37 

The Head of Medical Services is further authorized, following the publication of a declaration, to 

remove or arrest infected persons and subject them to supervision, medical examination, or 

treatment. Persons in touch with the infected person may also be subjected to this authority. 

 

31 Id. § 8. 

32 Id. § 9. 

33 Id. §§ 17–19. 

34 Id. § 12. 

35 Public Health Ordinance No. 40 of 1940, § 15. 

36 Id. § 20. 

37 Id. § 23. An extension to airplanes could be interpreted as applying to territorial air space as well. 
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Similarly, the Head of Medical Services is also authorized to perform all acts required to obtain 

samples from such persons for laboratory exam, such as 

 entering any private or public premises; 

 establishing sanitary supervision; 

 seizing, decontaminating, or destroying articles subjected to contamination; 

 burying or disposing of the dead; 

 taking possession of buildings or land (subject to compensation) to establish temporary 

hospitals; and 

 taking possession of transportation vehicles (subject to compensation) needed to prevent the 

spread of the disease.38 

The Head of Medical Services or a government doctor may also order the destruction of any 

building or shelter used by humans or animals that may provide a center for disseminating 

disease because of poor sanitary conditions. The owner may be reimbursed, depending on the 

owner’s liability for the unsanitary conditions.39 In the case of a disease outbreak in a limited 

area, an order may be made not to allow any person to exit the place. The police may be called 

upon to assist in enforcing such an order.40 

E. Enforcement 

All legal instruments regulating the handling of a public health crisis provide authorized persons 

with the power to sanction violations of law and violations of their orders. For example, the 

failure to inform the government regional doctor of an infected person may result in a one-month 

term of imprisonment or a fine. Any person under obligation to provide critical information 

must also carry out the temporary quarantine orders imposed by the regional 

government doctor.41 

Certain expenses related to quarantine and decontamination of an infected vessel will be paid by 

its captain.42 In addition, penalties are imposed under the Public Health Ordinance on anyone 

infected with a communicable disease who knowingly exposes himself in a manner that 

endangers public health or sells or loans clothes and sheets. Persons who transport an infected 

person without decontaminating the transport vehicle afterward are likewise subject to penalties. 

Similarly, the parents of a child or a dependent infected with a communicable disease 

specifically listed in the third appendix of the Ordinance who knowingly or negligently allow the 

child to visit his school without a medical certificate permitting such a visit are subject to a 

criminal penalty and a fine. A teacher who knowingly permits such a child to attend school is 

 

38 Id. § 20(2). 

39 Id. § 20(4)(a). 

40 Id. § 20(4)(b). 

41 Id. § 12(2). 

42 See Quarantine Regulations, supra note 28, § 14. 
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also subject to penalties. Fines are also imposed on infected persons for engaging in any 

occupation related to food supply or any other occupation without taking the proper precautions 

against spreading the disease.43 

F. Impact on the Protection of Human Rights 

The powers exercised by authorities in public health crises appear to conflict with patients’ rights 

guaranteed by the Protection of Patients’ Rights Law, 5756-1996,44 as well as those prescribed 

by Basic Law: Human Dignity and Freedom.45 For example, the delivery of information on 

infected patients contradicts the rights of patients to medical confidentiality. The Protection of 

Patients’ Rights Law, 5756-1996, however, provides that caretakers or medical institutions may 

provide medical information to others if they are under a legal obligation to do so.46 The 

provision of medical information in cases involving communicable diseases is mandatory under 

the 1940 Public Health Ordinance and, therefore, not in violation of the Protection of Patients’ 

Rights Law. 

Removal of persons, forced decontamination, and other measures taken to prevent the spread of 

disease appear to be in violation of the principle of protecting the life, body, and dignity of a 

person, guaranteed by Basic Law: Human Dignity and Freedom. Such infringement, however, 

may be legal under the conditions enumerated in section 8—namely, relevancy and 

proportionality. The law states that “[t]here shall be no violation of rights under this Basic Law 

except by a law befitting the values of the State of Israel, enacted for a proper purpose, and to an 

extent no greater than is required.”47 

It is reasonable to assume that the authority bestowed upon the Health Minister and his 

designees, specifically those permitting forced entry and quarantine, is one that can be viewed as 

an authority that is provided “for a proper purpose” in fighting the spread of infectious diseases. 

Accordingly, orders for forced entry and quarantine that are limited in duration may be 

considered to meet the requirement that any violation of rights be “to an extent no greater than 

is required.” 

V. Actions for Preparedness and Prevention of Pandemics 

The MOH issues instructions on preparedness for and the prevention of pandemic diseases as 

necessary. The following sections provide examples of actions taken by the MOH regarding 

preparedness for and the prevention of Ebola and pandemic influenza. 

 

 

43 Public Health Ordinance No. 40 of 1940, § 22. 

44 Protection of Patients’ Rights Law, 5756-1996, SH 327 (5756-1996). 

45 Basic Law: Human Dignity and Freedom, SH 1391 (9752-1992). 

46 Protection of Patients’ Rights Law § 20(a)(2). 

47 Basic Law: Human Dignity and Freedom § 8, SH 5752 No. 1391 p. 150. 
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A. Preparedness for and Prevention of Ebola 

No Ebola cases had been identified in Israel at the time this report was prepared. On August 7, 

2014, however, the MOH, issued a recommendation to avoid visiting infected countries to the 

extent possible. Travelers visiting Guinea, Liberia, and Sierra Leone are required to refrain from 

having contact with Ebola patients, their excreta, and their personal items. Among other things, 

they are advised to refrain from visiting health institutions or obtaining medical care in those 

countries to the extent possible.48 According to guidelines issued by the Ministry, a patient who 

develops a temperature of 100.4°F (38°C) within twenty-one days of returning to Israel from any 

of these three countries must immediately inform hospital authorities prior to their arrival at the 

hospital in order to receive proper protection instructions.49

A memorandum titled The Ebola Outbreak in West Africa issued by the MOH on August 7, 

2014, provides information on the virus’s epidemiologic and microbiologic origin, clinical 

symptoms, and incubation period and treatment.50 The Memorandum outlines procedures for the 

prevention of the spread of Ebola by requiring health care institutions to increase awareness of 

the potential spread of the virus, identify suspicious cases, and give advance notice to emergency 

and other health personnel regarding admission and treatment of Ebola patients. Additional 

requirements on health care institutions introduced by the Memorandum include the duties of 

issuing emergency alerts for health care personnel,51 issuing instructions regarding patients’ 

admission, and following the memorandum’s guidelines regarding case reporting management 

and the treatment of patients.52 

At a minimum, the Memorandum requires the implementation of transmission-based 

precautions—specifically, regarding contact, droplet, and airborne protections.53 The following 

is a summary of relevant procedures and instructions that were issued on the basis of the 

Memorandum at an exercise conducted in October 2014 at the Tel-Aviv’s Ben-Gurion airport. 

1. Identification 

a. Ebola Patients Arriving at the Airport 

According to instructions given at the exercise, a person returning to Israel from the infected 

countries should be screened. The screening is to include a medical interview and taking the 

person’s temperature. Anyone found to have temperature above 100.4°F is to be immediately 

 

48 Press Release, MOH, Guidelines and Preparedness of the Health System Following the Outbreak of the Ebola 

Virus in West Africa (Aug. 7, 2014), http://www.health.gov.il/NewsAndEvents/SpokemanMesseges/Pages/ 

07082014_2.aspx. 

49 Id. 

50 Memorandum No. 13/14 by Head of Public Health Services, supra note 1. 

51 Id. § 1. 

52 Id. at 4–9. 

53 Id. § 1. 
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transferred to isolation in a hospital. During the transfer to a protected ambulance, the patient is 

to be placed on a protected stretcher.54 

b. Patients’ Arrival at Health Facility Following Advance Notice 

According to the Memorandum issued by the MOH, every hospital must assign a physician on 

every shift to answer telephone calls concerning suspicion of Ebola infection. Any patient who 

has visited a country where the Ebola virus has spread and reports a high fever upon return is to 

be instructed to appear for an examination at the Emergency Room. The patient must be 

instructed to minimize risk to others while on route by adopting such measures as covering 

his/her face, refraining from using public transportation, meeting a health team member who is 

wearing protective gear, and arriving directly at a secluded area in the admissions department 

designated ahead of time for this purpose.55 

c. Patients’ Arrival at Health Facility with No Advance Notice 

The Memorandum requires the posting of signs at admissions areas instructing patients who have 

stayed in an Ebola-infected country twenty-one days prior to admission and developed a high 

fever to immediately report these facts to the receptionist. The receptionist must instruct these 

patients and people accompanying them to wear protective masks and wait in an isolated area.56

The admissions office must immediately report any such cases to the medical team assigned to 

conduct a brief interview of the patient to determine if it is required that he/she be isolated. 

While conducting the interview the team will wear an N-95 protective mask, face/eyes protector, 

a robe, and gloves.57

When a patient, who is already being treated either at the ER or at another hospital unit is 

diagnosed with Ebola, he/she must immediately be transferred to a suitable isolation room. The 

patient and the treatment team providing care to the patient must wear a surgical mask, and the 

team must wear protective gear.58

2. Treatment Management of Suspicious Cases 

The Memorandum requires that the physician and the nurse responsible for managing a 

suspected case of Ebola will appoint a treatment team that will treat the patient exclusively. 

Team members must wear full protective gear.59 Upon admission the patient must be transferred 

to an isolation room that will be under full supervision to ensure that entry and exit from the 

 

54 Itai Gal, First Publication: This Is How Ebola Patients Will Be Treated in Israel, YNET (Oct. 20, 2014), 

http://www.ynet.co.il/articles/0,7340,L-4581372,00.html. 

55 Memorandum No. 13/14 by Head of Public Health Services, supra note 1, § 2.1. 

56 Id. § 2.2.1.1. 

57 Id. § 2.2.1.2. 

58 Id. § 2.2.2. 

59 A detailed description of the gear requirements is provided. Id. § 3.3.1. 
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room is in accordance with guidelines. The Memorandum requires the filling out of a special 

form documenting all persons who were in either direct or indirect contact with the patient prior 

to the patient’s entry into the room.60

The Memorandum limits the number of visitors that can be in touch with the patient and requires 

that they use the same protective gear required of the treatment team.61 It further provides that 

after complying with all required measures for preventing contamination, the patient must be 

diagnosed and treated for any additional dangerous diseases he/she might have, particularly those 

“common among travelers returning from Africa”—diseases whose symptoms may be similar to 

those of Ebola, including malaria, typhoid, and hepatitis A.62 

The Memorandum requires preventing the contamination of materials and equipment as 

appropriate, by full isolation or by sterilization and fumigation.63 It also provides specific 

guidelines for handling and transferring blood and other bodily fluids, for conducting activities 

that may create aerosols, for procedures involving the use of contained centrifuges, and for the 

transfer of samples for diagnosing contamination from a patient suspected of having Ebola.64 

3. Notice Requirement 

The Memorandum imposes on the MOH regional physician the duty of immediately reporting by 

phone every suspicious case of Ebola. The regional physician must immediately transmit the 

information to the heads of the Ministry’s departments of epidemiology and public health 

services. The Memorandum requires that all announcements be made exclusively via the 

Ministry’s Press Release office.65

4. Determination of Treatment Location 

Patients must be treated only at hospitals that provide suitable isolation conditions and whose 

personnel possess the required training and abilities. The MOH management may decide to 

transfer a patient to another hospital as needed. Such a transfer will be conducted in accordance 

with the protocol on “Encountering an Unusual Biological Event—the First Hours.” 66 

 

 

60 Id. § 3.3.2. 

61 Id. § 3.3.3. 

62 Id. § 3.3.6. 

63 Id. § 3.10. 

64 Id. § 5. 

65 Id. § 6. 

66 Id. § 7; MOH EMERGENCY UNIT, ENCOUNTERING AN UNUSUAL BIOLOGICAL EVENT – THE FIRST HOURS (Aug. 

2008), http://www.health.gov.il/Subjects/emergency/preparation/DocLib/tora/BIO_TORA_BIO_EVENT_HOURS. 

pdf (in Hebrew). 
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5. Epidemiological Investigation and Follow-Up of Patients and Their Contacts 

An epidemiological questionnaire must be filled out for every case where Ebola is suspected. 

The questionnaire, a copy of which is appended to the Memorandum, includes information 

identifying the patient and his/her residence address, insurance, treating physician and hospital, 

clinical symptoms, laboratory results, history of travel, and meetings with any person who 

returned from a foreign country in the twenty-one days before the onset of symptoms (including 

meetings to medically treat such a person).67 

B. Preparedness for and Prevention of Pandemic Influenza 

As indicated above, in 2007 Israel’s MOH issued its Pandemic Influenza Preparedness Plan for 

the Health System.

68 The Plan provides a list of measures to be employed by HIEs and local and 

district medical facilities. The Plan also provides special instructions for the Magen David 

Adom, Israel’s national emergency medical, disaster, ambulance and blood bank service.69 

The Plan lists the following actions to be taken in the community to prevent the spread 

of disease: 

1. Public Health Guidelines 

Guidelines regarding the cleanliness of surfaces, personal and respiratory hygiene, and other 

relevant information related to disease transmission and prevention must be easily accessible to 

the public via the MOH’s website and influenza pandemic site, and through leaflets titled 

Hygiene Rules.

70 

2. Restrictions on Social Gathering 

Restrictions on social gathering may be imposed, depending on the scope and duration of the 

contamination and the conditions of the area where it occurs (open or closed). Schools, day-care 

centers, and nursery schools may be closed; restrictions may be imposed on the use of public 

transportation; employees may be encouraged to work from home by phone, fax, computer, etc.; 

cultural and sports events may be cancelled; and patients may be voluntarily secluded.71 

3. Limitations on Freedom of Movement 

Recommendations to avoid unnecessary travel and restrictions on local and international travel 

may be issued. In the event of pandemic influenza occurrences involving transmission from 

human to human, the recommendations of the WHO and the Centers for Disease Control and 

 

67 Memorandum No. 13/14 by Head of Public Health Services, supra note 1, § 10. 

68 Pandemic Influenza Preparedness Plan for the Health System, supra note 2. 

69 Id. ch. C(6). 

70 Id. ch. C(7)(a)(1). 

71 Id. ch. C(7)(a)(2). 
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Prevention in the United States should be followed. The Plan also provides for preparing control 

measures for closed or semiclosed facilities, including elderly homes, military facilities, and 

prisons. To reduce the spread of disease in medical facilities through contact between medical 

teams, the Plan, among other measures, authorizes the organization of labor teams that work in 

shifts without meeting each other. The Plan requires the adoption of personal hygiene measures, 

such as the use of face masks by patients, medical teams, and the public at large.72 

VI. Transparency of Public Health Crisis Management System 

The Department of Epidemiology of the MOH prepares a weekly report based on data received 

on communicable diseases in the country. The reports have been available to the public in paper 

or digital form since the year 2000.73 Israel cooperates with the WHO and provides the 

organization with data on contagious diseases. Israel protects freedom of the press, and the 

public may obtain information through any means of communication. 

VII. Response to Threats of Chemical and Biological Attacks 

Preparing for chemical, biological or radiological attacks is the responsibility of both the 

Ministry of Defense Home Front Command and the MOH. These Ministries have prepared 

working procedures; stockpiled vaccines, antibiotics, and other medications; and trained health 

providers for crisis events. Specific information on such attacks and instructions on how to 

protect against chemical, biological, and radiological attacks are provided on the website of the 

Home Front Command.74 

Information on the state’s preparedness for chemical, biological, and radiological attacks is not 

easily accessible. A 2002 report prepared by the Knesset Information and Research Center in 

anticipation of the 2003 Iraq War states that the reluctance of the Israeli defense system and its 

MOH to disclose information on the state’s preparedness stems from the concern that this will 

expose the extent of the state’s vulnerability to such attacks.75 The following is a summary of 

relevant portions of the report. 

 

 

72 Id. ch. C(7)(a)(3)–(6). 

73 Infectious Disease Unit, MOH, http://www.health.gov.il/UnitsOffice/ICDC/Units/Infectious_Diseases/Pages/ 

default.aspx (in Hebrew; last visited Oct. 23, 2014); for weekly influenza status reports, see Weekly Influenza 

Reports, MOH, http://www.health.gov.il/UnitsOffice/ICDC/Infectious_diseases/Flu/Pages/FWR.aspx (in Hebrew; 

last visited Oct. 23, 2014). 

74 Chemical Weapons, HOME FRONT COMMAND, http://www.oref.org.il/10648-en/Pakar.aspx (last visited Oct. 23, 

2014); Biological Weapons, HOME FRONT COMMAND, http://www.oref.org.il/10649-en/Pakar.aspx (last visited Oct. 

23, 2014); Radiological Terror, HOME FRONT COMMAND, http://www.oref.org.il/10654-en/Pakar.aspx (last visited 

Oct. 23, 2014). 

75 Y. SHAI, IMMUNIZATIONS AGAINST CHICKEN POX AND ANTHRAX 2, KNESSET INFORMATION AND RESEARCH 

CENTER (Oct. 20, 2002), http://www.knesset.gov.il/mmm/data/pdf/m00465.pdf (in Hebrew). 
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A. General Preparedness 

The general health system has been reportedly prepared, potential threats identified, and 

operating procedures formalized for hospitals, health clinics, and localities, including procedures 

for cooperation among the different bodies. An intensive instruction of thousands of doctors and 

nurses began at the time the report was issued.76 

B. Anthrax Preparedness 

A health system plan for the treatment of anthrax victims has been prepared. While most of the 

treatment would be provided by the HIEs, the health system plan includes immunizations and 

preventive antibiotic treatments for affected persons. The report stated that the authorities had a 

sufficient supply of antibiotic medications for the treatment of anthrax. The report further 

recommended not vaccinating the entire population against anthrax because of possible serious 

side effects.77 

C. Smallpox Preparedness 

It was decided at the time not to vaccinate the entire public against smallpox. Instead, fifteen 

thousand medical and security personnel were to be vaccinated, some of whom would be among 

the first teams to come in contact with future patients. Approximately six thousand five hundred 

persons had been vaccinated by October 2002. These teams would also serve as first reactors 

from whom antibodies would be extracted to enable countering complications and side effects of 

the disease.78 

The report concluded that there was enough vaccine for the country’s population. The vaccines 

and antibiotics are not available at the HIEs, but are kept by the Homeland Command and the 

MOH. There were several plans for vaccinating the population that were expected to be 

implemented on the basis of government decisions or the consequences of an event.79 

At the time of the report, the MOH had requested the Ministry of Education to prepare three 

hundred schools around the country to serve as smallpox vaccination centers if the need arose.80 

 

76 Id. § 4(B). 

77 Id. § 4(C). 

78 Id. § 4(D)(1). 

79 Id. § 4(D)(2). 

80 Id. § 4(D)(3). 
The Law Library of Congress 114

Italy 

Dante Figueroa 

Senior Legal Information Analyst*

SUMMARY Italy’s Constitution recognizes the protection of health as a fundamental individual right 

and public interest, and also enshrines the principle of respect for the human personality. 

Within this constitutional framework, the Consolidated Health Laws and various other 

legal and regulatory provisions assign responsibility for confronting health crises to 

national and regional authorities, authorize measures to address infectious and 

communicable diseases, establish a reporting system, and grant authority for the issuance 

of special orders when the nation is threatened with an epidemic. The Minister of Health 

and the National Health Service play leading roles in this field. Freedom of information, 

including access to public health information, is constitutionally guaranteed. Italy actively 

cooperates with the World Health Organization, European institutions, and other 

international organizations. 

Given Italy’s geographic proximity to Africa, recent parliamentary debates about the Ebola 

epidemic in Africa have centered on the country’s immigration policies. The Health 

Ministry has now updated its protocols and guidelines concerning preventative and 

response measures vis-à-vis Ebola. These guidelines set forth measures addressing the 

treatment of suspected, probable, and confirmed cases of Ebola; sanitation and 

decontamination; the disposal of waste; and the handling of corpses. Most regions follow 

the Ebola protocols established at the national level. 

I. Government Structure 

Italy is a democratic republic whose president is the Head of State. The executive power resides 

in the Council of Ministers, which is headed by the Prime Minister (officially referred to as the 

President of the Council of Ministers). Legislative power is exercised jointly by the Chamber of 

Deputies and by the Senate. The judicial branch is an autonomous order independent from any 

other power. The territory of the Republic is divided into twenty regions and further into 

provinces and municipalities. 

II. Structure of Public Health Crisis Management System 

Health protection and the handling of public health crises in Italy are regulated by statutory and 

regulatory provisions based on the constitutional principle of the protection of health as a 

fundamental individual right and a public interest. The Constitution further states that health 

 

*

 This report updates a report originally prepared by former Senior Legal Specialist Giovanni Salvo in 2003, which 

was previously updated in 2009 by Senior Legal Research Analyst Constance A. Johnson. 
Legal Responses to Health Emergencies: Italy 

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treatments may be imposed by law only if they do not violate the principle of respect for the 

human personality.1

 

Italy’s National Health Service, under the Ministry of Health, aims at ensuring the sanitary and 

epidemiological well-being of the whole population. It assures the coordination of all activities 

and interventions of agencies, institutions, and services that perform any duty concerning 

individual and collective health. The central and local governments are jointly responsible for 

the implementation of the National Health Service. The law provides health authorities with the 

necessary powers to perform mandatory health controls and treatments.2

The Consolidated Health Laws contains specific provisions concerning infectious diseases. It 

establishes that the Minister of Health may, on the advice of the Superior Council of Health, 

issue a list of infectious and communicable diseases subject to special procedures and measures.3 

The Act imposes a system of reporting such diseases through the various levels of responsible 

authorities up to the Minister of Health. It provides for preventative measures, necessary 

assistance, and disinfection interventions for such diseases. It further grants the Minister of 

Health, when the nation is threatened with an infectious disease epidemic, the authority to issue 

special orders for the inspection and disinfection of premises, the organization of special services 

and medical assistance, and the adoption of protective measures against the spread of such 

diseases. The ordinances of the Minister are published in the Official Gazette. Under the 

provisions concerning veterinary regulations, the Act requires coordination between the 

Municipal Veterinary Office and the Municipal Health Office for the reporting of animal 

diseases that can be transmitted to humans.4

Preventing, monitoring, and responding to public health emergencies including epidemics, even 

when caused by terrorists, is the responsibility of government officials and civil servants at the 

central, regional, and municipal levels. The Minister of Health assesses and makes decisions 

concerning situations of national crisis, and issues the ordinance that triggers the response to a 

specific emergency.5

 The Civil Protection Department, under the supervision of the Prime 

Minister or the duly delegated Interior Minister, deals with emergencies that are the result of 

natural disasters or the consequence of human activities, as well as other events that, because of 

 

1

 CONSTITUTION OF THE ITALIAN REPUBLIC art. 32, https://www.senato.it/documenti/repository/istituzione/ 

costituzione_ inglese.pdf (English version published by the Parliamentary Information, Archives and Publications 

Office of the Senate Service for Official Reports and Communication of the Senato della Repubblica, Apr. 2009). 

2

 Legge 23 dicembre 1978, n. 833, Istituzione del servizio sanitario nazionale [Law No. 833 of December 23, 1978, 

National Health Service Institution], GAZZETTA UFFICIALE DELLA REPUBBLICA ITALIANA [G.U.] No. 360, Dec. 28, 

1979, http://www.normattiva.it/uri-res/N2Ls?urn:nir:stato:legge:1978-12-23;833. 

3 Id. arts. 9 & 62. 

4

 Royal Decree No. 1265 of July 27, 1934, as amended, approving the Consolidated Health Law, in CODICE DELLA 

SANITA’ (Torino, UTET 1999). 

5 Law No. 833. See also Ordinanza 10 Apr. 2003 of the Minister of Health, G.U. No. 89 of Apr. 16, 2003; DecretoLegge 9 maggio 2003 No. 103, Disposizioni urgenti relative alla sindrome respiratoria acuta severa (SARS) 

[Decree-Law No. 103 of May 9, 2003, Urgent Provisions Related to the Severe Acute Respiratory Syndrome 

(SARS)], G.U. No. 108, May 12, 2003, http://www.normattiva.it/uri-res/N2Ls?urn:nir:stato:decreto. legge:2003;103

(concerning urgent provisions for the SARS syndrome). 
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their intensity and scope, require the coordinated intervention of public authorities at the central 

and local government levels.6

Under legislation enacted in 1998,7 urgent interventions in cases of health emergencies can be 

made by regional and local authorities. The intervention of the central government authorities 

takes precedence according to the relevance and the magnitude of the emergency.8 The Prime 

Minister may appoint a special commissioner when a state of emergency has been declared.9

III. Powers of Public Health Authorities 

Article 32 of the Italian Constitution states that no one may be forced to receive medical 

treatment unless provided for by law, and that the law may not violate limits imposed by respect 

for the human personality. The powers granted to public health authorities to adopt a range of 

protective measures against the spread of disease in a health crisis, such as mandatory medical 

treatments, are limited by the constitutional guarantee of respect for the human personality and, 

 

6

 In addition to the existing body of laws on Civil Protection (Codice della Protezione Civile, Piacenza, La Tribuna, 

2002), see Decree of the President of the Republic, Mar. 27, 1992, Course of Action and Coordination for the 

Regions for the Purpose of Determining Levels of Health Assistance During Emergencies, G.U. No. 76 of Mar. 

31,1992; Agreement Between the State and the Regions Approving Guidelines on the Health Emergency System 

Pursuant to the Decree; Decree of Feb. 13, 2001, on Adoption of General Criteria for the Organization of Health 

Relief in Disasters; Law No. 401 of Nov. 9, 2001, G.U. No. 262 of Nov. 11, 2001; Legge 9 novembre 2001, n. 401, 

Conversione in legge, con modificazioni, del decreto-legge 7 settembre 2001, n. 343, recante disposizioni urgenti 

per assicurare il coordinamento operativo delle strutture preposte alle attivita’ di protezione civile [Law No. 401 of 

Nov. 9, 2001, Conversion into Law, with Amendments, of Decree-Law No. 343, Sept. 7, 343, Concerning 

Provisions for the Operational Coordination of the Structures of Civil Protection and Improving Logistics of Civil 

Defense], G.U. No. 262 of Nov. 11, 2001, http://www.normattiva.it/uri-res/N2Ls?urn:nir:stato:legge:2001;401; 

Decree of Mar. 2, 2002, G.U. No. 66 of Mar. 19, 2002, Establishing the Operational Committee for Civil Protection. 

7

 Decreto Legislativo 31 marzo 1998, n. 112, Conferimento di funzioni e compiti amministrativi dello Stato alle 

regioni ed agli enti locali, in attuazione del capo I della legge 15 marzo 1997, n. 59 [Legislative Decree No. 112 of 

March 31, 1998, Granting Administrative Powers and Competences of the State to the Regions and Local Entities, 

in Accordance with Chapter I of Law No. 59, of March 15, 1997], G.U. No. 92, Apr. 21, 1998, http://www.normat 

tiva.it/uri-res/N2Ls?urn:nir:stato:decreto.legge:1998-03-31;112vig. See also Decreto Legislativo 18 agosto 2000, n. 

267, Testo unico delle leggi sull’ordinamento degli enti locali [Legislative Decree No. 267 of August 18, 2000, 

Approving the Consolidation Act of Provisions Governing Local Administrative Bodies], G.U. No. 227, Sept. 28, 

2000, http://www.normattiva.it/uri-res/N2Ls?urn:nir:stato:decreto.legislativo:2000-08-18;267. 

8

 Consolidated Health Laws art. 49. 

9

 Decreto del Presidente del Consiglio dei Ministri 28 marzo 2003, Dichiarazione dello stato di emergenza in 

relazione alla tutela della pubblica incolumita’ nell’attuale situazione internazionale [Decree of the President of the 

Council of Ministers of March 28, 2003, Declaration of State of Emergency with Relation to the Protection of Public 

Safety in the Current International Situation], G.U. No. 74, Mar. 29, 2003, http://www.protezionecivile.gov.it/ 

cms/attach/decreto_28marzo2003.pdf; Ordinanza del Presidente del Consiglio dei Ministri 30 aprile 2003 n. 3285, 

Concerning Further Measures of Civil Protection for the International Health Emergency, G.U. No. 106, May 9, 

2003, http://www.protezionecivile.gov.it/cms/attach/ordinanza3285del30.pdf. See also Ordinanza 28 marzo 2003 n. 

3275, Disposizioni urgenti di protezione civile per fronteggiare l’emergenza derivante dalla attuale situazione 

internazionale [Ordinance No. 3275, of March 28, 2003, Urgent Provisions of Civil Protection to Face the 

Emergency Deriving from the Current International Situation], G.U. No. 74, Mar. 29, 2003, http://www.ambiente 

diritto.it/Onlus/2003/opcm%202003%20n.3275.htm; Ordinanza del Presidente del Consiglio dei Ministri 18 aprile 

2003 n. 3282, Disposizioni urgenti di protezione civile [Ordinance No. 3282 of the President of the Council of 

Ministers of April 18, 2003, Urgent Provisions for Civil Protection], G.U. No. 99, Apr. 30, 2003, http://www.gaz 

zettaufficiale.it/atto/serie_generale/caricaDettaglioAtto/originario?atto.dataPubblicazioneGazzetta=2003-04-

30&atto.codiceRedazionale=03A05416&elenco30giorni=false. 
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to some extent, in the application of the law protecting privacy.10 One author has observed that 

the Italian Constitution appears to favor the collective public health interest as opposed to the 

individual’s interest when it comes to protection from epidemics and infectious diseases.11 

Health authorities may impose stricter controls on travelers coming from areas at risk, require air 

or other carriers to provide detailed information regarding their passengers’ itineraries, impose 

health checks, and require hospitalization for infected persons. International preventive 

measures and public hygiene measures concerning imported goods, travelers, and migrants are 

carried out by the health authorities set up by the Ministry of Health at the territorial borders, 

ports, and airports.12 

Italy’s public health laws provide for the imposition of administrative and penal sanctions, 

including terms of imprisonment, for noncompliance. Punishable conduct includes failure to 

provide assistance in emergency health situations, especially for health professionals; violations 

of reporting procedures; and failure to abide by a lawful order of the authority in a health crisis.13 

In addition, the Italian Penal Code makes causing an epidemic by spreading noxious germs a 

crime punishable by life imprisonment.14

IV. Transparency of Public Health Crisis Management System 

The right of the public to access official information is a fundamental right provided in article 21 

of the Italian Constitution. 

Decisions by the Italian Constitutional Court under article 21 have emphasized not only the 

freedom to provide and divulge news, opinions, and comments, but also the right to obtain 

information. This interest implies a plurality of sources of information, free access to them, and 

the absence of unjustified legal obstacles, even temporary ones, to the circulation of news 

and ideas.15

 

10 Legge 31 dicembre 1996, n. 675, Tutela delle persone e di altri soggetti rispetto al trattamento dei dati personali 

[Law No. 675 of December 31, 1996, Protection of the Person and other Subjects Concerning the Treatment of 

Personal Data], G.U. No. 5, Jan. 8, 1997, http://www.normattiva.it/uri-res/N2Ls?urn:nir:stato:legge:1996;675; 

Decreto Legislativo 11 maggio 1999, n. 135, Disposizioni integrative della legge 31 dicembre 1996, n. 675, sul 

trattamento di dati sensibili da parte dei soggetti pubblici [Legislative Decree No. 135 of May 11, 1999, 

Supplementary Provisions of Law No. 675, of December 31, 1996, http://www.normattiva.it/urires/N2Ls?urn:nir:stato:decreto.legislativo:1999;135. 

11 See generally La Privacy nella sanità [Privacy in Health], DIRITTO E RISPOSTE, http://www.dirittierisposte. 

it/Schede/Tutela-della-privacy/Diritti/la_privacy_nella_sanita_id1129480_art.aspx (last visited Nov. 6, 2014). 

12 Regio Decreto 30 marzo 1942, n. 327 Approvazione del testo definitivo del Codice della Navigazione [Royal 

Decree No. 327 of March 30, 1942, Approving the Final Text of the Navigation Code], G.U. No. 93, Apr. 18, 1942, 

http://www.normattiva.it/uri-res/N2Ls?urn:nir:stato:regio.decreto:1942-03-30;327. 

13 CODICE PENALE [C.P.] [PENAL CODE] art. 415, available at http://www.altalex.com/index.php?idnot=36766. 

14 Id. art. 438. 

15 Italian Constitutional Court, Decision No. 105 of 1972, Consulta Online, http://www.giurcost.org/decisioni/1972/ 

0105s-72.html. In Decision No. 112 of 1993, http://www.giurcost.org/decisioni/1993/0112s-93.html, the Court, 

referring to its established interpretation of article 21, recognized the existence of a full, individual right to 

be informed. 
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The Consolidated Health Laws reserves to the central government the administrative duties and 

responsibilities concerning the functioning of the national Health Information System. The 

central government is also required to coordinate (1) the regional information systems in 

cooperation with public and private entities, (2) statistical analysis of the data disseminated, (3) 

information to be provided to Parliament, and (4) any other reporting of national relevance.16 

Especially during a public health crisis, the Minister of Health issues directives and disseminates 

information through any appropriate means, including its website.17 Health information is 

further disseminated by newspapers and public and private radio and television stations. 

V. Cooperation with the WHO 

The Italian government works closely with the WHO in meeting public health crises. The 

Ministry of Health, through its website, keeps the public informed of international developments 

and of WHO standards and guidelines.18 

Italy enacted legislation implementing the International Health Regulations of 1969 as amended 

in 1973.19 Italy is also a party to the International Health Regulations of 2005.20

VI. Response to Ebola Virus Epidemic in West Africa 

A. National Measures 

In response to the Ebola epidemic in West Africa, the Italian Ministry of Health issued a Circular 

on April 4, 2014, recommending the “adoption of all useful surveillance actions related to 

indirect arrivals” from Guinea and other bordering countries where symptoms of Ebola have 

been found.21 While the Circular seeks to minimize the danger of Ebola spreading in Italy, key 

government ministries and agencies have nonetheless been alerted, including the Italian 

Red Cross.22

 

16 Consolidated Health Laws art. 118. 

17 MINISTERO DELLA SALUTE, http://www.sanita.it (last visited Nov. 5, 2014). 

18 Id. 

19 Legge 9 febbraio 1982, n. 106 Approvazione ed esecuzione del regolamento sanitario internazionale, adottato a 

Boston il 25 luglio 1969, modificato dal regolamento addizionale, adottato a Ginevra il 23 maggio 1973 [Law No. 

106 of February 9, 1982, G.U. 87 of Mar. 30, 1982, Approval and Implementation of the International Sanitary 

Regulations Adopted at Boston on July 25, 1969, Amended by the Additional Regulations Adopted in Geneva on 

May 23, 1973], G.U. No. 87, Mar. 3, 1982, http://www.normattiva.it/uri-res/N2Ls?urn:nir:stato:legge:1982-02-

09;106@originale. 

20 States Parties to the International Health Regulations (2005), WORLD HEALTH ORGANIZATION, 

http://www.who.int/ihr/legal_issues/states_parties/en/. 

21 Circolare Ministeriale N° 0026708, Procedure operative per la gestione di casi sospetti, probabili o confermati e 

contatti di malattia da virus Ebola (MVE) in Africa Occidentale [Operational Procedures for the Management of 

Suspected, Probable, or Confirmed Cases and Contacts of the Ebola Virus Disease in Western Africa] (Circular) 

(Oct. 14, 2014), http://www.inmi.it/file/ebola/procedura_ebola_unita_crisi_rev2_16_10_2014.pdf. 

22 Id. 
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On May 14, 2014, the Italian Chamber of Deputies held a parliamentary debate to review the 

preparedness of Italy’s health system to prevent and fight Ebola.23 The debate highlighted the 

fact that during the months prior to May 2014, Italy witnessed a growing influx across its 

southern border of thousands of illegal African immigrants, many of whom came from the 

Ebola-affected areas of West Africa. During the debates, many participants argued this situation 

required action from the National Government, in particular from the Health Ministry, to address 

illegal immigration, as well as to provide the public with transparent and prompt information, 

especially to protect school children. Some participants in this session proposed that the 

government impose a sanitary cordon throughout the country to protect the population, but the 

government has not adopted this proposal. 

 

The Health Ministry responded to the parliamentary inquiry by requiring immigrants arriving at 

coastal areas of Italy to undergo thorough clinical evaluations to exclude the presence of signs or 

symptoms of Ebola before they reach immigration centers.24 Isolation measures are 

implemented when necessary.25 Immigration centers are also staffed with sanitary personnel 

whose function is to ensure the adequate flow of information to and from the Health Ministry, 

and to adopt immediate measures when specific dangers to public health are involved.26 

While parliamentary debate has generated new regulations, no specific legislative bills 

containing extraordinary measures to address the Ebola epidemic have yet been introduced 

in Italy. 

On October 14, 2014, the National Institute for Infectious Diseases (Istituto nazionale per le 

malattie infettive, Lazzaro Spallanzani), updated its Operational Procedures for the Management 

of Suspected, Probable, or Confirmed Cases and Contacts of the Ebola Virus Disease in Western 

Africa (the Procedure).27 The Procedure contains three parts: the first describes the Ebola virus 

disease; the second regulates the treatment of Ebola patients; and the third deals with other stages 

in the treatment of the disease, including disinfection and sanitation, waste treatment, disposal 

corps, and surveillance of health personnel. 

 

23 Camera dei deputati, Session No. 228 (May 14, 2014), Misure sanitarie per tutelare i cittadini in relazione al 

flusso di immigrati provenienti dal Mediterraneo, con particolare riferimento alla diffusione di un’epidemia del virus 

ebola in varie aree dell’Africa [Sanitary Measures to Protect Citizens with Relation to the Influx of Immigrants 

Coming from the Mediterranean, with Particular Reference to the Dissemination of the Ebola Virus in Several Areas 

of Africa], http://banchedati.camera.it/sindacatoispettivo_17/showXhtml.asp?highLight=0&idAtto=18464&stile=7;

XVII Legislatura, Resoconto stenografico dell’Assemblea Seduta n. 228 di mercoledì 14 maggio 2014 [XVII 

Legislature, Transcript of Assembly Session No. 228, of May 14, 2014], http://www.camera.it/leg17/ 

410?idSeduta=0228&tipo=stenografico#. 

24 Id. See also FAQ – Malattia da virus Ebola (EVD), Question 16, Qual è la situazione in Italia e quali misure sono 

state prese? [FAQ – What Is the Situation in Italy, and What Measures Have Been Taken?], MINISTERO DELLA 

SALUTE [HEALTH MINISTRY], http://www.salute.gov.it/portale/p5_1_1.jsp?lingua=italiano&id=184 (last visited 

Nov. 7, 2014). 

25 FAQ, supra note 24. 

26 Id. 

27 Circular, supra note 21. 
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In the case of suspected patients, health personnel must observe a series of guidelines concerning 

the sanitation of the areas exposed to the patient, his or her transfer to an isolated room or 

facility, and his or her immediate treatment by a qualified physician.28 Suspected patients may 

be repatriated from overseas or transferred to another specialized facility at the national or 

regional levels.29 

The treating physician must issue a diagnostis of the patient as “nonsuspected,” or suspected of 

low or high risk.30 If the patient is characterized as of low or high risk, he needs to be treated in 

a facility devoted to the treatment of infectious diseases.31 The sanitation procedures for the 

facilities used for the patient must be strictly followed in order to avoid contaminating 

other patients.32

The test for Ebola virus must be carried out only on suspected patients.33 If the test is negative, 

and the symptoms remain for at least forty-eight hours, caution must be observed in the handling 

of the patient until the test is repeated.34 If the test results are negative a second time, then the 

patient is moved to a recovery unit.35

The Procedure states that there are no international guidelines, criteria, or procedures for the 

release of patients.36 However, based on the Institute’s experience and observations of 

comparable scenarios, the Procedure establishes two concurrent criteria that must be met for the 

release of patients: (i) when the patient is in a good and stable clinical condition; and (ii) when at 

least two Ebola virus tests have been applied to the patient in a space of at least twenty-four 

hours, with negative results.37 Diagnostic activities performed at laboratories must meet 

specified minimum requirements.38 Samples taken from the patient are subject to the “rule of 

triple packaging,”39 and transportation of samples is subject to stringent rules.40

Finally, the Procedure lists stringent measures in case of the death of the patient,41 and the 

sanitation and decontamination of health personnel.42

 

28 Id. 

29 Id. at 9. 

30 Id. 

31 Id. 

32 Id. at 12. 

33 Id. at 14. 

34 Id. 

35 Id. 

36 Id. at 15. 

37 Id. 

38 Id. at 17. 

39 Id. 

40 Id. at 18. 

41 Id. at 25. 
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The Italian Health Ministry is permanently updating its information concerning the 

Ebola epidemic.43

B. Regional Measures 

Ebola virus protocols at the regional level follow the guidelines issued by the National Health 

Ministry. For example, the Lazio Region (where Rome, Italy’s capital, is located) has issued a 

Regional Protocol for the Ebola Virus Epidemics in Western Africa: Indications for Surveillance 

and Control.44 This Protocol states that it was written “based on the indications received from 

the national Health Ministry issued pursuant to a central protocol for the management of 

suspected/probably/confirmed cases of [Ebola], including their contacts.”45

 42 Id. 

43 Eventi epidemici all’estero [Epidemic Events Overseas], MINISTERO DELLA SALUTE, http://www.salute.gov.it/ 

portale/news/p3_2_1_3_4.jsp?lingua=italiano&menu=notizie&p=avvisi&%20tipo=eventiEpidemici (last visited 

Nov. 7, 2014). 

44 LAZIO REGION, EPIDEMIA DA VIRUS EBOLA IN AFRICA OCCIDENTALE: INDICAZIONI PER LA SORVEGLIANZA E IL 

CONTROLLO. PROTOCOLLO REGIONALE, http://www.regione.lazio.it/binary/rl_main/tbl_news/Protocollo_Ebola.pdf. 

45 Id. at 3. 
The Law Library of Congress 122

Japan 

Sayuri Umeda 

Foreign Law Specialist

SUMMARY In addition to Japan’s general crisis management system, the Japanese government has 

implemented a health crisis management system. The Ministry of Health, Labour and 

Welfare, the primary agency in charge of responding to infectious disease outbreaks and 

other health crises, has issued guidelines for health crisis management. Japan’s Infectious 

Diseases Prevention Act of 1998 provides the legislative framework for the country’s 

response to a potential health crisis caused by infectious disease. The Act classifies 

infectious diseases covered by the Act into several categories, depending on infectiousness 

and the severity of symptoms. Under the Act, the Ministry of Health, local governments, 

and the institutions under them monitor and report on the outbreak of infectious diseases 

and coordinate their roles to prevent more infections. Medical doctors report incidences of 

infectious disease to governors through local health centers. Those health centers have 

broad jurisdiction over health-related issues and play an important role in health crisis 

management. 

 Japan has designated hospitals with special facilities to deal with patients who are infected 

with serious and highly infectious diseases. A governor may order the hospitalization of 

patients in certain cases. A quarantine system is activated when the outbreak of an 

infectious disease overseas becomes a threat to the Japanese people. When the system is 

activated quarantine officers may ask questions of incoming passengers and take their 

temperatures. When the head of a quarantine station finds or suspects that a person is 

infected with one of several specified diseases, he or she may isolate the person in an 

appropriate place. 

 The Special Measures Act on New Influenza was also enacted in 2012, creating an 

emergency system specifically for influenza. 

I. Government Structure 

In Japan executive power is vested in the Cabinet, which consists of the Prime Minister and other 

ministers. The Prime Minister is designated from among the members of the Diet (Parliament) 

by a resolution of the Diet. He then appoints the other ministers. Localities are divided into 

prefectures and municipalities. 

II. Structure of Public Health Crisis Management System 

A. National Health Crisis Management 

The Cabinet has a Deputy Chief Cabinet Secretary for Crisis Management who manages 

emergency measures when a situation causing significant damage to Japanese people’s lives or 
Legal Responses to Health Emergencies: Japan 

The Law Library of Congress 123

assets occurs or is likely to occur.1

 As stated below, the Deputy Chief Cabinet Secretary for 

Crisis Management chairs the conference of relevant ministries and agencies on Ebola, which is 

preparing to take coordinated measures among government agencies in case Japanese nationals 

are infected with Ebola abroad or persons infected with Ebola are found within Japan. 

The Ministry of Health, Labour, and Welfare (MHLW) is the primary agency in charge of 

responding to infectious disease outbreaks and other health crises in Japan.2

 In 1997, the 

MHLW published the Basic Guidelines in Health Crisis Management3 and four management 

implementation guidelines for health crises caused by medicine, infectious diseases, drinking 

water contamination, and food poisoning.4 The MHLW has established an electronic health 

crisis management information system and has also issued guidelines for municipal 

governments, instructing them to make preparations and develop plans for 

emergency situations.5 

The Health Risk Management Office of MHLW is continually gathering domestic and overseas 

information from related departments and from national research and development institutes. 

Departments within MHLW exchange information at the Health Risk Management Coordination 

Meeting held two times per month.6 A Coordination Meeting can also be convened in an 

emergency and members may act to establish emergency management headquarters, dispatch 

staff and experts to the affected areas, and provide citizens with information on health risks.7

B. Local Public Health Crisis System 

Prefectures are in charge of conducting various on-the-spot measures during a health crisis. In 

Japan, local government health centers play an important role in local health care management.8 

Prefectures and designated cities have established at least one health center in each of their 

jurisdictions,9 resulting in the creation of approximately five hundred health centers throughout 

 

1

 Naikaku hō [Cabinet Act], Act No. 5 of 2010, amended by Act No. 108 of 2013, art. 15. 

2

 Ministry of Health, Labor, and Welfare Establishment Act, Act No. 97 of 1999, art. 4, para. 1, items 4 and 19. 

3 MHLW, Kosei rōdō shō kenkō kikikanri kihon shishin [Basic Guidelines in Health Crisis Management], 

http://www.mhlw.go.jp/general/seido/kousei/kenkou/sisin/index.html (last visited Oct. 8, 2014). 

4

 The four health crisis management implementation outlines are available on the MHLW website, 

http://www.mhlw.go.jp/general/seido/kousei/kenkou/index.html (last visited Oct. 8, 2014). 

5 Chiiki ni okeru kenko kikikanri ni tsuite [Regarding Local Health Crisis Management], MHLW (Mar. 2001), 

http://www.mhlw.go.jp/general/seido/kousei/kenkou/guideline/index.html. 

6

 MHLW, ANNUAL HEALTH, LABOUR AND WELFARE REPORT 2009–2010, pt. 2, ch. 1, § 9, http://www.mhlw.go.jp/ 

english/wp/wp-hw4/dl/honbun/2_1_9.pdf. 

7 Regarding Health Emergency Management Measures of the MHLW, MHLW, http://www.mhlw.go.jp/ 

seisaku/2010/03/01.html (in Japanese; last visited Oct. 10, 2014). 

8

 Chiiki kenko kiki kanri gaidorain [Local Health Crisis Management Guidelines], MHLW Circular, Kenso No. 17 

(Mar. 30, 2001), I, 1, http://www.mhlw.go.jp/general/seido/kousei/kenkou/guideline/index.html.

9

 Chiiki hoken hō [Local Health Act], Act No. 101 of 1947, last amended by Law No. 83 of 2014, art. 5. 
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the country as of April 2014.10 The health centers have broad jurisdiction over health-related 

issues, including administration of food sanitation, administration of medical and pharmaceutical 

matters, and prevention of infectious diseases.11 

During a health crisis, the health centers become the center of local health crisis management.12 

The Basic Guidelines Regarding Promotion of Measures to Improve Local Health Issues, issued 

by the MHLW, recommend that local governments create manuals containing concrete measures 

for managing a health crisis.13 The director of the local health department and the heads of 

health centers manage health crises at the local level. Health centers are to respond to 

emergency information twenty-four hours a day, seven days a week. Health centers are expected 

to coordinate services provided by medical service providers.14 

C. Pandemic Influenza Special Measures 

Japan established a system to deal with new influenza when avian flu (H5N1) threatened its 

citizens. In 2004, the government established the Conference of Relevant Ministries and 

Agencies to Counter New Influenza and Avian Influenza.15 The Action Plan to Counter 

Influenza was approved by the Conference in November 2005,16 and revised in February 2009.17 

When a new influenza outbreak occurs, the Prime Minister and all Ministers form the 

Headquarters Against New Influenza, which in turn forms the New Influenza Countermeasures 

Expert Advisory Committee.18

 

10 Jichitai betsu hokenjo secchi sū no suii [Changes of Numbers of Health Centers by Local Governments], as of 

April 1, 2014, Zenkoku hoken sho chō kai [Japanese Association of Public Health Center Directors], 

http://www.phcd.jp/03/HCsuii/index.html. 

11 Local Health Act art. 6. 

12 Basic Guidelines Regarding Promotion of Measures to Improve Local Health Issues Based on Local Health Act 

Article 4, Paragraph 1, MHW Notification No. 374 (Dec. 1, 1994), last amended by MHLW Notification No. 464 

(July 31, 2012), http://www.mhlw.go.jp/file/06-Seisakujouhou-10900000-Kenkoukyoku/0000049526.pdf

(in Japanese). 

13 Id. 

14 Local Health Crisis Management Guidelines, supra note 8, II 1(4)(5). 

15 Shingata infuruenza oyobi tori infuruenza ni kansuru kankei shōchō taisaku kaigi no secchi ni tsuite [Regarding 

Establishment of Conference of Relevant Ministries and Agencies to Counter New Flu and Avian Flu], Agreement 

Among Relevant Ministries (Mar. 2, 2004), http://www.cas.go.jp/jp/seisaku/ful/konkyo.pdf. 

16 Press Release, MHLW, Pandemic Influenza Preparedness Action Plan of the Japanese Government (Summary), 

(Nov. 2005), http://www.mhlw.go.jp/english/topics/influenza/pandemic01.html. 

17 Shingata Infuruenza taisaku kōdō keikaku [Action Plan to Counter Influenza], Conference of Relevant Ministries 

and Agencies to Counter New Influenza and Avian Influenza (Feb, 2009), http://www.cas.go.jp/jp/seisaku/ 

ful/kettei/090217keikaku.pdf. 

18 Guidelines for the Prevention and Control of Pandemic Influenza (Phase 4), Introduction, Conference of Relevant 

Ministries and Agencies to Counter New Influenza and Avian Influenza (Mar. 26, 2009), http://www.mhlw.go.jp/ 

bunya/kenkou/kekkaku-kansenshou04/pdf/09-e01.pdf. 
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To improve the system, the Special Measures Act on New Influenza was enacted in May 2012.19 

Under the new Act, the government’s action plan20 and guidelines21 were updated.22 When an 

influenza outbreak involving a new strain of influenza occurs, the Prime Minister establishes the 

New Influenza Countermeasures Headquarters upon a Cabinet decision, unless symptoms of the 

new influenza are no graver than usual seasonal influenza.23 The Prime Minister is in charge of 

the Headquarters24 and, as such, can declare an emergency when the infection route of the new 

influenza is not determined by the local governments’ investigations or when such investigations 

reveal that the activities of the person infected or suspected of being infected pose a great risk of 

widely spreading the disease.25 

When an emergency is declared, emergency measures can be implemented for up to two years, 

with the possibility of a one-year extension. The area of the emergency must also be specified.26 

Authorized emergency measures include 

 requesting residents to refrain from going outside and requesting entertainment businesses to 

limit or close their business or events,27

 vaccinating residents,28

 opening emergency medical facilities,29 and 

 requesting the sale of specified goods to the government.30

 

19 Shingata infuruenza tō taisaku tokubetsu sochi hō [Special Measures Act on New Influenza], Act No. 31 of 2012. 

20 Shingata infuruenza tōtaisaku seihu kodo keikaku [National Action Plan for Pandemic Influenza and New 

Infectious Diseases] (June 7, 2013), English translation available on the Cabinet Secretariat website, at 

http://www.cas.go.jp/jp/seisaku/ful/keikaku/pdf/national%20action%20plan.pdf. 

21 Shingata infuruenza to taisaku gaidorain [Guidelines on Countermeasures Against Pandemic Influenza and New 

Infectious Diseases], Conference of Relevant Ministries and Agencies to Counter New Influenza and Avian 

Influenza (June 26, 2013), http://www.cas.go.jp/jp/seisaku/ful/keikaku/pdf/gl_guideline.pdf. 

22 Government plans are available on the Cabinet Secretariat’s website, at http://www.cas.go.jp/jp/seisaku/ 

ful/keikaku.html (last visited Oct. 24, 2014). 

23 Special Measures Act on New Influenza art. 15. 

24 Id. art. 16. 

25 Id. art. 32; Enforcement Order of Special Measures Act on New Influenza, Order No. 122 of 2013, art. 6. 

26 Special Measures Act on New Influenza art. 32. 

27 Id. art. 45. 

28 Id. art. 46. 

29 Id. art. 48. 

30 Id. art. 55. 
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III. Powers of Public Health Authorities 

A. Surveillance 

Japan conducts nationwide surveillance of infectious diseases on an ongoing basis. The 

Infectious Diseases Prevention Law classifies infectious diseases into the following eight 

categories based on their infectiousness, the seriousness of the symptoms, and types of diseases: 

 Category I: Ebola hemorrhagic fever, plague, smallpox, and others. 

 Category II: Tuberculosis, SARS (severe acute respiratory syndrome), H5N1 avian influenza, 

and others. 

 Category III: Cholera, bacillus dysentery, E. coli O157 infection, typhoid, and paratyphoid. 

 Category IV: Hepatitis E, hepatitis A, yellow fever, anthrax, infantile botulism, avian 

influenza (excluding H5N1) and others. An infectious disease can be added to this category 

by Cabinet order. 

 Category V: Influenza (excluding avian flu and new influenza), viral hepatitis (excluding 

hepatitis E and A), AIDS, MRSA (methicillin-resistant Staphylococcus aureus), and others. 

An infectious disease can be newly added to this category by MHLW ordinance. 

 New Influenza. 

 Designated Infectious Disease. 

 New Infectious Disease.31 

When physicians make a diagnosis or suspect the incidence of symptoms of one of the diseases 

in Categories I through IV, or a New Infectious Disease, they must immediately report the 

incidences to the governors through health centers. In the case of incidences of Category V 

diseases, physicians have seven days to make such reports.32 Veterinarians must do the same 

when they make a diagnosis in monkeys or other designated animals of Ebola hemorrhagic fever, 

Marburg hemorrhagic fever, and other infectious diseases in Categories I through IV that are 

designated by a Cabinet order because they are regarded as being infectious to humans as well.33 

The governors must forward such reports to the Minister of MHLW.34 

Governors designate hospitals and clinics to monitor incidences of (1) specified Category V 

infectious diseases; and (2) incidences of fever and respiratory problems, and fevers and rashes 

that are similar to symptoms of diseases in Categories II to IV and some Category V infectious 

 

31 Kansen shō no yobō oyobi kansenshō no kanja ni taisuru iryō ni kansuru hōritsu [Act on Prevention of Infectious 

Diseases and Medical Care for Patients of Infectious Diseases] (Infectious Diseases Prevention Act), Act No. 114 of 

1998, last amended by Act No. 30 of 2008, art. 6, para. 2, items 2–9. 

32 Id. art. 12, para. 1. 

33 Id. art. 13, para. 1. 

34 Id. art. 12, para. 2 & art. 13, para. 3. 
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diseases. Managers of designated hospitals must report cases treated by their physicians to the 

governors, and the governors must in turn forward the reports to the Minister of MHLW.35 

Governors may question doctors and conduct investigations of incidences and suspected cases of 

infectious diseases in Categories I to V and New Diseases if necessary to determine the cause of 

the incidences. In an emergency, the Minister of MHLW can do the same.36 

The National Institute of Infectious Diseases (NIID), under the supervision of the Health Science 

Division of the MHLW,37 collects reports of the detection of infectious agents from prefectural 

public health institutes and those of incidents of infectious diseases from selected clinics.38 The 

NIID also maintains and distributes reference materials on matters such as microbial pathogens, 

antigens, and antisera.39 In the case of an epidemic or outbreak of an infectious disease, NIID 

carries out epidemiological investigations and exchanges information with infectious disease 

surveillance organizations in other countries. To make these activities more efficient, the 

Infectious Disease Surveillance Center (IDSC) was organized within NIID.40 IDSC publishes 

the Infectious Disease Weekly Report and other publications and makes them available online.41 

B. Infectious Disease Control 

A prefectural governor may advise a person who is reasonably suspected of being infected with a 

Category I, II, or III disease, or New Influenza, to undergo a medical examination.42 If the 

person does not voluntarily undergo an examination, the governor may dispatch an officer to 

examine the person.43 Except in emergencies, however, the governor must give notice to the 

person before issuing a medical examination recommendation or dispatching an officer.44 

When a governor receives a report that a person is infected with a Category I through III disease 

or New Influenza from a medical doctor, the governor sends a notice to the person prohibiting 

him or her from engaging in specified jobs, such as chef and waiter positions at a restaurant, for a 

period of time that depends on the disease.45 

 

35 Id. art. 14; Infectious Diseases Prevention Act Enforcement Ordinance, MHLW Ordinance No. 99 of 2008, 

arts. 6 & 7. 

36 Infectious Diseases Prevention Act art. 15. 

37 MHLW Organization Order, Order No. 252 of 2000, art. 26. 

38 Outline – Organization: History, NIID, http://www.niid.go.jp/niid/en/aboutniid-2.html (last visited Oct. 10, 2014). 

39 Id. 

40 Outline – Organization: Functions, NIID, http://www.niid.go.jp/niid/en/aboutniid-2.html (last visited 

Oct. 10, 2014). 

41 Infectious Disease Weekly Report, NIID, http://www.niid.go.jp/niid/ja/idwr.html (in Japanese; last visited Oct. 11, 

2014). Some publications are available in English at http://www.niid.go.jp/niid/en/idwr-e.html (last visited 

Oct. 11, 2014). 

42 Infectious Diseases Prevention Act art. 17, para. 1. 

43 Id. art. 17, para. 2. 

44 Id. art. 17, para. 3. 

45 Id. art. 18. 
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A system of recommended or forced medical diagnosis and hospitalization may be activated 

when a person is suspected of being infected with certain infectious diseases. A governor may 

advise a person infected with a Category I or II disease or New Influenza to be hospitalized in a 

designated hospital. If the person does not follow the advice, the prefectural governor may force 

the person to stay in a designated hospital.46 The term of the hospitalization must be seventy-two 

hours or less initially.47 If the governor finds during the initial hospitalization that it is necessary 

to continue to hospitalize the person to prevent the spread of a Category I or II disease or New 

Influenza, the governor may recommend hospitalization for up to an additional ten days, with the 

possibility of two ten-day extensions, if necessary.48 If the person does not follow the advice, the 

governor may force the hospitalization,49 but must give the patient and/or his or her guardian an 

opportunity to state their opinions.50 

The Infectious Diseases Prevention Act contains provisions aimed at protecting the rights of 

patients. All measures taken against individuals who are infected or suspected of being infected 

with certain infectious diseases must be at the minimally required level.51 A person must be 

released from the hospital when it is determined that he or she does not have a pathogen. The 

hospitalized person can request release from hospitalization, whereupon the governor must test 

the person to determine whether he or she has a pathogen.52 The governor may seek the opinion 

of experts before making a decision. Such an opinion is provided by an infectious disease 

examination council that each health center maintains. When a governor issues a notice that 

restricts the infected person from engaging in certain jobs, advises hospitalization, and extends 

the period of hospitalization, as stated above, the council gives its opinion to the governor.53 A 

hospitalized person can appeal the governor’s decision to the Minister of the MHLW. The 

Minister then makes a decision in consultation with the MHLW experts’ council.54 

In addition to the examination and hospitalization of persons infected with certain infectious 

diseases, prefectural governors may take various measures when necessary to prevent incidences 

or the spread of particular infectious diseases. In order to prevent incidences or the spread of 

Category I through IV infectious diseases and New Influenza, a governor may order the infected 

person, the guardian of the person, or the person or organization that manages the place affected 

to disinfect that place. If such disinfection is not effective, the governor may order a 

municipality that has control of the site where the patient was or other contaminated places to 

sterilize such places.55 A governor may also order a person or organization that manages the site 

 

46 Id. art. 19, paras. 1–3 & art. 26. 

47 Id. art. 19, para. 4 & art. 26. 

48 Id. art. 20, para. 4 & art. 26. 

49 Id. art. 20, paras. 1–3 & art. 26. 

50 Id. art 20, para. 6 & art. 26. 

51 Id. art. 22-2. 

52 Id. art. 22. 

53 Id. art. 24. 

54 Id. arts. 25 & 26. 

55 Id. art. 27. 
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where rodents or insects contaminated by the pathogen exist to exterminate such rodents and 

insects. If such extermination is not effective, the governor may order municipalities to 

exterminate them.56 Further, a governor may order holders of possibly contaminated food, 

clothing, bedding, and other items to restrict the movement of, sterilize, or dispose of the items. 

A governor may also dispatch prefectural officials or order a municipal government to sterilize 

or dispose of such items.57 

To prevent incidences or the spread of Category I through III infectious diseases and New 

Influenza, a governor may restrict the movement of an infected corpse, or require a permit for the 

burial of an infected corpse. Generally, an infected corpse must be cremated, but with 

sterilization treatment and a permit, the body can be buried.58 To prevent incidences or the 

spread of Category I through III infectious diseases, a governor may restrict the use of water or a 

water supply that is suspected of being contaminated. In such cases, municipalities must provide 

clean water for residents.59 

To prevent incidences or the spread of Category I infectious diseases, stronger measures may be 

taken. A governor may restrict access to buildings that are contaminated or suspected of being 

contaminated with a Category I infectious disease,60 and may also restrict traffic for up to 

seventy-two hours around the place where the patient is located or the place suspected of 

being contaminated.61 

C. New Infectious Diseases or New Threats by Known Infectious Diseases 

The Infectious Diseases Prevention Act has provisions to combat new infectious diseases or new 

threats by known infectious diseases. Where threats of new influenza, or known influenza that 

poses renewed threats to public health, are recognized, a governor may seek a report of the health 

conditions, including body temperature, of the person suspected of being infected for a period 

that is determined after considering the incubation period of the influenza. A governor may also 

request that such person not go outside of his or her residence, and take other actions that are 

necessary to confine the disease. In such cases, the governor may provide meals and other 

necessities for the infected person.62 Where the influenza is virulent and it is especially 

necessary to prevent its incidence or spread, the national government can restrict access to a 

building and control traffic, as stated in the previous section—measures that are normally applied 

to Category I infectious diseases.63 

 

56 Id. art. 28. 

57 Id. art. 29. 

58 Id. art. 30. 

59 Id. art. 31. 

60 Id. art. 32. 

61 Id. art. 33. 

62 Id. art. 44-3. 

63 Id. art. 44-4. 
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In the case of a new disease other than influenza, the governor may recommend that a person 

who is suspected of being infected receive a medical examination. If the person does not 

voluntarily undergo a medical examination, the governor may have a prefectural official examine 

the person.64 Other measures used for other categories of infectious diseases under the Infectious 

Diseases Prevention Act can be used, including mandatory hospitalization and sterilization of the 

affected building.65 The governor must consult with the Minister of the MHLW prior to taking 

these actions, however,66 and the Minister must give the governor technical advice.67 When the 

MHLW has devised effective measures to prevent the spread of a new infectious disease, the 

government issues an order to make available all measures for Category I infectious diseases 

under the Act for up to a year in order to prevent the spread of the new disease.68 

Designated Infectious Disease is a category for a known infectious disease (other than Category I 

through III infectious diseases and New Influenza) that newly becomes a threat to the Japanese 

people. The government makes this designation by issuing an order that makes all measures 

under the Act available for the newly designated disease for up to a year.69 

For example, severe acute respiratory syndrome (SARS) was designated as a New Infectious 

Disease on April 3, 2003, and then named a Designated Infectious Disease on June 20, 2003.70 

Later, at the time of the 2006 amendment to the Infectious Diseases Prevention Act, SARS was 

added to Category II infectious diseases.71 H5N1 avian influenza was designated as a 

Designated Infectious Disease on June 2, 2006.72 Later, at the time of the 2008 amendment to 

the Infectious Diseases Prevention Act, H5N1 avian influenza was added to Category II 

infectious diseases.73 

D. Designated Hospitals 

Japan has a designated medical institution system for particular infectious diseases under the 

Infectious Diseases Prevention Act. 

 

64 Id. art. 45. 

65 Id. arts. 46 & 50. 

66 Id. art. 51, para. 1. 

67 Id. art. 51, para. 2. 

68 Id. art. 53. 

69 Id. art. 6, para. 8 & art. 7. 

70 Jūshō kyūsei kokyūki shōkō gun [SARS], IDSC (Feb. 2005), http://idsc.nih.go.jp/idwr/kansen/k05/k05_06/ 

k05_06.html. 

71 Act to Amend the Infectious Diseases Prevention Act, Act No. 106 of 2006. 

72 Infuruenza (H5N1) o shitei kansenshō to site sadameru tō no seirei [Order Concerning Designation of Influenza 

(H5N1) as Designated Infectious Disease], Order No. 208 of 2006. 

73 Act to Amend the Infectious Diseases Prevention Act and Quarantine Act, Act No. 30 of 2008. 
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 A Designated Specified Infectious Disease Medical Institution is designated by the Minister 

of the MHLW upon the institution’s consent, and treats patients stricken with New Infectious 

Diseases, Category I and II infectious diseases, and New Influenza.74 

 A Designated Category I Infectious Disease Medical Institution is designated by a governor 

upon the institution’s consent and treats patients with Category I and II infectious diseases 

and New Influenza.75 

 A Designated Category II Infectious Disease Medical Institution is designated by a governor 

upon the institution’s consent and treats patients with Category II infectious diseases and 

New Influenza.76 

These Designated Medical Institutions must accept patients with the specified diseases for 

hospitalization, and follow instructions from the Minister of MHLW or the governor.77 

The MHLW has issued standards for Designated Category I and II Infectious Disease Medical 

Institutions. The standards for the designated hospital for Category I diseases is significantly 

higher than the one for Category II diseases. For example, the hospital standards for Category I 

diseases require that 

 the patient’s room have air pressure that is lower than the surrounding area so that pathogens 

will not exit the room; 

 there must be a room between the patient’s room and hall or other area; 

 there must be an independent ventilation system for the patient’s room; and

 there must be equipment that sanitizes drained water from the room or the area where the 

room is located.78 

As of April 2014, Japan had three Designated Specified Infectious Disease Medical Institutions, 

forty-four Designated Category I Infectious Disease Medical Institutions, and 335 Designated 

Category II Infectious Disease Medical Institutions.79 

 

 

74 Infectious Diseases Prevention Act art. 6, para. 13 & art. 38, para. 1. 

75 Id. art. 6, para. 14 & art. 38, para. 2. 

76 Id. art. 6, para. 15 & art. 38, para. 2. 

77 Id. art. 38, para. 3. 

78 Kansenshō no yobō oyobi kansenshō no kanja ni taisuru iryōni kansuru hōritsu dai 38 jō dai 2 kō no kitei ni 

motoduku kōsei rōdō daijin no sadameru kansenshō shitei iryō kikan no kijun [Standards for Designated Infectious 

Disease Medical Institutions Set by the Minister of MHLW, Based on the Infectious Disease Prevention Law, 

Article 38, Paragraph 2], MHLW Notification No. 43 (Mar. 19, 1999). 

79 Kansenshō shitei iryō kikan no shitei jōkyō [Statistics of Designated Infectious Disease Medical Institutions], 

MHLW (Apr. 1, 2014), http://www.mhlw.go.jp/bunya/kenkou/kekkaku-kansenshou15/02-02.html. 
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E. Quarantine 

Two ministries have jurisdiction over quarantines. Human and food quarantine is under the 

MHLW’s jurisdiction. Plant and animal quarantine falls under the jurisdiction of the Ministry of 

Agriculture, Forestry and Fishery. 

Under the Quarantine Law, vessels or aircraft that originated from or visited a foreign country, or 

encountered and received persons or material from a foreign country, must obtain a Free 

Pratique, or a Provisory Free Pratique before they enter into ports in Japan, except when they 

enter into designated quarantine areas.80 The captains of vessels or aircraft must inform the 

Chief of the Quarantine Station in advance of matters prescribed in the MHLW ordinances, such 

as whether patients suffering from or who have died from quarantine infectious diseases have 

been on board.81 “Quarantine infectious diseases” refers to Category I infectious diseases, New 

Influenza under the Infectious Diseases Prevention Act, and other infectious diseases specified 

by Cabinet order.82 People on board vessels and aircraft must not leave the designated area until 

a Free Pratique or a Provisory Free Pratique is issued unless the Chief of the Quarantine Station 

has confirmed that persons or materials on board are not contaminated by pathogenic 

microorganisms causing infectious diseases that are subject to quarantine.83 

When vessels and aircraft enter into the designated quarantine areas, the head of a quarantine 

office may order quarantine officers to ask questions of the passengers of vessels and aircraft 

from foreign countries.84 Quarantine officers may also examine passengers, vessels, and aircraft 

in order to determine the existence of a pathogen.85 When swine influenza spread in Mexico, the 

US, and Canada in 2009, international airports in Japan strengthened their quarantine measures. 

Quarantine officers went into airplanes arriving from these three countries, distributed health 

condition questionnaires, and examined body temperatures. Where a passenger was found to 

have symptoms of swine influenza infection, an instant infection test kit was used for 

the person.86

When a vessel leaves or passes areas where there was a case of a quarantined disease, when a 

passenger of a vessel was infected with a quarantined disease, or when the existence of mice that 

were likely infected with plague is confirmed in a vessel, the head of the quarantine office may 

take the following measures, among others, if necessary: 

 

 

80 Ken-eki hō [Quarantine Act], Act No. 201 of 1951, last amended by Act No. 69 of 2014, art. 4. 

81 Id. art. 6. 

82 Id. art. 2. 

83 Id. art. 5. 

84 Id. art. 12. 

85 Id. art. 13. 

86 Measures Against New Influenza at Narita Airport Quarantine Office, 30 INFECTIOUS AGENTS SURVEILLANCE 

REPORT 257 (Oct. 2009), http://idsc.nih.go.jp/iasr/30/356/dj3561.html (in Japanese). 
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 Isolate the person infected with a Category I disease or New Influenza; 

 Force the person suspected of being infected with a Category I disease or New Influenza to 

stay at the designated facility or on the vessel, provided that this is necessary to prevent 

entrance of the pathogen into Japan, and that the infection is recognized in the relevant 

foreign country and would seriously threaten people’s health and lives in Japan; 

 Sanitize items and places that are suspected of being contaminated, or discard items if they 

are not sanitized effectively; and 

 Vaccinate people.87 

Persons who are infected with Category I infectious diseases or New Influenza are isolated at an 

appropriate, designated medical institution.88 Persons suspected of being infected with a 

Category I disease or New Influenza are also kept in appropriate designated medical institutions, 

but can be kept in other medical institutions or onboard the vessel on which they arrived under 

special circumstances.89 Persons suspected of being infected with New Influenza can be kept at 

a designated medical institution, other medical institutions, hotels, or the vessel on which they 

arrived.90 Persons who were isolated or kept at a designated place will be released when a 

medical professional confirms that the person does not have a pathogen.91 Other than Category I 

infectious diseases and New Influenza, when the incidences of other known infectious diseases 

or a new infectious disease is recognized in a foreign country and the government recognizes the 

necessity of quarantine to prevent the entry and spread of the disease, the government may apply 

these measures of isolation and forced stay.92 

F. Tracking Persons 

The head of a quarantine office must report specified information concerning a quarantined 

person who is infected with a Category II through IV disease, or a Designated or New Infectious 

Disease, to the governor who has jurisdiction over the person’s residence.93 In addition, when 

the head of a quarantine office decides not to keep in quarantine a person who might be infected 

with a Category I disease or New Influenza, the head of the quarantine office must collect 

information on the person, such as name, address, or place of stay in Japan, and the schedule of 

his or her travels in Japan, and notify the governor who has jurisdiction over the address or place 

of stay of this information.94 The governor who receives such a report may monitor the 

 

87 Quarantine Act art. 14. 

88 Id. art. 15. 

89 Id. art. 16, para. 1. 

90 Id. art. 16, para. 2. 

91 Id. art. 15, para. 2 & art. 16, para. 4. 

92 Id. arts. 34-2, 34-3, 34-4. 

93 Id. art. 26-3. 

94 Id. art. 18, paras. 4 & 5. 
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condition of the person by asking the person for a report or by dispatching a local health care 

officer to talk to the person.95 

G. Animal Quarantine 

To prevent infectious diseases of animal origin, the Infectious Diseases Prevention Act provides 

for animal quarantines and bans.96 For example, the import of monkeys from Africa is basically 

prohibited. To import them, special permission from the MHLW and the MAFF are needed,97 in 

order to prevent the incursion into Japan of Ebola hemorrhagic fever and Marburg viral 

disease.98 In addition, the Rabies Prevention Law provides that dogs, cats, raccoons, foxes, and 

skunks imported into the country must be quarantined.99 The Livestock Infectious Diseases 

Prevention Act also has quarantine provisions for imported livestock.100 

IV. Transparency of the Public Health Crisis Management System 

The MHLW Basic Guidelines makes the administration of health care crises transparent. The 

guidelines also direct the MHLW to provide and publicize various pieces of information it holds 

about a given crisis.101 Health care crisis management by local governments is based on the 

MHLW’s Local Health Crisis Management Guidelines, which identify providing information to 

the public as one important task of local health centers.102 

The Infectious Diseases Prevention Act also has provisions to ensure the transparency of public 

health crisis management information. The Act provides that the national and local governments 

must educate people with correct information on infectious diseases and provide analytical 

information on infectious disease trends.103 

V. Cooperation with WHO 

Japan is a member of the World Health Organization (WHO)104 and complies with the 

International Health Regulations (IHR).105 When the MHLW recognizes an incidence of an 

 

95 Infectious Diseases Prevention Act arts. 15-2 & 15-3. 

96 Id. ch. 10. 

97 Id. art. 54; Ordinance to Set Areas from Which Imports Are Banned Based on Infectious Diseases Prevention Act 

Article 54, Item 1, MHLW & MAFF Ordinance No. 2 of 1999, art. 1. 

98 What Is Animal Quarantine?, ANIMAL QUARANTINE SERVICE, MAFF, http://www.maff.go.jp/aqs/english/ (last 

visited Oct. 19, 2014). 

99 Kyōkenbyō yobō hō [Rabies Prevention Act], Act No. 247 of 1950, last amended by Act No. 160 of 1999, art. 2; 

Kyōkenbyō yobō hō shikō rei [Rabies Prevention Act Implementation Order], Order No. 236 of 1953, art. 1. 

100 Kachiku densenbyō yobo hō [Livestock Infectious Diseases Prevention Act], Act No. 166 of 1951. 

101 Basic Guidelines in Health Crisis Management, supra note 3. 

102 Local Health Crisis Management Guidelines, supra note 8. 

103 Infectious Diseases Prevention Act art. 3, para. 1 & art. 16, para. 1. 

104 Countries, WHO, http://www.who.int/countries/en/ (last visited Oct. 20, 2014). 
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infectious disease listed in the IHR, it reports the information to the WHO. The MHLW may 

report information to the WHO even if the disease is not subject to reporting under the IHR 

Regulations.106 Japan’s National Institute of Infectious Diseases (NIID) has been designated as 

the Collaborating Center for Influenza along with other WHO-assigned centers 

and laboratories.107 

VI. Recent Developments 

As discussed in Part II(C), the Special Measures Act on New Influenza was enacted in 2012. 

That Act created an influenza emergency system. 

More recently, a bill to amend the Infectious Diseases Prevention Act was submitted to the Diet 

in October 2014. Pursuant to the bill, Middle East Respiratory Syndrome (MERS) would be 

added to Category II infectious diseases. Avian flu (H7N9), which was temporarily added to 

Category II by Cabinet order designation, would also be added to Category II on a permanent 

basis. In addition, the bill contains provisions that would enable the governor to collect 

specimens from persons infected with specified infectious diseases.108 

In response to the Ebola outbreak in West Africa in 2014, the Japanese government decided to 

allow the use of a drug approved for influenza treatment in certain situations109 for Ebola 

treatment, and to enhance detection and examination of people who arrive at airports in Japan 

and have been in four African countries where Ebola has spread (Liberia, Sierra Leone, Guinea, 

and Nigeria).110 Yasuhisa Shiozaki, Minister of MHLW, said that Japan stockpiles the drug 

sufficient to treat 20,000 people.111 On October 27, 2014, Prime Minister Shinzo Abe met with 

Minister Shiozaki and directed him to set up a meeting of relevant Cabinet members on 

responses to Ebola.112 The meeting was approved by the Cabinet on October 28, and the first 

 105 See About IRH (International Health Regulations), WHO, http://www.who.int/ihr/about/en/ (last visited 

Oct. 20, 2014). 

106 Kansenshō kenkō kiki kanri jisshi yōryō [Infectious Disease Health Risk Crisis Management Implementation 

Manual], Health Div., MHLW, Mar. 2007, last amended Oct. 2013, 3(2) ko, http://www.mhlw.go.jp/general/seido/ 

kouse i/kenkou/kansen/index.html. 

107 Outline – Organization: Functions, supra note 40. 

108 Bill to Amend the Infectious Diseases Prevention Act (submitted Oct. 14, 2014), available at http://www.mhlw. 

go.jp/topics/bukyoku/soumu/houritu/187.html (in Japanese). 

109 Press Release, Toyama Chemical Co., Ltd., The New Drug Application Approval of “AVIGAN® Tablet 200mg” 

in Japan for the Anti-influenza Virus Drug (Mar. 24, 2014), https://www.toyama-chemical.co.jp/eng/news/ 

news140324e.html. 

110 Ebola taiō kyōgi e kankei kakuryō kaigi . . . shushō ga shiji [Meeting of Relevant Cabinet Members on 

Responses to the Ebola Virus Disease . . . Prime Minister Directed], YOMIURI NEWSPAPER (Oct. 27, 2014) (on file 

with author). 

111 Ebora kokunai taisaku, mishōnin yaku 2man nin bun bichiku . . . Kōrōsō [Ebola Measures, Stockpiled 

Unapproved Drug for 20,000 People . . . MHLW Minister], YOMIURI NEWSPAPER (Oct. 28, 2014) (on file 

with author). 

112 Id. 
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meeting was held immediately after the Cabinet meeting.113 The meeting established the 

conference of relevant ministries and agencies on Ebola, which is chaired by the Deputy Chief 

Cabinet Secretary for Crisis Management.114 The goal is to prepare for coordinated measures 

among government agencies in cases where Japanese nationals are infected with Ebola abroad or 

persons infected with Ebola are found within Japan.115

 

113 Ebora shukketsu netsu taisaku kankei kakuryō kaigi no kaisai ni tsuite [Regarding Opening of Meeting of 

Relevant Cabinet Members on Responses to the Ebola Virus Disease], orally approved by Cabinet Meeting, Prime 

Minister of Japan and His Cabinet, Oct. 28, 2014, http://www.kantei.go.jp/jp/singi/ebola/youkou.pdf. 

114 Ebora shukketsu netsu ni kansuru seifu no taisei ni tsuite [Regarding System to Counter Ebola Hemorrhagic 

Fever], Deputy Chief Cabinet Secretary’s Office, Oct. 28, 2014, http://www.kantei.go.jp/jp/singi/ebola/ 

dai1/sankou3.pdf. 

115 Ebora shukketsu netsu taisaku kankei kakuryō kaigi [Meeting of Relevant Cabinet Members on Responses to the 

Ebola Virus Disease], Prime Minister of Japan and His Cabinet, http://www.kantei.go.jp/jp/singi/ebola/index.html

(last visited Oct. 28, 2014). 
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Kenya 

Hanibal Goitom 

Foreign Law Specialist* 

SUMMARY Kenyan officials enjoy broad legal authority to impose various forms of restrictions during 

public health crises. The Constitution authorizes the head of state to declare a state of 

emergency and put in place wide-ranging public security preservation measures, including 

restrictions on movement and assembly, appropriation of private property and labor, and 

restrictions on entry into the country. However, in order for actions under this authority to 

remain in place for an extended period of time, they need legislative approval. 

 

 Similarly, the Public Health Act (PHA), the primary legislation applicable to matters of 

public health crises, authorizes public health authorities, particularly the Minister of 

Health, to take various actions during public health crises, including declaring an 

infectious disease a “notifiable infectious disease” or a “formidable epidemic, endemic or 

infectious disease,” and taking the necessary prevention and suppression measures to fight 

the disease. Specific powers accorded to health authorities for the purpose of prevention 

and suppression of an infectious disease include search, seizure, and detention powers; the 

power to designate any place as a quarantine area, including ships and aircraft; and the 

power to restrict or ban immigration into the country. 

 Kenyan and international laws impose certain transparency requirements on the country’s 

government. Chief among these are the requirement under the PHA to periodically 

publish information regarding infectious diseases in Kenya, neighboring countries, and 

around the world, and the obligation under the International Health Regulations to report 

any public health emergency to the World Health Organization (WHO). 

 

 Although Kenya is geographically far from the Ebola-stricken West African region and to 

this day remains infection-free, the WHO recently declared the country at high risk for an 

Ebola infection given that it is a transportation hub in East Africa. As a result, the Kenyan 

government has taken various measures to prepare for an outbreak, including putting in 

place a contingency plan; establishing an Ebola response advisory task force; partially 

closing border crossings with Uganda, where there was a recent suspected Ebola death; 

and instituting a travel ban on persons traveling from the Ebola-stricken countries. 

I. Government Structure 

Kenya previously had a unitary system of government but recently introduced a system akin to a 

federation with the adoption of the 2010 Kenya Constitution, which established a two-tiered 

system of government involving the national and county levels.1

 

 

* This report updates a report originally prepared in 2003 by Charles Mwalimu, former Senior Legal Specialist. 

1

 CONSTITUTION art. 1 (2010), available on the Kenya Law website, at http://www.kenyalaw.org:8181/exist/ 

kenyalex/actview.xql?actid=Const2010. 
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A. National Government 

In adherence to the principle of separation of powers, government power at the national level is 

shared by three branches tasked with constitutionally delimited powers and obligations: the 

executive, the legislature, and the judiciary.2

 

1. The Executive 

The national executive consists of the President, the Deputy President, and the rest of the 

Cabinet, which includes the Attorney-General, who is the principal legal advisor to the 

government among other functions, and fourteen to twenty-two Cabinet Secretaries.3 

2. The Legislature 

Another new feature in the country’s government structure is the establishment of a bicameral 

legislative body consisting of a 349-member National Assembly and a sixty-seven-member 

Senate.4

 The National Assembly enjoys broad legislative and supervisory powers, enacting 

legislation on any matter over which the national government has jurisdiction under the 

Constitution, determining revenue allocation between the different tiers of government, 

appropriating funds for government spending, and exercising oversight over government 

spending and the conduct of the executive branch of government.5

 The role of the Senate, both 

in terms of legislative and supervisory powers, is by and large limited to matters that affect the 

interests of the counties.6

3. The Judiciary 

The Kenyan judiciary consists of what are known as superior courts (the Supreme Court, the 

Court of Appeal, and the High Court) and subordinate courts (magistrates’ courts, kadhis’ courts, 

the courts marshal, and tribunals).7 While all of these courts have distinct jurisdictional 

mandates, for the purposes of this report it is sufficient to point out that the High Court’s subject 

matter jurisdiction includes matters of constitutional interpretation in relation to “constitutional 

powers of State organs in respect to county governments” and “the constitutional relationship 

between levels of government,” and questions relating to conflicts between national and countyissued laws.8

 This may be significant given that the national and county governments share 

legislative jurisdiction on public health issues (see below).9 Decisions of the High Court on 

 

2 Id. 

3 Id. §§ 130, 152 & 156. 

4 Id. §§ 93, 97 & 98. 

5 Id. §§ 95 & 109. 

6 Id. §§ 96, 109–113. 

7 Id. § 162; The Courts, REPUBLIC OF KENYA, THE JUDICIARY, http://www.judiciary.go.ke/portal/page/courts (last 

visited Oct. 21, 2014). 

8

 CONSTITUTION § 165. 

9 Id. § 186. 
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issues relating to the Constitution may always be appealed to the Court of Appeal and thereafter 

the Supreme Court.10

B. County Governments 

Kenya has forty-seven counties, including Nairobi (the capital), which have their own legislative 

(county assembly) and executive (county executive) organs.11 The functions of the county 

assemblies include 

 making laws on matters within their legislative jurisdiction (matters specified under the 

Fourth Schedule of the Constitution); 

 exercising oversight over county executive bodies (for instance the county assembly 

approves the appointments of the governor to the county executive committee, which is the 

cabinet of the county government); and 

 approving management and exploitation plans for the counties’ resources, and the 

development and management of county institutions and infrastructure.12 

The executive branch of the county government, the county executive committee, consists of the 

county governor, the deputy county governor, and county executive members.13

II. Structure of the Public Health Management System 

Ordinarily the national and county governments enjoy concurrent legislative jurisdiction on 

health-related matters. The national government enjoys legislative jurisdiction on matters 

relating to “[h]ealth policy” and “[n]ational referral health facilities,” while the county 

governments may legislate on issues relating to county health services, including county health 

facilities and cemeteries, funeral parlors, and crematoria.14 While the health issues over which 

the county governments are accorded jurisdiction appear local in nature, the ongoing Ebola crisis 

in Liberia reveals that rules on issues such as burial rituals during public health crises may have 

great ramifications for the prevention and suppression of an infectious disease outbreak.15 

As noted below, in times of public health crises, the national government has broad, unfettered 

powers to impose nationally applicable response measures regardless of whether a county 

government has jurisdiction over the matter. 

 

10 Id. §§ 163 & 164. 

11 Id. §§ 6 & 176. 

12 Id. § 185; County Governments Act, No. 17 of 2012, §§ 5 & 8 (July 24, 2012), available on the Kenya Law 

website, at http://www.kenyalaw.org:8181/exist/kenyalex/actview.xql?actid=NO.%2017%20of%202012. 

13 CONSTITUTION § 179; County Governments Act § 30. 

14 CONSTITUTION § 186. 

15 Ebola Cremation Ruling Prompts Secret Burials in Liberia, THE GUARDIAN (Oct. 24, 2014), 

http://www.theguardian.com/world/2014/oct/24/ebola-cremation-ruling-secret-burials-liberia. 
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III. Powers of National Public Health Authorities 

A. Declaration of a State of Emergency Under the Constitution 

One of the ways that the national government may respond to a public health crisis is through the 

application of constitutional powers of the executive body. Subject to certain limitations, the 

President has the power to declare a state of emergency, including when the country is under 

threat from a “natural disaster or other public emergency” and doing so “is necessary to meet the 

circumstances for which the emergency is declared.”16 Any law issued under a state of 

emergency can impose limitations on the rights and fundamental freedoms enshrined in the Bill 

of Rights, so long as the emergency requires the limitation and it is in keeping with applicable 

international law.17 

However, the declaration of an emergency and any laws issued or actions taken by the President 

are effective for only fourteen days unless extended by the National Assembly.18 The National 

Assembly can extend the declaration of a state of emergency by a maximum of two months at a 

time.19 While a first extension can be adopted with the support of at least two-thirds of all 

members of the National Assembly, all subsequent extensions require the support of threequarters of all members of the National Assembly.20

The President is authorized under the Constitution to bring into operation Part III of the Public 

Preservation Security Act21 and issue regulations for the purpose of “preservation of public 

security,” including “the securing of the safety of persons and property, . . . [and] the provision 

of administrative and remedial measures during periods of actual apprehensible national danger 

or calamity.”22 These regulations may make provisions for 

. . . 

B. the registration, restriction of movement (into, out of or within Kenya), and 

compulsory movement of persons, including the imposition of curfews: 

Provided that no person shall be restricted on account of his political beliefs or 

activities; 

C. the control of aliens, including the removal of diplomatic privileges; 

D. the censorship, control or prohibition of the communication of any information, or of 

any means of communicating or of recording ideas or information, including any 

publication or document, and the prevention of the dissemination of false reports; 

 

16 CONSTITUTION §§ 58, 132. 

17 Id. 

18 Id. § 58. 

19 Id. 

20 Id. 

21 Preservation of Public Security Act of 1960, 16 LAWS OF KENYA, Cap. 57 (rev. ed. 2012), available on the Kenya 

Law website, at http://www.kenyalaw.org:8181/exist/kenyalex/actview.xql?actid=CAP.%2057. 

22 Id. §§ 2 & 4. 
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E. the control or prohibition of any procession, assembly, meeting, association or 

society; 

F. the control or prohibition of the acquisition, possession, disposition or use of any 

movable or immovable property or undertaking; 

G. the compulsory acquisition, requisitioning, control or disposition of any movable or 

immovable property or any undertaking; 

H. requiring persons to do work or render services, including the direction of labour and 

supplies, the conscription of persons into any of the disciplined forces (including the 

National Youth Service) and the billeting of persons; 

I. the control and regulation of harbours, ports and the movement of vessels; 

J. the control and regulation of transport by land, air or water; 

K. the control of trading and of the prices of goods and services, including the regulation 

of the exportation, importation, production, manufacture or use of any property or 

thing; 

L. amending, applying with or without modification or suspending the operation of any 

law (including legislation of the East African Common Services Organization) other 

than this Act or the Constitution; 

M. any matter, not being a matter specified in any of the foregoing paragraphs of this 

subsection, for which provision is necessary or expedient for the preservation of 

public security.23

It is evident that the Preservation of Public Security Act is a catch-all statute that covers all 

aspects of security in the country including those dealing with a public health crisis or threat, 

such as bioterrorism, and infectious diseases, such as anthrax, malaria, cholera, leprosy, foot and 

mouth diseases, and other outbreaks such as severe acute respiratory syndrome (SARS) and 

Ebola. It appears that in order for a special public security measure to be put in place, the only 

thing required is the classification of an event as a threat or an act that threatens the security 

of Kenya. 

B. Statutory Regime 

1. Powers of Authorities in a Public Health Crisis 

Although there are various laws applicable to public health matters, the Public Health Act (PHA) 

of 1921, including its subsidiary legislation, is the primary law that governs matters of public 

health crises in Kenya.24 This law established and regulates the functions and powers of a 

number of health authorities that deal with public health crises. 

The PHA requires that health authorities take all the necessary, lawful actions imposed on them 

under any law to prevent or deal with an outbreak or the prevalence of “any infectious, 

 

23 Id. § 4. 

24 Public Health Act of 1921, 16 LAWS OF KENYA, Cap. 242 (rev. ed. 2012), http://www.kenyalaw.org:8181/exist/ 

kenyalex/actview.xql?actid=CAP.%20242. 
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communicable or preventable disease, to safeguard and promote the public health and to exercise 

the powers and perform the duties in respect of the public health.”25

2. Central Board of Health 

The PHA envisages what is called the Central Board of Health (the Board), to be based in 

Nairobi, which is composed of the Director of Medical Services, a sanitary engineer, a secretary, 

and up to six additional members, at least three of whom must be medical practitioners.26 The 

main function of the Board is to advise the Minister of Health on “all matters affecting public 

health,” including on the prevention of infectious diseases from reaching Kenyan borders and the 

“prevention, limitation or suppression of infectious, communicable or preventable disease within 

Kenya.”27 However, sources consulted for this report indicated that the Board has yet to 

be established.28

3. The Medical Department 

The PHA also established the Medical Department, which is tasked with a host of 

responsibilities to prevent and/or play a key role in managing public health crises. The functions 

of the Department are 

to prevent and guard against the introduction of infectious disease into Kenya from 

outside; to promote the public health and the prevention, limitation or suppression of 

infectious, communicable or preventable disease within Kenya; to advise and direct local 

authorities in regard to matters affecting the public health; to promote or carry out 

researches [sic] and investigations in connexion with the prevention or treatment of 

human diseases; to prepare and publish reports and statistical or other information 

relative to the public health; and generally to carry out in accordance with directions the 

powers and duties in relation to the public health conferred or imposed by this Act.29

The Department is required by law to “obtain and publish periodically” information concerning 

infectious disease in Kenya and similar information regarding neighboring or other countries, as 

required by the interests of public health.30

 

25 Id. § 13. 

26 Id. § 3. 

27 Id. §§ 8 & 10. 

28 David I. Muthaka et al., Kenya Institute for Public Policy Research and Analysis (KIPPRA), A Review of The 

Regulatory Framework for Private Healthcare Services in Kenya 28 (KIPPRA Discussion Paper No. 35, Mar. 

2004), available on the International Finance Corporation (IFC) website, at https://www.wbginvestment 

climate.org/toolkits/health-in-africa-policy-toolkit/upload/PNADS076.pdf; TRANSPARENCY INTERNATIONALKENYA, THE KENYA HEALTH SECTOR INTEGRITY STUDY REPORT 15 (2011), http://www.gtzkenyahealth.com/ 

blog3/wp-content/uploads/2011/01/TI%20Health%20report.pdf. 

29 Public Health Act § 10. 

30 Id. 
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4. Minister of Health and General Delegated Authority 

The Minister may, on the advice of the Board or the Department, order an inquiry regarding any 

public health matter.31 A person authorized by the Minister to conduct an inquiry is accorded 

broad powers under the Public Health Act, which states as follows: 

When an inquiry is directed to be made by the Minister, the person directed to make the 

same shall have free access to all books, plans, maps, documents and other things 

relevant to the inquiry, and shall have in relation to witnesses and their examination and 

the production of documents similar powers to those conferred upon magistrates by the 

Criminal Procedure Code . . . , and may enter and inspect any building, premises or place 

the entry or inspection whereof appears to him requisite for the purpose of such inquiry.32

5. Notifiable Infectious Diseases (NIDs) 

The manner in which the Kenyan health authorities responded to the HIV/AIDS epidemic is 

illustrative of the process of declaring a disease to be an NID. 

HIV/AIDS has impacted Kenya greatly since the first diagnosis of a case of AIDS in Kenya was 

made in 1984. By August 1993, the Kenya National Aids Control Program estimated that 

841,700 persons were infected with HIV.33 By 2003, there were 1.2 million adults and children 

living with HIV/AIDS in Kenya.34 Of these, 1.1 million were adults between the ages of fifteen 

and forty-nine with an adult rate of 6.7%.35 Adult women age fifteen to forty-nine accounted for 

750,000 of the total number, while 100,000 of the people living with HIV/AIDS were children 

under the age of fifteen.36 In the same year, an estimated 150,000 people (including adults and 

children) are said to have died of AIDS and 650,000 children under the age of seventeen lost one 

or two of their parents to AIDS in the country.37 

In response to this health crisis, in July 1987, the Minister declared AIDS an NID under section 

17(1) of the Public Health Act.38 With such a declaration AIDS joined the ranks of other 

diseases already on the NID list. A disease can be added to this list in one of two ways: by 

legislative action or ministerial notice. 

 

31 Id. § 11. 

32 Id. § 12. 

33 CENTER FOR REPRODUCTIVE RIGHTS, WOMEN OF THE WORLD: LAWS AND POLICIES AFFECTING THEIR 

REPRODUCTIVE LIVES. ANGLOPHONE AFRICA 11 (1997), http://reproductiverights.org/sites/crr.civicactions. 

net/files/documents/WOWAA01.pdf. 

34 UNAIDS/UNICEF/WHO, Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections: 

Kenya 2 (2004 update), available on the United Nations Program on HIV and AID (UNAIDS) website, at 

http://data.unaids.org/publications/Fact-Sheets01/kenya_en.pdf. 

35 Id. 

36 Id. 

37 Id. 

38 Notice of the Minister of Health (July 23, 1987) Gazette Notice, No. 3539, THE KENYA GAZETTE of July 31, 1987, 

at 110. 
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Diseases already listed as NIDs under the PHA are 

smallpox, plague, cholera, scarlatina or scarlet fever, typhus fever, diphtheria or 

membranous croup, measles, whooping-cough, erysipelas, puerperal fever (including 

septicaemia, pyaemia, septic pelvic cellulitis or other serious septic condition occurring 

during the puerperal state), enteric or typhoid fever (including para-typhoid fever), 

epidemic cerebro-spinal meningitis or cerebro-spinal fever, acute poliomyelitis, leprosy, 

anthrax, glanders, rabies, Malta fever, sleeping sickness or human trypanosomiasis, beriberi, yaws and all forms of tuberculosis which are clinically recognizable apart from 

reaction to the tuberculin test.39

In addition, the PHA accords the Minister broad powers to list a disease as an NID, designate the 

geographic area to which the categorization will apply, and dictate the response to the disease.40 

In addition to the 1987 declaration of AIDS as an NID, the Minister has used this authority to 

add to the list of NID the following diseases: 

 Influenza 

 Relapsing fever 

 Blackwater fever 

 Encephalitis lethargica 

 Yellow fever 

 Kala-azar 

 Malaria, microscopically diagnosed within the municipality of Kitale 

 Bacillary dysentery and amoebic dysentery (within the municipality of Nairobi) 

 SARS41

6. Prevention and Suppression of Infectious Disease 

Declaration of a disease as an NID triggers reporting as well as prevention and suppression 

measures whenever the disease is detected or its presence suspected. A person who comes 

across a case of an NID is required to report it to the nearest medical practitioner.42 A medical 

practitioner who comes across such a disease or is notified of its suspected presence is required 

to inform the nearest medical officer of health and to inform those who live in proximity to or 

looked after the patient of the infectious nature of the disease and the precautions they need to 

 

39 Public Health Act § 17. 

40 Id. 

41 Id. 

42 Id. § 18. 
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take in order to prevent it from spreading.43 Failure to provide such notice as required by the 

PHA is an offense.44 

In addition to the reporting requirements, the suspicion or detection of any infectious disease 

triggers the application of certain broad powers resembling those accorded to the executive for 

purposes of preservation of public security. For instance, a medical officer is authorized to 

search a premises or medically examine any person found there if “he has reason to believe” a 

person exposed to or suffering from an infectious disease is or was on the premises.45 In 

addition, the medical officer may cause other actions to be taken, including 

 having the premises exposed to infectious disease cleaned and disinfected; 

 having a building, bedding, or other articles exposed to an infection destroyed; 

 removing an infected person to a hospital; or 

 putting an exposed person in isolation by an order of a magistrate.46 

The PHA states that the health authority may bear certain cost associated with the suppression or 

prevention of an infectious disease, including compensating a person for destroyed property and 

paying for disinfecting premises or other articles.47 The cost of isolating an infected person is 

born by the local authority where the person resides.48 

The PHA criminalizes certain acts that spread infectious diseases. Any infected person who, 

without proper precautions, willfully exposes himself “in any street, public place, shop, inn or 

public conveyance, or enters any public conveyance without previously notifying the owner, 

conductor or driver thereof” commits an offense and is, on conviction, subject to a fine of up to 

KES 30,000 (about US$337) and/or up to a three-year prison term.49 The same applies to a 

person tasked with caring for an infected person who exposes anyone to such person, and to a 

person who “gives, lends, sells, transmits or exposes” anything exposed to infection without first 

disinfecting the item.50 In addition, failure to properly disinfect any mode of transportation or 

dwelling exposed to an infection before transporting or leasing it to other people is an offense.51

 

43 Id. 

44 Id. 

45 Id. § 21. 

46 Id. §§ 22, 23, 26 & 27. 

47 Id. §§ 23 & 24. 

48 Id. § 27. 

49 Id. § 28. 

50 Id. 

51 Id. §§ 29 & 30. 
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7. Formidable Epidemic, Endemic or Infectious Disease 

A number of infectious diseases are categorized as formidable epidemic, endemic or infectious 

diseases (FEEIDs). These are smallpox, plague, Asiatic cholera, yellow fever; sleeping sickness, 

and human trypanosomiasis.52 In addition, the Minister is authorized to declare any infectious 

disease an FEEID.53

Whenever any part of the country is under the threat of an FEEID, the Minister is authorized to 

issue rules on a variety of measures, including 

 quarantining infected areas and preventing anyone from leaving the area without first going 

through the applicable precautionary measures put in place, including a medical examination, 

disinfection, or spending time in an observation camp/station; 

 removing infected persons and anyone with whom they have been in contact; 

 removing corpses; and 

 destroying or disinfecting buildings and any other articles that may have been exposed to 

an FEEID.54

The Minister is also authorized to issue rules specifying which areas in the country or vessels 

within the country’s territory are considered infected areas.55

In addition, the Director or his representatives are accorded broad powers to deal with FEEIDs. 

The PHA gives the Director or his representatives the power to enter any premises in order to 

enforce any rules the Minister issues for the purpose of dealing with an FEEID.56 The Director 

also has the power to requisition land, equipment, or any other item for the purpose of dealing 

with an FEEID in return for reasonable compensation.57

The PHA imposes reporting and other requirements on residents and health authorities of a 

locality during an outbreak of an FEEID. Anyone aware of “any unusual sickness or mortality 

among rats, mice, cats, dogs, or other animals susceptible to plague” or another FEEID is 

required to report the matter to the closest medical officer of health; failure to do so is a crime.58 

The medical officer of health in any part of Kenya is bound by law to promptly report to the 

Director “every notification received” with regard to a suspected case of an FEEID.59 In 

 

52 Id. § 35. 

53 Id. 

54 Id. § 36. 

55 Id. 

56 Id. § 38. 

57 Id. § 42. 

58 Id. § 40. 

59 Id. § 41. 
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addition, the local medical authority or the medical officer of health must do everything possible 

to mitigate the spread of an FEEID or execute rules made to suppress the FEEID.60 

8. Ports and Borders 

Unless it is in danger, the master or anyone on board a vessel arriving in Kenya is prohibited 

from communicating with the shore or other vessels or boats except via a signal until it is granted 

pratique.61 When necessary, the Minister may apply this or any other requirement under the 

PHA to aircraft arriving in Kenya.62 However, this restriction does not affect the right of any 

authorized person to approach or board the vessel or aircraft.63 As a matter of procedure, 

pratique is granted to an arriving vessel or aircraft via radio communication if the appropriate 

health officer, based on the information provided by the vessel or aircraft is satisfied that clearing 

the vessel or aircraft will not result in the introduction of a quarantinable disease (plague, 

cholera, yellow fever, smallpox, typhus, and relapsing fever) into Kenya.64 Notification 

requirements regarding the detection or suspicion of infectious disease discussed above are 

applicable to vessels or aircraft arriving in Kenya. 

Kenyan health authorities are accorded broad powers in dealing with vessels seeking entry into 

the country. For instance, the port health officer is authorized to board a vessel, inspect any of 

its sections, and examine and/or ask any person on board any question for the purpose of 

establishing the existence of an infectious disease.65 If the health officer suspects the existence 

of an infectious disease on board a vessel, he may grant conditional pratique or deny pratique 

and quarantine the vessel.66 He may have any infected person on a ship, aircraft, vehicle, or train 

removed and isolated on arrival to Kenya.67 He may also put anyone exposed to an infectious 

disease under surveillance and subject the person to medical testing.68 In addition, he may 

require a person in charge of a vessel or aircraft suspected of carrying an infectious disease to 

provide a passenger and cargo manifest as well as a crew list.69 

The Minister’s authority includes regulating immigration into the country for the purpose of 

preventing the introduction of infectious diseases. Thus, he may issue an order to 

 

60 Id. § 37. 

61 Id. § 58. 

62 Id. § 71. 

63 Id. § 58. 

64 Id. § 59; Public Health (Port, Airport, and Frontier Health) Rules, Public Health Act-Subsidiary Legislation, 

§§ 2 & 5. 

65 Public Health Act § 60. 

66 Id. § 62; Public Health (Port, Airport, and Frontier Health) Rule § 22. 

67 Public Health Act § 66; Public Health (Port, Airport, and Frontier Health) Rule § 7. 

68 Public Health Act § 68; Public Health (Port, Airport, and Frontier Health) Rule § 8. 

69 Public Health (Port, Airport, and Frontier Health) Rule § 14. 
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prohibit, restrict or regulate the immigration or importation into Kenya of any person, 

animal, article or thing likely, in his opinion, to introduce any infectious disease, or 

impose restrictions or conditions as regards the examination, detention, disinfection or 

otherwise of any such animal, article or thing.70

In addition, the Minister is authorized to engage in foreign relations activities in which he is 

authorized to enter into agreements with other governments regarding reciprocal notification of 

outbreaks of any FEEID or any other matter relating to public health relations with 

other nations.71 

IV. Transparency of the Public Health Management System 

As noted above, the Department is mandated to collect and periodically publish information 

regarding infectious diseases and other matters of public health concern in Kenya, contagious 

countries, or any other part of the world.72 In addition, categorization of a particular infectious 

disease as an NID via a ministerial order requires publication of a notice in the Gazette.73 Any 

medical practitioner who becomes aware that a patient has an NID must inform those people 

who, due to their proximity to the patient, may have been exposed to the infection.74 Similarly, 

the terms or summary of every agreement with another country concerning reciprocal 

notification of infectious disease outbreaks must be published in the Gazette.75 In addition, 

Kenya is required to notify the WHO of any event in its territory that may constitute a public 

health emergency of international concern within twenty-four hours of detection (see discussion, 

Part V, below). 

V. Cooperation with the World Health Organization 

Kenya cooperates with the WHO a great deal with regard to matters relating to public health 

crises. As a member state to both the WHO and the International Health Regulations (IHR), 

Kenya is bound by the requirements under the 2005 IHR, an international legal instrument aimed 

at preventing the spread of disease.76 Among other things, the IHR require that Kenya “develop, 

strengthen and maintain . . . the capacity to detect, assess, notify and report” outbreaks of 

infectious diseases.77 Accordingly, Kenya has put in place systems for early detection through 

 

70 Public Health Act § 63; see also id. § 71. 

71 Public Health Act § 72. 

72 Id. § 10. 

73 Id. § 17. 

74 Id. § 18. 

75 Id. § 72. 

76 WHO, INTERNATIONAL HEALTH REGULATIONS (2005): A BRIEF INTRODUCTION TO IMPLEMENTATION IN 

NATIONAL LEGISLATION 1 (Jan. 2009), http://www.who.int/ihr/Intro_legislative_implementation.pdf?ua=1; WHO, 

International Health Regulations (IHR) app. 1 (2d ed. 2005), http://whqlibdoc.who.int/publications/2008/9789241 

580410_eng.pdf?ua=1; Countries, WHO, http://www.who.int/countries/en/ (last visited Oct. 24, 2014). 

77 IHR, supra note 76, § 5. 
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what is known as an Integrated Disease, Surveillance and Response Strategy (IDSR).78 The 

objectives of this strategy are to 

 Strengthen capacity for effective capacity[;] 

 Improve use of surveillance information[; and] 

 Improve laboratory involvement in epidemic detention.79

According to the WHO, the IDSR is “the backbone for communicable disease prevention and 

control in Kenya” and the WHO provides technical support in its development and expansion.80 

For instance, the WHO is currently assisting in the training of healthcare workers in Kenya in 

preparation for a possible Ebola outbreak (see discussion, Part VI, below). 

Similarly, by simply being a member state of the WHO and IHR, Kenya has agreed to fulfill its 

obligation under the IHR to notify the WHO of any event that constitutes a public health 

emergency within twenty-four hours of assessment of such event.81

Significantly, the WHO-Kenya 2008–2013 cooperation strategy indicates that providing 

technical assistance in strengthening Kenya’s ability for early detection, diagnosis, management, 

and control of communicable diseases, including strengthening the country’s capacity to prevent 

and respond to major epidemics and pandemic-prone disease, is one of the main areas 

of cooperation.82 

VI. Recent Developments 

The Ebola outbreak in West Africa, specifically in Guinea, Liberia, and Sierra Leone, is the most 

recent public health crisis of global concern. Although Kenya is thousands of miles away from 

the Ebola-stricken countries in West Africa, in August 2014, the WHO classified the country as a 

high-risk country for Ebola transmission (level two) due to the fact that it is a transportation hub 

in East Africa.83 

 

78 WHO, WHO COUNTRY COOPERATION STRATEGY 2008–2013: KENYA 9 (2009), http://www.who.int/country 

focus/cooperation_strategy/ccs_ken_en.pdf. 

79 Kenya National Council for Science and Technology, Disease Surveillance and Response in Kenya, available on 

the United Nations Office at Geneva (UNOG) website, at http://www.unog.ch/80256EDD006B8954/%28http 

Assets%29/BFC81C5C68522575C12576460049B118/$file/BWC_MSP_2009_MX-Poster-Kenya.pdf (last visited 

Oct. 24, 2014). 

80 WHO COUNTRY COOPERATION STRATEGY, supra note 78, at 24. 

81 IHR, supra note 76, art. 6. 

82 WHO COUNTRY COOPERATION STRATEGY, supra note 78, at 33. 

83 WHO: Kenya at High Risk for Transmission of Ebola, VOICE OF AMERICA (Aug. 12, 2014), http://www.voanews. 

com/content/germany-guinea-bissau-react-to-ebola-outbreak/2411822.html. 
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According to reports, Kenya has put in place a contingency plan (the Plan) to guide health 

institutions in the event of an Ebola outbreak following the WHO declaration.84 The Plan, which 

is intended to serve as a roadmap for preparing and responding to an Ebola outbreak, calls for the 

establishment of a reference and response information center to “provide accurate information 

for health workers and the community, provide guidance on key actions to be taken during 

different phases of the outbreak, prepare clinicians for appropriate action, and identify and 

mobilise resources for response.”85 As part of the Plan, the Ministry of Health has put together a 

taskforce, including representatives from various, relevant governmental and nongovernmental 

organizations, to advise on how to respond to the outbreak.86 The taskforce is currently 

coordinating and implementing surveillance through the screening of travelers at entry points, 

which has been intensified following the WHO declaration.87 

The Plan also calls for training of various healthcare workers in dealing with an Ebola 

outbreak.88 The Kenyan government recently announced plans to train thirty-thousand health 

care workers on Ebola screening, prevention, control, and case management.89 This training will 

take place in all forty-seven counties in the country (it calls for counties to be involved in its 

implementation) and will target 60% of all health care workers in the country, including 

clinicians, epidemiologists, health promotion experts, and health workers stationed at airports 

and border crossings.90 The government has allocated KES 350 million (about US$3.9 million) 

for the purpose of implementing the Plan,91 a large percentage of which will likely be used for 

the training program. The WHO has deployed training experts to help facilitate the training.92

The Plan puts in place procedures for dealing with a person suspected of exposure to Ebola. 

Those procedures call for isolating persons exposed to Ebola, limiting the number of medical 

workers that have direct contact with the person, and reserving contiguous rooms for medical 

personnel to change into protective gear.93

 

84 Action Plan over Ebola Risk, HEALTH RIGHTS ADVOCACY FORUM (HERAF) (Aug. 21, 2014), http://www.heraf. 

or.ke/index.php?option=com_content&view=article&id=1352&catid=24?option=com_content&view=article&id=1

352&catid=24. 

85 Id. 

86 Id. 

87 Press Release, WHO Regional Office for Africa, Kenya Steps Up its EBOLA Contingency Plan with Training of 

Trainers (Sept. 26, 2014), http://www.afro.who.int/fr/kenya/press-materials/item/7053-kenya-steps-up-its-ebolacontingency-plan-with-trainings-of-trainers/7053-kenya-steps-up-its-ebola-contingency-plan-with-trainings-oftrainers.html; Kenya Intensifies Surveillance to Prevent Ebola Outbreak, XINHUA (Oct. 24, 2014), http://news. 

xinhuanet.com/english/africa/2014-08/13/c_133553824.htm. 

88 Press Release, WHO Regional Office for Africa, supra note 87. 

89 Kenya to Train 30,000 Health Workers on Ebola, XINHUA (Oct. 23, 2014), http://news.xinhuanet.com/ 

english/africa/2014-10/23/c_133735637.htm. 

90 Press Release, WHO Regional Office for Africa, supra note 87; HERAF, supra note 84. 

91 Id. 

92 Press Release, WHO Regional Office for Africa, supra note 87. 

93 HERAF, supra note 84. 
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In addition to putting a plan in place, Kenya has also suspended entry of passengers traveling 

from the three Ebola-stricken West African countries as of August 19, 2014, except for Kenyan 

citizens and health workers participating in the effort to curb the spread of Ebola.94 Similarly, 

following reports of an Ebola-related death in Uganda’s Bukwo district, Kenya recently closed 

the northwest region border crossings with Uganda.95 

As of the date of this report, Kenya remained free of Ebola. Although there have been a number 

of cases in which Ebola infection was suspected, all were ruled out after testing.96 In one of the 

cases, where the person suspected of having contracted Ebola arrived in an aircraft from West 

Africa, it appears that the protocols required under the PHA were properly followed. According 

to Nicolas Muraguri, the Director of Medical Services, the flight crew alerted Kenyan health 

authorities that one of the passengers was ill, as required by the PHA.97 The health authorities 

immediately quarantined the aircraft and screened everyone on board, also in accordance with 

the provisions of the PHA,98 and released everyone only after discovering that the suspected 

person was in fact suffering from other, noncommunicable ailments.99

 

94 Flight Bans from Ebola-hit Countries Will Stay in Effect, Kenya Tells AU, SABAHI (Sept. 17, 2014), 

http://sabahionline.com/en_GB/articles/hoa/articles/newsbriefs/2014/09/17/newsbrief-04; Travel Restrictions, Flight 

Operations and Screening, INTERNATIONAL SOS (Nov. 3, 2014), https://www.internationalsos.com/ebola/index. 

cfm?content_id=435&. 

95 Kenya Closes Border with Uganda over Ebola Fear, XINHUA (Oct. 11, 2014), http://news.xinhuanet.com/ 

english/africa/2014-10/11/c_133706916.htm. 

96 Kenya Rules Out Ebola After Two Tested Negative, THE NEW INDIAN EXPRESS (Sept. 5, 2014), http://www.new 

indianexpress.com/world/Kenya-Rules-out-Ebola-After-Two-Tested-Negative/2014/09/05/article2415768.ece; 

Kenya Rules Out Ebola Case Following Scare at Airport, XINHUANET (Aug. 2, 2014), http://news.xinhuanet. 

com/english/health/2014-08/02/c_133525986.htm; Press Release, WHO Regional Office for Africa, supra note 87. 

97 XINHUANET, supra note 96; Public Health Act §§ 59 & 71; Public Health (Port, Airport, and Frontier Health) Rule 

§ 5. 

98 Public Health Act § 62; Public Health (Port, Airport, and Frontier Health) Rule § 8. 

99 XINHUANET, supra note 96. 
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Lebanon 

Issam M. Saliba 

Senior Foreign Law Specialist

SUMMARY In Lebanon the executive power is vested in a Council of Ministers, of which the Ministry 

of Public Health is the ultimate authority on matters related to responses to public health 

crises. The law provides that where such crises are so severe that the capabilities of the 

Ministry of Public Health are insufficient, that Ministry may seek assistance by proposing 

the issuance of a presidential decree that defines the assistance needed, the entities 

involved, and the measures to be taken by each. The Ministry has taken several measures 

to address the Ebola threat, and thus far has not seen a need to request a 

presidential decree. 

I. Government Structure 

Lebanon is a republic that has a centralized parliamentary form of government, with the 

executive power vested in a Council of Ministers.1

 The Ministry of Public Health is the ultimate 

authority in charge of all public health matters, including responses to public health crises. The 

main mission of the Ministry is to protect and improve the status of public health.2 The Ministry 

defines its mission as follows: 

To Improve the health status of the population by ensuring an equitable accessibility to 

high quality health services through a fairly financed universal coverage. And by 

addressing economic and social determinants of health through trans-sectoral policies.3

II. Public Health Crises 

Public health crises are generally associated with threats to the health of the population of a 

geographic area or areas caused by the spread of communicable diseases. Lebanon has enacted a 

special law, the Law of Communicable Diseases, to deal with these situations when they arise.4 

This law assigns certain duties and responsibilities relating to individual cases of communicable 

diseases and provides a general framework for the response needed to deal with any outbreak of 

such diseases that might endanger public health. 

 

1

 LEBANESE CONSTITUTION arts. 1, 17, http://www.lp.gov.lb/CustomPage.aspx?id=26&masterId=1 (in Arabic). 

2

 Presidential Decree 8377 of 1961, art 2, http://www.moph.gov.lb/Rules%20and%20Regulations/Marsoum8377-

1961.pdf (in Arabic). 

3

 MINISTRY OF PUBLIC HEALTH, http://www.moph.gov.lb/AboutUs/pages/missionandvision.aspx (last visited 

Nov. 5, 2014). 

4

 Law of Communicable Diseases, Dec. 31, 1957, http://ar.jurispedia.org/index.php/%D9%82%D8%A7%D9 

%86%D9%88%D9%86_%D8%A7%D9%84%D8%A3%D9%85%D8%B1%D8%A7%D8%B6_%D8%A7%D9%8

4%D9%85%D8%B9%D8%AF%D9%8A%D8%A9_(lb) (in Arabic). 
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Article 3 of the law provides for combatting communicable diseases by one or more of the 

following means: reporting or informing about the disease, quarantining or isolating those 

infected, isolating those who came in contact with those affected and providing them with 

preventive treatment, disinfection, investigating the source of the disease, making environmental 

adjustments, and providing general health education.5

Treating physicians are required by the law to convey information on cases of listed 

communicable diseases to the authority designated by an order of the Minister of Public Health.6

Family heads, guardians, the Mukhtar (an elected local official), and managers of industrial or 

commercial enterprises (such as a plant, hotel, etc.) and of any public or private organization 

involved in health or social matters are required to call a physician whenever they suspect they 

have someone who might be affected by a communicable disease, report the incident, facilitate 

the reporting of it by the physician, and not hide the incident.7

 

The law gives the Minister of Public Health the power pursuant to a recommendation by the 

Director General of the Ministry to modify the list of the diseases considered contagious or 

communicable and for which those affected shall be quarantined.8

 

The law empowers the Ministry at any time to enter and search any place that might be suspected 

of harboring a case of communicable disease.9

All the other means mentioned in article three shall be implemented in accordance with orders of 

the Minister of Public Health issued separately for each contagious disease.10 

The measures listed in article three employed in accordance with such orders can be used by the 

Ministry of Public Health to respond to public health crises. But there are instances where that 

Ministry might also need outside assistance to deal with a crisis when the spread or the threat of 

spreading of a contagious disease among the population is overwhelming. To address such 

instances, the law establishes a general framework for the Ministry to seek needed assistance by 

proposing a plan to be adopted by a presidential decree. The law specifically provides the 

following: 

If an epidemic disease threatened all or a part of the territories of the Republic or started 

to spread within such territories without the local measures being sufficient [to deal with 

it] the Ministry of Health shall ask for a presidential decree to be issued which shall 

designate the measures that shall be taken to prevent the spread of the epidemic.11 

 

5 Id. art. 3. 

6 Id. art. 4. 

7 Id. art. 5. 

8 Id. art. 11. 

9 Id. art. 12. 

10 Id. arts. 6, 7, 8. 

11 Id. art. 9. 
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Such a decree shall designate the role of each authority and body which have been appointed to 

deal with the crisis, along with the manner by which they are to be established, the limitations on 

their authority, and the time accorded to them to carry out their duties. The funding cost of such 

plans shall be borne by the central government paying three-fourths of the cost and the 

municipalities paying the remaining one-fourth.12

It is clear from the foregoing that while the legislature in Lebanon has provided a legal 

framework to create plans to respond to public health crises, the actual creation of such plans and 

their attendant details is left to the executive branch of government, to be decided on a crisis-bycrisis basis. 

III. The Ebola Threat 

Lebanon recognizes the threat caused by the Ebola outbreak in certain foreign countries. The 

Ministry of Public Health has taken a number of measures to prevent the disease from entering 

the country, and apparently feels capable to deal with the situation without devising a special 

plan requiring the issuance of a presidential decree. Among the measures taken by the Ministry 

of Public Health in this regard are the following: 

 Dissiminating information about the history, symptoms, and how to avoid contracting the 

disease. The sources of most of this information are the World Health Organization (WHO) 

and the United States Centers for Disease Control and Prevention (CDC).13 

 Requiring hospitals in Lebanon to create special units equipped to deal with Ebola cases.14

 Requiring all passengers entering the country to fill specially designed cards that allow the 

Ministry to monitor individual situations and take necessary measures when such measures 

are warranted.15

 Requiring the Airport Authority to advise airlines on how to deal with suspected cases of 

Ebola on planes.16

The Ministry has also decided to assist Lebanese citizens living abroad who might have 

contracted the Ebola virus or any other communicable disease by providing them with 

 

12 Id. 

13 This information is posted on the Ministry website and can be accessed individually, at http://www.moph.gov.lb/ 

Prevention/Pages/EbolaOutbreak.aspx (last visited Nov. 5, 2014). 

14 Letter of the Minister of Public Health No. 33150/1/14 (Oct. 23, 2014), http://www.moph.gov.lb/Prevention/ 

Documents/2014-1-33150.pdf; Letter of the General Director of the Ministry of Public Health No. 31703/1/14 (Oct. 

13, 2014), http://www.moph.gov.lb/Prevention/Documents/Letter14-1-31703.pdf. 

15 Letter of the Minister of Public Health No. 33153/1/14 (Oct. 23, 2014), http://www.moph.gov.lb/Prevention/ 

Documents/2014-1-33153.pdf; Letter of the Minister of Public Health No. 33148/1/14 (Oct. 23, 2014), 

http://www.moph.gov.lb/Prevention/Documents/2014-1-33148.pdf. 

16 Letter of the Minister of Public Health (July 31, 2014), http://www.moph.gov.lb/Prevention/Documents/ 

Procedures.pdf. 
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hospitalization and lab exams if they decide to repatriate, on the condition that they inform the 

Lebanese Embassy in the relevant country in advance.17 

 

17 Letter of the General Director of the Ministry of Public Health No. 24740/1/14 (Aug. 13, 2014), 

http://www.moph.gov.lb/Prevention/Documents/2014-1-24740.pdf. 
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Mexico 

Gustavo Guerra 

Senior Foreign Law Specialist

SUMMARY Mexico’s system for managing public health emergencies is mainly administered by the 

nation’s General Health Council (GHC) and the federal Department of Health (DOH). 

The GHC has the authority to issue orders that classify communicable diseases that may 

cause a health emergency as serious threats and subject them to epidemiological 

monitoring, prevention, and control mechanisms. The DOH has the responsibility to 

monitor serious communicable diseases listed by law, as well as diseases classified as 

serious threats by the GHC, to detect and control outbreaks. In cases of actual or potential 

grave outbreaks of communicable diseases, the DOH has the power to order immediate 

and appropriate measures to prevent and contain damages to public health, with approval 

from Mexico’s President. Furthermore, the DOH must notify to the World Health 

Organization of all measures taken in order to address matters related to international 

health and of any incidence of diseases that may cause an outbreak. Mexico recently 

signed a Declaration of Intent with the US and Canada on how these countries will 

exchange public information in times of a health emergency of common interest.

I. Structure of Public Health Crisis Management System 

Mexico is a federal republic formed by thirty-one states and a Federal District. Mexico’s system 

for managing public health emergencies is primarily managed by the nation’s General Health 

Council (GHC) and federal Department of Health (DOH), with support from state governments. 

The GHC reports directly to Mexico’s President and has broad powers on health matters of 

national importance, including the authority to issue orders that classify communicable diseases 

that may cause a health emergency as serious threats and subject them to epidemiological 

monitoring, prevention, and control mechanisms.1

 

The GHC is headed by the Secretary of the DOH, and is comprised of high-ranking government 

officials (including secretaries and executives from federal and state government departments) 

and executives from private health institutions, nongovermental organizations, and 

industry associations.2

 

The DOH has responsibility for establishing and operating the National System for 

Epidemiological Surveillance (Sistema Nacional de Vigilancia Epidemiológica, SINAVE), 

 

1

 Reglamento Interior del Consejo de Salubridad General [Regulation of the General Health Council ] arts. 1, 

9(XVII), DIARIO OFICIAL DE LA FEDERACIÓN [D.O.], Dec. 11, 2009. See also Consejo de Salubridad General, 

Acuerdo mediante el cual se determina que la enfermedad transmisible por el virus del Ébola, debe estar sujeta a 

vigilancia epidemiológica, prevención y control en términos de lo dispuesto por el artículo 134, fracción XIV, de la 

Ley General de Salud [Order that Determines that the Ebola Virus Must Be Subject to Epidemiological Surveillance, 

as well as to Prevention and Control Measures], D.O., Oct. 23, 2014. 

2

 Reglamento Interior del Consejo de Salubridad General, supra note 1, arts. 3, 4. 
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which monitors serious communicable diseases listed by law, as well as diseases classified as 

serious threats by the GHC, in order to detect and control outbreaks.3

 

SINAVE is comprised of an extensive national network of health surveillance units (over 20,000 

as of May 2014) operating in all public and private health institutions, which monitor and report 

relevant information on health developments to a central unit managed by DOH’s Directorate of 

Epidemiology (DOE).4

The DOE processes this information and prepares reports and health alerts as necessary, which 

are used to plan and implement appropriate responses.5

 

II. Powers of Public Health Authorities 

A. Powers to Control Communicable Diseases 

Mexico’s General Law on Health provides that certain communicable diseases listed in the law 

(such as epidemic influenza, viral hepatitis, and AIDS), as well as diseases classified as serious 

threats by the GHC (such as the Ebola virus, as explained in Part V of this report), are subject to 

prevention and control measures executed by the DOH and state governments in their respective 

jurisdictions, with support from other federal government agencies and private health institutions 

and individuals.6

 

Outbreaks of these diseases must be notified immediately to the DOH, which has at its disposal a 

number of powers to monitor and control such outbreaks, including 

 confirmation of the disease by available clinical means; 

 temporary isolation of sick individuals, as well as those who are expected to become sick; 

 administration of vaccines and other preventive and therapeutic resources; 

 decontamination of areas, living quarters, clothing, utensils, and other objects exposed to 

viral, parasitic, or microbial contamination; 

 inspection of travelers suspected of being infected, as well as their luggage and other 

belongings that may be contaminated; 

 

3

 Ley General de Salud [General Law of Health], as amended through June 2014, arts. 133(II), 134, D.O., Feb. 7, 

1984, available on the website of Mexico’s House of Representatives, at http://www.diputados.gob.mx/LeyesBiblio/ 

pdf/142_040614.pdf. 

4 Información Epidemiologica [Epidemiological Information], SECRETARÍA DE SALUD, DIRECCION GENERAL DE 

EPIDEMIOLOGIA [DEPARTMENT OF HEALTH, DIRECTORATE OF EPIDEMIOLOGY], http://www.epidemiologia.salud. 

gob.mx/dgae/infoepid/intd_informacion.html (last updated May 2014). See also Norma Oficial Mexicana NOM017-SSA2-2012, Para la vigilancia epidemiológica [Mexican Health Standard NOM-017-SSA2-2012, for 

Epidemiological Surveillance], D.O., Feb. 19, 2013. 

5 Id. 

6

 Ley General de Salud arts. 134, 137, 138, 139, 140, 141. See also Acuerdo mediante el cual se determina que la 

enfermedad transmisible por el virus del Ébola, supra note 1. 
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 temporary closure of establishments or gathering locations of any kind; and 

 requesting appropriate support from civilian and military authorities, as well as from private 

individuals, as needed.7

B. Department of Health Powers in Health Emergencies 

In cases of actual or potential grave outbreaks of communicable diseases, the DOH has the 

power to order immediate and appropriate measures to prevent and contain damage to public 

health, including 

 issuing sanitary measures governing departures and arrivals of individuals from 

population centers; 

 regulating ground, maritime, and air traffic; 

 instructing federal, state, and local authorities and health professionals to support emergency 

measures, and requiring cooperation from private entities and individuals as necessary; 

 using, freely and with priority, radio and television air time, as well as telephone, mail, and 

telegraphic services.8

These urgent measures must ratified by Mexico’s President thereafter.9 In addition, the President 

may issue an executive order indicating the specific regions that are subject to emergency 

measures to protect public health.10 When the health emergency is controlled, the President must 

order the end of the emergency measures.11

III. Transparency of Public Health Crisis Management System 

Pursuant to applicable regulations, information generated by Mexico’s DOH through the 

National System for Epidemiological Surveillance (which, as explained above, monitors

developments concerning communicable diseases) must be disseminated through reports 

available electronically and in print in a way that facilitates accessibility to the data contained 

therein.12 Consistent with this requirement, a wide variety of data concerning events related to 

communicable diseases is publicly available on the website of the DOH’s Directorate 

of Epidemiology.13

 

7

 Ley General de Salud arts. 139, 147, 151, 152. 

8 Id. arts. 181, 184. 

9 Id. art. 181. 

10 Id. art. 183. 

11 Id. 

12 SECRETARÍA DE SALUD, DIRECCION GENERAL DE EPIDEMIOLOGIA, supra note 4. See also Norma Oficial 

Mexicana NOM-017-SSA2-2012, supra note 4, § 10. 

13 SECRETARÍA DE SALUD, DIRECCION GENERAL DE EPIDEMIOLOGIA, supra note 4. 
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With respect to recent measures adopted by the Mexican government concerning the Ebola virus, 

the DOH provides comprehensive information on this topic on a website that includes general 

information for citizens and technical information for experts.14 

At the international level, Mexico recently signed a Declaration of Intent with the United States 

and Canada that provides principles and guidelines concerning how these countries will 

exchange public information in the event of a health emergency of common interest.15 

Specifically, the Declaration provides that these countries intend to share with each other plans 

and statements concerning health emergencies prior to their release to the public.16 

IV. Cooperation with the WHO 

Mexico is signatory to the 2005 International Health Regulations (IHR), which are aimed at 

helping the international community respond to and prevent severe global public health risks, 

and provide that signatory countries must report to the World Health Organization (WHO) 

information concerning certain public health events and outbreaks.17

Consistent with the IHR, Mexico’s General Law on Health provides that the DOH must notify 

the WHO about all measures taken in order to address matters related to international health 

(particularly measures aimed at restricting the transit of persons or cargo due to sanitary 

reasons), and must also provide information on any case of diseases listed in the IHR that may 

cause an outbreak.18 

V. Recent Developments

As of mid-November 2014, no cases of individuals infected with the Ebola virus have been 

reported in Mexico. However, the Mexican government recently issued guidelines applicable to 

the treatment of this disease. Specifically, on October 23, 2014, Mexico’s GHC issued a 

directive indicating that the Ebola virus is a matter of public health that may cause a health 

 

14 Todo Sobre el ébola, SECRETARÍA DE SALUD, http://todosobreelebola.com/ (last visited Nov. 10, 2014). 

15 Press Release, U.S. Department of Health and Human Services (HHS), United States, Canada and Mexico 

Strengthen Information Sharing in Health Emergencies (May 20, 2014), http://www.hhs.gov/news/press/ 

2014pres/05/20140520a.html; Declaration of Intent to Coordinate Health Emergency Public Communications 

Between the Department of Health and Human Services of the United States of America, the Public Health Agency 

of Canada, and the Secretariat of Health of the United Mexican States (May 20, 2014), available at

http://www.hhs.gov/news/press/2014pres/05/wha-declaration-us-canada-mexico-en.pdf. See also Gustavo Guerra, 

Mexico; United States; Canada: Agreement on Health Emergencies, GLOBAL LEGAL MONITOR (July 2, 2014), 

http://www.loc.gov/lawweb/servlet/lloc_news?disp3_l205404053_text. 

16 Press Release, HHS, supra note 15; Declaration of Intent to Coordinate Health Emergency Public 

Communications, supra note 15; see also Guerra, supra note 15. 

17 Norma Oficial Mexicana NOM-017-SSA2-2012, supra note 4; WHO, International Health Regulations (2d ed. 

2005), http://www.who.int/ihr/publications/9789241596664/en/. 

18 Ley General de Salud art. 359. See also Reglamento de la Ley General de Salud en Materia de Sanidad 

Internacional [Regulation of General Law on Health on International Health] art. 14, D.O., Feb. 18, 1985. 
Legal Responses to Health Emergencies: Mexico 

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emergency and as a result ordered that this virus must be subject to epidemiological surveillance, 

as well as to preventive measures.19

On October 24, 2014, Mexico’s DOH issued a set of measures aimed at controlling health risks 

caused by the Ebola virus.20 Those measures include 

 confirmation of infections caused by the Ebola virus through lab tests administered by 

the DOH; 

 provision of medical treatment through available means; 

 destruction of clothing and equipment utilized by personnel that transport and provide care to 

infected individuals and those who are suspected of infection; 

 requesting support from federal, state, and local authorities, as well as from health 

professionals, as needed; 

 appropriate disposal of human remains of infected individuals, in order to prevent contagion; 

 decontamination and sanitization of areas and living quarters exposed to the Ebola virus; 

 authority to utilize, freely and with priority, radio and television air time, as well as 

telephone, mail, and telegraphic services, in order to disseminate guidelines concerning the 

prevention and control of health risks caused by the Ebola virus; 

 authority to regulate ground, maritime, and air traffic;

 authority to request necessary support from international organizations;

 authority to locate and order the quarantine or observation of healthy individuals who have 

had contact with individuals infected with the Ebola virus; 

 acquisition from national or international sources of medical equipment, diagnostic tools, 

surgical and medical supplies, and any other type of supplies and services necessary to 

implement measures aimed at controlling health risks caused by the Ebola virus; and 

 authority to build and remodel health facilities as necessary.21 

On October 24, 2014, Mexico’s President issued an executive order ratifying these measures.22

 

19 Acuerdo mediante el cual se determina que la enfermedad transmisible por el virus del Ébola, supra note 1. 

20 Secretaria de Salud, Acuerdo por el que se establecen las medidas preventivas que se deberán implementar para la 

vigilancia epidemiológica, prevención, control y combate de los riesgos para la salud que implica la Enfermedad por 

el Virus del Ébola [Order Issued by the DOH Establishing Preventive Measures that Must Be Implemented for the 

Epidemiological Surveillance, Prevention, Control and Combat of Health Risks of the Disease Caused by the Ebola 

Virus], D.O., Oct. 24, 2014. 

21 Id. 

22 Decreto por el que se Sanciona el Acuerdo por el que se establecen las medidas preventivas que se deberán 

implementar para la vigilancia epidemiológica, prevención, control y combate de los riesgos para la salud que 

implica la Enfermedad por el Virus del Ébola [Decree Whereby Mexico’s President Ratifies the Order Issued by the 

DOH Establishing Preventive Measures that Must Be Implemented for the Epidemiological Surveillance, 

Prevention, Control and Combat to Health Risks of the Disease Caused by the Ebola Virus], D.O., Oct. 24, 2014.
The Law Library of Congress 161

Nigeria 

Hanibal Goitom 

Foreign Law Specialist 

SUMMARY The legal authority of the Nigerian federal government to take extraordinary measures 

during public health crises is based on the emergency powers of the president and the 

legislature under the 1999 Constitution and the authority accorded to the executive body, 

specifically the health authorities, under the 1926 Quarantine Act. The Quarantine Act 

gives the president and the country’s health authorities broad powers to deal with public 

health crises. The President is authorized, among other things, to declare any infectious 

disease a dangerous infectious disease, declare any area in or outside of Nigeria an infected 

area, and issue regulations to prevent the spread of any dangerous infectious disease. It 

appears that the power to issue regulations has been exercised only once, with the issuing 

of the Quarantine (Ships) Regulations, which authorize or require port health officers to 

take a host of measures to prevent the importation into and spread of infectious diseases 

within Nigeria. 

 

 A bill (SB 210) aimed at replacing the Quarantine Act is currently being considered by the 

upper chamber of Nigeria’s legislature. Among other things, SB 210 seeks to streamline 

the public health response by establishing a commission that will prepare a plan for 

prevention and containment of public health emergencies, including ensuring that all tiers 

of government are duly prepared for such events. It also seeks to introduce transparency in 

the way that the Nigerian government handles public health crises by requiring the 

constant dissemination of a specific set of information to the public. In addition, it aims to 

provide certain protections to persons subjected to isolation or quarantine. 

 Nigeria’s ability to effectively deal with public health crises was tested with a recent 

outbreak of Ebola in Lagos and Port Harcourt. Nigeria immediately mobilized the relevant 

government institutions and allocated the necessary funds to take prevention and 

suppression measures, particularly to conduct wide contact-tracing investigations. This 

and other factors enabled the country to contain the outbreak quickly with only nineteen 

infections and seven deaths. As of the date of this report, Nigeria was Ebola free. 

I. Government Structure 

Nigeria, with an estimated population of over 168 million and a population density of 182.8 

people per square mile, is by far the most populous country in Africa.1

 A federation, Nigeria has 

a three-tiered government structure including the federal government, thirty-six states2

 and a 

federal capital (Abuja), as well as 768 local government areas within the states.3 

 

1 Nigeria, UNITED NATIONS DATA, https://data.un.org/CountryProfile.aspx?crName=NIGERIA (last visited 

Oct. 28, 2014). 

2

 These are: Abia, Adamawa, Akwa Ibom, Anambra, Bauchi, Bayelsa, Benue, Borno, Cross River, Delta, Ebonyi, 

Edo, Ekiti, Enugu, Gombe, Imo, Jigawa, Kaduna, Kano, Katsina, Kebbi, Kogi, Kwara, Lagos, Nasarawa, Niger, 

Ogun, Ondo, Osun, Oyo, Plateau, Rivers, Sokoto, Taraba, Yobe, and Zamfara. CONSTITUTION OF NIGERIA (1999), 
Legal Responses to Health Emergencies: Nigeria 

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Legislative power at the federal level is vested in a bicameral legislative body with a 360-

member House of Representatives and a 109-member Senate.4

 At the state level, this power is 

vested in house assemblies whose seats range from twenty-four to forty members depending on 

the population of a particular state.5

The federal executive power is vested in the president, vice-president, and members of the 

cabinet, whereas at the state level the same power is exercised by the governor, deputy governor, 

and commissioners of the government of the state.6

 

The judiciary consists of constitutionally formed courts and other courts. The Nigerian 

Constitution established what are known as the superior courts of record: the Supreme Court of 

Nigeria, the Court of Appeal, the Federal High Court, the High Court of the Federal Capital 

Territory (Abuja), the Sharia Court of Appeal of the Federal Capital Territory, the Customary 

Court of Appeal of the Federal Capital Territory, a High Court of a State, a Sharia Court of 

Appeal of a State, and a Customary Court of Appeal of a State.7 The Constitution permits the 

federal and state legislatures to establish additional, subordinate courts.8

 

This report focuses on the powers of the federal government in times of public health crises. 

However, it is important to note that state and local governments do play a key role in matters of 

public health crisis management. This is particularly true with regard to the issues of disease 

surveillance and notification systems. Nigeria’s National Policy on Integrated Disease 

Surveillance and Response (ISDR) states that the country’s surveillance structure involves the 

active participation of the three tiers of government and assigns each a specific role in the 

process of identifying and reporting epidemic-prone diseases (including cholera, meningitis, viral 

hemorrhagic fevers, and human influenza) and notifiable diseases.9 For instance, it requires local 

and state governments to report data collected on epidemic-prone diseases on a weekly basis.10 

II. Applicable Law 

Two sources of legal authority authorize the federal government to take preventative and 

suppression measures in anticipation of, or during, a public health crisis. The Constitution, 

which empowers the president to declare a public emergency and curtail certain individual rights 

 § 3(1), available on the International Centre for Nigerian Law (ICFNL), at http://www.nigeria-law.org/Constitution 

OfTheFederalRepublicOfNigeria.htm. 

3 Id. 

4 Id. §§ 4, 47, 48 & 49. 

5 Id. §§ 4, 90 & 91. 

6 Id. § 5. 

7 Id. § 6. 

8 Id. 

9

 FEDERAL MINISTRY OF HEALTH, NATIONAL POLICY ON INTEGRATED DISEASE SURVEILLANCE AND RESPONSE 

(IDSR) 3, 5, 13 & 14 (Dec. 2010), http://www.fmh.gov.ng/images/PolicyDoc/FMOH_IDSR_Policy.pdf. 

10 Id. at 13, 17 & 27. 
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(including the right to personal liberty and property) is one source of authority (see discussion, 

Part III, below). The second is the statutory regime. The 1926 federal Quarantine Act, which 

remains in force today, is the primary law governing matters concerning public health crises in 

Nigeria.11 It is based on the exclusive legislative jurisdiction accorded to the federal government 

under the Constitution on issues of “quarantine” and “[a]ny matter incidental or supplementary” 

to it.12 

The current statutory legal regime is likely to change soon. The upper chamber of the country’s 

legislative body is currently considering a bill, the Nigerian Public Health Bill (SB 210), aimed 

at replacing the Quarantine Act (see discussion, Part VI, below).13 SB 210, having passed first 

and second readings in the Chamber on October 2012 and April 2013, respectively, was referred 

to the Health and Agriculture Committee.14 Before it can become law, the bill will need to pass a 

third reading in the Senate, be passed by the House of Representatives, and be signed by the 

country’s President.15 

III. Powers of National Public Authorities 

A. Constitutional Powers 

1. Executive Powers 

The President is authorized to unilaterally or at the request of a state governor declare a state of 

emergency in certain instances, including when 

. . . 

(c) there is actual breakdown of public order and public safety in the Federation or any 

part thereof to such extent as to require extraordinary measures to restore peace 

and security; 

(d) there is a clear and present danger of an actual breakdown of public order and public 

safety in the Federation or any part thereof requiring extraordinary measures to avert 

such danger; 

 

11 Quarantine Act of 1926, 14 LAWS OF THE FEDERATION OF NIGERIA, Cap. Q2 (rev. ed. 2004), available on the 

Policy and Legal Advocacy Centre (PLAC) website, at http://www.placng.org/new/laws/Q2.pdf. See also Oluchi 

Aniaka, Law and Ethics of Ebola Outbreak in Nigeria 2 (Canadian Institute of Health Research, Aug. 8, 2014), 

available on the Social Science Research Network, at http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2477856

(access restricted). 

12 Quarantine Act of 1926 § 4. 

13 Bill for an Act to Establish the Nigeria Public Health (Quarantine, Isolation and Emergency Health Matters 

Procedure) Act . . . (Public Health Bill) (2013), available on the Nigerian Senate website, at http://www.nassnig. 

org/nass/legislation.php?id=1316. 

14 Senate Bill Charts, POLICY AND LEGAL ADVOCACY CENTRE (PLAC), http://www.placng.org/new/senate-billscharts.php?page=6 (last visited Oct. 29, 2014). 

15 CONSTITUTION OF NIGERIA § 58; Senate Standing Orders 2007 as Amended § 86, available on Senator Ayo 

Arise’s website, at http://www.senatorarise.com/senaterules.html (click on upper-left link to Constitution). 
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(e) there is an occurrence or imminent danger, or the occurrence of any disaster or natural 

calamity, affecting the community or a section of the community in the Federation; [or] 

(f) there is any other public danger which clearly constitutes a threat to the existence of 

the Federation . . . .16

The declaration of a state of emergency must be published in the country’s Official Gazette, and 

the President is required to immediately notify the Speaker of the House Representatives and the 

President of the Senate.17 Once in place, a state of emergency can be terminated 

 if the President revokes it; 

 if it is not subsequently endorsed by the federal legislature within two days of its declaration 

when the legislature is in session or within ten days otherwise; 

 after six months of its declaration, but the legislature may extend it for another six-month 

term; or 

 if the legislature, having initially endorsed or extended the declaration, at any time revokes it 

by a vote of a simple majority in both houses.18

The consequences of declaring a state of emergency may take one of two forms. First, the 

country’s legislature may adopt laws that curtail certain fundamental rights guaranteed under the 

Constitution (see discussion, Part III(A)(2), below). It may also allow the executive to take 

certain actions that restrict such constitutional rights. For instance, the Constitution appears to 

permit the executive to temporarily suspend the constitutional protection against forced or 

compulsory labor “in the event of any emergency or calamity threatening the life or well-being 

of the community.”19 It is conceivable that this authority could be used to ensure that hospitals 

and health centers are properly staffed during an outbreak of a deadly infectious disease 

like Ebola. 

President Goodluck Jonathan recently exercised his authority to declare the control and 

containment of the Ebola virus a national emergency, following the confirmation of seven 

infections in the country.20 President Jonathan directed all relevant federal and state authorities 

to work in concert to make sure that all necessary steps were taken to suppress the spread of 

Ebola.21 In addition, he approved a Special Intervention Plan and the immediate release of NGN 

1.9 billion (about US$11.5 million) to fight the virus, fast-tracking the disbursement of funds for 

 

16 CONSTITUTION OF NIGERIA § 305. 

17 Id. 

18 Id. 

19 Id. § 34. 

20 Nigeria’s Jonathan Declares State of Emergency over Ebola, REUTERS (Aug. 8, 2014), http://www.reuters.com/ 

article/2014/08/08/us-health-ebola-nigeria-jonathan-idUSKBN0G81WB20140808; Ebola: Jonathan Declares 

National Emergency, Approves N2BN Special Intervention Fund, EMBASSY OF NIGERIA, SEOUL SOUTH KOREA

(Aug. 21, 2014), http://www.nigerianembassy.or.kr/ebola-jonathan-declares-national-emergency-approves-n2bnspecial-intervention-fund-2/. 

21 EMBASSY OF NIGERIA, SEOUL SOUTH KOREA, supra note 20. 
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Ebola containment efforts.22 However, no information was located indicating that this authority 

was used to curtail any constitutionally guaranteed rights. 

2. Legislative Powers 

As noted above, the declaration of a state of emergency permits the legislature to pass laws that 

may otherwise be unconstitutional. The Constitution permits the adoption of a law limiting 

certain constitutionally guaranteed fundamental rights if it is “reasonably justifiable” and done 

“in the interest of . . . public health.”23 Such a law may impose limitations on the right to 

privacy; the right to freedom of thought, conscience, and religion; the right to freedom of 

expression and the press; the right to peaceful assembly and association; and the right to freedom 

of movement.24 

Similarly, the Constitution allows the adoption of a law for the compulsory acquisition of 

movable or immovable property “that is in a dangerous state or is injurious to the health of 

human beings.”25 In addition, the Constitution permits the adoption of a law imposing 

restrictions on a person’s personal liberty if the person is “suffering from infectious or 

contagious disease . . . [,] for the purpose of [the person’s] care or treatment or the protection of 

the community.”26

These constitutional provisions provide the authority for the imposition of statutory limitations 

on rights otherwise protected under the Constitution during public health crises. This justifies 

the restrictions imposed on any of the above-stipulated, constitutionally guaranteed rights by the 

current statutory regime, the Quarantine Act, or any other similar law that may be enacted in 

the future. 

B. Statutory Regime 

1. General Provisions 

As noted above, the Quarantine Act (the Act) is the primary law governing the prevention and 

suppression of dangerous infectious diseases. The Act states that it is intended to regulate “the 

imposition of quarantine and to make other provisions for preventing the introduction into and 

spread in Nigeria, and the transmission from Nigeria, of dangerous infectious diseases.”27 This 

includes “cholera, plague, yellow fever, smallpox and typhus.”28 In addition, the Act authorizes 

the President to declare any infectious or contagious disease as a dangerous infectious disease, an 

 

22 Id. 

23 CONSTITUTION OF NIGERIA § 45(1)(a). 

24 Id. 

25 Id. § 44(2)(f). 

26 Id. § 35(1)(e). 

27 Quarantine Act of 1926, pmbl., 14 LAWS OF THE FEDERATION OF NIGERIA, Cap. Q2 (rev. ed. 2004), available at 

http://www.placng.org/new/laws/Q2.pdf. 

28 Id. § 2. 
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authority apparently used at least once in the past to categorize sleeping sickness as a dangerous 

infectious disease.29 Similarly, the Act authorizes the President to declare any place in or outside 

of Nigeria to be an infected local area.30

The Act further authorizes the President to issue regulations for the purpose of preventing or 

suppressing a dangerous infectious disease in an infected local area, any other area in Nigeria, or 

any area outside of Nigeria, stating as follows: 

The President may make regulations for all or any of the following purposes – 

(a) prescribing the steps to be taken within Nigeria upon any place, whether within 

or without Nigeria, being declared to be an infected local area; 

(b) prescribing the introduction of any dangerous infectious disease into Nigeria or 

any part thereof from any place without Nigeria, whether such place is an infected local area or not; 

(c) preventing the spread of any dangerous infectious disease from any place 

within Nigeria, whether an infected local area or not, to any other place within 

Nigeria; 

(d) preventing the transmission of any dangerous infectious disease from Nigeria 

or from any place within Nigeria, whether an infected local area or not, to any 

place without Nigeria; 

(e) prescribing the powers and duties of such officers as may be charged with carrying out such regulations; 

(f) fixing the fees and charges to be paid for any matter or thing to be done under 

such regulations, and prescribing the persons by whom such fees and charges 

shall be paid, and the persons by whom the expenses of carrying out any such 

regulations shall be borne, and the persons from whom any such expenses incurred by the Government may be recovered; 

(g) generally for carrying out the purposes and provisions of this Act.31

State governors are accorded the same powers as the President to categorize diseases as 

dangerous infectious diseases, declare a particular location an infected local area, or issue 

regulations for any of the above-stipulated purposes in the absence of presidential action on a 

particular matter.32 

Only one set of regulations, the Quarantine (Ships) Regulations have been issued under this 

authority to date at the national level.33 No relevant document issued at the state level 

was located. 

 

29 Id.; Subsidiary Legislation, Declaration of Dangerous Infectious Disease, available at http://www.placng.org/ 

new/laws/Q2.pdf (scroll to “Subsidiary Legislation,” page 3). 

30 Quarantine Act of 1926 § 2. 

31 Id. § 4. 

32 Id. § 8. 

33 Aniaka, supra note 11, at 11. 
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2. Quarantine of Ships 

The Quarantine (Ships) Regulations authorize a port health officer to take a number of measures 

for the purpose of prevention and suppression of infectious diseases. Whenever a person in a 

ship34 approaching Nigeria is suffering from an infectious disease or there is suspicion of the 

presence of an infectious disease onboard, the master must contact the port health authority and 

provide a specific list of information necessary for the officer to determine, among others, the 

gravity and origin of an infection, if any.35 The officer may clear the ship to proceed to its 

intended destination if, on the basis of the information provided by the master, he is satisfied that 

the arrival of the ship will not result in the spread of an infectious disease.36 Until and unless the 

ship is given clearance, no one may board or leave the ship without the permission of the officer 

except the pilot.37

While the port health officer is authorized to inspect any ship already in the port or on arrival, he 

is required to inspect all ships that contacted the port health authority about the possible presence 

of an infectious disease onboard or any other ship present that he has reasonable grounds to 

believe is carrying a “quarantinable disease.”38 The master of the ship is required to fully 

cooperate with the officer, including by answering all questions regarding health conditions on 

board the ship and notifying him of anything that may lead to an infection or the spread of a 

quarantinable disease.39

A ship, which before its arrival had called at a foreign port, is subject to additional requirements. 

Such ship must submit what is known as the maritime declaration of health (MDH), in a form 

specified by World Health Organization (WHO) Regulation No. 2, which must be countersigned 

by the ship’s surgeon if it has one.40 The form requires the listing of all ports of call and contains 

a number of questions including whether, during the voyage, there were suspected cases of an 

infectious disease or nonaccidental death.41 In addition to completing the MDH, the master must 

submit a Deratting Certificate or Deratting Exemption Certificate, issued under the International 

Sanitation Regulations.42 Failure to produce either certificate leads to an inspection by the port 

health officer.43

 

34 A ship includes any “sea-going or . . . inland navigation vessel making an international voyage.” Quarantine 

(Ships) Regulations § 2, Quarantine Act–Subsidiary Legislation. 

35 Quarantine (Ships) Regulations § 10, Quarantine Act–Subsidiary Legislation. 

36 Id. § 9. 

37 Id. § 14. 

38 Id. § 3. A quarantinable disease includes “cholera, plague, relapsing fever, smallpox, typhus or yellow 

fever.” Id. § 2. 

39 Id. § 4. 

40 Id. § 12. 

41 Id. 

42 Id. § 14. 

43 Id. 
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If the port health officer has reason to believe that a ship may be an “infected ship”44

 or a 

“suspected ship,”45 or has experienced a case of quarantinable disease in the last four weeks 

before its arrival and was not granted clearance in another port, he may direct the ship to a 

desirable mooring station and must inspect it and everyone onboard.46 If, upon inspection, the 

officer discovers that what are known as “additional measures”47 are required, he may detain the 

ship in the same place or at another location for as long as needed for the application of the 

necessary measures.48 For instance, if a ship is suspected of being infected with cholera, the 

officer may place anyone who disembarks from the ship under surveillance, require the 

disinfection of any contaminated area of the ship or article onboard, and/or require the 

disinfection or removal of any contaminated water onboard.49

The port health officer may, on his own volition or upon the request of the master (in which case 

it is a requirement), examine a person onboard a ship if the person is suffering from an infectious 

disease or tuberculosis, or has been exposed to an infectious disease. 50 The officer may take a 

number of actions, including detaining the person for examination in the ship or another location, 

ordering the person and his belongings to be disinfected, or restricting his movements.51

 

44 An “infected ship” is 

(a) a ship which has on board on arrival a case of human cholera, plague, small-pox or yellow fever; 

(b) a ship on which a plague-infected rodent is found on arrival; or 

(c) a ship which has had on board during its voyagei.a case of cholera within five days before arrival; or 

ii.a case of human plague developed by the person more than six days after his embarkation; or 

iii.a case of yellow fever or smallpox, and which has not before arrival been subjected in respect of such 

case to appropriate measures equivalent to those provided for in these Regulations.” Id. § 2. 

45 A “suspected ship” is defined as 

(a) a ship which has had on board during the voyage a case of cholera more than five days before arrival; 

or 

(b) a ship which, not having on board on arrival, a case of human plague, has had on board during the 

voyage a case of that disease developed by the person within six days of his embarkation; or 

(c) a ship which left within six days before arrival an area infected with yellow fever: 

Provided that a ship to which the foregoing paragraph (a) or (b) applies shall not be deemed to be a suspected ship if 

in respect of such case of human cholera or plague, as the case may be, the ship has before arrival been subjected to 

appropriate measures equivalent to those provided for in these Regulations.” Id. § 2. 

46 Id. § 15. 

47 Additional measures are stipulated in Schedule Five of the Regulations and are tailored to specific quarantinable 

diseases. Id. 

48 Id. 

49 Id. 

50 Id. § 17. 

51 Id. 
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If the Minister of Health notifies the port health officer of a “grave danger to public health” due 

to an outbreak of an infectious disease in an area where a ship is docked, the officer is authorized 

to require anyone disembarking from the ship to provide his personal information and the areas 

he intends to visit.52

In addition to quarantinable diseases, the Regulations require that additional measures (measures 

stipulated under Schedule Five of the Regulations) be applied to the following: 

(a) any infected or suspected ships; 

(b) any ship on which there is a case of typhus or relapsing fever; 

(c) any ship which has during its voyage been in a local area infected with cholera, 

plague or yellow fever; 

(d) any suspect for smallpox on a ship other than an infected ship;

(e) any person on any ship which has come from an area infected with typhus or 

relapsing fever; 

(f) any ship or any person on board, when the port health officer is satisfied that, 

notwithstanding the application of sanitary measures to that ship or person at a 

previous port, an incident has occurred since such previous application which makes 

it necessary again to apply additional measures, or when the medical officer has 

definite evidence that the previous measures applied were not 

substantially effective.53

In addition, the Regulations impose a number of requirements and procedures relating to the 

prevention and suppression of infectious diseases in relation to outgoing ships.54 

IV. Transparency of the Public Health Management System 

Under the current public health regulatory regime, transparency requirements are minimal. Only 

two types of transparency requirements were located. One mandates that the President (with 

regard to the declaration of a state of emergency) or the Minister of Health (with regard to the 

declaration of a particular location as an infected area) issue a public notice via the Official 

Gazette.55 The other, which forms part of the country’s obligation as a WHO member state, 

requires that Nigeria notify the WHO of any event that constitutes a public health emergency 

within twenty-four hours of the assessment of such event.56

If the recent Ebola outbreak is any indication, the question of transparency is not a problem in 

Nigeria. The country’s Ministry of Health created a web page dedicated to informing the public 

about Ebola, including what the virus is, how it spreads, and signs and symptoms of infection.57 

 

52 Id. § 19. 

53 Id. § 20. 

54 Id. §§ 21 & 22. 

55 CONSTITUTION OF NIGERIA § 305; Quarantine Act of 1926 § 22, 14 LAWS OF THE FEDERATION OF NIGERIA, Cap. 

Q2 (rev. ed. 2004), available at http://www.placng.org/new/laws/Q2.pdf. 

56 WHO, International Health Regulations (IHR) art. 6 (2d ed. 2005), http://whqlibdoc.who.int/publications/2008/97 

89241580410_eng.pdf?ua=1. 

57 EBOLA VIRUS INFORMATION UNIT, http://www.health.gov.ng/ebolainfo/ (last visited Nov. 3, 2014). 
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In addition, the Ministry issued multiple press releases to inform the public about the status of 

the virus in the country.58 In fact, a successful information campaign by the government, 

intended both to educate the public about the disease and inform the public of actions the 

government was taking for its suppression, is said to have contributed to the country’s success in 

curbing the outbreak.59 

It is important to note that, if adopted in its current form, SB 210 would require the development 

of guidelines on mechanisms to communicate with and inform the public during public health 

crises (see discussion, Part VI, below). It would also mandate that the public health authority 

provide information to the public regarding 

 the declaration or termination of a state of public health emergency, 

 the precautions that members of the public need to take in order to protect themselves from 

the prevailing danger that caused the emergency, and 

 the actions that the relevant authorities are taking to address the emergency.60

In addition, it would require that the information be disseminated via all of the available modes 

of communication and languages accessible to the general public, including to individuals 

with disabilities.61 

V. Cooperation with the World Health Organization (WHO) 

Nigeria is a member country of both the WHO and the International Health Regulations (IHR).62 

As such, Nigeria is bound by the requirements under the International Health Regulations (IHR) 

(2005), an international legal instrument aimed at preventing the spread of disease.63 Among 

others, the IHR require Nigeria “to develop, strengthen and maintain . . . the capacity to detect, 

assess, notify ad report” outbreaks of infectious diseases.64 According to the WHO Country 

Cooperation Strategy 2008–2013, strengthening Nigeria’s integrated disease surveillance and 

response and building the capacity of public health facilities for disease control and eradication 

efforts are among the main focus areas of cooperation with Nigeria.65

 

58 Press Releases, FEDERAL MINISTRY OF HEALTH, http://www.health.gov.ng/index.php/news-media/press-releases

(last visited Nov. 3, 2014). 

59 Nigeria Is Now Free of Ebola Virus Transmission, WHO (Oct. 20, 2014), http://www.who.int/mediacentre/news/ 

ebola/20-october-2014/en/. 

60 Public Health Bill § 29, available at http://www.nassnig.org/nass/legislation.php?id=1316. 

61 Id. 

62 Alphabetical List of WHO Member States, WHO, http://www.who.int/choice/demography/by_country/en/ (last 

visited Oct. 31, 2014); IHR, supra note 56, App. 1. 

63 WHO, INTERNATIONAL HEALTH REGULATIONS (2005): A BRIEF INTRODUCTION TO IMPLEMENTATION IN 

NATIONAL LEGISLATION 1 (Jan. 2009), http://www.who.int/ihr/Intro_legislative_implementation.pdf?ua=1; IHR, 

supra note 56, App. 1; Countries, WHO, http://www.who.int/countries/en/ (last visited Oct. 24, 2014). 

64 IHR, supra note 56, § 5. 

65 WHO, WHO COUNTRY COOPERATION STRATEGY 2008–2013: NIGERIA 6 & 24 (2009), http://www.who.int/ 

countryfocus/cooperation_strategy/ccs_nga_en.pdf. 
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In addition, as a member of the WHO and the IHR, Nigeria must cooperate with the WHO by 

meeting its obligations under the IHR, including a requirement to notify the WHO of any event 

that constitutes a public health emergency within twenty-four hours of assessment of 

such event.66

VI. Recent Developments 

A. Legislative Reform 

Nigeria is in the process of reforming its public health crisis legal framework, which is currently 

governed under a 1926 law. As indicated above, the Public Health Bill (SB 210), aimed at 

replacing the current health crisis management regulatory regime, is pending in the upper 

chamber of the country’s National Assembly. 

A notable provision of SB 210 would establish a public health emergency planning body, the 

Public Health Emergency Planning Commission. Staffed through presidential appointments, the 

Commission would prepare a plan for the prevention and suppression of a host of public health 

emergencies.67 Its plan would include requirements or guidelines, including on 

 communication with and notification of the public during a public health crisis; 

 coordinating responses of the different tiers of government during a public health crisis; 

 the evacuation and temporary relocation of communities during a public health crisis; 

 providing training to public health workers to diagnose and treat infectious diseases; and 

 ensuring that all levels of government have made adequate preparations for public health 

crises, including identifying isolation or quarantine locations, locations for housing and 

feeding health workers, locations for distributing food to the public, and routes and means of 

public and material transportation.68

Another notable provision seeks to impose a strict reporting requirement, including on all health 

care providers,69 coroners, pathologists, and medical examiners, with regard to any disease or 

illness that may cause a public health emergency.70 It mandates that any one of the listed 

professionals who comes across any disease or illness that could possibly cause a public health 

emergency report it to the public health authority in a prescribed format either electronically or 

 

66 IHR, supra note 56, art. 6. 

67 Public Health Bill §§ 5 & 6, available at http://www.nassnig.org/nass/legislation.php?id=1316. 

68 Id. § 6. 

69 A health care provider is “any person or entity who provides health care services including, but not limited to, 

hospitals, medical clinics and offices, special care facilities, medical laboratories, physicians, pharmacists, dentists, 

physicians assistants, nurse practitioners, registered and other nurses, paramedics, emergency medical or laboratory 

technicians, and ambulance and emergency medical workers.” Id. § 3. 

70 Id. § 7. 
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in writing.71 The same requirements apply to individuals who deal with animals, including 

veterinarians, livestock owners, and laboratory technicians.72

Also notable is part IV of SB 210, which deals with the power of the president to declare a public 

health emergency, including the mechanics for and consequences of such action. The president 

may declare a public health emergency whenever there is “an occurrence or imminent threat of 

an illness or health condition that . . . is believed to be caused by . . . bioterrorism [or] the 

appearance of [an] . . . infectious agent or biological toxin” that poses a “high probability” of 

harm to the public.73 In such instances, the President may declare a public health emergency for 

a thirty-day period, which he may renew for an indefinite number of thirty-day terms; however, 

the legislature may terminate the declaration at any time with a simple majority vote if convinced 

that the underlying threat to public health no longer exists.74

A declaration of a public health emergency accords the president certain emergency powers, 

including the power to suspend laws imposing procedures for the normal functioning of state 

bodies, and to mobilize “any part of the organized forces.”75 It also authorizes the public health 

authorities to take certain measures with regard to management of property and protection of 

persons.76 For instance, the public authority would have the power to isolate77 or quarantine78

individuals or groups, and the failure to follow isolation or quarantine orders would constitute 

a crime.79 

The provisions on isolation or quarantine include language for the protection of subjects of such 

actions. These include the requirement that isolation or quarantine must be imposed in the least 

restrictive manner and that it must automatically end upon the determination that the person or 

persons no longer pose a risk of transmission.80 While SB 210 would allow the public health 

authority to unilaterally impose a temporary isolation or quarantine in situations in which delay 

would “significantly jeopardize . . . [its] ability to prevent or limit the transmission of a 

 

71 Id. 

72 Id. 

73 Id. §§ 3(m) & 10. 

74 Id. § 14. 

75 Id. § 12. 

76 Id. §§ 15–29. 

77 “Isolation” is defined as the “physical separation and confinement of an individual or groups of individuals who 

are infected or reasonably believed to be infected with a contagious or possibly contagious disease from non-isolated 

individuals.” Id. § 3. 

78 “Quarantine” is defined as “the physical separation and confinement of an individual or group of individuals, who 

are or may have been exposed to a contagious or possibly contagious disease and who do not show signs of 

symptoms of a contagious disease, from non-quarantined individuals, to prevent or limit the transmission of the 

disease to non-quarantined individuals.” Id. § 3. 

79 Id. § 25. 

80 Id. 
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contagious or possibly contagious disease to others,” extended isolation or quarantine would be 

subject to judicial oversight.81 

B. Ebola Outbreak 

The most recent public health crisis in Nigeria came in the form of an Ebola outbreak in two sites 

in the country. The primary (index) outbreak occurred in Lagos when on July 20, 2014, a person 

who had contracted the virus in Liberia arrived at the Lagos International Airport.82 This 

primary patient was suspected of having potentially exposed seventy-two individuals.83 The 

second outbreak occurred in Port Harcourt when the close contact of the primary patient who 

was under quarantine in Lagos travelled to seek medical attention from a private physician in 

August 1, 2014.84 By the time the WHO officially declared Nigeria Ebola free on October 20, 

2014, a total of nineteen individuals had been infected with the disease, seven (40%) of 

whom died.85

This was potentially catastrophic in large part because Lagos is far from being an ideal place to 

contain an infectious disease. Home to twenty-one million people, most of whom live in 

crowded and unsanitary slums, Lagos is the largest city in Africa.86 Lagos’s population is as 

large as the total combined populations of Guinea, Liberia, and Sierra Leone, the three West 

African countries hardest hit by the ongoing Ebola outbreak in the region.87 In addition, with its 

air, land, and sea ports of entry, Lagos is the region’s transit hub.88 

According to commentators, these factors make the swift containment of the spread of Ebola in 

Nigeria with only a few victims a great success story. Sources indicate that this was possible 

because Nigeria mobilized its resources and took the necessary suppression measures quickly 

and efficiently. Following the confirmation of the first Ebola case, the Ministry of Health, with 

the help of the Nigeria Center for Disease Control (NCDC) declared an Ebola Emergency.89 

Nigeria moved quickly to activate the Incident Management Center (now the Emergency 

 

81 Id. § 26. 

82 Faisal Shuaib et al., Ebola Virus Disease Outbreak – Nigeria, July–September 2014, 63(39) MORTALITY &

MORBIDITY WEEKLY REPORT (MMWR) 1 (Oct. 3, 2014), available on the Centers for Disease Control and 

Prevention website, at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6339a5.htm. 

83 Id. 

84 Ebola Situation in Port Harcourt, Nigeria, WHO (Sept. 3, 2014), http://www.who.int/mediacentre/news/ebola/3-

september-2014/en/. 

85 WHO, supra note 59. 

86 Population, LAGOS STATE GOVERNMENT, http://www.lagosstate.gov.ng/pagelinks.php?p=6 (last visited Nov. 3, 

2014); WHO, supra note 59; Urban Slums in Lagos ‘Mega City’, VANGUARD (Jan. 11, 2014), http://www.vanguard 

ngr.com/2014/01/urban-slums-lagos-mega-city/; Nigeria: Lagos, The Mega-City of Slums, IRINNEWS (Sept. 5, 

2006), http://www.irinnews.org/report/60811/nigeria-lagos-the-mega-city-of-slums. 

87 WHO, supra note 59. 

88 Shuaib et al., supra note 82, at 3. 

89 Id. at 1. 
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Operations Center, EOC) to respond to the outbreak.90 The EOC, as the implementing arm of 

the national response to the Ebola outbreak, expanded its work beyond Lagos, specifically to 

Rivers State (where Port Harcourt is located) and Enugu State (for the purpose of monitoring 

people who had come into contact with the primary patient).91 Nigeria identified 894 persons 

who had come into contact with an infected person and contact tracers conducted over 18,000 

face-to-face interviews.92 Individuals suspected of an infection were isolated and those with 

confirmed cases of an infection were sent to facilities in Lagos and Port Harcourt.93

According to the WHO, Nigeria’s performance in curbing the spread of Ebola is attributable to a 

number of factors including 

 rapid utilization of public institutions and prompt establishment of an EOC; 

 availability of a “first-rate virology laboratory” to make quick and reliable diagnoses; 

 availability of qualified contact-tracers who were able to detect infections early and isolate 

suspected cases; 

 full attention of the country’s leadership, including that of the head of state; 

 generous allocation of resources and their quick disbursement; 

 effective public communication campaigns; and 

 experience accumulated fighting previous outbreaks such as polio.94 

As at the date of this report, no new cases of infection have emerged in Lagos or Port Harcourt 

since August 18 and August 31, 2014, respectively.95 As noted above, the WHO declared 

Nigeria Ebola free on October 20, 2014. However, the fact that the Ebola outbreak in the region 

remains uncontained coupled with Nigeria’s geographic proximity to the hardest-hit countries 

and its extensive borders make Nigeria vulnerable to additional cases.96

 

90 Id. at 3. 

91 Id. 

92 Id. at 2. 

93 Id. at 2. 

94 WHO, supra note 59, at 2. 

95 Shuaib et al., supra note 82, at 3. 

96 WHO: Nigeria is Free of Ebola but Must Remain Vigilant for New Cases, THE GUARDIAN (Oct. 20, 2014), 

http://www.theguardian.com/world/2014/oct/20/nigeria-declared-ebola-free-must-remain-vigilant; Okon Bassey, 

Health Minister Reiterates Need for Vigilance Despite Clean Bill, ALLAFRICA (Nov. 2, 2014), 

http://allafrica.com/stories/201411031718.html. 
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Portugal 

Eduardo Soares 

Senior Foreign Law Specialist

SUMMARY Constitutional principles guarantee the rights to health protection and protection of 

personal data in Portugal. A national health system provides healthcare to the population, 

while a national commission is charged with the power to supervise and monitor 

compliance with the laws and regulations on personal data protection. 

 A 1990 law provides the general principles and policies that guide the health sector in the 

country, the sanitary protection of its borders, and the powers granted to the Minister of 

Health to manage serious public health emergencies. 

 Working under the authority of the Ministry of Health are the General Board of Health, 

which is in charge, inter alia, of regulating, guiding and coordinating the activities of health 

promotion and disease prevention in the country, including epidemiologic surveillance at 

national level; and the National Institute of Emergency Medicine, which is responsible for, 

among other things, collaborating in national civil emergency planning and the development 

and implementation of specific plans regarding emergencies or disasters. 

 

 A system of public health surveillance monitors the health status of the population to 

determine the risk of transmission of diseases, and a national council performs advisory 

functions in prevention and control of transmissible diseases. 

 Additional laws compose the legal framework available to the government to manage 

public health crises, such as the government’s ability to issue compulsory licenses for a 

patent for public interest reasons; to impose criminal sanctions on persons who spread 

contagious diseases; and, the adoption, in 2008, of the International Health Regulations. 

 To respond to a possible Ebola virus outbreak, Portugal is implementing 

contingency plans. 

I. Constitutional Principle – Health 

According to the Portuguese Constitution, everyone has the right to health protection and the duty to 

defend and promote health.1

 The Constitution states that the right to health protection shall 

be fulfilled 

(a) through a universal national health service that, taking into account the economic and social 

conditions of citizens, will generally be free of charge;2

 [and] 

 

1

 CONSTITUIÇÃO DA REPÚBLICA PORTUGUESA [C.R.P.], (VII Revisão Constitucional (2005)), art. 64(1), available at

ASSEMBLEIA DA REPÚBLICA, http://www.parlamento.pt/Legislacao/Paginas/ConstituicaoRepublicaPortuguesa.aspx. 

2 Id. art. 64(2)(a). 
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(b) by creating economic, social, cultural and environmental conditions that will 

particularly protect childhood, youth and old age; by systematically improving the 

conditions of life and work and promoting physical fitness and sport at school and 

among the people; and by developing the people’s sanitary education and practices of 

healthy living.3

II. National Health System 

A National Health System (Sistema Nacional de Saúde, SNS) was created in 1979 by Law No. 

56 of September 15, 1979, through which the government guarantees the right under the 

Constitution to health protection.4 The SNS is composed of the organs and services listed in 

Law No. 56. Its purpose is to provide comprehensive health care to the entire population.5 The 

SNS involves all integrated health care, including health promotion, public health surveillance, 

disease prevention, diagnosis and treatment of patients, and patients’ medical and 

social rehabilitation.6

A. Basis of the Health Sector 

On August 24, 1990, Law No. 48, the Basic Health Law, was enacted to establish the basis and 

structure of the health sector in Portugal.7

 Law No. 48 provides the general principles8 and 

policies9

 that must guide the country in this area. Failure to comply with the Basic Health Law 

entails criminal, civil and disciplinary liability.10

The Portuguese government promotes the sanitary protection of its borders, in compliance with 

general rules issued by the competent bodies.11 The appropriate bodies are charged with 

studying, proposing, implementing and enforcing necessary measures to prevent the import or 

export of diseases subject to international health regulations; responding to threats of the spread 

of transmissible diseases; and promoting all necessary sanitary actions required by the 

international community.12 

 

3 Id. art. 64(2)(b). 

4

 Lei No. 56/79, de 15 de Setembro, art. 1, http://www.parlamento.pt/Legislacao/Paginas/Leis_area_saude.aspx. 

Scroll down to Section I(2) and click on Lei No. 56/79. See also Base XII of Law No. 48/90, infra note 7. 

5 Id. art. 2. 

6 Id. art. 6(2). 

7

 Lei No. 48/90, de 24 de Agosto, http://www.parlamento.pt/Legislacao/Paginas/Leis_area_saude.aspx (scroll to 

Section I(1) and click on “Lei No. 48/90”). 

8 Id. Base I. 

9 Id. Base II. 

10 Id. Base III. 

11 Id. Base XI(1). 

12 Id. Base XI(2). 
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The organization of the health system is based on the division of the national territory into health 

regions.13 The regions can be further divided into sub-regions, according to the needs of the 

population and the operability of the system.14 

The health authorities are located at national, regional and council levels to ensure timely and 

discretionary state intervention in situations of serious risk to public health, and are 

hierarchically subordinate to the Ministry of Health, through the appropriate general-director.15

The health authorities are in charge, among other things, of exercising sanitary border 

surveillance;16 and requesting services, facilities and the assistance of health professionals in 

cases of severe epidemics and other similar situations.17

In the event of a catastrophe or other serious public health emergency, the Minister of Health is 

in charge of taking exceptional and indispensable measures, and must coordinate the activities of 

the central services of the Ministry with the SNS’s bodies and the various health authorities.18 If 

necessary, the government may request the services of professionals and healthcare facilities of 

the private sector in cases where such assistance is absolutely indispensable.19

All Portuguese citizens are beneficiaries of the SNS.20 All nationals of Member States of the 

European Community may receive services of the SNS as well, in accordance with the European 

Community rules.21 Foreigners residing in Portugal may receive benefits on a reciprocal basis; 

stateless persons residing in the country also receive benefits.22

Decree-Law No. 11 of January 15, 1993 approved the SNS Statute,23 which defines, among other 

things, the ambit of its application;24 its nature and objective;25 and the organization and 

functioning of the SNS.26 It also provides for the cooperation of the SNS with other entities.27

 

13 Id. Base XVIII(1). 

14 Id. Base XVIII(3). 

15 Id. Base XIX(1). 

16 Id. Base XIX(3)(d). 

17 Id. Base XIX(3)(e). 

18 Id. Base XX(1). 

19 Id. Base XX(2). 

20 Id. Base XXV(1). 

21 Id. Base XXV(2). 

22 Id. Base XXV(3). 

23 Decreto-Lei No. 11/93, de 15 de Janeiro, art. 1, http://www.sg.min-saude.pt/sg/conteudos/legisaude/legis+sns.htm

(scroll to Estatuto do SNS and click on “Decreto-Lei No. 11/93”). 

24 Id. art. 2. 

25 Id. Anexo, arts. 1, 2. 

26 Id. Anexo, Capítulo II. 

27 Id. Anexo, Capítulo VI. 
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B. Ministry of Health 

The Ministry of Health is the government department responsible for defining and guiding the 

national health policy, ensuring a sustainable use of resources, and evaluating results.28 The 

Ministry of Health is responsible for regulating the SNS.29 Article 7(2) of Decree-Law No. 124 

of December 29, 2011 further provides that all services and public health care providers, 

particularly groups of health care centers, hospitals(regardless of designation), and local health 

care units are to be integrated into the SNS.30

1. General Board of Health 

The General Board of Health (Direção-Geral da Saúde, DGS)31 is responsible for the direct 

administration of government within the Ministry of Health.32 The DGS’s mission is to regulate, 

guide and coordinate the activities of health promotion and disease prevention; define the 

technical conditions for the provision of adequate health care; plan and program the national 

policy for quality in the health system, as well as ensure the development and implementation of 

the National Health Plan (Plano Nacional de Saúde, PNS);33 and coordinate the international 

relations of the Ministry of Health.34

The responsibilities of the DGS include issuing rules and guidelines, developing and promoting 

programs on public health and improving the delivery of care in relevant areas of health;35 and 

 

28 Decreto-Lei No. 124/2011, de 29 de Dezembro, art. 1, http://www.portaldasaude.pt/portal/conteudos/a+saude 

+em+portugal/ministerio/lei+organica/lei+organica3.htm. 

29 Id. art. 2(b). 

30 Id. art. 7(2). 

31 DIREÇÃO-GERAL DA SAÚDE, http://www.dgs.pt/. The DGS is regulated by Decree No. 14 of January 26, 2012, 

http://www.dgs.pt/institucional/diplomas-legais-e-organograma.aspx (click on “Decreto Regulamentar No. 

14/2012”). 

32 Decreto-Lei No. 124/2011, art. 4(c). Pursuant to article 2(1) of Law No. 4 of January 15, 2004, (Lei No. 4/2004, 

de 15 de Janeiro, http://www.pgdlisboa.pt/leis/lei_mostra_articulado.php?nid=1561&tabela=leis&ficha= 

1&pagina=1&), direct administration consists of central and peripheral services which, by the nature of their powers 

and functions, must be subject to the direction of the respective member of the government. The services included 

in the direct administration of the state encompass those whose duties arise out of the exercise of sovereign powers, 

authority, and political representation of the state, or that involve the exercise of functions of study and creation, 

coordination, support and control, or supervision of other administrative services. Id. art. 2(2). In contrast, indirect 

administration consists of bodies vested with legal personality that are subject to the supervision and authority of the 

government. Services included in indirect administration are those that, due to their specificity, must not be 

subjected to the direct administration of the government, and, as a rule, are endowed with administrative and 

financial autonomy, including those of public institutions, which are governed by Law No. 3 of January 15, 2004 

(Lei No. 3/2004, de, de 15 de Janeiro, http://www.pgdlisboa.pt/leis/lei_mostra_articulado.php?nid=1472&tabela= 

leis&ficha=1&pagina=1&). See MINISTÉRIO DAS FINANÇAS, DIRECÇÃO GERAL DA ADMINISTRAÇÃO E DO EMPREGO 

PÚBLICO, http://www.dgaep.gov.pt/index.cfm?OBJID=a21efe4b-790e-4b90-8371-0f45231ab4fc. 

33 DIREÇÃO-GERAL DA SAÚDE, PLANO NACIONAL DE SAÚDE (2012–2016), http://pns.dgs.pt/nhp-in-english/. 

34 Decreto-Lei No. 124/2011, art. 12(1). 

35 Id. art. 12(2)(a). 
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coordinating and ensuring epidemiologic surveillance at the national level and Portugal’s 

contribution at the international level.36

2. National Institute of Emergency Medicine 

The National Institute of Emergency Medicine (Instituto Nacional de Emergência Médica, 

INEM)37 is under the supervision and control of the Ministry of Health38 and is responsible, 

along with other institutions and organisms, for the indirect administration of the government.39 

The INEM’s mission is to define, organize, coordinate, participate in and evaluate the activities 

and operation of the Integrated System of Emergency Medicine (Sistema Integrado de Emergência 

Médica) in order to ensure victims of accidents or sudden illnesses receive prompt and proper 

health care.40 

The INEM’s responsibilities include, inter alia, collaborating in national civil emergency 

planning, including developing and implementing disaster relief plans; participating in the national 

emergency telecommunications network;41 and developing national and international actions of 

bilateral or multilateral cooperation.42

C. System of Public Health Surveillance 

Law No. 81 of August 21, 200943 created a System of Public Health Surveillance (Sistema de 

Vigilância em Saúde Pública, SVSP); a national network to collect information from 

epidemiologic surveillance; and the National Council of Public Health. 

1. System of Public Health Surveillance 

The SVSP consists of entities in the public, private and social sectors coordinating public health 

activities according to their respective statutory duties that prevent, alert, control and respond to 

transmissible diseases and other risks to public health, to ensure the right of citizens to the 

defense and protection of health.44

 

36 Id. art. 12(2)(e). 

37 INSTITUTO NACIONAL DE EMERGÊNCIA MÉDICA, http://www.inem.pt/. The INEM is regulated by Decree-Law 

No. 34/2012, http://www.sg.min-saude.pt/sg/conteudos/legisaude/legis+leoms.htm (scroll to “Instituto Nacional de 

Emergência Médica, IP,” and click on “Decreto-Lei No. 34/2012”). 

38 Decreto-Lei No. 124/2011, art. 5(c). 

39 Id. art. 5. For a discussion of the difference between direct and indirect administration, see note 32, supra. 

40 Id. art. 16(1). 

41 Id. art. 16(2)(f). 

42 Id. art. 16(2)(g). 

43 Lei No. 81/2009, de 21 de Agosto, http://www.parlamento.pt/Legislacao/Paginas/Leis_area_saude.aspx (scroll to 

Section 13. 7 and click on Lei No. 81/2009). 

44 Id. art. 1(1). 
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Law No. 81 applies to all entities of the public, private and social sectors that collect, analyze, 

interpret, and disseminate health data, or perform epidemiologic studies relating to transmissible 

diseases and other public health risks.45

All measures for preventing and containing the spread of transmissible diseases and other risks to 

public health by public bodies under Law No. 81, including conducting epidemiologic 

investigations pursued by health authorities and analysis of their risk factors, are subject to the 

personal data protection requirements discussed below.46

The purpose of the SVSP is to monitor the health status of populations across time, evaluate the 

risk of transmission of any disease, and prevent the entry or spread of disease on 

Portuguese territory.47

2. National Network 

The national network includes public health services, laboratories, and other health authorities 

and bodies in the public, private and social sectors that contribute to a National System of 

Information of Epidemiologic Surveillance (Sistema Nacional de Informação de Vigilância 

Epidemiológica, SINAVE).48

3. National Council of Public Health 

The National Council of Public Health (Conselho Nacional de Saúde Pública, CNSP) performs 

advisory functions in the area of prevention and control of transmissible diseases and other risks 

to public health and, in particular, analysis and evaluation of serious conditions, including largescale disease outbreaks and pandemics. It is responsible for proposing declarations of states of 

emergency caused by public calamities.49

III. Compulsory Patent Licensing 

According to the Portuguese Code of Industrial Property, compulsory licenses allowing the use 

of patented technologies may be granted for reasons of public interest.50 Such reasons include 

when increasing or improving the exploitation of the patented technology is of paramount 

importance for public health or national defense.51 

 

45 Id. art. 2(1). 

46 Id. art. 2(2). 

47 Id. art. 3(1). 

48 Id. art. 1(2). 

49 Id. art. 4(1). 

50 CÓDIGO DA PROPRIEDADE INDUSTRIAL, Decreto-Lei No. 36/2003, de 5 de Março, arts. 107(1)(c), 110(1), 

http://www.pgdlisboa.pt/leis/lei_print_articulado.php?tabela=leis&artigo_id=&nid=438&nversao=&tabela=leis. 

51 Id. art. 110(2). 
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IV. Right to Privacy 

A. Constitutional Principle

The Constitution provides that the law must establish effective guarantees against the acquisition 

and abusive use, or use that is contrary to human dignity, of information concerning individuals 

and families.52 Also, the protection of personal data used in connection with information 

technology is a fundamental right guaranteed by the Constitution.53 

B. Personal Data Protection 

Personal data in Portugal is protected by Law No. 67 of October 26, 199854 and supplemented by 

Law No. 41 of August 18, 2004.55

1. Law No. 67 of October 26, 1998 

Law No. 67 requires that the processing of personal data be done transparently and with strict 

respect for subjects’ private lives, as well as for fundamental rights, freedoms, and guarantees.56

Law No. 67 defines “personal data” (dados pessoais) as information of any type, irrespective of 

the type of media involved, relating to an identified or identifiable natural person.57 

The “processing of personal data” (tratamento de dados pessoais) is defined broadly as any 

operation or set of operations performed upon personal data.58

The processing of various specified types of personal data, including data concerning a person’s 

health or sex life or genetic data, is prohibited under article 7(1) of Law No. 67.59 

Article 7(2) of the Law determines that the processing of the data mentioned in article 7(1) is 

allowed if permission is provided by law or authorized, in specific situations, by the National 

Commission of Data Protection (Comissão Nacional de Protecção de Dados, CNPD).60 

 

52 C.R.P. art. 26(2). 

53 Id. art. 35. 

54 Lei da Protecção de Dados Pessoais [Personal Data Protection Law], Lei No. 67/98, de 26 de Outubro,

http://www.pgdlisboa.pt/pgdl/leis/lei_mostra_articulado.php?nid=156&tabela=leis&ficha=1&pagina=1. 

55 Lei No. 41/2004, de 18 de Agosto, http://www.pgdlisboa.pt/pgdl/leis/lei_mostra_articulado.php?nid= 

707&tabela=leis&ficha=1&pagina=1. 

56 Lei No. 67/98, art. 2. 

57 Id. art. 3(a). 

58 Id. art. 3(b). 

59 Id. art. 7(1). 

60 Id. art. 7(2). Article 22(1) of Law No. 67/98 provides that CNPD is the national authority charged with the power to 

supervise and monitor compliance with the laws and regulations in the area of personal data protection, with strict 

respect for the human rights and the fundamental freedoms and guarantees provided by the Constitution and the law. 
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The processing of data relating to a person’s health and sex life, including genetic data, is 

permitted if it is necessary for the purposes of preventive medicine, medical diagnosis, provision 

of care or treatment, or management of health-care services, provided that those data are 

processed by a health professional bound by professional secrecy, the CNPD is notified, and 

suitable safeguards are provided.61 

2. Law No. 41 of August 18, 2004 

Law No. 41 of August 18, 2004, applies to the processing of personal data in the context of 

networks and electronic communication services available to the public, specifying and 

supplementing the provisions of Law No. 67.62

3. Criminal and Administrative Sanctions 

Violations of the privacy provisions discussed above may result in fines and/or imprisonment. 

For example, some crimes are punishable by up to two years in prison and the payment of a fine, 

including non-compliance with obligations relating to data protection,63 unauthorized access to 

personal data,64 falsification or destruction of personal data,65 and breach of secrecy.66 

4. Data Protection Agency 

The National Commission of Data Protection (Comissão Nacional de Protecção de Dados – 

CNPD) is the agency is charge of controlling and overseeing the enforcement of laws and 

regulations on the protection of personal data.67 

C. Personal Health Information 

1. Law No. 12 of January 26, 2005 

The concepts of health information and genetic information, the flow of information and the 

intervention on the human genome in the health system, and the rules for the collection and 

preservation of biological products for the purpose of genetic testing or research are defined by 

Law No. 12 of January 26, 2005.68

 

61 Id. art. 7(4). 

62 Lei No. 41/2004, art. 1(2). 

63 Lei No. 67/98, art. 43. 

64 Id. art. 44. 

65 Id. art. 45. 

66 Id. art. 47. 

67 O que é a CNPD, COMISSÃO NACIONAL DE PROTECÇÃO DE DADOS, http://www.cnpd.pt/bin/cnpd/ acnpd.htm (last 

visited Oct. 22, 2014). 

68 Lei No. 12/2005, de 26 de Janeiro, art. 1, http://www.parlamento.pt/Legislacao/Paginas/Leis_area_saude.aspx

(scroll to Section II(6) and click on “Lei No. 12/2005”). 
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For the purposes of Law No. 12, health information includes all kinds of information directly or 

indirectly related to the health, present or future, of a person, whether alive or deceased, and the 

person’s clinical and family history.69 All such health information is owned by the person. The 

units of the health system are the custodians of this information, which cannot be used for 

purposes other than the provision of care, health research, or other purposes specifically allowed 

by law.70

2. Decree-Law No. 131 of August 29, 2014 

Law No. 12 is regulated by Decree-Law No. 131 of August 29, 2014, regarding the protection 

and confidentiality of genetic information, the basis of human genetic data for the purpose of 

providing healthcare and health research, the conditions of supply and offer of genetic testing 

and the conditions under which consultations on medical genetics are assured.71 The release of 

genetic information related to the health of a person to third parties is prohibited, except as 

provided in Law No. 67 of 26 October, 1998.72 Articles 31 to 34 of Decree-Law No. 131 

establish the offenses (contra-ordenações) that are punishable by a fine and the respective 

amount of such fines. 

3. Law No. 5 of January 23, 2012 

Law No. 5 of January 23, 2012 regulates the requirements for processing personal data for the 

establishment of nationwide files containing health data using information technology resources, 

including in the context of the SNS.73 Law No. 5 applies to all public healthcare facilities, to acts 

performed in private or social establishments that involve charges to the SNS, and to persons who 

deal with health data of others in the course of their activities.74

The personal data and the processing of personal data encompassed by Law No. 5 are subject to 

authorization of the CNPD, under the terms of Law No. 67 of 26 October, 1998.75 Everything 

else that is not expressly regulated by Law No. 5 is applicable the regime provided by Law No. 

67 of 26 October, 1998.76

 

 

69 Id. art. 2. 

70 Id. art. 3(1). 

71 Decreto-Lei No. 131/2014, de 29 de Agosto, art. 1, http://www.pgdlisboa.pt/leis/lei_mostra_articulado.php?nid= 

2214&tabela=leis&nversao. 

72 Id. art. 20. 

73 Lei No. 5/2012, de 23 de Janeiro, art. 1, https://dre.pt/application/dir/pdf1s/2012/01/01600/0036000361.pdf. 

74 Id. art. 3. 

75 Id. art. 11(1). 

76 Id. art. 12(2).
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4. Portuguese Medical Code of Ethics 

Under the Medical Code of Ethics, medical confidentiality must be observed in all circumstances 

as a result of the inalienable right of all patients to such confidentiality.77 The confidentiality 

includes all facts that have come to the attention of a physician in the exercise of his or her 

profession, and especially comprises: 

a) The facts disclosed by the person directly, by others at the person’s request or by a 

third party who has contacted with the person during care, or because of it; 

b) Circumstances perceived by the physician, whether or not originating from clinical 

observation of the patient or others; 

c) The facts resulting from knowledge of supplementary diagnostics and therapeutics 

related to the patient; 

d) The facts reported by another physician or health professional, bound by 

confidentiality.78

The obligation of medical confidentiality exists whether the requested service has been rendered 

or not and whether paid or unpaid.79 The obligation to such confidentiality remains after the 

patient's death.80 A physician is excused from medical confidentiality in certain situations, such 

as cases involving diseases that require mandatory notification.81 

V. Criminal Sanctions 

The Portuguese Penal Code punishes with two years in prison and a fine whoever spreads 

disease that is harmful to plants or animals.82 If the spread is caused by negligence, the person is 

punished by up to six months in prison and a fine.83 In addition, whoever spreads contagious 

diseases is punished with one to eight years in prison.84 If the spread is caused by negligence, 

the person is punished with three years in prison or a fine.85

 

 

77 ORDEM DOS MÉDICOS, CÓDIGO DEONTOLÓGICO art. 86(1), https://www.ordemdosmedicos.pt/?lop=conteudo& 

op=9c838d2e45b2ad1094d42f4ef36764f6&id=cc42acc8ce334185e0193753adb6cb77. 

78 Id. art. 86(2). 

79 Id. art. 86(3). 

80 Id. art. 86(4). 

81 Id. art. 88(d). 

82 CÓDIGO PENAL, Decreto-Lei No. 48/95, de 15 de Março, as amended by Law No. 69/2014, de 29 de Agosto, art. 

281(1)(a), http://www.pgdlisboa.pt/leis/lei_mostra_articulado.php?nid=109&tabela=leis. 

83 Id. art. 281(3). 

84 Id. art. 283(1)(a). 

85 Id. art. 283(3). 
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VI. International Health Regulations 

Portugal is a member of the World Health Organization (WHO)86 and follows the International 

Health Regulations (IHR) adopted by the WHO in 1969 and later amended in 1973 and 1981. 

In 1995, the 48th World Health Assembly called for a substantial revision of the Regulations 

adopted in 1969.87 After extensive work, on May 23, 2005, IHR (2005) was adopted by the 58th 

World Health Assembly and on June 15, 2007, it entered into force.88 The purpose and scope of 

the IHR (2005) are “to prevent, protect against, control and provide a public health response to 

the international spread of disease in ways that are commensurate with and restricted to public 

health risks, and which avoid unnecessary interference with international traffic and trade.”89 

IHR (2005) was incorporated into Portugal’s domestic legal system through Notice 12/2008 

issued by the Ministry of Foreign Affairs on January 3, 2008 and published on January 23, 2008.90 

VII. Current Crisis/Recent Developments 

The Portuguese Ministry of Health has been reporting measures that the government has been 

taking to fight and prevent the spread of the Ebola virus in the country. 

On October 10, 2014, the Ministry reported that the National Institute of Medical Emergencies, 

under the Contingency Plan of Action Against the Infection by Ebola Virus (Plano de 

Contingência de Atuação Face à Infeção por Vírus Ébola), is prepared to respond to any 

suspected cases occurring in the continental territory or in case of nationals who are being 

repatriated and possibly infected with the disease.91

A Response Platform to the Ebola Virus Disease (Plataforma da Resposta a Doença por Vírus 

Ebola), which establishes a hierarchical command that can be adapted according to the evolution 

of the epidemiologic situation, was approved on October 15, 2014, during a meeting of the 

National Council of Public Health. The Council also discussed, among other things, the draft of 

a proposal for a Communication Plan and the legality of measures that may, eventually, limit 

individual rights.92

 

86 WORLD HEALTH ORGANIZATION, http://www.who.int/countries/prt/en/. 

87 WHO, International Health Regulations (2d ed. 2005), http://www.who.int/ihr/publications/ 9789241596664/en/. 

88 Id. at 1. 

89 Id. 

90 DIREÇÃO-GERAL DE SAÚDE, http://www.dgs.pt/autoridade-de-saude-nacional/regulamento-sanitariointernacional.aspx (click on “Aviso no 12/2008, Diário da República, 1a série, no 16, de 23 de Janeiro de 2008”). 

91 INEM Tem Plano de Contingência para Lidar com Infecções por Vírus Ebola, PORTAL DA SAÚDE (Oct. 10, 2014), 

http://www.portaldasaude.pt/portal/conteudos/a+saude+em+portugal/noticias/inem+reforca+equipas.htm. 

92 Comunicado do Conselho Nacional de Saúde de 15/10/2014, DIREÇÃO-GERAL DA SAÚDE, http://www.dgs.pt/adireccao-geral-da-saude/comunicados-e-despachos-do-director-geral/comunicado-do-conselho-nacional-de-saudepublica.aspx (click on “Abrir Documento”) 
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On October 16, 2014, the General Board of Health issued Order No. 9/2014 (Despacho), which 

created the Response Platform to the Ebola Virus Disease at the national level.93 The objective 

of the Response Platform is the early detection of imported cases, and prevention or 

minimization of the occurrence of secondary cases and chains of transmission of the disease in 

the country. The Response Platform also defines, disseminates and operationalizes a 

Response/Contingency Plan, with guidelines and performance protocols.94

The Portuguese Council of Ministers approved on October 23, 2014 the creation of a 

commission to coordinate the responses to and political decisions on Ebola of all sectors of 

government. The commission, coordinated by the Ministry of Health, will comprise 

governmental representatives in charge of Foreign Affairs, National Defense, Internal 

Administration, Infrastructure and Transportation, and representatives from the regional councils 

of Azores and Madeira.95 

 

93 Direção-Geral da Saúde, Despacho No. 9/2014, de 15/10/2014, atualizado a 22/10/2014, http://www.dgs.pt/adireccao-geral-da-saude/comunicados-e-despachos-do-director-geral/plataforma-de-resposta-a-doenca-por-virusebola.aspx (click on “Abrir Documento”). 

94 Id. No. 1. 

95 Governo Cria Comissão Interministerial de Coordenação da Resposta ao Ebola, GOVERNO DE PORTUGAL,

MINISTÉRIO DA SAÚDE (Oct. 23, 2014), http://www.portugal.gov.pt/pt/os-ministerios/ministerio-da-saude/mantenhase-atualizado/20141023-ms-ebola.aspx#.VE0y0kQoybA.email. 
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Russian Federation 

Peter Roudik 

Director of Legal Research*

SUMMARY The health crisis management system in Russia is regulated by a number of laws and 

statutory documents issued by federal and regional authorities. The Federal Service for the 

Surveillance of Consumer Rights Protection and Human Well-Being (Rospotrebnadzor) is 

the leading government agency in the field and coordinates the activities of military and 

civilian government agencies and social organizations whose aim is to protect Russia’s 

population and territory from epidemic outbreaks. This report contains a comprehensive 

analysis of the legislation in force and its implementation.

I. Structure of Public Health Crisis Management System 

The Russian health care system is based on a strong governmental role in ensuring the country’s 

sanitary and epidemiologic well-being. The fight against epidemics and overcoming of 

emergencies are included in the joint jurisdiction of federal and provincial authorities.1 

Government policy in the area of protection from medical emergencies is formulated in a number 

of federal and provincial legislative acts, presidential decrees, government regulations, and 

government programs. There is no special legislation aimed at the regulation of issues related to 

public health emergencies and epidemics. The outbreak of epidemics is considered an 

emergency situation, and all rules prescribed by the Federal Constitutional Law on Emergency 

Situations apply.2

 Also, these issues are regulated by the following legislative acts: 

 Federal Law on the Protection of the Population and Territories from Emergency Situations 

of Natural and Technogenic Character3 

 Federal Law on Civil Defense4

 Federal Law on the Sanitary and Epidemiological Welfare of the Population5 

 Federal Law on the Immunoprophylaxis of Infectious Diseases6 

 

*

 This report was prepared with the assistance of Nerses Isajanyan, Foreign Law Consultant. 

1

 CONSTITUTION OF THE RUSSIAN FEDERATION art. 72, available at http://www.constitution.ru/en/10003000-01.htm. 

2

 Federal Constitutional Law No. 3 on Emergency Situations, SOBRANIE ZAKONODATELSTVA ROSSIISKOI 

FEDERATSII [SZ RF] [RUSSIAN FEDERATION OFFICIAL GAZETTE], 2001, No. 23, Item 2277, available at

http://base.garant.ru/12123122/ (in Russian). 

3

 Federal Law No. 68 of Dec. 21, 1994 on the Protection of the Population and Territories from Emergency 

Situations of Natural and Technogenic Character, SZ RF 1994, No. 35, Item 3648, http://base.garant.ru/10107960/

(in Russian). 

4

 Federal Law No. 28 of Feb. 12, 1998 on Civil Defense, SZ RF 1998, No. 7, Item 799, http://base.garant.ru/178160/

(in Russian). 

5

 Federal Law No. 52 of Mar. 30, 1999 on the Sanitary and Epidemiological Welfare of the Population, SZ RF 1999, 

No. 14, Item 1650, http://base.garant.ru/12115118/ (in Russian). 
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 Government Regulation on the Unified State System for the Prevention and Elimination of 

Emergency Situations7

These pieces of legislation determine the powers of Russian authorities in the event of health 

care emergencies. 

The President of the Russian Federation defines public policy and makes the most important 

decisions related to protecting the population and territory from emergencies. He leads Russia’s 

Security Council and makes decisions regarding the involvement of troops and other militarized 

units in eliminating the consequences of emergencies. According to the Law on Emergency 

Situations, the President has the power to declare a state of emergency for thirty days for the 

entire nation or for sixty days for a particular region when a threat to the health of population 

exists. Approval of the upper house of the legislature is needed to declare or extend a state 

of emergency.8 

Russia’s Federal Assembly (the legislature) provides for unified legislation and approves budget 

allocations to finance activities necessary to manage a health crisis. Parliamentary hearings on 

related issues can be conducted.9

 

Implementing laws and federal programs aimed at protecting the population from epidemics is 

the duty of the Russian Federation government. Collecting related information, preparing for 

emergencies, and managing activities to eliminate crises, on the other hand, are included in the 

sphere of responsibility of regional executive authorities, who must also make decisions 

regarding the evacuation or isolation of the population. Each region has its own set of laws on 

related issues.10 

The Federal Service for the Surveillance of Consumer Rights Protection and Human Well-Being 

(Rospotrebnadzor) is the leading government institution in the area of epidemiological security. 

It reports directly to the government of the Russian Federation and coordinates the efforts of 

various departments and agencies (the Ministry of Defense, Ministry of Internal Affairs, Federal 

Security Service, etc.) to prevent and eliminate the consequences of mass epidemics.11 The 

Federal Civil Defense Medical Service and the Medical Service Used for Catastrophes were 

established under the Ministry of Health Protection. They are used depending on the situation—

for example, a war, the consequences of an emergency, or the outbreak of an infectious disease. 

 6

 Federal Law No. 157 of Sept. 17, 1998 on the Immunoprophylaxis of Infectious Diseases, SZ RF 1998, No. 38, 

Item 4236, http://base.garant.ru/12113020/ (in Russian). 

7

 Government Regulation No. 794 on the Unified State System for the Prevention and Elimination of Emergency 

Situations of Dec. 30, 2003 (amended Nov. 19, 2012), ROSSIISKAIA GAZETA [RG], No. 271, Nov. 23, 2012, 

http://base.garant. ru/186620/ (in Russian). 

8

 Law on Emergency Situations arts. 4, 7, 9. 

9

 Constitution of the Russian Federation art. 105. 

10 Law on Emergency Situations arts. 24, 25. 

11 Statute on Rospotrebnadzor, approved by Government Regulation No. 322 of June 30, 2004, available on the 

Rospotrebnadzor website, at http://64.rospo§trebnadzor.ru/309 (in Russian). 
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These services provide medical and sanitation services to the population during epidemics and 

work to prevent adverse consequences.12 

The Rospotrebnadzor includes administrative offices in the constituent provinces, centers of 

hygiene and epidemiology, research institutes, and antiplague facilities, and cooperates with 

sanitary and epidemiological services within the following government agencies: the Ministry of 

Defense, Ministry of Internal Affairs, Federal Security Service, Federal Protection Service, 

Directorate of Special Programs Under the President, Federal Penitentiary Service, and Federal 

Biomedical Agency.13

II. Implementation of the Emergency/Crisis Response System 

The management of antiepidemic measures is one of the duties of Rospotrebnadzor. These 

measures may include 

 organizing and conducting sanitary and epidemiological monitoring; 

 preventing infectious diseases from entering an emergency zone; 

 locating, mandatorily isolating, and evacuating patients with infectious diseases; 

 locating and monitoring persons with chronic forms of infectious diseases; 

 maintaining an antiepidemic regime during medical evacuations; 

 disinfection measures; 

 preventive and urgent immunization; and 

 sanitary education and psychological assistance to the population and responders.14

Rospotrebnadzor is in charge of conducting planning and training exercises, which are 

considered the major actions aimed at preventing emergencies and eliminating their 

consequences. The main purpose of these planning and training exercises is to ensure the 

sufficiency and full use of existing resources. The elimination of an emergency’s consequences 

must be conducted by the authorities of Russia’s constituent components and the territorial 

branches of the federal agencies where the emergency has occurred. If necessary, federal 

resources can be used.15 

To ensure that all resources are gathered in one place in order to provide the most efficient 

response, the federal Ministry of Health Protection has designated one hospital in each of 

Russia’s constituent components to respond in case of an infectious disease outbreak. These 

 

12 Statute on Medical Service Used for Catastrophes, approved by Government Regulation No. 734 of Aug. 26, 

2013, available on the Ministry of Health Protection website, at http://static-1.rosminzdrav.ru/system/attachments/ 

attaches/000/012/778/original/Ob_utverzhdenii_Polozheniya.pdf?1389715517 (in Russian).

13 Statute on Rospotrebnadzor § 8. 

14 Id. § 5. 

15 Id. § 4. 
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hospitals focus on treating patients who have been diagnosed with diseases as a consequence of a 

health crisis. Support is provided to these hospitals by the National Institute of Emergency 

Medical Services, which conducts research in the field of emergency medical services and 

supplementary professional education of medical staff. Services of other state and private 

medical establishments can be enlisted for the duration of an emergency situation.16 

A quarantine regime can be introduced where danger of an epidemic outbreak appears. The 

quarantine of a particular territory incurs travel restrictions, mandatory vaccinations, and the 

cancellation of all mass events. Special procedures are prescribed for the distribution or sale of 

food and basic commodities, and local authorities can restrict the sale of alcoholic beverages. 

During the quarantine period, police have extended authority to take quarantine violators 

into custody.17 

Implementation mechanisms are prescribed by federal target-program documents, which define 

means for conducting practical health care activities. Several federal target programs for 

preventing health care emergencies have been approved, financed, and implemented, including 

 emergency measures to ensure the public’s sanitary and epidemiologic well-being; 

 prevention of the most prevalent diseases; 

 disaster medicine; 

 protecting the territory from the influence of especially dangerous human, animal, and plant 

diseases and toxic chemicals; and 

 a vaccination program.18 

Within the vaccination program framework, a one-hundred-million-dose stockpile of vaccines 

for all major known infectious diseases has been established, and federal control over the 

vaccines’ quality introduced.19 The federal registration of the producers of products potentially 

dangerous to humans, the registration of specific kinds of products being imported into Russia 

for the first time, and the registration of all potentially dangerous chemical and biological 

substances has been in force since June 2001.20 The legal basis for the vaccination against major 

communicable diseases is determined by the Law on the Immunoprophylaxis of Infectious 

 

16 Order No. 220 of Sept. 17, 1993 of the Russian Federation Health Protection Ministry on the Development and 

Improvement of the Infectious Disease Service in the Russian Federation, available at http://www.consultant.ru/ 

document/cons_doc_law_100796/?frame=3 (in Russian). 

17 Government Regulation No. 529 of Aug. 19, 2005 on Organization and Control for Introducing and Cancelling 

Quarantine Measures, http://base.garant.ru/12141665/ (in Russian). 

18 Information about ongoing Federal Target Programs is available on the Russian Government web portal at 

http://www.programs-gov.ru/ (in Russian; last visited Nov. 20, 2014). 

19 V. K. Tatochenko, Questions and Answers About Federal and Regional Vaccination Programs, REGIONAL 

PROGRAMS (No. 5: Sept./Oct. 2005), available at http://medi.ru/doc/15b41.htm (in Russian). 

20 Information on the Federal Registry of Potentially Dangerous Chemical and Biological Substances is available on 

the Rospotrebnadzor website, at http://www.rpohv.ru/ (in Russian; last visited Nov. 20, 2014). 
Legal Responses to Health Emergencies: Russian Federation 

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Diseases.21 The Law recognizes vaccination as a national security instrument. It provides for 

federal budget funding of all preventive vaccination and states that those who become 

incapacitated because of postvaccination complications are subject to social security protection. 

The National Calendar of Preventive Vaccination and deadlines for vaccinating different 

categories of the population against particular diseases were developed following the adoption of 

this Law. Enforcement measures can be applied to those who refuse vaccination. These may 

include a prohibition on traveling abroad, an employment hiring ban, and university admission 

restrictions. In order to increase incentives, all firms specializing in the research on and 

production of medical and veterinary vaccines for the purpose of fighting epidemics are exempt 

from federal property taxes.22 

All activities related to fighting epidemics are financed by the federal budget from a special 

reserve fund. In 2000, Russia’s Supreme Court confirmed that all services provided by the 

National Sanitary Service (predecessor of Rospotrebnadzor) to the population are to be free of 

charge.23 Budget appropriations for fighting epidemics can be spent on special measures aimed 

at eliminating outbreaks of epidemic illnesses. One quarter of these funds can be appropriated 

for unscheduled antiepidemic measures in the event of a threat of an epidemic or increase in 

morbidity. These funds can be spent by local governments for 

 the creation of temporary infectious hospitals, according to a regional executive government 

resolution if the existing regular hospital network cannot satisfy needs; 

 the organization and activities of temporary antiepidemic teams and creation of 

isolation points; 

 the payment of salaries to detailed medical personnel; 

 related transportation and communication expenditures; and 

 the organization and activities of temporary antiepidemic laboratories. 

In 2006, the Government Reserve Fund was used to finance measures aimed at preventing the 

expansion of the SARS epidemic in Russia. According to a government resolution, an amount 

equal to US$3 million was allocated for this purpose. This money was divided between the 

Ministry of Health Protection and the Ministry of Defense.24 

After the Chernobyl catastrophe when information about radioactive contamination was 

concealed by Soviet leaders, the management of health- and safety-related information became a 

sensitive issue regulated by legislative acts. Information on protecting the population from 

health emergencies consists of data on previously occurring or forecasted emergencies and their 

 

21 Federal Law No. 157 of Sept. 17, 1998 on the Immunoprophylaxis of Infectious Diseases art. 4, SZ RF 1998, No. 

38, Item 4236, http://base.garant.ru/12113020/. 

22 Id. arts. 5.2, 6. 

23 Ruling of the Russian Federation Supreme Court No. GKPI2000-1453 of Feb. 5, 2001, available at

http://www.consultant.ru/document/cons_doc_LAW_31907/. 

24 Rospotrebnadzor Letter No. 0100/1828 of Feb. 20, 2006 on the Accounting of Expenses Related to Fighting 

Epidemics, available at http://www.businesspravo.ru/Docum/DocumShow_DocumID_113411.html (in Russian). 
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consequences, and data on the radiation, chemical, medical, biological, explosive, fire, and 

environmental security of related territories. Information about government activities in this area 

must be open to public access and cannot be classified.25 

The concealment or distortion of information about developments, facts, or events endangering 

human life or health, or the environment, by a person whose duty is to provide such information 

to the population is a crime punishable by a fine or deprivation of freedom for a term of up to 

two years, with or without disqualification to hold specified offices or engage in specified 

activities for a term of up to three years. Stricter punishments are prescribed for the same acts 

committed by a person holding a post at any level of government.26 

III. Responsibilities for Failure to Comply with Sanitary Requirements 

Russian criminal legislation considers the violation of sanitary rules and creation of health 

emergencies as attempts on human life regardless of the consequences and punishes the criminal 

according to the act committed, whether it was a murder or intentionally inflicting harm 

on health.27 

The violation of sanitary and epidemiological rules that results in the spread of a disease or 

poisoning of people is a crime under Russian criminal law. This also applies to individuals who 

violate quarantine requirements. Such actions are punishable by a fine, disqualification to hold 

specified offices or engage in specific activities for a term of up to three years, corrective labor 

for a term of up to one year, or imprisonment for one year. If the death of a person was the 

consequence, the term of imprisonment extends up to five years.28

Also, individuals whose negligence in dealing with dangerous biological agents has inflicted 

harm on human health are held criminally responsible. Individuals who violate safety 

regulations for handling microbiological or other biological agents or toxins and thereby cause 

harm to human health or the spread of an epidemic or disease or other grave consequences are 

punishable by a fine, compulsory labor for a term of up to two years, or imprisonment for a term 

of up to two years.29 

Russian law provides for the possibility of imposing some restrictive measures on foreigners 

suspected of being infected with a communicable disease. Article 7 of the Law of June 21, 2002 

on the Legal Status of Foreign Citizens in the Russian Federation allows authorities to reject a 

petition or annul previously issued permission for a foreigner to take up temporary residence in 

Russia if he/she is a drug addict, does not have a document certifying that he/she does not have a 

 

25 Federal Law on Information, Information Technologies, and the Protection of Information No. 149 of July 27, 

2006, SZ RF 2006, No. 31(1), Item 3448, http://base.garant.ru/12148555/ (in Russian). 

26 CRIMINAL CODE OF THE RUSSIAN FEDERATION art. 237, SZ RF 1996, No. 25, Item 2954 (in Russian). 

27 A.B. BORISOV, COMMENTARIES ON THE CRIMINAL CODE OF THE RUSSIAN FEDERATION 729 (Moscow, 2012) 

(in Russian). 

28 CRIMINAL CODE OF THE RUSSIAN FEDERATION art. 236. 

29 Id. art. 248. 
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disease induced by the AIDS virus, or is suffering from an infectious disease considered 

dangerous to other people. The list of these diseases and the procedure for medical evaluation of 

a person suspected of being infected has been established by the federal government.30

IV. Cooperation with the World Health Organization 

Russia is a member of the World Health Organization (WHO) and has accepted the obligation to 

bring its health crisis management procedures in line with WHO requirements. In 2009, the 

Framework Cooperation Agreement was signed between the WHO and the Ministry of Health 

Protection,31 and ongoing developments in the Russian health care sector are tied to WHO 

strategic goals.32

The Ministry of Health Protection has set a goal of bringing Federal Target Programs in line with 

WHO requirements33 and, in 2014, the Ministry of Health Protection reported that systemic 

changes recommended by the WHO had been implemented.34 Existing Russian rules and 

procedures for sanitation and epidemiological control do not contradict the requirements of the 

International Health and Sanitary Regulations of 2005, which were adopted by Russia without 

reservations, and are followed in case of emergencies.35 

V. Response to the Outbreak of Infectious Diseases 

Recently, Russian authorities have undertaken preventive epidemiologic measures in response to 

two global health crises, the SARS epidemic in 2006 and the swine flu epidemic in 2009. When 

the WHO issued an emergency alert in April 2009 because of the spread of the swine flu, the 

Russian government formed an executive commission on preventing the introduction and spread 

in Russian territory of diseases caused by flu viruses. The Commission consisted of heads of all 

relevant government executive agencies. The government decree defined its duty as the 

coordination and supervision of the activities of federal and regional authorities in this regard.36 

 

 

30 Federal Law No. 115 of July 25, 2002 on the Legal Status of Foreign Citizens in the Russian Federation, SZ RF 

2002, No. 26, Item 2513, http://base.garant.ru/184755/ (in Russian). 

31 Russia and WHO Sign Framework Cooperation Agreement, MEDLINKS.RU (Jan. 21, 2009), available at

http://www.medlinks.ru/article.php?sid=34871 (in Russian). 

32 Natalia Valkina, Cooperation Strategy Between Russia and WHO Is Signed, ARGUMENTY I FAKTY (July 24, 

2014), http://www.aif.ru/health/life/1214975 (in Russian). 

33 Id. 

34 Press Release, Russian Federation Ministry of Health Protection, Minister Skvotsova Participates in World 

Healthcare Assembly (May 19, 2014), http://www.rosminzdrav.ru/news/2014/05/19/1839-ministr-veronikaskvortsova-prinyala-uchastie-vo-vsemirnoy-assamblee-zdravoohraneniya (in Russian). 

35 Rospotrebnadzor Order No. 39 of Nov. 29, 2007, available at http://www.mossanexpert.ru/view_info.php?id=38

(in Russian). 

36 Government Regulation No. 367 of April 27, 2009, on the Government Commission on Preventing the Spread of 

Highly Pathogenic Flu in Russia, RG, May 5, 2009, http://www.rg.ru/2009/05/05/virus-dok.html (in Russian). 
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The Commission ordered 

 the surveillance of passengers coming from Mexico and other countries where cases of swine 

flu had been reported; 

 the mandatory checking of the body temperature of all arriving travelers and the creation of 

quarantine points at the ports of entry; 

 the monitoring of disease reporting by regional institutions; 

 the allocation of increased funds for select major national research institutes; and 

 the stockpiling of antiviral medicines. 

In addition, the import of pork from the countries affected by the epidemic was stopped for 

several days.37

In 2006, in order to prevent the spread of the SARS virus, the government ordered the Federal 

Border Service to close certain checkpoints on the Russian border with Mongolia and China. 

Airlines were ordered to reduce the number of flights to infection-affected regions, and eleven 

medical groups consisting of physicians and sanitary control specialists were formed. Placed on 

trains traveling between Russia and China, these groups conducted medical examinations of 

more than one thousand suspicious passengers and railroad personnel. A network of federal 

medical centers was set up in major Russian regional centers with the task of diagnosing the 

disease and identifying the presence of the virus. Airport terminals in Moscow were equipped 

with infrared detectors able to determine any traveler’s temperature at a distance of fifty yards. 

In order to protect the capital city, public transport and open markets were disinfected daily, and 

one million respiratory masks were acquired for public use.38

VI. Response to the Ebola Virus Outbreak 

Russia’s Foreign Ministry announced it had allocated the equivalent of US$3.8 million to help 

the country prepare for a possible outbreak of Ebola and the equivalent of US$3.95 million for 

research work.39 Russia also set aside the equivalent of US$5.2 million in humanitarian aid for 

the West African countries hit hardest by the outbreak.40 

 

37 Id. 

38 Dmitri Vladimirov, Cabinet of Ministers Decide to Be Proactive in Fighting Bird Flu, RG (Apr. 11, 2007), 

http://www.rg.ru/2007/04/11/medvedev.html (in Russian). 

39 More Than 3 Million Travelers Checked for Ebola at Russian Airports, MOSCOW TIMES (Oct. 24, 2014), 

http://www.themoscowtimes.com/news/article/more-than-3-million-travelers-checked-for-ebola-at-russianairports/510021.html. 

40 Russia Allocated 779 Million Rubles to Fight Ebola, LENTA.RU (Oct. 16, 2014), http://lenta.ru/news/2014/10/16/ 

dorogoivirus/ (in Russian). 
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Following the outbreak of Ebola in West Africa, a team of epidemiologists, virologists, and 

bacteriologists was sent by Rospotrebnadzor to Guinea to participate in fighting Ebola.41 The 

team delivered a mobile laboratory and took part in diagnosing and treating the Ebola virus.42 

Russia is considering sending additional medics to Africa in order to stop the epidemic spread.43 

The possibility of deploying planes with special medical equipment, including life-support 

capsules for transporting Ebola-infected patients, is being explored.44 Protective equipment, 

such as sealed medical suits, masks, eye shields, and disinfecting materials, was supplied to 

Guinea.45 Also, production of a trial batch of the Ebola vaccine Triazavirin has been launched. 

This vaccine will be sent to Africa for efficacy tests.46

The Russian Ministry of Education and Science recommended that universities postpone the 

academic year for students from Africa because of the Ebola virus.47 It is estimated that Russia 

has about two thousand students from the Ebola-affected countries.48 About five hundred 

students from West Africa were tested for the virus and placed under observation.49 They were 

not isolated, but doctors checked their temperature and other vital signs.50 No Ebola case 

was confirmed.51

The initiative to check all African residents in Russia for Ebola was discussed by the legislature; 

however, the Ministry of Health Protection deemed this measure excessive because Africans 

who already live in Russia do not need to be checked for Ebola, as control border controls are 

sufficient to keep the disease out of the country.52 

 

41 Russia’s Putin Vows Closer Cooperation with WHO in Ebola Fight, SPUTNIK (Oct. 13, 2014), http://en.ria.ru/ 

russia/20141013/194031322/Russias-Putin-Vows-Closer-Cooperation-with-WHO-in-Ebola-Fight.html. 

42 Russia Offers to Send More Experts to Tackle Ebola in West Africa, MOSCOW TIMES (Oct. 8, 2014), 

http://www.themoscowtimes.com/news/article/russia-offers-to-send-more-experts-to-tackle-ebola-in-westafrica/508598.html. 

43 SPUTNIK, supra note 41. 

44 Id. 

45 Irina Nevinnaia, Russian Federation and Guinea Will Sign a Memorandum on Ebola Fight, RG (Oct. 24, 2014), 

http://www.rg.ru/2014/10/24/golodec-site.html (in Russian). 

46 Russia Ready to Introduce New Ebola Vaccines in Six Months: Russian Health Minister, SPUTNIK (Oct. 11, 2014), 

http://en.ria.ru/russia/20141011/193961655/Russia-Ready-to-Introduce-New-Ebola-Vaccines-in-6-MonthsRussian.html. 

47 Gleb Fedorov, Chances of Ebola Epidemic Reaching Russia Are Slim, Say Researchers, RUSSIA BEYOND THE 

HEADLINES (Oct. 13, 2014), http://rbth.co.uk/science_and_tech/2014/10/13/chances_of_ebola_epidemic_reaching_ 

russia_are_slim_say_resea_40553.html. 

48 Id. 

49 MOSCOW TIMES, supra note 42. 

50 Id. 

51 African Students Hospitalized in Russia Do Not Have Ebola: Russia’s Health Watchdog, SPUTNIK (Oct. 23, 2014), 

http://en.ria.ru/russia/20141018/194264877/African-Students-Hospitalized-in-Russia-Do-Not-Have-Ebola.html. 

52 Ebola Checks for African Residents in Russia Unnecessary: Health Ministry, SPUTNIK (Oct. 23, 2014), 

http://en.ria.ru/russia/20141023/194495826/Ebola-Checks-for-African-Residents-in-Russia-UnnecessaryHealth.html. 
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From August to October 2014, more than three million passengers arriving at the country’s 

airport from various countries were checked by the Rospotrebnadzor specialists.53 Of those 

checked, twenty-two people were hospitalized and examined for signs of Ebola, but all were 

found to be free of the disease.54 The agency also introduced a system of registration and 

mandatory twenty-one-day monitoring of people arriving from Ebola-affected African 

countries.55 According to the Ministry of Health Protection, Russia has an active antibacterial 

system that annually discovers and isolates about two hundred cases of exotic viruses.56 

Reportedly, Russian airports will be provided with additional equipment to increase the 

effectiveness of examinations.57

 

53 MOSCOW TIMES, supra note 39. 

54 Id. 

55 On the Ebola Situation (as of 24.10.2014), ROSPOTREBNADZOR (Oct. 24, 2014), http://rospotrebnadzor.ru/about/ 

info/news/news_details.php?ELEMENT_ID=2537&sphrase_id=191869 (in Russian). 

56 Fedorov, supra note 47. 

57 Additional Equipment Will Be Installed in Russian Airports in Connection with the Ebola Virus, TASS (Oct. 17, 

2014), http://itar-tass.com/obschestvo/1515553 (in Russian). 
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Senegal 

Nicolas Boring 

Foreign Law Specialist*

SUMMARY Senegal has contained many disease outbreaks and has been particularly credited for 

keeping its HIV/AIDS epidemics and, recently, the Ebola pandemic at bay. Keys to this 

success include the involvement of government authorities from the national level to the 

local level, through a decentralized public health structure; measures aimed at early 

detection; an extensive use of the media and public information campaigns; and 

collaboration with the WHO and health-related NGOs for surveillance, immunization, 

and crisis management. 

I. Introduction 

Senegal, a West African nation, became independent from France in 1960 and inherited a legal 

and institutional system that was almost identical to the system prevailing in France. Senegal is 

a republic with a democratic government. It is regarded as one of the most politically stable 

countries in Africa.1 A new Constitution was adopted on January 22, 2001, which guarantees the 

right to health.2

II. Structure of Public Health Crisis Management System 

A. The Ministry of Health 

Two directorates of the Ministry of Health are primarily involved in the fight against 

communicable diseases. The Directorate of Health has the task of formulating, implementing, 

and monitoring health policy and programs. To this end, it is responsible, among others, for the 

control of communicable and noncommunicable diseases. The Directorate of Prevention 

formulates, implements, and monitors prevention policy. It is responsible for immunization, 

monitoring and managing of epidemics, and communicating with the public.3

 In addition, the 

 

*

 This is a revised and updated version of a 2003 report authored by Senior Foreign Law Specialist Nicole 

Atwill (retired). 

1 Senegal, CIA WORLD FACTBOOK, https://www.cia.gov/library/publications/the-world-factbook/geos/sg.html

(accessed on Oct. 30, 2014). 

2

 CONSTITUTION DE LA RÉPUBLIQUE DU SÉNÉGAL DU 22 JANVIER 2001 (CONSTITUTION) art. 8, JOURNAL OFFICIEL DE 

LA RÉPUBLIQUE DU SÉNÉGAL [J.O.], Jan. 22, 2001, http://www.gouv.sn/-Constitution-du-Senegal-.html. 

3

 Décret No. 2003-466 du 24 juin 2003 portant organisation du Ministère de la Santé, de l’Hygiène et de la 

Prévention [Decree No. 2003-466 of June 24, 2003 Organizing the Ministry of Health, Hygiene, and Prevention] 

arts. 1–7 (June 24, 2003), http://www.jo.gouv.sn/spip.php?article284. 
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Ministry of Health maintains partnerships with several international or foreign organizations 

including the World Health Organization (WHO), USAID, and the World Bank.4

B. Medical Regions 

Senegal has eleven medical regions,5

 each divided into sanitary districts, which are operational 

zones comprising at least one health center around which several health posts have been 

established. The districts’ boundaries do not necessarily coincide with the boundaries of other 

territorial entities such as municipalities or départements.

6

 Each district is supposed to cover a 

population of between 100,000 and 150,000.7

 Each medical region is headed by a doctor and has 

several bureaus, one of which is specifically in charge of immunization for and the management 

of epidemics.8

C. National Service of Sanitary Information 

The National Service of Sanitary Information, attached to the Health Minister’s cabinet, collects 

and analyzes sanitary information. It centralizes and updates all information concerning the 

sanitary system of Senegal and compiles health statistics. These data are available to other 

services, researchers, and the Ministry of Health’s partners.9

D. Notification Requirements 

The Public Health Code requires that doctors report to the public health authorities any case that 

they may come across of a disease listed in a regulation established by the Ministry of Health.10

Additionally, the head of family, spouse, nearest relative, or any other person residing with or 

taking care of a sick person is required to report the illness to the public health authorities if they 

are aware that the patient is suffering from one of the listed diseases.11 Failure to notify 

 

4 Partenaires [Partners], MINISTÈRE DE LA SANTÉ ET DE L’ACTION SOCIALE [MINISTRY OF HEALTH AND SOCIAL 

ACTION] (Aug. 21, 2013), http://www.sante.gouv.sn/index.php?option=com_content&view=article&id=1298& 

Itemid=764. 

5 Les Régions Médicales [The Medical Regions], MINISTÈRE DE LA SANTÉ ET DE L’ACTION SOCIALE, 

http://www.sante.gouv.sn/index.php?option=com_content&view=article&id=1294&Itemid=636 (last visited 

Oct. 31, 2014). 

6

 FÉLIX ATCHADÉ, RADIOSCOPIE D’UN SYSTÈME DE SANTÉ AFRICAIN: LE SÉNÉGAL [RADIOSCOPY OF AN AFRICAN 

HEALTHCARE SYSTEM: SENEGAL] 67, 74 (2013). 

7

 COL. MASSAMBA DIOP, LA SANTÉ AU SÉNÉGAL DE 1960 À 2010 [HEALTH IN SENEGAL FROM 1960 TO 2010]

at 22 (2011). 

8

 Décret No. 2003-466 du 24 juin 2003, arts. 22, 23 & 24. 

9 Id. art. 29. 

10 CODE DE L’HYGIENE, Loi No. 83-71 du 5 juillet 1983 portant Code de l’Hygiène [Law No. 83-71 of July 5, 1983, 

Establishing the Hygiene Code] art. L3 (July 5, 1983), J.O., Aug. 6, 1983, http://www.servicepublic.gouv.sn/ 

assets/textes/code-Hygiene.pdf. 

11 Id. 
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authorities of the disease is punishable by a fine from 9,000 to 18,000 Francs CFA 

(approximately US$17 to US$35), imprisonment from five to eight days, or both.12

III. Powers of Public Health Authorities 

A. Mandatory Immunization of Health Care Personnel 

All personnel working in public or private health establishments in a capacity where they risk 

being exposed to certain specified diseases are required to get vaccinated. The Ministry of 

Health sets forth the list of these establishments and the conditions under which this 

immunization takes place. The diseases in question are tuberculosis, diphtheria, tetanus, typhoid 

and paratyphoid fevers, and poliomyelitis.13

B. Disinfection Measures 

Disinfection measures are mandatory for any of the diseases that must be reported. The Ministry 

of Health decides which measures should be implemented. The National Hygiene Service 

carries out the disinfection process.14 It is unlawful to oppose such measures. The penalties for 

failing to take such measures are identical to the penalties set forth for failing to notify 

authorities of a listed disease.15 

C. Sanitary Controls at the Borders 

Sanitary controls at the borders are governed by the World Health Organization’s (WHO) 

International Health Regulations, and any bilateral or multilateral agreement and national 

regulations in this field, aimed at preventing the spread of communicable diseases by air, sea, or 

land.16 Violations of these provisions are recorded either by public health doctors, doctors or 

officers from the National Hygiene Service, or by other agents specifically commissioned for 

such a task.17 

If a civil servant, public agent, or commanding officer of a ship or airplane falsifies or 

voluntarily conceals information that may compromise the health of the population, he may be 

punished by a fine of 20,000 to 260,000 Francs CFA (approximately US$39 to US$500), 

imprisonment from two months to two years, or both.18

Senegal, for example, stepped up its vigilance against Severe Acute Respiratory Syndrome 

(SARS) and took special measures to protect itself when the WHO issued its alerts. Surveillance 

 

12 Id. art. L75. 

13 Id. art. L1. 

14 Id. art. L4. 

15 Id. art. L75. 

16 Id. art. L5. 

17 Id. art. L6. 

18 Id. arts. L7 & L77. 
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was reinforced at the Dakar International Airport and at other points of entry. Airport personnel 

were trained and given the necessary knowledge to be able to identify suspected SARS cases.19

IV. Transparency of Public Health Crisis Management System 

The Constitution of Senegal recognizes a right to a plurality of information.20 The government 

of Senegal has extensively used the media to fight public health crises. In 2003, it launched a 

radio campaign to heighten public awareness of SARS.21 Currently, the Senegalese Ministry of 

Health provides information on the Ebola virus on its website and through a toll-free number.22

V. Cooperation with the WHO 

Senegal is a member of the WHO. As noted above, it abides by the WHO International Health 

Regulations dealing with notification of certain communicable diseases and measures to be taken 

at entry points to avoid the spread of such diseases. Senegal worked with the WHO on 

precautionary measures to protect its people from SARS. Through the years, the WHO has 

provided epidemiological, clinical, and logistical support to Senegal. The WHO and the 

Ministry of Health have worked together in the areas of surveillance, immunization, and 

coordination with respect to yellow fever.23

VI. Recent Crises 

A. HIV/AIDS 

Senegal also stands as one of the few countries in the region to have succeeded thus far in 

containing the spread of HIV/AIDS, thanks to a strong surveillance system; an aggressive focus 

on treatment and support of high-risk groups; extensive information to the general public; and a 

high level of involvement of local authorities, teachers, soldiers, religious leaders, 

nongovernmental organizations, and the media to achieve a greater mobilization of the 

community. Its long democratic experience and the relative freedom of its national press have 

also resulting in freely debating the problem and publishing information concerning the 

disease.24 Senegal has also scaled up access to anti-retroviral treatment and encouraged 

 

19 Africa Steps Up Vigilance After Continent’s First Probable SARS Case Dies, AGENCE FRANCE PRESSE (Apr. 30, 

2003), available at Lexis, News Group File. 

20 CONSTITUTION art. 8, http://www.gouv.sn/-Constitution-du-Senegal-.html. The concept of a “right to a plurality 

of information” is similar to the principle in the European Union Charter that the “freedom and pluralism of the 

media shall be respected.” Charter of Fundamental Rights of the European Union art. 11(2), 2000 O.J. (C 364) 1, 

http://www.europarl.europa.eu/charter/pdf/text_en.pdf. 

21 AGENCE FRANCE PRESSE, supra note 19. 

22 MINISTÈRE DE LA SANTÉ ET DE L’ACTION SOCIALE, http://www.sante.gouv.sn/ (last visited Oct. 31, 2014). 

23 Country Cooperation Strategy at a Glance, WHO (May 2014), http://www.who.int/countryfocus/cooperation_ 

strategy/ccsbrief_sen_en.pdf; Senegal to Launch Pan West-African Campaign to Prevent Yellow Fever, WHO (Dec. 

5, 2007), http://www.afro.who.int/fr/ghana/press-materials/item/74-senegal-to-launch-pan-west-african-campaignto-prevent-yellow-fever.html. 

24 Mamadou Mika Lom, Le Sénégal, un modèle de réussite, 15(1–2) AFRIQUE RELANCE 24 (June 2001). 
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voluntary counseling and testing. As a result, the country has Africa’s lowest HIV prevalence 

rate, at 0.7%.25

B. Yellow Fever 

Due to its climate, Senegal is prone to periodic yellow fever epidemics. One such epidemic 

caused twelve deaths in 2002.26 In response, the Senegalese authorities organized mass 

vaccination campaigns, gradually covering the entirety of the country over the next several years. 

Since 2007, inoculation against yellow fever is routinely given throughout Senegal.27

C. Ebola Virus 

Senegal has largely been spared by the current Ebola pandemic, despite sharing a border with 

Guinea, one of the hardest-hit countries.28 Senegal’s response to the Ebola threat has focused on 

four types of measures: quick testing of individuals suspected of being infected, identifying and 

monitoring anyone who has been in contact with infected patients, increased monitoring at the 

country’s entry points, and national public awareness campaigns.29 After Senegalese authorities 

identified a young man who had arrived from Guinea as being infected, they tracked down 

seventy-four people with whom he had had contact and screened them for the virus.30 

Additionally, Senegal closed its border with Guinea, and has prohibited aircraft and ships from 

Guinea, Sierra Leone, and Liberia from landing in the country.31

From early on, the Senegalese government has been working closely with the WHO and NGOs 

such as Doctors Without Borders, both of which have provided Senegal with teams of doctors 

and epidemiologists to help deal stave off the pandemic.32

 

25 Senegal: A Success Story of AIDS Investments and Impact, UNAIDS (Oct. 11, 2012), http://www.unaids.org/ 

en/resources/presscentre/featurestories/2012/october/20121011senegal/. 

26 ATCHADÉ, supra note 6, at 206. 

27 Id.; Senegal to Launch Pan West-African Campaign to Prevent Yellow Fever, supra note 23. 

28 Karen Weintraub, From Senegal and Nigeria, 4 Lessons on How to Stop Ebola, NATIONAL GEOGRAPHIC (Oct. 24, 

2014), http://news.nationalgeographic.com/news/2014/10/141024-ebola-nigeria-outbreak-lessons-virus-health/. 

29 Press Release, WHO, WHO Congratulates Senegal on Ending Ebola Transmission (Oct. 17, 2014), 

http://www.who.int/ mediacentre/ news/statements/2014/senegal-ends-ebola/en/. 

30 Id.; Weintraub, supra note 28. 

31 Jacque Wilson, Borders Closing Over Ebola Fears, CNN (Aug. 22, 2014), http://www.cnn.com/2014/08/22/ 

health/ebola-outbreak/. 

32 Ebola: le Sénégal sort de la liste rouge de l’OMS [Ebola: Senegal Comes Off the WHO’s Red List], LES ECHOS

(Oct. 17, 2014), http://m.lesechos.fr/industrie-services/ebola-le-senegal-sort-de-la-liste-rouge-de-l-oms0203868882831.htm. 
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South Korea 

Sayuri Umeda 

Foreign Law Specialist*

SUMMARY The Ministry of Health and Welfare is the government agency responsible for responding 

to health crises in South Korea. The Korea Centers for Disease Control and Prevention 

(KCDC) was established by the relevant Minister who delegated certain powers to the 

KCDC to address infectious disease emergencies. 

 The aims of the Infectious Diseases Control and Prevention Act include preventing the 

occurrence and prevalence of infectious diseases and prescribing the necessary measures 

for their prevention and control. The Quarantine Act provides measures for preventing 

infectious diseases from spreading inside South Korea and outside its borders. 

 South Korea has an infectious disease surveillance system. When a person is infected with 

a specified infectious disease, the person may be treated and hospitalized in 

designated hospitals. 

I. Structure of the Public Health Crisis Management System 

The Minister of Health and Welfare is responsible for the administration of affairs related to 

health, sanitation, and the prevention of epidemics, among other things.1 The Infectious 

Diseases Control and Prevention Act was enacted in 2009 “to contribute to the improvement and 

maintenance of citizens’ health by preventing the occurrence and prevalence of infectious 

diseases hazardous to citizens’ health, and prescribing necessary matters for the prevention and 

control thereof.”2

 The Act confers upon the Minister of Health and Welfare various powers and 

obligations. The authority of the Minister of Health and Welfare stipulated under the Act may be 

partially delegated to the Director of the Korea Centers for Disease Control and 

Prevention (KCDC).3

The Minister of Health and Welfare formulates and implements a “master plan” for the 

prevention and control of infectious diseases every five years. The master plan must include 

the following: 

 

*

 At present there are no Law Library of Congress research staff members versed in Korean. This report has been 

prepared by the author’s reliance on practiced legal research methods and on the basis of relevant legal resources, 

chiefly in English, currently available in the Law Library and online. 

1

 Government Organization Act, Act No. 1, July 17, 1948, amended by Act No. 11690, Mar. 23, 2013, art. 38, 

English translation available on Korea Legislation Research Institute’s (KLRI) online database, at http://elaw.klri.re. 

kr/eng_service/lawView.do?hseq=27695&lang=ENG. 

2

 Infectious Disease Control and Prevention Act, Act No. 9847, Dec. 29, 2009, amended by Act No. 11645, Mar. 22, 

2013, art. 1, English translation available at http://elaw.klri.re.kr/eng_service/lawView.do?hseq=29938&lang=ENG. 

3 Id. art. 76(1). 
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1. Basic objectives of and direction-setting for executing the prevention and control of 

infectious diseases; 

2. Project plans for the prevention and control of major infectious diseases, and methods 

of executing them; 

3. Schemes to train experts and enhance emergency preparedness capability for 

infectious diseases; 

4. Schemes to manage statistics and information on infectious diseases . . . [.]4

An Infectious Disease Control Committee was established under the Ministry of Health and 

Welfare (MOHW) to deliberate on major policies concerning the prevention and control of 

infectious diseases, including the formulation of a master plan and crisis control measures.5 The 

Vice Minister of Health and Welfare chairs the Committee.6 The Minister of Health and Welfare 

formulates and implements crisis control measures against infectious diseases following 

Committee deliberations on these matters.7

 The crisis control measures include the following: 

1. A response system and roles of each agency at emergency scenes; 

2. A determination and decision-making system of emergencies; 

3. Schemes of stockpiling and supplying medical supplies . . . ; 

4. Education and training schemes, such as citizens’ codes of conduct in each case 

of emergency . . . [.]8

The Minister of Health and Welfare may establish organizations consisting of private 

professionals to support infectious disease control projects, the implementation of master plans 

and implementation plans, and international cooperation in health affairs.9

 The KCDC is one 

such organization,10 and contains the following divisions: Infectious Disease Control, Quarantine 

Support, Infectious Disease Surveillance, Epidemic Intelligence Service, Bioterrorism 

Preparedness and Response, and Public Health Crisis Response.11 The Division of Public Health 

Crisis Response “is in charge of the planning and running of the national emerging disease 

response, response and management of avian influenza human infection and pandemic influenza, 

education and training of public health officials, research and development of public health 

crisis, and international cooperation.”12 The Management Team for Public Health Crisis 

 

4 Id. art. 7(1). A copy of the master plan was not located. 

5 Id. art. 9(1) & (2). 

6 Id. art. 10(2). 

7 Id. art. 34(1). 

8 Id. art. 34(2). A copy of the crisis control measures was not located. 

9 Id. art. 8(1). 

10 See Center for Infectious Disease Control, KCDC, http://www.cdc.go.kr/CDC/eng/contents/CdcEngContentView. 

jsp?cid=17908&menuIds=HOME002-MNU0575-MNU0633 (last visited Oct. 29, 2014). 

11 Id. 

12 Hye-Young Lee et al., Public Health Crisis Preparedness and Response in Korea, 4(5) OSONG PUB. HEALTH RES.

PERSP. § 1, 278–84 (Oct. 2013), http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC3845460/.
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Response “supports effective and professional strategy formulation and execution of projects for 

the crisis caused by emerging infectious diseases of the division.”13 

II. Surveillance 

The Infectious Diseases Control and Prevention Act classifies infectious diseases in groups, 

depending on the speed of transmission or degree of danger and harm: 

 Group 1: infectious diseases spread via drinking water or food, with a high risk of mass 

outbreak, requiring immediate control measures upon their outbreak or prevalence. These 

diseases include cholera, typhoid fever, paratyphoid fever, bacterial dysentery, colon bacillus 

infection with enterorrhagia and viral hepatitis A. 

 Group 2: infectious diseases that can be prevented and controlled by vaccinations, subject to 

national vaccination programs. These diseases include diphtheria, pertussis, tetanus, 

measles, mumps, rubella, poliomyelitis, viral hepatitis B, Japanese encephalitis, varicella, 

and haemophilus influenza type B. 

 Group 3: infectious diseases requiring continuous surveillance and the establishment of 

control measures against their outbreak. These diseases include malaria, tuberculosis, 

Hansen’s disease, scarlet fever, meningococcal meningitis, legionellosis, vibrio vulnificus 

sepsis, epidemic typhus, murine typhus, scrub typhus, leptospirosis, brucellosis, anthrax, 

rabies, hemorrhagic fever with renal syndrome, influenza, AIDS, syphilis and CreutzfeldtJakob disease. 

 Group 4: infectious diseases, as designated by Ordinance of the MOHW, that have newly 

broken out or are likely to break out in Korea, or that are epidemics overseas with a risk of 

transmission to Korea. 

 Group 5: infectious diseases that are spread by parasite infection and are designated by 

Ordinance of the MOHW as requiring surveillance through regular investigations. 

 Designated infectious diseases: infectious diseases designated by the Minister of Health and 

Welfare, other than infectious diseases in Groups 1–5, requiring surveillance to investigate 

whether they are epidemic. 

 Infectious diseases under surveillance of the World Health Organization (WHO): infectious 

diseases being monitored to prepare for international public health emergencies, as 

announced by the MOHW. 

 Infectious diseases spread through bioterrorism: infectious diseases publicly announced by 

the MOHW as being among those spread by pathogens through deliberate use or 

for terrorism. 

 Sexually transmitted infectious diseases: infectious diseases announced by the Minister of 

Health and Welfare as being transmitted by sexual contact. 

 Zoonoses: infectious diseases spread by pathogens transmittable from animals to humans and 

vice versa, announced as requiring surveillance by the MOHW. 

 

13 Id. § 4.3. 
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 Nosocomial infectious diseases: infectious diseases contracted by people involved in medical 

activities or undergoing medical procedures, announced as requiring surveillance by 

the MOHW.14

No specific information was located concerning the classification of Ebola in one of the 

abovementioned infectious disease groups, but it appears that Ebola could be included under 

“Infectious diseases under surveillance of the WHO” or several other categories. 

Under the Infectious Diseases Control and Prevention Act, a medical doctor must report the 

following infectious disease situations to the head of the medical institution to which he/she 

belongs or to a competent public health clinic if he/she does not belong to a medical institution: 

 A doctor diagnoses a patient as being infected with a disease belonging to any of the groups 

listed above, or examines the corpse of such a patient. 

 A patient infected with a disease from Groups 1–4 dies.15

The medical institution that receives such a report from a doctor must forward it to the competent 

public health clinic.16 

The Infectious Diseases Control and Prevention Act obligates anyone who becomes aware of a 

person that he/she suspects is infected with or has died from a disease belonging to any of the 

groups listed above to inform the head of a competent public health clinic.17 A definite or 

suspected case of a Group 1 infectious disease, or a death resulting from a Group 1 disease, 

obligates the following people either to pursue a medical examination or diagnosis, or to make a 

report to the public health clinic in their jurisdiction: 

 In the case of a family, the head of the household or, in the absence of the head of the 

household, another member of the household. 

 In the case of a school, hospital, government office, company, place of entertainment or 

worship, vessel, place of business, restaurant, inn, or other place of gathering, the head, 

manager, proprietor, or representative of the establishment.18

Violation of the Act’s provisions regarding required medical examinations or reports is 

punishable by a fine not to exceed ₩2 million (approximately US$1,890).19

The head of a public health clinic on receipt of an infectious disease notification must report the 

details “to the Governor of the competent Special Self-Governing Province or the head of the 

 

14 Infectious Diseases Control and Prevention Act art. 2. 

15 Id. art. 11(1). 

16 Id. art. 11(2). 

17 Id. art. 12(2). 

18 Id. art. 12(1). 

19 Id. art. 81. 
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competent Si/Gun/Gu who shall, in turn, report them to the Minister of Health and Welfare and 

the competent Mayor/Do Governor.”20 The KCDC receives all such information and creates 

relevant statistics.21

The KCDC conducts an epidemiological investigation when it deems that an infectious disease 

has broken out and “is likely to prevail subsequently.”22

III. Powers of Public Health Authorities

A local government may designate a medical institution as an infectious disease control 

institution. The MOHW Ordinance requires the head of a designated medical institution to 

establish necessary facilities for preventing infectious diseases and for examining and treating 

infected patients.23 The expenses incurred for the establishment of such facilities are subsidized 

by the local government.24 In the case of mass infections or difficulty in accommodating all 

infected patients, the Minister of Health and Welfare and heads of local governments can 

designate other medical institutions as infectious disease control institutions for a certain period, 

as well as establish and operate isolation wards, sanatoriums, and clinics.25

In August 2014, “the Health Ministry designated a total of 17 hospitals with quarantine units as 

official facilities to treat patients should Ebola occur in South Korea.”26 However, one expert on 

infectious disease epidemiology has stated that 

[a]lthough there are 17 government-designated hospitals with quarantine units, these 

units were constructed for airborne infectious diseases like influenza. As such, currently 

no hospitals in South Korea are designed to provide one-stop testing and treatment for 

diseases like Ebola that are transmitted through body fluids.27

A person who has contracted a disease specified by the Minister of Health and Welfare as 

infectious must be hospitalized at the designated infectious disease control institution. If such an 

institution is full, the Minister of Health and Welfare or the head of the local government may 

 

20 Id. art. 13(1). 

21 Byungguk Yang, PowerPoint Presentation, Infectious Disease Surveillance System in Korea, Thirty-first AsiaPacific Advanced Network Meeting, slides 7–15 (Feb. 2011), http://www.apan.net/meetings/ HongKong2011/ 

Session/Slides/Medical/6-6.pdf. 

22 Infectious Diseases Control and Prevention Act art. 18. 

23 An English translation of the Ordinance is not available. 

24 Infectious Diseases Control and Prevention Act art. 36(1) & (2). 

25 Id. art. 37(1). 

26 South Korea Ill-Prepared for Possible Ebola Outbreak, Say Health Experts, STRAITS TIMES (Oct. 20, 2014), 

http://www.straitstimes.com/news/asia/east-asia/story/south-korea-ill-prepared-possible-ebola-outbreak-say-healthexperts-201410. 

27 Moran Ki, What Do We Really Fear? The Epidemiological Characteristics of Ebola and Our Preparedness, 36 

EPIDEMIOLOGY & HEALTH 1, 4 (Aug. 18, 2014), http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC4153011/pdf/epih36-e2014014.pdf. 
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permit the patient to be hospitalized at another medical institution.28 The Minister of Health and 

Welfare or the head of the local government must provide notice to the person to be 

hospitalized.29 Refusing hospital treatment is punishable by a fine not to exceed ₩3 million 

(approximately US$2,790).30 The Minister of Health and Welfare or the head of the local 

government may require the relevant public official to conduct an investigation or medical 

diagnosis by entering the residence, means of transportation (such as a ship, aircraft, or train), or 

any other place where there are persons infected with a disease from Group 1 or a specified 

infectious disease from other groups. When a medical diagnosis identifies an infected person, 

the relevant public official may escort the patient to undergo required medical treatment 

or hospitalization.31 

The head of the local government may require any of the following persons to undergo a medical 

examination or receive a vaccination necessary for the prevention of an infectious disease: 

1. Family members of a patient, etc. infected by an infectious disease, or 

his/her cohabitants; 

2. A person suspected of being infected by an infectious disease, who lives in or 

frequents an area where an infectious disease has occurred; 

3. A person suspected of being infected by an infectious disease, as he/she has come 

into contact with a patient, etc. infected by an infectious disease.32

In order to prevent the further spread of an infectious disease once it has broken out, the head of 

the local government is obligated to take all or some of the following measures: 

1. To isolate traffic to places where patients, etc. infected by an infectious disease exist 

or to the places deemed to have been infected by the pathogen of an infectious 

disease for a certain period; 

2. To keep persons suspected of being infected by the pathogen of an infectious disease 

hospitalized or in quarantine at an appropriate place for a certain period; 

3. To prohibit the use, receipt, transfer, abandonment, or washing of articles infected or 

suspected of being infected by the pathogen of an infectious disease, or to incinerate 

or destroy such articles; 

4. To order the disinfection of or other necessary measures for places infected by the 

pathogen of an infectious disease; 

5. To prohibit laundry at a specified place, or to order the disposal of waste at a 

specified place.33

 

28 Infectious Diseases Control and Prevention Act art. 41(1) & (2). 

29 Id. art. 43. 

30 Id. art. 80(2). 

31 Id. art. 42. 

32 Id. art. 46. 

33 Id. art. 47. 
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IV. Quarantine Act 

Means of transport (ships, aircraft, trains, or automobiles), people, or cargo entering or departing 

from the Republic of Korea must undergo quarantine inspections.34 No one besides public 

officials in charge of quarantine is permitted to embark or board a means of transport subject to a 

quarantine inspection before a quarantine certificate has been issued.35 

Under the Quarantine Act, diseases subject to quarantine are cholera, pest and yellow fever, 

SARS, avian influenza, pandemic influenza, and other infectious diseases that break out abroad 

and are likely to spread within the Republic of Korea, or break out within the Republic of Korea 

and are likely to spread abroad, and that the Minister of Health and Welfare designates.36 

The director of the quarantine station conducts quarantine inspections related to any of 

the following: 

1. Progress and current status of health and sanitary conditions of the means 

of transport; 

2. Matters concerning the control and management of quarantinable communicable 

diseases for passengers, crew members and . . . [pedestrians]; 

3. The storage status of food and the status of the cargo loaded in the means of 

transport; [and] 

4. Whether vehicles for communicable diseases inhabit [sic] and the state of 

their breeding.37 

The director of the quarantine station can take all or some of the following measures: 

1. Isolate a patient infected with a quarantinable communicable disease or a patient 

suspected of being infected with a quarantinable communicable disease . . . ; 

2. Supervising or isolating a person who has had contact with patients infected with a 

quarantinable communicable disease, etc. or who is exposed to the pathogen of a 

quarantinable communicable disease without any symptom . . . but to whom the 

quarantinable communicable disease is suspected to break out . . . ; 

3. Disinfecting, destructing or prohibiting the movement of cargo contaminated with or 

suspected of being contaminated with the pathogen of a quarantinable 

communicable disease; 

4. Disinfecting any place contaminated or suspected of being contaminated with the 

pathogen of a quarantinable communicable disease, and prohibiting or restricting the 

use of such place; 

 

34 Kŏmyŏkpŏp [Quarantine Act], Act No. 1273, Feb. 9, 1963, amended by Act No. 11972, July 30, 2013, art. 6, 

English translation available at http://elaw.klri.re.kr/eng_service/lawView.do?hseq=29132 &lang=ENG. 

35 Id. art. 13(1). 

36 Id. art. 2. 

37 Id. art. 12(1). 
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5. Dissecting any corpse . . . which is contaminated or suspected of being contaminated 

with a quarantinable communicable disease in order to inspect the corpse; 

6. Ordering the head of a means of transport or the owner or manager of cargo to 

disinfect the means of transport or the cargo, and eradicating the pathogen of a 

communicable disease; 

7. Medically examining or checking persons, deemed necessary to be confirmed 

whether they are infected with a quarantinable communicable disease; [and] 

8. Vaccinating persons who need the prevention of [sic] a quarantinable 

communicable disease.38 

The director of the quarantine station may ask the head of the local government to monitor the 

health status of a person suspected of being infected once that person enters his jurisdiction.39 If 

a person is confirmed as being infected with a disease subject to quarantine, the head of the local 

government must promptly take necessary measures, such as isolation, and immediately notify 

the director of the relevant quarantine station of the confirmed diagnosis and measures taken.40

The Minister of Health and Welfare may request the Minister of Justice to prohibit foreigners 

infected with a quarantinable communicable disease who are likely to pose a substantial risk to 

public health from entering or leaving Korea, and to prohibit infected Korean nationals from 

leaving Korea.41

The director of the quarantine station may take any of the following measures with regard to a 

person who intends to enter or leave Korea when a quarantinable communicable disease is likely 

to spread: 

1. To request information on a travel region and time; 

2. To request information on the health status related to a quarantinable 

communicable disease; 

3. To request the documents certifying the vaccination; and 

4. To examine or check in order to check [sic] whether he/she is infected with a 

quarantinable communicable disease.42

 

 

38 Id. art. 15(1). 

39 Id. art. 17(1). 

40 Id. art. 17(2). 

41 Id. art. 24. 

42 Id. art. 26. 
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V. Recent Developments 

After the WHO issued its Statement on the First Meeting of the IHR Emergency Committee on 

the 2014 Ebola Outbreak in West Africa on August 8, 2014,43 the Vice Minister of Health and 

Welfare, Jang Ok-ju, held an emergency meeting with ten relevant ministries and agencies and 

discussed the WHO’s announcement and Ebola prevention and control measures. After the 

meeting, a special travel advisory was issued, which urged Koreans residing in these Ebolaaffected countries to return to Korea and Koreans elsewhere to cancel or postpone nonessential 

trips to Ebola-affected countries. In addition, the government of South Korea announced that 

inbound travelers from Nigeria and from the three Ebola-affected countries would be 

quarantined, undergo thermal screening at the time of entry, and be closely monitored over a 

certain period of time (for up to twenty-one days) for any Ebola infection. Inbound travelers on 

direct or transit flights from the four Ebola-affected countries would be quarantined at deplaning 

gates instead of at general quarantine zones. The government would identify people entering the 

country after traveling from or through the Ebola-affected countries in advance, through 

cooperation with the airlines, immigration offices, and embassies in those four Ebola-affected 

countries, and through voluntary reporting by travelers. Transit passengers from the four Ebolaaffected countries would also go through the quarantine process when they enter Korea. 

Passengers on direct flights from Africa or on flights through a third country from Africa would 

also undergo enhanced screening.44

 

43 Press Release, WHO, Statement on the First Meeting of the IHR Emergency Committee on the 2014 Ebola 

Outbreak in West Africa (Aug. 8, 2014), http://www.who.int/mediacentre/news/statements/ 2014/ebola20140808/en/. 

44 Government Steps Up Measures to Prevent Ebola from Entering Korea, MOHW (Sept. 1, 2014), http://english. 

mw.go.kr/front_eng/al/sal0101vw.jsp?PAR_MENU_ID=1002&MENU_ID=100201&page=1&CONT_SEQ 

=304721. 
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Spain

Graciela Rodriguez-Ferrand 

Senior Foreign Law Specialist

SUMMARY The Spanish Constitution recognizes the right to public health and divides such matters 

between the state and the autonomous communities. Based on this constitutional 

framework Spain has created an integrated and coordinated network of agencies and 

institutions to address public health crises and also closely follows World Health 

Organization standards, alerts, and directives. In cases of public health emergencies, the 

Ministry of Public Health, Social Services and Equality is the authority in charge of 

maintaining health and hygiene control over the international transit of people and goods at 

Spanish ports of entry. The state has the authority to monitor and coordinate public health 

services with all other local authorities when there is a risk to public health with domestic 

or international consequences. The National Network of Epidemiological Surveillance and 

the Carlos III Health Institute are the entities in charge of epidemiological planning, 

coordination, and research. Information of a personal nature in cases of the declaration of 

an epidemic remains mainly confidential. 

The most recent case of a health crisis impacting Spain was caused by the Ebola outbreak 

in West Africa. In spite of all the preventive measures taken by the health care authorities, 

Spain had the first confirmed case of Ebola virus contracted outside Africa after a Spanish 

nurse came into contact with two Spanish nationals who were infected in Africa. The 

nurse has now fully recovered. 

I. Government Structure 

Spain is a parliamentary monarchy1 with a bicameral Parliament (Cortes Generales) composed of 

the Senate and the Congress of Deputies.2 The Constitution recognizes and guarantees the right 

to autonomy of the regions that comprise the state.3

 Bordering provinces with common 

historical, cultural, and economic characteristics may accede to self-government and form 

autonomous communities (comunidades autónomas).4

 The country’s fifty-two provinces have 

been grouped into autonomous communities since adoption of the 1978 Constitution. 

 

1

 CONSTITUCIÓN ESPANOLA art. 1(3), Dec. 27, 1978, BOLETÍN OFICIAL DEL ESTADO [B.O.E.], English translation

available at http://www.boe.es/legislacion/ documentos/ConstitucionINGLES.pdf. 

2 Id. art. 66(1). 

3

 Id. art. 2. 

4 Id. art 143(1). 
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II. Structure of Public Health Crisis Management System 

Spain’s Constitution expressly recognizes the right to the protection of public health, stating that 

it is incumbent upon the authorities to safeguard public health through preventive measures and 

necessary care and services, which are regulated by law.5 

The Constitution determines which health matters are reserved for the state and which are to be 

delegated. The autonomous communities are responsible for regulating social assistance matters 

and health and hygiene,6

 while the state reserves the exclusive right to regulate matters 

pertaining to the structure and coordination of the public health system, and to enact legislation 

on pharmaceuticals.7

 The state is also responsible for regulating matters pertaining to the basic 

legislation and economic structure of the social security system, even when the services are 

rendered through the autonomous communities.8

Based on the constitutional mandate, Law 14/1986 on General Public Health9

 created a National 

Health System (NHS) that integrates and coordinates all health services of the autonomous 

communities, including those rendered at centers and hospitals managed by the municipalities.10 

The Law expressly provides that the state is the exclusive authority over international health 

relations and agreements and over external health.11 It further states that matters of external 

health are those related to vigilance over and control of potential health risks imported and/or 

exported through the international transit of people or goods.12 

The Ministry of Public Health, Social Services and Equality (MPH) was recently reorganized 

under Royal Decree 200/2012,13 under which the central administration is given the authority to 

uphold the powers assigned to the state in health matters and to guarantee the population’s 

constitutional right to health protection.14 The MPH cooperates with other government 

departments to ensure that the inspection and control of external health matters is coordinated 

within the government in order to simplify and expedite international transit, in compliance with 

international agreements.15 The regulatory directive of Law 14/1986 has been implemented by 

 

5 Id. art. 43. 

6

 Id. art. 148(1)(xx), (xxi). 

7 Id. art. 149(1)(xvi). 

8

 Id. art. 149(1)(xvii). 

9

 Ley 14/1986, General de Sanidad [Law 14/1986, General Health], Apr. 25, 1986, last updated Mar. 28, 2014, 

http://boe.es/ buscar/act.php?id=BOE-A-1986-10499. 

10 Id. art. 50. 

11 Id. art. 38. 

12 Id. art. 38(2). 

13 Real Decreto 200/2012, Jan. 23, 2012, http://boe.es/diario_boe/txt.php?id=BOE-A-2012-1034. 

14 A. GONZALEZ BUENO, MANUAL DE LEGISLACIÓN FARMACÉUTICA 43 (Aranjuez, 1999). 

15 Ley 14/1986 art. 38.3, as implemented by Real Decreto 65/2006, Jan. 30, 2006, http://boe.es/diario_boe/txt.php? 

id=BOE-A-2006-1916. 
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Royal Decree 1418/1986,16 which provides that the MPH has the power to manage relations with 

other international health and consumer affairs entities through the Ministry of Foreign Affairs;17

adopt all necessary measures under international agreements on health and consumer affairs to 

which Spain is a party; and maintain health and hygiene control over, and surveillance of, 

international traffic at Spanish ports, airports, customs ports, and terminals. The MPH also 

works in conjunction with the Ministry of Agriculture to oversee the transportation of people, 

corpses, and human remains, and of animals and animal derivatives. Together with the Ministry 

of Economy, it oversees the transportation of goods and of any other merchandise that could 

pose a potential risk to public health.18 

In the event of an emergency, the MPH has the authority to coordinate international transit that 

could affect the health of people or their legitimate interests when they may be affected by the 

international traffic of goods or services.19 

The Law on General Public Health provides that the state, without prejudice to the authorities 

assigned to the autonomous communities, is responsible for monitoring and analyzing epidemics 

and for coordinating the services of the different public health administrations in situations that 

may create public health risks with domestic or international consequences.20 It also provides 

that the state is in charge of setting up a health information system and preparing statistics of 

general interest to the autonomous communities.21 The state is also responsible for establishing a 

network of information and communication between the state and the autonomous communities 

in health matters.22

III. Powers of Public Health Authorities 

Health emergencies are declared by the state through the MPH, or by the autonomous 

communities when such power has been delegated by the state.23

Organic Law 3/86 on Special Measures in Matters of Public Health lists the conditions under 

which the Spanish health authorities may, within their jurisdiction, adopt urgent and necessary 

public health measures in times of emergencies.24

 

16 Real Decreto 1418/1986, June 13, 1986, sobre Funciones del Ministerio de Sanidad y Consumo en Materia de 

Sanidad Exterior [Royal Decree 1418/1986, on the Powers of the Ministry of Public Health and Consumer Affairs in 

Matters of External Health] (now the MPH), http://www.boe.es/buscar/act.php?id=BOE-A-1986-18374. 

17 Id. art. 2(1.1). 

18 Id. art. 2(1.4). 

19 Id. art. 2(2.4). 

20 Id. art. 40(12). 

21 Id. art. 40(13), implemented by Decreto 605/2003, May 23, 2003, por el que se Establecen Medidas para el 

Tratamiento Homogéneo de la Información sobre las Listas de Espera en el Sistema Nacional de Salud [Decree 

605/2003, May 23, 2003, Establishing Measures for the Homogeneous Treatment of Information on the Waiting 

Lists of the National Health System], http://www.boe.es/buscar/act.php?id=BOE-A-2003-11266. 

22 Id. art. 40(16), implemented by Decreto 605/2003. 

23 Id. art. 41. 
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The government has the authority to declare a state of alert in extraordinary circumstances that 

make it impossible to keep public order by normal means,25 and in public health crises, such as 

an epidemic or situation of serious contamination.26 Measures taken under a state of alert must 

be temporary, restricted to a specific area, and limited to those measures necessary to contain the 

emergency.27 If the emergency is limited to a specific autonomous community, the community’s 

president may request that the government declare a state of alert in that community.28 The state 

or the president of the affected autonomous community serves as the competent authority for 

purposes of the state of alert.29 The declaration of a state of alert is enacted through a decree 

issued by the Council of Ministries.30 

Under a state of alert, the Minister of Public Health and Consumer Affairs may temporarily order 

the restriction of the movement of people or motor vehicles; search and seizure procedures; the 

occupation of facilities or industries (but not private dwellings); the limited consumption or use 

of necessary food items; and any other measure to fight infectious diseases, protect water and the 

environment, and protect against forest fires.31 In these cases, the state may also order the 

participation of companies and services and the mobilization of their personnel.32

The MPH is in charge of the study and management of epidemics, the promotion of health, 

preventive measures against epidemics, and the surveillance and control of possible health risks 

derived from the import or export of goods and the international movement of people.33 The 

Underdirectorate for the Promotion of Public Health and Epidemiology (Sudireccion General de 

Promocion de la Salud y Epidemiologia) is in charge of planning, coordinating, and developing 

strategies for the National Network of Epidemiological Surveillance (NNES) (Red Nacional de 

Vigilancia Epidemiologica), in conjunction with the Carlos III Health Institute (Instituto de 

Salud Carlos III), a public research institute created in 1986 to provide scientific and technical 

support to the MPH and the health services of the autonomous communities.34 One of the Carlos 

 24 Ley Orgánica 3/1986 de Medidas Especiales en Materia de Salud Pública [Organic Law 3/1986, on Special 

Measures in Matters of Public Health] art. 1, Apr. 14, 1986, http://www.boe.es/buscar/act.php?id=BOE-A-1986-

10498. 

25 Ley Orgánica 4/1981, June 1, 1981, de los Estados de Alarma, Excepción y Sitio [Organic Law 4/1981, June 1, 

1981, on States of Alert, Exception and Siege] art. 1(1), http://www.boe.es/buscar/act.php?id=BOE-A-1981-12774. 

26 Id. art. 4(2). 

27 Id. art. 1(2). 

28 Id. art. 5. 

29 Id. art. 7. 

30 Id. art. 6. 

31 Id. arts. 11, 12(1). 

32 Id. art. 12 (2). 

33 Ley 14/1986 arts. 8, 38. 

34 Id. arts. 111–113, as implemented by Real Decreto 375/2001 por el que se Aprueba el Estatuto del Instituto de 

Salud “Carlos III” [Royal Decree 375/2001, Approving the Bylaws of the “Carlos III” Institute of Health], Apr. 6, 

2001, http://www.boe.es/buscar/doc.php?id=BOE-A-2001-8157. 
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III Health Institute’s specific functions is conducting research and studies in epidemiology that 

are carried out by the Underdirectorate for the Promotion of Public Health and Epidemiology.35 

The NNES was created by Royal Decree 2210/199536 within the NHS to collect and analyze 

information on epidemics, contribute to the application of individual and collective control 

measures in cases where a health risk may have national or international consequences, and 

inform all operational levels about health risks.37 The National Directorate of Public Health 

(Dirección General de Sanidad Pública) of the MPH has been established as the Spanish health 

authority liaison to the World Health Organization (WHO) for tracking and reporting alerts on 

transmissible diseases.38 

The NNES is responsible for 

$ identifying health problems related to epidemics, endemics, and risks throughout 

the autonomous communities; 

$ participating in the individual and collective control of public health problems throughout the 

autonomous communities, and ensuring coordination between surveillance and decision 

making by the competent health authorities for the prevention and control of public health 

problems; 

$ executing epidemiological analysis to identify changes in and the evolution of the 

abovementioned public health problems, as well as any other epidemiological research; 

$ providing operative information for planning purposes; 

$ distributing information to all designated operative levels; and 

$ contributing the development of related statistics for official use.39

The NNES’s surveillance activity involves the systematic collection of epidemiological 

information, its analysis and interpretation, and the distribution of results and 

recommendations.40 

The NNES is composed of (1) a basic surveillance system that includes obligatory notifications 

about diseases, epidemics, and outbreaks, as well as microbiological information; (2) specific 

systems of epidemic surveillance based on case records, surveys, watch systems, and other 

methods that could be applicable to the surveillance of AIDS and other preventable immune 

 

35 Real Decreto 375/2001 Estatuto del Instituto de Salud “Carlos III” art. 19(6)–(9). 

36 Real Decreto 2210/1995 por el que se Crea la Red Nacional de Vigilancia Epidemiológica [Royal Decree 

2210/1995, Creating the National Network of Epidemic Surveillance], Dec. 28, 1995, http://www.boe.es/buscar/ 

act.php? id=BOE-A-1996-1502. 

37 Id. art. 1. 

38 Orden Ministerio de Sanidad y Consumo [Order of the Ministry of Health], SCO 3870/2006, Dec. 15, 2006, art. 1 

https://www.boe.es/diario_boe/txt.php?id=BOE-A-2006-22360. 

39 Real Decreto 2210/1995 art. 2. 

40 Id. art. 3. 
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diseases; and (3) any other surveillance system that the MPH and the autonomous communities, 

within their jurisdiction and through the Interterritorial Council of the National Health System 

(Consejo Interterritorial del Sistema Nacional de Salud), believe necessary to develop in order to 

control specific problems or use as a complement to other measures.41

The basic surveillance system of the NNES includes a list of diseases42 that are required to be 

reported. The required report refers to new cases of these listed diseases that appear each week 

and constitute a concern. Attending physicians both from the public and private sector are the 

agents responsible for the reporting.43 The same procedure is applicable at the autonomous 

communities level, which then transfers all the reported information to the MPH. The 

information collected must reach the MPH no later than three weeks after the first case 

is reported.44

All practicing physicians and health centers, both public and private, that first detect the outbreak 

of an epidemic are required to immediately report the outbreak to the MPH.45 An “outbreak” is 

defined as a significant increase in the number of cases; the presence of a case in an area that was 

free of such disease; the presence of cases of acute, collective poisoning due to consumption, 

handling, or accidental causes; and the presence of any catastrophic incident that may affect the 

health of the community.46 

The NNES may also rely on networks of “monitoring physicians,” and on networks to trace 

diseases selected by the designated health authorities in predetermined geographic areas.47 

Additional regulatory measures have been implemented to address certain diseases, such as 

AIDS and SARS, that are considered to be or could become an epidemic of serious proportions. 

Spain created and maintains a national AIDS registry for epidemic surveillance purposes. The 

autonomous communities also keep registries of AIDS cases in their respective territories and 

have an obligation to report them to the central health authorities every three months.48 

Although no SARS cases were found in Spain, Real Decreto 350/2003,49 now superseded, 

 

41 Id. art. 4. 

42 Id., Annex I. The list includes, among others, botulism, brucellosis, cholera, diphtheria, hepatitis A and B, 

leprosy, meningitis, malaria, polio, tetanus, and tuberculosis. 

43 Id. art. 9. 

44 Id. art. 12. 

45 Id. art. 16. 

46 Id. art. 15. 

47 Id. arts. 28–30. 

48 Id. arts. 31–36. 

49 Real Decreto 350/2003, Mar. 21, 2003, https://www.boe.es/buscar/doc.php?id=BOE-A-2003-5851 (superseded by 

Real Decreto 776/2011, de 3 de junio [2011], por el que se Suprimen Determinados órganos colegiados y se 

establecen criterios para la normalización en la creación de órganos colegiados en la Administración General del 

Estado y sus Organismos Públicos [Royal Decree 776/2011, June 3, [2011], Dissolving Some Collegiate Entities 

and Establishing Normalization Criteria for Creating Collegiate Entities Within the General Administration of the 

State and Its Public Agencies], http://www.boe.es/boe/dias/2011/06/04/pdfs/BOE-A-2011-9736.pdf). 
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created the Inter-Ministerial Commission for the Surveillance of SARS50 to coordinate the 

response to the illness throughout the national territory. The Decree also required coordinated 

actions and information sharing in case of an outbreak.51 In addition, the Scientific Committee 

on SARS52 was created to provide scientific support and to advise the Inter-Ministerial 

Commission. By 2011 this Commission was no longer operative.53

The NHS is the enforcement authority that manages cases of infectious diseases.54 Each 

province and autonomous community has the power to order the isolation of infected individuals 

and to impose restrictions on their movements to prevent placing others at risk. The same power 

is assigned to mayors at the municipal level if a case falls under their jurisdiction.55 

Violations of health safety directives may result in criminal charges for provoking a risk to life, 

physical integrity, and the health of the population or environment—offenses that are punishable 

by imprisonment of six months to two years, a fine, and the inability to hold public office or 

practice a profession for three to six years.56

IV. Transparency of Public Health Crisis Management System

The MPH and National Center on Epidemiology,57 together with the competent provincial 

councils, are the authorities in charge of declaring an epidemic.58 

The MPH is the enforcement authority of the NNES, ensuring the coordination and uniformity of 

information, as well as its evaluation and analysis, throughout the country. Information of a 

personal nature, managed as a consequence of the application of the NNES, is otherwise to 

remain confidential.59 Personal data in databases may be used without the owner’s consent only 

when the information is required in urgent cases or to carry out epidemiological studies.60 The 

 

50 Id. art. 2. 

51 Id. art. 3. 

52 Orden Ministerio de Sanidad y Consumo [Order of the Ministry of Health], SCO/1134/2003, May 6, 2003, B.O.E., 

May 10, 2003. 

53 Real Decreto 776/2011, Annex, B.O.E. No. 133, June 4, 2011, p. 10. 

54 Real Decreto 1030/2006, Sept. 15, 2006, Annex III, § 5.1(1), http://www.msssi.gob.es/profesionales/prestaciones 

Sanitarias/CarteraDeServicios/docs/RD_1030_2006_act25072014.pdf. 

55 Id. 

56 CÓDIGO PENAL Y LEYES PENALES ESPECIALES art. 348 (Navarra, Thomson/Aranzadi 2007). 

57 Real Decreto 2210/1995 arts. 1–5. 

58 Id. arts. 15–21. 

59 Id. art. 8. 

60 Ley Orgánica 15/1999 sobre el Tratamiento de Datos Personales [Organic Law 15/1999, on the Treatment of 

Personal Data in Databases] art. 11(2)(f), Dec. 13, 1999, https://www.boe.es/buscar/pdf/1999/BOE-A-1999-23750-

consolidado.pdf. 
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MPH also coordinates such information with the European Union (EU), the WHO, and other 

international organizations.61

The MPH is required to immediately inform the autonomous communities of any epidemic 

outbreak so that pertinent controls and preventive measures may be set up.62 Reporting such data 

also ensures compliance with international health standards, such as the international reporting of 

diseases subject to quarantine and those subject to special surveillance by the WHO and 

the EU.63

The MPH issues updated press releases to keep the population informed of any health threat. 

During the latest health epidemic alerts, such as the swine flu outbreak in 2009 and the recent 

Ebola virus outbreak, the MPH, through the Center for the Coordination of Health Warnings and 

Emergencies (Centro de Coordinación de Alertas y Emergencias Sanitarias), issued 

recommendations to the population via the Internet and all other major media, as requested by 

the WHO.64

V. Current Crisis 

The MPH, in cooperation with the health authorities of the autonomous communities, the 

Institute of Health Carlos III (Instituto de Salud Carlos III), and scientific societies, has 

established a protocol to deal with the Ebola virus.65 The protocol reflects the recommendations 

of international organizations and experts to ensure the early detection and diagnosis of possible 

Ebola cases and to adopt immediate control measures.66

The MPH has also established a procedure applicable to all points of entry into the country to 

make sure that all airplanes and ships coming from Ebola-affected areas meet the applicable 

health standards.67 Information pamphlets for passengers coming from these areas, and for any 

passenger arriving in Spain, have been published and made available online.68

 

61 Real Decreto 2210/1995 art. 6(1), (2). 

62 Id. art. 19. 

63 Id. art. 6(3). 

64 Centro de Coordinación de Alertas y Emergencias Sanitarias, Actualización Epidemiológica: Brotes de 

Enfermedad por Virus Ébola en África [Epidemiological Update: Outbreaks of the Ebola Virus in Africa] (Oct. 27, 

2014), http://www.msssi.gob.es/profesionales/saludPublica/ccayes/alertasActual/ ebola/docs/Actualizacionn 

15BIS(27.10.14)EPI-EVE_Africa_2014.pdf. 

65 Medidas del Gobierno de Espana [Measures by the Government of Spain], GOBIERNO DE ESPAÑA, COMITÉ 

ESPECIAL PARA LA GESTIÓN DEL ÉBOLA (Oct. 12, 2014), http://infoebola.gob.es/2014/10/10/que-medidas-estatomando-el-gobierno-de-espana/. 

66 Id. 

67 Id. 

68 Información sobre el Brote de Enfermedad por Virus Ébola (EVE), Información para los Ciudadanos/Viajeros 

[Information on the Outbreak of the Ebola Virus, Information for Citizens and Travelers], MINISTERIO DE SANIDAD,

SERVICIOS SOCIALES E IGUALDAD, https://www.msssi.gob.es/en/profesionales/saludPublica/ccayes/alertasActual/ 

ebola/infCiudadanos.htm (last visited Nov. 17, 2014). 
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In spite of all the preventive measures, Spain had the first confirmed case of Ebola virus 

contracted outside Africa. The infected woman, a nurse named Teresa Romero, was treated in a 

Madrid hospital. She had been part of a medical team treating two Spanish missionaries with 

Ebola, who had been brought back to Spain from Sierra Leone and Liberia. Both died in the 

hospital in Madrid in August and September 2014. Romero is reported to have entered the room 

of one of the missionaries who later died.69 Six other people were also placed in quarantine, 

while around fifty other healthcare workers were placed under observation because of their 

interaction with the nurse and the two missionaries who died.70

On October 10, 2014, in response to what appears to have been a failure in established protocols, 

the Spanish government created a Special Committee on the Management of Ebola (Comité 

Especial en la Gestión del Ébola), headed by the Vice President of the Spanish government, to 

supervise, coordinate, and manage all actions by and resources from the state necessary for the 

management of the virus.71 

The Minister of Health, Ana Mato, informed Congress that the revised procedures applicable for 

the early detection of Ebola would include the daily monitoring of anyone known or suspected to 

have come into contact with Ebola victims, and that even minor increases in body temperature 

would be taken as a likely sign of their being infected.72

At the same time, supervision would be tightened in hospitals when staff remove protective body 

suits, since Romero appears to have been infected when her glove brushed against her face while 

she was removing her suit. Closed circuit television cameras would also likely be installed in 

isolation units.73 On November 5, 2014, Romero was released from the hospital free 

from Ebola.74 

 

69 Elisa Silió & Emilio de Benito, Una Sanitaria de Madrid, Primer Contagio por Ébola Fuera de África [A Health 

Professional in Madrid, First Ebola Infection Outside Africa], EL PAÍS (Oct. 7, 2014), http://elpais.com/elpais/2014/ 

10/06/ciencia/1412611515_352524.html. 

70 Id. 

71 Santamaría Presidirá un Comité Especial para la Gestión de la Crisis del Ébola [Santamaría Will Head a Special 

Committee for the Management of the Ebola Crisis], LA VANGUARDIA (Oct. 10, 2014), http://www.lavanguardia. 

com/politica/20141010/54417805465/santamaria-presidira-comite-especial-gestion-crisis-ebola.html. 

72 Mato Analizará Esta Tarde con las CCAA los Cambios en los Protocolos Frente al Ébola [This Afternoon Mato 

Together with ACs Will Analyze Changes in the Protocols Applicable in Ébola Cases], LA VANGUARDIA (Oct. 10, 

2014), http://www.lavanguardia.com/local/20141010/54416960358/mato-analizara-esta-tarde-con-las-ccaa-loscambios-en-los-protocolos-frente-al-ebola.html. 

73 Los Fallos del Caso de Romero Llevan a Ana Mato a Cambiar en los Protocolos [Mistakes in the Romero Case 

Cause Ana Mato to Change Protocols], EL PAÍS (Oct. 9, 2014), http://politica.elpais.com/politica/2014/10/09/ 

actualidad/1412838533_047257.html. 

74 Teresa Romero Recibe Este Miércoles el Alta Hospitalaria Tras Casi un Mes de Ingreso [Teresa Romero Is 

Discharged from the Hospital Wednesday Nearly a Month After Admission], LA VANGUARDIA (Nov. 5, 2014), 

http://www.lavanguardia.com/vida/20141105/54418948378/teresa-romero-recibe-alta-ebola.html?rel=rosEP. 
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Sweden 

Elin Hofverberg 

Foreign Law Research Consultant 

SUMMARY Sweden’s response to public health crises is governed by statute. Smittskyddslagen (the 

Communicable Diseases Act) regulates the response to outbreaks and threats of outbreaks 

of contagious diseases. Power and responsibility for the containment of contagious 

diseases are shared between state and local authorities. Both individual patients and 

treating physicians have a duty to report cases of possible contagious disease. Coercive 

powers such as isolation, quarantine, and restrictions on work and travel are available to 

the state but only as specified by law and only if there is a serious threat that a dangerous 

disease may spread. The intentional and negligent spreading of a disease is a crime. The 

National Board on Health and Welfare is responsible for coordinating with the World 

Health Organization. Sweden has not had to respond to a public health crisis recently. 

I. Structure of Public Health Crisis Management System 

A. General Government Structure 

The national government,1 municipalities, and local county councils share power on issues of 

public health crisis management. Municipal self-governance is fundamental to the Swedish 

system and is explicitly listed as a right in the Swedish Constitution.2 The municipalities are 

generally responsible for health care, education, and elder care.3 

B. Legislation 

1. General Principles 

Sweden does not have overarching legislation that deals with all public health crises but instead 

uses individual acts and regulations that deal with crises in different areas—for instance the 

Communicable Diseases Act4

 deals with protection against infectious diseases. This report 

focuses solely on the infectious disease aspect of public health crises and thus only covers the 

Communicable Diseases Act and its relevant ordinances, procedures, etc. 

While Sweden has no overarching legislation it has general guiding principles that apply to all 

crisis management efforts. These are the principles of responsibility, equal treatment,5

 and 

 

1

 Note: Swedish authorities and agencies often change names as a result of government changes, and there was such 

a government change in September of 2014. The names of relevant state authorities used in this report reflect the 

names in force in October 2014. 

2

 REGERINGSFORMEN [RF] [CONSTITUTION] 1:1 para. 2. 

3

 For municipalities’ general responsibilities, see KOMMUNALLAG (SFS 1991:900), http://www.riksdagen.se/sv/ 

Dokument-Lagar/Lagar/Svenskforfattningssamling/Kommunallag-1991900_sfs-1991-900/. 

4

 SMITTSKYDDSLAGEN [COMMUNICABLE DISEASES ACT] (Svensk Författningssamling [SFS] 2004:168). 

5

 Ch. 2:2 § KOMMUNALLAGEN. 
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“geographic closeness” (whereby authority is determined by proximity to the crisis).6

 This 

means that Sweden also has a general division of responsibility between national and local 

authorities that is similar in all crisis management situations. 

2. Smittskyddslagen (Communicable Diseases Act) 

The main legislation covering contagious diseases is the Communicable Diseases Act. The 

Communicable Diseases Act classifies diseases into three different categories: (1) contagious 

diseases,7

 (2) diseases dangerous to public health,8 and (3) diseases dangerous to society.9 

Contagious diseases are diseases that can be transferred between individuals and that pose more 

than an insignificant threat to the health of the individual contracting it.10 Diseases dangerous to 

public health are contagious diseases that can be “life-threatening, result in continuous illness or 

difficult suffering or cause other serious consequences where there is a possibility of preventing 

the spread of the disease through measures aimed at the infected individual.”11 Diseases 

dangerous to society are diseases that are dangerous to public health and can spread in society in 

a manner that would create a serious disruption or imminent risk of a serious disruption of 

important public functions, and demand extraordinary measures.12 All diseases classified as 

dangerous to public health or dangerous to society, and some communicable diseases, are subject 

to mandatory contact tracing.13 These diseases are referred to as “diseases that must be reported” 

or “contact tracing diseases,” depending on whether the disease must be traced and reported or 

only traced.14 

The government decides how to classify each illness. Currently diseases dangerous to public 

health include: campylobacteriosis, diphtheria, bird-flu (H5N1), E.coli (EHEC) infection, giardia 

infection, gonorrhea, hepatitis A-E, HIV infection, infection with HTLV I or II, chlamydia, 

cholera, infection with methicillin-resistant staphylococcus aureus (MRSA), anthrax, 

paratyphoid fever, plague, infection with pneumococci with reduced susceptibility to penicillin 

G, polio, rabies, salmonella infection, shigellosis, smallpox, severe acute respiratory syndrome 

(SARS), syphilis, tuberculosis, typhoid fever, and viral hemorrhagic fevers except Dengue fever 

nefropathia epidemica. Diseases dangerous to society include smallpox and SARS,15 and, as of 

 

6 Tre grundprinciper, KRISINFORMATION.SE (Dec. 13, 2012), http://www.krisinformation.se/web/Pages/Page____ 

11261.aspx. 

7

 Ch. 1:3 para. 1 § SMITTSKYDDSLAGEN. 

8 Id. ch. 1:3 para. 2 §. 

9 Id. ch. 1:3 para. 3 § (in Swedish: smittsamma sjukdomar, allmänfarliga sjukdomar, and samhällsfarliga sjukdomar) 

(translation by author). 

10 Id. ch. 1:3 para. 1 § SML. 

11 Id. ch. 1:3 para. 2 § SML (translation by author). 

12 Id. ch. 1:3 para. 3 § SML. 

13 Socialstyrelsens Författningssamling (SOSFS) 2012:2 (M) Föreskrifter, Smittspårningspliktiga sjukdomar 

[Instructions, Communicable Diseases Which Require Tracing], http://www.socialstyrelsen.se/Lists/Artikelkatalog/ 

Attachments/18593/2012-2-7.pdf. 

14 Ch. 1:3 para. 3 § SMITTSKYDDSLAGEN (translation by author). 

15 SMITTSKYDDSLAGEN add. 1. 
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October 23 2014, Ebola.16 Ebola was added to the list by the Swedish government following a 

request from the National Board of Health and Welfare (NBHW).17 These classifications 

determine the lawful measures that the national, municipal, and local representatives may take to 

intervene to stop the spread of the disease and provide treatment.18 

3. International Measures 

Sweden has implemented the World Health Organization’s (WHO’s) 2005 International Health 

Regulations into law.19 The implementing legislation divides responsibility between the 

municipalities, which are responsible for animal protection, the county councils, which are 

responsible for human protection, and the NBHW, which is responsible for coordination.20 All 

diseases dangerous to society that are listed in the Communicable Diseases Act are also 

considered international threats to people’s health. Currently this list includes smallpox, SARS, 

and Ebola.21 The government decides what additional diseases are considered a serious threat to 

society.22 All serious diseases are subject to the Communicable Diseases Act.23 

International public health threats are monitored by the NBHW, and all national and local 

authorities must report any discovered threat to that Board.24 The NBHW must in turn inform 

WHO within twenty-four hours of receiving such reports.25 In addition, the NBHW must 

cooperate with international organizations and foreign governments to combat international 

health threats.26 Information provided to the WHO should be submitted even if it is covered by 

domestic secrecy laws.27 

Compliance with the aforementioned legislation is monitored by the Health and Social Care 

Inspectorate.28 Decisions made relying on the authority of the Act can be appealed to the 

administrative courts.29 

 

16 Press Release, Regeringskansliet, Regeringsbeslut möjliggör fler skyddsåtgärder mot Ebola [Government 

Decision Enables Additional Safety Precautions Against Ebola] (Oct. 23, 2014), http://www.regeringen.se/sb/d/ 

14850/a/248949. 

17 Id. 

18 See Part II(D) & (E), below. 

19 LAG OM SKYDD MOT INTERNATIONELLA HOT MOT MÄNNISKORS HÄLSA [ACT ON PROTECTION AGAINST 

INTERNATIONAL THREATS TO PEOPLE’S HEALTH] (SFS 2006:1570). 

20 Id. 4–5 §§. 

21 Press Release, Regeringskansliet, supra note 16. 

22 2 para. 3 § LAG OM SKYDD MOT INTERNATIONELLA HOT MOT MÄNNISKORS HÄLSA. 

23 Id. 2 para. 2 §. 

24 Id. 10 §. 

25 Id. 11 §. 

26 Id. 9 §. 

27 Id. 12 §. 

28 Id. 26 §. For more information on the Health and Social Care Inspectorate, see About the Health and Social Care 

Inspectorate, IVO, http://www.ivo.se/om-ivo/about-health-and-social-care-inspectorate/Sidor/default.aspx (last 

visited Oct. 31, 2014). 
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4. Preparedness for Extraordinary Events in Times of Peace 

Other legislation related to public health crisis management includes a specific act on how 

municipalities and county councils should prepare for extraordinary events during peace time,30

as well as a regulation on emergency preparation and heightened preparedness.31 Regarding 

extraordinary events, each municipality has a responsibility to implement a Crisis Management 

Committee.32 According to the regulation on Emergency Preparation and Heightened 

Preparedness, county administrative boards have the overall responsibility for their region’s 

preparedness,33 but all agencies have joint responsibility to cooperate with each other.34 Each 

authority is required to continuously monitor the threat level and make adjustments to their 

preparedness levels accordingly.35 The analysis of the threat and weakness level should 

culminate in a “risk and weakness report” that is sent to the government and the Swedish Civil 

Contingencies Agency.36

C. Responsible National and Local Authorities 

1. Responsible National Authorities37

On the national level, public health crisis management is divided between a responsible authority 

that coordinates with national entities, an expert authority that tracks public health threats and 

builds a planned response, and local authorities that monitor and react to public health threats.38

The main national actors in public health crisis management are the Ministry of Health and 

Social Affairs, the National Health and Welfare Agency, the Swedish Civil Contingencies 

Agency and the NBHW. The responsible government department for public health crisis 

management is the Ministry of Health and Social Affairs.39 

 29 32 § LAG OM SKYDD MOT INTERNATIONELLA HOT MOT MÄNNISKORS HÄLSA. 

30 LAG OM KOMMUNERS OCH LANDSTINGS ÅTGÄRDER INFÖR OCH VID EXTRAORDINÄRA HÄNDELSER I FREDSTID OCH 

VID FÖRHÖJD BEREDSKAP [ACT ON MUNICIPALITIES AND COUNTY COUNCILS MEASURES AHEAD OF AND DURING 

EXTRAORDINARY EVENTS DURING PEACE TIME AND TIMES OF HEIGHTENED PREPAREDNESS] (SFS 2006:544). 

31 7 § Förordning om krisberedskap och höjd beredskap [Government Regulation] (SFS 2006:942), 

http://www.notisum.se/rnp/sls/lag/20060942.htm. 

32 Ch. 2:2 § LAG OM KOMMUNERS OCH LANDSTINGS ÅTGÄRDER INFÖR OCH VID EXTRAORDINÄRA HÄNDELSER I 

FREDSTID OCH VID FÖRHÖJD BEREDSKAP. 

33 7 § Förordning om krisberedskap och höjd beredskap. 

34 Id. 5 §. 

35 Id. 9 §. 

36 Id. 9 para. 2 §. 

37 Note that Sweden underwent a change in government in September of 2014 and that the new government may 

make changes to the organization of its government agencies responsible for public crises. No such changes have yet 

been announced, however. 

38 Ch. 1: 7-10 SMITTSKYDDSLAGEN. 

39 Ministry of Health and Social Affairs, REGERINGSKANSLIET, http://www.government.se/sb/d/2061 (last visited 

Oct. 31, 2014). 
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The expert authority on public health crises (infectious diseases) is the National Health and 

Welfare Agency.40 It is responsible for monitoring global and national developments in 

communicable diseases, informing the government and local health care providers of the current 

state of threats, and proposing actions on how to combat these threats.41 The Public Health 

Agency of Sweden is also responsible for all laboratory testing related to the Communicable 

Diseases Act.42

The Swedish Civil Contingencies Agency is responsible for supporting designated agencies with 

measures and information, and for providing information to the public.43 Its primary focus is to 

coordinate efforts and to train personnel in preparedness for national contingencies, as well as to 

develop better routines for this work.44 The Agency is also responsible for medical research on 

how to prevent communicable diseases from spreading.45 

The NBHW acts with authority from the Ministry of Health and Social Affairs and is the national 

coordinating authority on communicable diseases, whereas the National Health and Welfare 

Agency is the expert authority.46 The NBHW or the government may also issue instructions on 

responding to public health crises.47 In September of 2014 the NBHW issued new (nonbinding) 

guidelines for how suspected Ebola cases should be treated.48 In addition the NBHW is 

responsible for reporting pandemic cases to the WHO (IHR).49

On the national level, a special working group, the National Pandemic Group, has been created 

to focus on pandemic threats. The Group consists of the directors for the NBHW, the National 

Health and Welfare Agency, the Swedish Work Environment Authority, the Medical Products 

Agency, and the Swedish Association of Local Authorities and Regions. It meets at the 

discretion of the NBHW.50 

 

40 Ch. 1:7 para. 2 § SMITTSKYDDSLAGEN. 

41 Id. 

42 Id. 

43 Förordning med instruktion för Myndigheten för samhällsskydd och beredskap [Regulation with Instruction for 

the Swedish Civil Contingencies Agency] (SFS 2008:1002), http://www.riksdagen.se/sv/DokumentLagar/Lagar/Svenskforfattningssamling/Forordning-20081002-med-ins_sfs-2008-1002/. 

44 Id. 

45 Forskning för ett säkrare samhälle, MSB, https://www.msb.se/Om-MSB/Forskning/ (last visited Oct. 31, 2014). 

46 Ch. 1:7 § SMITTSKYDDSLAGEN.

47 Id. ch. 2:7 §. 

48 NBHW, Rekommendation för handläggning av misstänkta fall av ebola – reviderad version 2014-09-26 

[Recommendations for the handling of suspected ebola cases – revised Sept. 26, 2014], http://www.socialstyrelsen. 

se/Lists/Artikelkatalog/Attachments/19458/2014-6-7.pdf. 

49 LAG OM SKYDD MOT INTERNATIONELLA HOT MOT MÄNNISKORS HÄLSA (SFS 2006:1570). 

50 Myndigheten för samhällsskydd och beredskap, KRISINFORMATION.SE (Sept. 8, 2011), http://www.kris 

information.se/web/Pages/Page____72962.aspx. 
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2. Responsible Local Authorities: County Councils and County Medical Officers 

On the local level, public health crises are managed by the local health authorities known as the 

county councils,51 which are responsible to the municipality and county administrative board. 

Each county council is overseen by a county medical officer (CMO)52 and is responsible for 

health services in general within its region. Local health care providers and the CMO are the 

points of first contact for most public health crises. Although County Councils are normally only 

responsible for the residents of their own municipality, all County Councils should cooperate 

among themselves during extraordinary events.53 All county councils must provide for the 

necessary precautions against transmission of disease.54. The county councils must also maintain 

a contingency plan. The local power to take forcible measures against individuals to combat a 

public health crisis is vested in the CMO. 

The CMO has primary responsibility for the prevention and containment of communicable 

diseases. He or she must “plan, organize and lead the effort and work for efficiency, 

coordination and consistency.”55 This includes ensuring that local residents have access to 

information on communicable diseases and the response thereto, providing guidelines and 

support, ensuring that preventative steps are taken to prevent diseases from spreading, supporting 

treating physicians, following up on reported illnesses, ensuring that persons who carry a 

communicable disease get the support and care needed, ensuring that measures are taken to 

prevent the spread of disease, and continuously following the local status of communicable 

diseases in the region.56 CMOs are also required to cooperate with CMOs from other regions 

and may transfer cases between themselves.57

D. Specialized Hospitals 

In addition to national and local authorities that follow and monitor potential contagious threats, 

Sweden also prescribes by law that specialized expertise should be vested in individual public 

hospitals designated to accept and treat patients from anywhere in Sweden.58 These specialized 

hospitals are responsible for national expertise in a specific area and are overseen by the NBHW, 

which grants a hospital the privilege of being a national hospital and issues the conditions that it 

needs to follow to maintain that status.59 The Board’s decisions cannot be appealed.60

 

51 Ch. 1: 8 § SMITTSKYDDSLAGEN. 

52 Id. ch. 1:9 §. 

53 2b§ HÄLSO- OCH SJUKVÅRDSLAG (SFS 1982:763). 

54 Ch. 1:8 § SMITTSKYDDSLAGEN. 

55 Id. ch. 6:1 §. 

56 Id. ch. 6:2 §. 

57 Id. ch. 6:6 §, ch. 6:8 §. 

58 9a § HÄLSO- OCH SJUKVÅRDSLAG (SFS 1982:763). For more information, see Rikssjukvård, SOCIALSTYRELSEN, 

http://www.socialstyrelsen.se/rikssjukvard (last visited Oct. 31, 2014). 

59 Id. 9b §. 

60 Id. 
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Linkoping University Hospital (a public hospital) is the specialized hospital on infectious 

diseases with capabilities to care for infectious patients in isolation for a prolonged period of 

time.61 The unit is specifically tailored for high-risk diseases such as Ebola and includes three 

separate “treatment rooms.”62 It also has access to a specialized ambulance as well as airplane 

transportation.63 Patients suffering from infectious diseases are transferred to Linkoping from 

other Swedish hospitals and it must be prepared to transport infected Swedes from anywhere in 

the world.64 

E. Nordic Cooperation 

1. Nordic Public Health Preparedness Agreement 

Sweden cooperates with other Nordic countries on health care.65 The Nordic Public Health 

Preparedness Agreement between the Nordic countries signed in Svolvær on June 14, 2002, 

makes treatment in another Nordic country possible in cases of national crises when Swedish 

resources are strained. Likewise, Sweden has an obligation to help its neighbors in their time of 

need.66 Specifically, the Nordic countries have agreed to “provide assistance to one another 

upon request”;67 “promptly inform of measures planned or implemented that impact the 

cooperation”;68 “promote cooperation and insofar as possible remove obstacles in national 

legislation, regulations, and other rules of law”;69 “provide opportunities for the exchange of 

experience, cooperation, and competence-building”;70 “promote the development of cooperation 

in this area”;71 and “inform one another of relevant changes in the countries’ preparedness 

regulations, including amendments to legislation.”72 The Nordic Public Health Preparedness 

 

61 For information on the operations of the High Risk Unit, see Högisoleringsenheten, LANDSTINGET I 

ÖSTERGÖTLAND (Oct. 14, 2014), http://www.lio.se/Om-landstinget/Vard-i-varldsklass/Hogisoleringsenheten/. 

62 Id. (translation by author). 

63 Linköping i fokus om Sverige får ett ebolafall, LÄKARTIDNINGEN (Aug. 15, 2014), http://www.lakartidningen. 

se/Aktuellt/Nyheter/2014/08/Linkoping-i-fokus-om-Sverige-far-ett-misstankt-ebolafall-/. 

64 LANDSTINGET I ÖSTERGÖTLAND, supra note 61. 

65 Nordic Public Health Preparedness Agreement, available at http://www.nordhels.org/Global/Nordhels/avtal/ 

Nordiskt%20h%C3%A4lsoberedskapsavtal%20-%20engelska.pdf. For example, see information on burn victims at 

Brännskadevård vid katastrofläge, AKADEMISKA SJUKHUSET, http://www.akademiska.se/sv/Verksamheter/ 

Brannskadecentrum/Brannskadevard-vid-katastroflage/ (last visited Oct. 31, 2014). 

66 Nordic Public Health Preparedness Agreement art. 4.1. 

67 Id. art. 4.1. 

68 Id. art. 4.2. 

69 Id. art. 4.3. 

70 Id. art. 4.4. 

71 Id. art. 4.5. 

72 Id. art. 4.6. 
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Agreement supplements the 1989 Nordic Rescue Service Agreement.73 Currently, no patients 

are being treated under the Agreement. 

2. General Nordic Cooperation 

The Nordic countries also cooperate generally in health care.74 During a meeting in Reykjavik in 

2014, fourteen suggestions for deeper cooperation on health care issues were presented.75 

Sweden has general Nordic cooperation with its neighbors through Nordred, a cooperative civil 

protection agency among the Nordic countries.76 Only one infectious patient was treated in 

another Nordic country during the 2005–2007 period.77 

3. Baltic Sea Cooperation 

A special action group against contagious diseases was set up at the Council of the Baltic Sea 

States (CBSS) meeting in Kolding, Denmark in 2000. Epidemic surveillance, HIV/Aids, 

tuberculosis, and antibacterial resistance, as well as primary care, were recognized as the most 

central issues to the region.78 

II. Powers of Public Health Authorities 

A. General 

As mentioned above, national and local authorities share responsibilities and powers to act in the 

face of a public health crisis. The NBHW has the power to seal off and quarantine certain areas 

and require that individual travelers arriving from certain areas be quarantined.79 The CMO is 

responsible for the local response to a public health crisis. As such, the CMO investigates the 

need for mandatory testing of suspected ill individuals;80 petitions the courts for mandatory 

testing of suspected ill individuals;81 issues, amends, and reviews care instructions for proven ill 

individuals;82 and petitions courts for the isolation of infected individuals.83 In urgent situations, 

 

73 Id. art. 3. 

74 See, e.g., Nordic Cooperation Following Dramatic Increase in Tick-borne Infections, UNIVERSITY OF 

GOTHENBURG (Nov. 28, 2012), http://www.sahlgrenska.gu.se/english/news_and_events/news/News_Detail//nordiccooperation-following-dramatic-increase-in-tick-borne-infections.cid1108094. 

75 Fjorton förslag om ökat nordiskt samarbete inom sjukvården, LIFE-TIME.SE (June, 16, 2014), http://www.lifetime.se/2014/06/16/fjorton-forslag-om-okat-nordiskt-samarbete-inom-sjukvarden/. 

76 For additional information see NORDRED, http://www.nordred.org (last visited Oct. 31, 2014). 

77 NORDEN, PATIENT MOBILITY IN THE NORDIC COUNTRIES (June 2011), http://www.nordicinnovation.org/Global/_ 

Publications/Reports/2011/2011_patientMobility_report.pdf. 

78 Prop. 2003/04:30 at 72. 

79 Id. ch. 3:8 para. 2 § and ch. 3:10 §; see also Part II(D)(4), below. 

80 Id. ch. 6:3 §. 

81 Id. ch. 3:2 §. 

82 Id. ch. 4:3 §. 
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the CMO has the power to place a person in temporary isolation provided that the CMO notifies 

the court within four days to review the continued isolation.84 Whereas the NBHW is 

responsible for designating quarantine areas, the County Medical Officer is responsible for the 

quarantine of people who are thought to be carriers of an illness and may demand testing of 

people arriving from abroad.85 The CMO can also demand information on a patient from other 

government and local agents who have come in contact with the patient.86 

B. National Mandatory Notification Systems 

The Communicable Diseases Act requires that certain infectious diseases be reported.87 

Reportable diseases include, for example, chlamydia, HIV, and during the 2009 pandemic the 

A(H1N1) (swine flu) influenza. 

1. Responsibilities of Medical Personnel 

A treating physician who comes into contact with an infected individual is required to report the 

disease to the local CMO as well as to the Public Health Agency of Sweden without delay.88 

The provision also applies to pathologists and laboratory physicians.89 The notification 

should include: 

1. the infected or suspected infected patient’s name, Swedish social security number, or 

government coordination number as well as address; 

2. the likely source of the infection; 

3. the likely spread of the disease; 

4. any and all measures that the physician has taken to prevent the spread of the 

disease; and 

5. other information that will affect the spread of the disease.90 

“Other information” includes whether or not the individual was a blood donor.91

 

 83 Id. ch. 5:2 §. 

84 Id. ch. 5:3 §. 

85 Id. ch. 3:8 para. 1 § and ch. 3:9 §. 

86 Id. ch. 4:9 §. 

87 For full list, see Communicable Diseases Act add. 1 & 2. 

88 Ch. 2:5 § SMITTSKYDDSLAGEN.

89 Id. ch. 2:5 para. 2 §. See also Anmälan av anmälningspliktig sjukdom i vissa fall (Socialstyrelsens föreskrifter 

[SOSF] 2007:1), as amended, http://www.socialstyrelsen.se/sosfs/2007-1 (specifically stating in article 3 that 

A(H1N1) influenza should be reported by treating physicians and a micro-lab technicians, but that pathologists need 

not report the illness). 

90 Ch. 2:6 § SMITTSKYDDSLAGEN. 

91 Marie Jönsson, Comment 25, Comment to Act 2004:168, in 2 KARNOV SVENSK LAGSAMLING MED 

KOMMENTARER at 2690 (Cecila Bergman et al. eds., 16th ed. 2011/2012). 
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2. Mandatory Self-reporting and Information 

A potentially sick person has the obligation to seek medical care to find out whether or not he or 

she is a carrier for a contagious disease covered by Communicable Diseases Act.92 The 

requirement does not include an obligation to undergo treatment for the disease.93 The patient 

must, however, inform the doctor of potential sources of the disease and indicate whether other 

individuals may have been infected.94

3. International 

Captains of ships and airplanes are required to inform Swedish Customs about any potential 

disease on board and Swedish Customs in turn is required to inform the County 

Medical Officer.95 

C. Powers of Disease Control 

Once an illness has been diagnosed the local CMO has the power to put in place certain 

sanctions.96 These sanctions may not go beyond what is required to contain the disease.97 The 

treating physician must, in conjunction with the patient, work out a treatment plan for the 

treatment and containment of the disease.98 If this plan is violated the CMO may intervene.99 

1. Issuing Individual Formal Instructions to Patients 

After a patient has been diagnosed with a contagious disease the treating physician should create 

individualized, formal instructions for the patient to follow to minimize the risk of spreading the 

disease.100 The instructions may only include the following measures: 

1. limits on socialization that pertain to work, education, or participation in other 

activity, 

2. prohibition on donating blood or organs, 

3. prohibition on lending or otherwise transferring used injection devices, 

4. duty to inform caretakers and others, who perform nonmedical procedures on the 

patient, of the disease, 

5. duty to inform sexual partners that he/she is carrying the disease, 

 

92 Ch. 3:1 § SMITTSKYDDSLAGEN. 

93 KARNOV, supra note 91, Comment 27 at 2691. 

94 Ch. 3:4 § SMITTSKYDDSLAGEN. 

95 16 § LAG OM SKYDD MOT INTERNATIONELLA HOT MOT MÄNNISKORS HÄLSA. 

96 See discussion, Part II(C)(2)–(4), infra. 

97 Ch. 1:4 § SMITTSKYDDSLAGEN.

98 Id. ch. 4:2 §. 

99 Id. ch. 5:1 para. 1 item 2 §. 

100 Id. 4:2 §. 
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6. duty, during sexual contacts, to adopt a behavior that minimizes the risk of spreading 

the disease, 

7. duty to practice special hygienic routines, and 

8. duty to keep in regular contact with the treating physician. 

These instructions shall be communicated in writing as soon as possible as well as be 

included in the patient’s health record. The treating physician shall as far as possible 

make sure that these instructions are followed.101

If the formal instructions are not followed the patient may be placed in isolation, if the risk to 

others requires isolation.102 

 

2. Patient Isolation 

Patients carrying a contagious disease may be placed in isolation for up to three months, which 

may be extended by six months at a time.103 During the isolation period the patient has the right 

to one hour of outside time per day as well as telephone calls.104 The patient also has the right to 

visitors, if visits can be conducted safely.105 Isolation can only be ordered if there is a violation 

or risk of violation of the formal instructions or if it is otherwise the only way to contain the 

disease.106 There must be a “considerable risk that others may be infected.”107 The European 

Court of Human Rights has ordered Sweden to pay damages to an HIV patient who was isolated 

for years, stating that there was not sufficient cause to keep him isolated.108

3. Extraordinary Measures 

Testing of individuals for a disease at ports of entry is permissible when a person shows signs of 

illness with a disease that is classified as dangerous to society or when the person is coming from 

a region of the world known to be suffering from certain contagious outbreaks.109 In both cases 

all passengers arriving on the same mode of transportation must undergo testing.110 However, 

such tests may not result in deprivation of liberty, or test-taking or other measures that constitute 

a physical violation.111 

 

101 Id. (translation by author). 

102 Id. ch. 5:1 para. 1 item 2 & ch. 5:1 para. 2 §. 

103 Id. ch. 5:5 §. 

104 Id. ch. 5:9–10 §. 

105 Id. ch. 5:10 §. 

106 Id. ch. 5:1 §. 

107 Id. ch. 5:1 para. 2 §. 

108 Enhorn v. Sweden, App. No. 56529/00 paras. 55–64 (Eur. Ct. H.R. Jan. 25, 2005), http://hudoc.echr.coe.int/ 

sites/eng/pages/search.aspx?i=001-68077; see also discussion, Part II(G)(3), infra. 

109 Ch. 3:8 para. 1 & 2 § SMITTSKYDDSLAGEN. 

110 Id. 

111 Id. ch. 3:8 para. 3 §. 
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Individuals who have potentially been exposed to a communicable disease (but who are not 

showing signs of disease)112 may be quarantined “within a facility or area.”113 Individuals in 

quarantine or isolation are not allowed to leave the country.114 Individuals who harbor a disease 

but are not under isolation or quarantine may leave the country after first notifying the CMO.115

4. Quarantine of Certain Areas, Harbors, and Airports 

Specific areas may be designated as quarantine areas.116 The government, or the agency 

appointed by the government, decides which ports and airports should be deemed “quarantine 

ports.”117 However, the government must work together with the county councils and 

municipalities in this effort.118 While the government ultimately determines the designation as a 

quarantine harbor, the county councils and municipalities are responsible for ensuring that the 

airports and ports in their regions have all the resources they need, as specified by government 

instruction.119 The local CMO is responsible for the care of patients and containment of the 

disease at these harbors.120 Aircraft and vessels may not be turned away but should instead 

relocate to the designated quarantine harbor or airport.121

D. Powers of Disease Prevention 

When the new Communicable Diseases Act was adopted in 2004 its main goal was to emphasize 

preventing the spread of diseases that are transmitted from human to human.122 Disease 

prevention includes vaccination programs as well as educational efforts on how disease is spread. 

1. National Vaccination Program and Seasonal Flu Vaccinations 

Sweden has a comprehensive, voluntary vaccination program for children, which includes 

vaccinations against Polio, MMR, DTap, IPV, HiB, PCV, and HPV,123 and administers free 

seasonal influenza vaccinations for risk groups as well as a general vaccination program for 

swine flu.124 Most Swedes are vaccinated against these diseases.125 The NBHW oversees the 

 

112 Prop. 2003/04:158 Extraordinära smittskyddsåtgärder at 105. 

113 Id. ch. 3:9 §. 

114 Id. ch. 3:12 para. 1–2 §. 

115 Id. ch. 3: 12 para. 3 §. 

116 Ch. 3:10 § SMITTSKYDDSLAGEN. 

117 6 para. 2 § LAG OM SKYDD MOT INTERNATIONELLA HOT MOT MÄNNISKORS HÄLSA. 

118 Id. 6 §. 

119 Id. 7 §. 

120 Id. 8 §. 

121 Id. 18 §. 

122 Comment, Marie Jönsson, in KARNOV, supra note 91, at 2689. 

123 Childhood Vaccination Schedule, EUVACNET, http://www.euvac.net/graphics/euvac/vaccination/sweden.html

(last visited Oct. 31, 2014). 

124 Ch. 2:3 SMITTSKYDDSLAGEN. 
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national vaccination program and makes changes as needed. For a vaccine to qualify for 

placement on the vaccination programs list, it must be “effective, socioeconomically cost 

effective and sustainable from an ethical and humanitarian ground.”126 These vaccinations are 

entered into a “national vaccination database” that tracks the vaccination of Swedish children.127 

The database may be expanded under the supervision and direction of the government to include 

all vaccinations administered in Sweden.128 

The NBHW issues recommendations as to who should get a seasonal flu vaccine and has 

recommended that all pregnant women in their second or third trimester get vaccinated.129 Other 

groups who are recommended to get the seasonal flu vaccines include the elderly and those who 

have underlying conditions, especially respiratory ones.130

2. Mandatory Vaccinations 

Although vaccinations under the national vaccination program and seasonal flu vaccines are not 

mandatory, the government may mandate vaccination during times of war and/or in other 

extraordinary circumstances.131 Failure to comply with such mandated vaccination may result in 

a fine as well as a court-mandated vaccination by force backed by the penalty of a fine, which 

can be reissued.132 Until 1991 the fine was limited by statute to between SEK 5 (US$.68) and 

SEK 50 (US$6.80) (unchanged since its initial adoption in 1952); following 1991 amendments 

the amount of the fine is no longer established by law.133

 

 125 Id. For statistics on how many Swedes are actually vaccinated, see WHO Vaccine-preventable Diseases: 

Monitoring System, 2014 Global Summary, WORLD HEALTH ORGANIZATION, http://apps.who.int/immunization_ 

monitoring/globalsummary/countries?countrycriteria%5Bcountry%5D%5B%5D=SWE (last visited Oct. 31, 2014). 

126 Ch. 2:3d § SMITTSKYDDSLAGEN.

127 Vaccinationsregister, FOLKHÄLSOMYNDIGHETEN (June 27, 2014), http://www.folkhalsomyndigheten.se/ 

amnesomraden/smittskydd-och-sjukdomar/vaccinationer/vaccinationsregister/. 

128 Frågor & svar, SMITTSKYDDSINSTITUTET (now FOLKHÄLSOMYNDIGHETEN), http://www.folkhalsomyndigheten. 

se/documents/smittskydd-sjukdomar/vaccinationer/faq-vaccinationsregistret.pdf?epslanguage=sv (last visited Oct. 

31, 2014). 

129 Gravida kvinnor rekommenderas vaccination mot säsongsinfluensa [Pregnant Women Recommended to Get 

Vaccination Against Seasonal Flu], SOCIALSTYRELSEN, http://www.socialstyrelsen.se/smittskydd/sjukdomar/ 

influensa/gravidakvinnor (last visited Oct. 31, 2014). 

130 Riksgrupper för årlig influensa [Risk Groups for Seasonal Flu], SOCIALSTYRELSEN, http://www.socialstyrelsen. 

se/smittskydd/sjukdomar/influensa/riskgrupper (last visited Oct. 31, 2014). 

131 LAG OM SKYDDSYMPNING VID KRIG ELLER KRIGSFARA M.M. [ACT ON PREVENTATIVE VACCINATION DURING WAR 

OR THREAT OF WAR] (SFS 1952:270); Proposition (Prop.) 2003/04:30 Ny smittskyddslag at 103. 

132 3 § LAG OM SKYDDSYMPNING VID KRIG ELLER KRIGSFARA M.M. 

133 Prop. 1990/91:68 Om ändringar i brottsbalken (böter) m.m. [Regarding Changes in the Criminal Code (fines) 

etc.] [Government Bill], http://www.riksdagen.se/sv/Dokument-Lagar/Forslag/Propositioner-och-skrivelser/omandring-i-brottsbalken-mm_GE0368/ (adopting SFS 1991:271). 
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3. Informational/Educational Material 

The county councils are responsible for producing and disseminating information on contagious 

diseases to the public.134

4. Forcible Screenings and Tests 

A person who is believed to be carrying a communicable disease and opposes testing can be 

forcibly tested but only at the order of a district administrative court.135 Only the CMO may 

petition for the court to issue such an order.136 Following a petition from the CMO the 

administrative court must issue a ruling on forcible testing within a week.137

E. Sanctions for Noncompliance 

Violations of formal instructions138 required by the Communicable Diseases Act are penalized. 

A person who intentionally transfers a disease to another can be punished with up to six years in 

prison.139 The negligent spreading of a disease is punishable with a fine or imprisonment of up 

to one year when the person realizes the danger of the spread and does not take precautions to 

stop it.140 When no transmission of a disease occurs, the risk alone (if known by the perpetrator) 

is punishable as “creation of danger to others” with up to two years imprisonment.141

F. Compensation 

Patients who receive treatment have no separate right to compensation for time spent in isolation, 

etc., but all health care and all medications are free to the patient and not part of the “maximum 

payment protection” limit, under which health care is only free following the expenditure of a 

regulated maximum annual fee that a patient may incur.142 All vaccinations carried out under the 

Communicable Diseases Act are also free of charge to the patient.143 

 

 

134 Ch. 2:3 § SMITTSKYDDSLAGEN. 

135 Id. ch. 3:2 §. 

136 Id. 

137 Id. ch. 8:5 item 1 §. 

138 See discussion, Part II(D)(1), supra. 

139 Ch. 13:7 § BROTTSBALKEN [CRIMINAL CODE] (SFS 1962:700). 

140 Id. ch. 13: 10 §. 

141 Id. ch. 3:9 § BRB; see also NYTT JURIDISKT ARKIV [NJA] [SUPREME COURT REPORTS] 2004 p. 176 B4189-03, 

where the defendant was HIV positive and was indifferent as to the risk of spreading the disease to his 

sexual partners. 

142 Ch. 7:1-2 § SMITTSKYDDSLAG. 

143 Id. ch. 7: 2a § (referencing the national vaccination program). 
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G. Conflicts with Constitutional Rights of Individuals 

Treatments for contagious diseases risk creating a conflict between fundamental human rights 

and health-care measures, as these interventions may limit the patient’s freedoms, including both 

the treatments in themselves and the collection of personal information used to track and prevent 

further spread. 

1. Treatment of Personal Information/Data 

According to the Swedish Personal Information Act, personal information may only be gathered 

and stored when it is necessary in the practice of preventative care, to make a medical diagnosis, 

to care for or treat the patient, or to administer health care.144 The administrator (i.e., the agency 

that keeps the record of personal information) is required to keep personal information as safe as 

possible, considering technology, budget, risks, and the sensitivity of the information.145 When 

the registration of personal information violates the Personal Information Act, the individual 

recorded is entitled to damages.146 Some decisions on the treatment of personal information are 

appealable to the administrative court system.147 

The Swedish government collects data on Swedish patients through the vaccination program and 

also through the sharing of information from the patient’s health record when he or she seeks 

medical treatment. The Act on Public Information and Secrecy prescribes secrecy for such 

health information.148

A person who has contracted a contagious disease is responsible for cooperating in finding the 

source of the disease as well as containing the spread of the disease and informing his or her 

health provider of other potential victims of the disease.149 This information is classified, and 

may not be divulged. However, patient information may be shared, regardless of secrecy, in 

international preventative work.150 Moreover, the CMO may, against the wishes of a contagious 

patient, inform his or her family that he or she is a carrier of a disease in efforts to prevent further 

spread of the disease.151

Individuals have the right to know what personal information about them is stored and may 

submit a request for this information at least once a year.152

 

144 18 § PERSONUPPGIFTSLAGEN [PUL] [PERSONAL INFORMATION ACT] (SFS 1998:204). 

145 31 § PUL. 

146 48 § PUL. 

147 51, 52, 53 §§ PUL. 

148 Ch. 1:6 § (for provisions, see chapter 25) OFFENTLIGHETS- OCH SEKRETESSLAG [ACT ON PUBLIC INFORMATION 

AND SECRECY] (SFS 2009:400). 

149 Ch. 2:2 § and ch. 3:4 § SMITTSKYDDSLAGEN. 

150 LAG OM SKYDD MOT INTERNATIONELLA HOT MOT MÄNNISKORS HÄLSA (SFS 2006:1570). 

151 Ch. 4:8 § SMITTSKYDDSLAG. 

152 26 § PUL. 
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2. Quarantine and Isolation 

Quarantine and isolation are infringements on human rights. Isolation requires prior approval by 

the courts or in cases of emergency speedy review by the courts.153 Because Sweden has signed 

on to the European Convention on Human Rights it is the European Court on Human Rights that 

establishes the case law on infringement of human rights. 

3. Case Law: Right to Freedom (Enhorn v. Sweden) 

Isolation of an individual may result in a violation of the patient’s fundamental rights under 

article 5 of the Convention. In Enhorn v. Sweden, the European Court of Human Rights found 

that placing the plaintiff in isolation was a breach of his right to liberty and security of person, as 

guaranteed in article 5 of the European Convention on Human Rights.154 The case involved an 

HIV-infected man who, after several breaches of conduct that violated the action plan prescribed 

by the local CMO, was placed under forced isolation.155 The European Court of Human Rights 

found that the isolation violated the plaintiff’s human rights because no less invasive method of 

preventing the spread of the disease had been considered.156 

Even before Enhorn, in the legislative history of the 2003 Communicable Diseases Act the 

Swedish government wrote that the forced isolation of an HIV-positive person is less likely to 

conform with human rights because transmission of the disease requires intimate contact. It 

remains unclear whether forced isolation due to a more contagious disease that spreads “by 

casual contact”157 is consistent with human rights as guaranteed by the European Convention on 

Human Rights. 

III. Transparency of Public Health Crisis Management System: Publication and 

Information-sharing Requirements 

A. Dissemination of Information to the Public 

The government has made available an online platform, Krisinformation.se, that serves as a 

central clearinghouse for all crisis information.158 

 

 

153 See ch. 5:2 § and ch. 5:3 § SMITTSKYDDSLAG. 

154 Enhorn v. Sweden, App. No. 56529/00 paras. 55–64 (Eur. Ct. H.R. Jan. 25, 2005), http://hudoc.echr.coe.int/ 

sites/eng/pages/search.aspx?i=001-68077

155 Id. paras. 8–26. 

156 Id. paras. 55–56. 

157 Prop. 2003/04:30 at 75. 

158 Vilket ansvar har landstingen när det gäller beredskapen mot ebola?, KRISINFORMATION.SE (Sept. 2, 2014), 

http://www.krisinformation.se/web/Pages/Faq/ShowFaqWithLeftMenu____75516.aspx?FaqId=0470029& 

LangID=SV. 
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B. Local Contingency Plans 

Each county council is required to have a publicly available local crisis preparedness plan,159 and 

to have an official on duty twenty-four hours a day, seven days a week to respond to a 

potential crisis.160 

C. Transmission of Information 

Sweden has a nationally coordinated communications system called the “VMA system” or the 

“important message to the public system”161 and a specialized radio system to communicate 

heightened preparedness in times of peace. Increased preparedness is communicated by radio 

and television.162 The highest level of preparedness is announced through a preparedness alarm. 

The preparedness alarm is an alarm indicating increased preparedness that is transmitted on 

facilities for outdoor alarms through thirty-second-long signals with a fifteen-second interval 

between the signals, for a total of five minutes.163 

IV. Cooperation with the World Health Organization 

The National Board of Health and Welfare is responsible for cooperation with the World Health 

Organization.164 Sweden also provides support to local initiatives and has provided resources to 

fight the Ebola epidemic in West Africa of SEK 139 million (about US$18.7 million) this year. 

V. Current Crisis/Recent Developments 

Sweden has been spared from recent public health crises. The government-run website 

Krisinformation.se lists events that qualify as recent national crises.165 Most are environmental 

(storms) or animal related (such as salmonella in animal fodder) but there are also some public 

health threats that could have developed into public health crises but did not—specifically the 

swine-flu outbreak in 2009,166 and the bird-flu outbreak in 2006. In addition, the current Ebola 

threat has the potential to develop into a public health crisis. 

 

 

159 See, e.g., Krishanteringsplan, STOCKHOLMS LÄNS LANDSTING (Apr. 7, 2009), http://www.sll.se/Global/Om 

%20landstinget/Krisberedskap/krishanteringsplan-stockholms-lans-landsting.pdf.

160 53 § Förordning med länsstyrelseinstruktion [Instruction for the County Administrative Board] (SFS 2007:825). 

161 VMA – Viktigt meddelande till allmänheten, MSB (Sept. 29, 2009), https://www.msb.se/sv/Insats--

beredskap/Hantera-olyckor--kriser/VMA/. 

162 23 § Förordning om krisberedskap och höjd beredskap. 

163 Id. 24 §. 

164 11 § LAG OM SKYDD MOT INTERNATIONELLA HOT MOT MÄNNISKORS HÄLSA.

165 KRISINFORMATION.SE, http://www.krisinformation.se (last visited Oct. 31, 2014). 

166 As determined by the government-run site Krisinformation.se. Influensa A(H1N1) 2009, även kallad 

svininfluensan, KRISINFORMATION.SE (Aug. 2, 2012), http://www.krisinformation.se/web/Pages/SubStart 

Page____72951.aspx. 
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A. Swine Flu, 2009 

Sweden was first informed of the threat of A(H1N1) (swine flu) in the spring of 2009. Initially, 

vaccination was recommended for risk groups, but this quickly changed after a pregnant woman 

died. When the WHO updated the classification of the A(H1N1) to a pandemic (level six on 

their scale) the pandemic vaccination program automatically came into force, requiring county 

councils to decide how much vaccine they needed.167 A total of eight million doses were ordered 

for the entire country.168 The infections peaked in October of 2009, with vaccinations initiated a 

week later, resulting in 11,000 laboratory-verified cases of A(H1N1) for all of 2009.169 The 

primary prevention focus was on the national vaccination campaign.170 

In its 2011 evaluation report the NBHW and Swedish Contingency Agency noted several 

problems with the swine flu response. First, it found that language barriers proved to be a 

greater obstacle than expected in portions of the population without Swedish as a primary 

language.171 Other problems included difficulties in following the transmission of the disease 

despite classifying the pandemic as a disease that requires a report to a CMO under the 

Communicable Diseases Act.172 Only the Stockholm County Council had a working, automated 

system for keeping track of the disease.173 Smaller county councils were especially hard hit in 

meeting the demands of the increased load of patients.174 Also, determining the distribution 

priorities of the initial doses of vaccine and how the public should be informed of it was 

difficult.175 Reportedly, the NBHW continues to work with how resources should be distributed 

during the next pandemic.176

Another issue noted in the evaluation report was the lack of coordination in the response, as 

emergency information was transmitted. Problems that occurred included certain county 

councils running out of vaccines and antiviral medicine and being unaware of where to order 

more.177 Long-term effects of the pandemic response included an unexpectedly large number of 

children diagnosed with narcolepsy following the use of the vaccine Pandemrix. Intensive care 

saw a steep increase in influenza patients, especially patients suffering from bronchitis and other 

 

167 SOCIALSTYRELSEN, INFLUENSA A(H1N1) 2009: UTVÄRDERING AV FÖRBEREDELSER OCH HANTERING AV 

PANDEMIN 10 (Feb. 2011), http://www.socialstyrelsen.se/Lists/Artikelkatalog/Attachments/18243/2011-3-3.pdf. 

168 Id. 

169 Id. at 10. 

170 Id. at 13. 

171 Id. 

172 Id. 

173 Id. 

174 Id. at 14. 

175 Id. at 17. 

176 Id. at 18. 

177 Id. at 73-75. 
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respiratory problems.178 The World Health Organization provides a graph of current 

influenza statistics.179 

Overall, the evaluation report found the A(H1N1) response was socioeconomically ineffective, 

which it attributed mostly to the delay in distributing vaccinations.180 The report did not take the 

side-effects (predominantly narcolepsy in children and teenagers)181 into account when 

estimating whether the response was efficient. In total, 60% of Sweden’s population was 

vaccinated.182 Thirty-one Swedes reportedly died from the virus.183 

Earlier this year (2014) it was discovered that a mild variant of the swine flu virus (H1N2) had 

been transmitted between some farmers in Sweden and their pigs, the first time this is known to 

have occurred in Sweden.184 

B. Bird Flu, 2006

Sweden was mildly affected by the bird flu virus in 2006.185 A number of birds but no humans 

were infected.186 The outbreak did, however, spur the response and intervention of national and 

local authorities, and its treatment resulted in a short report by the Swedish Contingency 

Agency.187 Coordinated government responses included setting up a public information website, 

Fagelinfluensa.info, and a round-the-clock telephone service for bird-flu related information and 

questions.188 Overall, the response was considered successful.189

 

178 Id. at 12. 

179 Chart, Number of Specimens Positive for Influenza by Subtype – Sweden, WHO (Nov. 12, 2014), 

http://gamapserver.who.int/gareports/Default.aspx?ReportNo=1&CountryCode=SE. 

180 SOCIALSTYRELSEN, supra note 167, at 93. 

181 For an overview in English, see Statement on Narcolepsy and Vaccination, WHO (Apr. 21, 2011), 

http://www.who.int/vaccine_safety/committee/topics/influenza/pandemic/h1n1_safety_assessing/narcolepsy_statem

ent/en/; see also Francesca Poli et al., Narcolepsy as an Adverse Event Following Immunization: Case Definition 

and Guidelines for Data Collection, Analysis and Presentation, ELSEVIER (Dec. 16, 2012), http://www.who.int/ 

vaccine_safety/initiative/BC_Narcolepsy_case_definition.pdf?ua=1. 

182 SOCIALSTYRELSEN, supra note 167, at 64. 

183 Id. at 57. 

184 Swedish Farmers Contracted Swine Flu, THELOCAL.SE (Oct. 22, 2014), http://m.thelocal.se/20141022/swedishfarmers-contracted-swine-flu. 

185 Utbrottet av fågelinfluensa i Sverige 2006, KRISINFORMATION.se (Aug. 2, 2012), http://www.krisinformation. 

se/web/Pages/Page____55168.aspx. 

186 Fågelinfluensa, KRISINFORMATION.SE (July 4, 2011), http://www.krisinformation.se/web/Pages/Page____ 

31992.aspx. 

187 Utbrotten av fågelinfluensa i Sverige 2006, KRISBEREDSKAPSMYNDIGHETEN (now the Swedish Contingencies 

Agency) (Dec. 7, 2006), http://www.krisinformation.se/web/Upload/Krisinformation.se/Handelser/F%c3%a5 

gelinfluensan/utbrotten_av_fagelinfluensa_2006.pdf. 

188 Fågelinfluensa, KRISINFORMATION.se (July 4, 2011), http://www.krisinformation.se/web/Pages/Page____ 

31992.aspx.

189 Id. at 36. 
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C. Current Ebola Threat 

On October 23, 2014, the government declared Ebola a disease dangerous to society.190 Despite 

declaring itself ready to handle an Ebola patient, the NBHW the same evening refused to admit 

an international Ebola patient on grounds that it did not know what was needed of it.191 As of yet 

no Ebola victim has been confirmed in Sweden. 

The country is increasing its spending and preparations for fighting the Ebola virus, currently 

recruiting additional personnel to be sent to Liberia.192 Sweden is allocating equipment and 

funding totaling SEK 489 million (about US$66 million) for 2014 to combat Ebola.193 Extra 

funding is also being provided as earmarks to the NBHW budget to help coordinate the effort 

both locally and abroad.194 Municipalities have raised their preparedness by issuing local 

guidelines for health care workers encountering Ebola patients at local, non-hospital, healthcare facilities.195

The Swedish Armed Forces has reported that it is prepared to fly an Ebola patient from Africa to 

Sweden within twenty-four hours.196 The transport would include a custom-made ambulance 

carried inside a Hercules airplane.197 There is no information on how long it would take to get 

the aircraft from Sweden to Africa. 

D. National Preparedness and Effectiveness of Routines 

A governmental study conducted following the bird flu outbreak resulted in recommendations to 

improve the cooperation between inpatient care, primary care, and municipal care, and to focus 

more heavily on logistical aspects, plans to secure resources, and preparedness within the 

individual communicable diseases units.198 Also, the European Center for Disease Prevention 

and Control’s (ECDC’s) investigation in 2007 found that local preparedness could be 

 

190 Press Release, Regeringskansliet, supra note 16. 

191 Landstinget i Östergötland vägrade ta emot ebolasjuk, CORREN.se (Oct. 24, 2014), http://www.corren.se/nyheter/ 

ostergotland/sverige-ville-inte-varda-ebolasjuk-7455211.aspx. 

192 Utökade Svenska Insatser i Västafrika, SOCIALSTYRELSEN (Oct. 9, 2014), http://www.socialstyrelsen.se/nyheter/ 

2014oktober/utokadesvenskainsatserivastafrika.

193 Ytterligare 400 miljoner till ebolabekämpning och humanitära kriser [Additional SEK 400 Million to the Fight 

Against Ebola and Humanitarian Crisises], REGERINGSKANSLIET (Oct. 24, 2014), http://www.regeringen.se/ 

sb/d/18915/a/248832; Sveriges stöd i kampen mot Ebola [Swedish Support in the Fight Against Ebola], 

REGERINGSKANSLIET (Oct. 23, 2014), http://www.regeringen.se/content/1/c6/24/88/32/94c6596e.pdf. 

194 Sveriges stöd i kampen mot Ebola, supra note 193; Utökade Svenska Insatser i Västafrika, SOCIALSTYRELSEN

(Oct. 9, 2014), http://www.socialstyrelsen.se/nyheter/2014oktober/utokadesvenskainsatserivastafrika. 

195 See, e.g., VÅRDHYGIEN ÖSTERGÖTLAND, EBOLA – LOKALT PM FÖR OMHÄNDERTAGANDE AV MISSTÄNKT EBOLASMITTAD PATIENT (Oct. 21, 2014), http://vardgivarwebb.lio.se/pages/248565/EBOLA.pdf. 

196 Förberedda att flyga ebolapatient, FÖRSVARSMAKTEN (Oct. 9, 2014), http://www.forsvarsmakten.se/ 

sv/aktuellt/2014/10/forberedda-att-flyga-ebolapatient/. 

197 Id. 

198 See SOCIALSTYRELSEN, supra note 167, at 8. 
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improved.199 The level of local preparedness was effectively tested during the 2009 response to 

the potential swine-flu pandemic. The response was investigated and culminated in a report in 

2011 in which the experts found that improvement efforts should continue to focus on 

coordination between national and local authorities.200 

 

199 Id. 

200 See Part V(A), supra. 
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European Union 

Theresa Papademetriou 

Senior Foreign Law Specialist

SUMMARY The European Union (EU) Member States are mainly individually responsible for 

responding to public health and other major emergencies within their borders. The EU’s 

role in the field of public health, as established by the Treaty on the Functioning of the EU, 

is limited to complimenting the national policies of the EU Members, coordinating their 

actions, and facilitating communication and the exchange of data between the European 

Commission and the EU Members. 

The most recent health crises in the EU acted as a catalyst for the Commission to reform 

the 1998 EU legislation. A new decision, Decision No. 1082/2013, expands the type of 

serious health threats with cross-border implications to also include threats of chemical, 

environmental, or unknown origin. Events that may constitute public health emergencies 

of international concern have been added to the list, in compliance with the 2005 revised 

WHO International Health Regulations, to which EU Members are bound. The Health 

Security Committee, which acquired formal status by Decision No. 1082/2013, assists the 

Commission in coordinating public health crises; it also advises the ministers on health of 

the EU Members and coordinates their actions. In implementing Decision No. 1082/2013, 

the EU Members have designated national authorities in charge of epidemiological 

surveillance, alert notification, and taking measures to protect public health. 

 The European Centre for Disease Prevention and Control (ECDC) plays a vital role in the 

surveillance, identification, assessment, and communication of current and/or emerging 

threats to human health. The ECDC has assumed operation of the Epidemiological 

Surveillance Network and the Early Warning and Response System, both of which were 

established in 1998 to enhance the EU’s ability to respond to public health emergencies. 

I. Introduction 

The European Union (EU), due to its specific nature as an area with no internal borders and the 

free circulation of people and goods, faces special challenges in the event of public health crises. 

Primary responsibility for responding to public health emergencies falls within the domain of the 

EU Member States. The EU has legal authority in the field of public health based on article 168 

of the Treaty on the Functioning of the European Union.1

 In general, EU action in the field of 

public health is intended to complement the national policies of the EU Members and to 

coordinate and support their actions. In this regard, the Commission plays a vital role, both in 

coordinating and exchanging information between the EU Member States and in maintaining the 

structures and mechanisms that operate at the EU level to address public health crises.2 In 

 

1

 Consolidated Version of the Treaty on the Functioning of the European Union (TFEU) art. 168, 2012 O.J. (C 326) 

47, http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:12012E/TXT. 

2 Outbreak of Ebola Virus Disease in Western Africa, EUROPEAN COMMISSION, DIRECTORATE-GENERAL FOR 

HEALTH AND CONSUMERS (Oct. 28, 2014; updated Nov. 12, 2014), http://ec.europa.eu/health/ebola/index_en.htm. 
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addition to twenty-eight EU Members, three non-EU Member countries that participate in the EU 

Single Market, Iceland, Lichtenstein, and Norway,3

 also cooperate with the Commission in 

matters involving public health. 

At the EU level, several agencies are engaged in preparedness and response planning to combat 

serious threats to health. The European Centre for Disease Prevention and Control (ECDC),4

which was established in 2005 and was modeled after the US Centers for Disease Control and 

Prevention,5

 plays a pivotal role in the field of communicable diseases and other public health 

crises. Other agencies involved at the EU level include the European Food Safety Authority 

(EFSA),6 the European Medicines Agency (EMEA),7 and the European Environment Agency 

(EEA).8 In addition, the European Commission’s Health Security Committee, which was 

established in the aftermath of the September 11, 2001, terrorist attacks on the US (9/11 attacks), 

acquired formal status by new EU legislation and has been given a specific mandate. The EU 

has also established two committees to assist the Commission when a scientific opinion is 

needed: (a) the Scientific Committee on Emerging and Newly Identified Health Risks, and (b) 

the Scientific Committee on Health and Environmental Risks.9

 

 

3

 The European Economic Area (EEC) agreement, which entered into force in January 1994, permits three of the 

European Free Trade Association (EFTA) countries (Iceland, Norway, and Liechtenstein) to participate in the EU 

single market. European Economic Area, EUROPEAN UNION EXTERNAL ACTION, http://eeas.europa.eu/eea/ 

index_en.htm (last visited Nov. 12, 2014). 

4

 EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL, http://ecdc.europa.eu/ (last visited Nov. 12, 2014). 

5

 The ECDC was established by Regulation (EC) No. 851/2004 of the European Parliament and of the Council of 21 

April 2004 Establishing a European Centre for Disease Prevention and Control, 2004 O.J. (L 142) 1, http://eurlex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:32004R0851:EN:HTML. 

6

 In the aftermath of the food crisis in the 1990s, especially the Bovine Spongiform Encephalopathy (BSE) or “mad 

cow disease” outbreak and dioxin contamination, the EU in 2002 established the EFSA, comprised of European 

experts who provide risk assessment and risk communication on issues involving food safety. See Regulation (EC) 

No. 178/2002 of the European Parliament and of the Council of 28 January 2002, Laying Down the General 

Principles and Requirements of Food Law, Establishing the European Food Safety Authority and Laying Down 

Procedures in Matters of Food Safety, 2002 O.J. (L 31) 1, http://eur-lex.europa.eu/LexUriServ/LexUriServ. 

do?uri=OJ:L:2002:031:0001:0024:EN:PDF. 

7

 The EMEA is based in London, and is responsible for the authorization and marketing of medicinal products for 

human and veterinary use. See About EMEA –Structure, (last visited Nov. 22, 2014) The EMEA was established by 

Regulation (EC) No. 726/2004 of the European Parliament and of the Council of 31 March 2004 Laying Down 

Community Procedures for the Authorisation and Supervision of Medicinal Products for Human and Veterinary Use 

and Establishing a European Medicines Agency, 2004 O.J. (L 136) 1, http://eur-lex.europa.eu/LexUriServ/LexUri 

Serv.do?uri=OJ:L:2004:136:0001:0033:en:PDF.

8

 The EEA began operations in 1994 and assists EU institutions and Member States on environmental issues. 

Council Regulation (EEC) No. 1210/90 of 7 May 1990 on the Establishment of the European Environment Agency 

and the European Environment Information and Observation Network, 1990 O.J. (L 120) 1, http://eur-lex.europa. 

eu/LexUriServ/LexUriServ.do?uri=CELEX:31990R1210:EN:HTML. 

9

 The Scientific Committee on Emerging and Newly Identified Health Risks and the Scientific Committee on Health 

and Environmental Risks were established by Commission Decision 2008/721/EC Setting Up an Advisory Structure 

of Scientific Committees and Experts in the Field of Consumer Safety, Public Health and the Environment and 

Repealing Decision 2004/210/EC, 2008 (L 241) 21, http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri= 

OJ:L:2008:241:0021:0030:EN:PDF. 
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Past experience with public health crises in the EU have clearly demonstrated that such crises 

affect numerous sectors, including health, food safety, environment, transport, and national 

security. Thus, the Commission in 2011 initiated new legislation to address the existing 

deficiencies in tackling health crises.10 A new decision, Decision No. 1082/2013 on Serious 

Cross-Border Threats to Health, expands the list of sources of danger to health to include not 

only communicable diseases but also biological, chemical, and environmental events, or events 

of unknown origin that may pose a risk to EU citizens.11 

At the international level, the Commission is engaged in promoting and improving collaborations 

on global public health issues by participating in the Global Health Security Initiative (GHSI), an 

international partnership launched in 2001 by the Commission, G7 countries (Canada, France, 

Germany, Italy, Japan, the United Kingdom, and the United States), and Mexico.12 Moreover, 

the Commission, the ECDC and other agencies have established solid cooperation with the 

World Health Organization (WHO) through its regional office in Europe (WHO/Europe).13

II. Recent Legislation on Serious Public Health Crises 

Article 2 of Decision No. 1082/2013/EU on Serious Cross-Border Threats to Health, issued in 

2013, recognizes the following categories of serious cross-border threats to health, which may 

trigger public health measures: 

(a) threats of a biological origin, consisting of: 

(i) communicable diseases; 

(ii) antimicrobial resistance and healthcare-associated infections related to 

communicable diseases . . .; 

(iii) biotoxins or the other harmful biological agents not related to communicable 

diseases; 

(b) threats of chemical origin; 

(c) threats of environmental origin; 

(d) threats of unknown origin; 

(e) events which may constitute public health emergencies of international concern 

under the IHR, provided that they fall under one of the categories of threats set out 

in points (a) to (d).14

 

10 Press Release, European Commission, Q&A: Health Security in the EU (Dec. 8, 2011), http://europa.eu/ 

rapid/press-release_MEMO-11-884_en.htm. 

11 Decision No. 1082/2013/EU of the European Parliament and of the Council of 22 October 2013 on Serious Crossborder Threats to Health and Repealing Decision No. 2119/98/EC, 2013 O.J. (L 293) 1, http://eur-lex.europa. 

eu/LexUriServ/LexUriServ.do?uri=OJ:L:2013:293:0001:0015:EN:PDF. 

12 Commission Staff Working Document, Health Security in the European Union and Internationally, SEC (2009) 

1622 final, at 3 (Nov. 23, 2009), http://ec.europa.eu/health/preparedness_response /docs/commission_staff_ 

healthsecurity_en.pdf. 

13 WORLD HEALTH ORGANIZATION/EUROPE, http://www.euro.who.int/en/home (last visited Nov. 21, 2014). 

14 Decision No. 1082/2013/EU, supra note 11, art. 2, para. 1. 
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In exceptional emergency situations, an EU Member State or the Commission may request 

response coordination within the Health Security Committee for serious cross-border threats to 

health other than the ones provided above.15 

Decision No. 1082/2013 introduced the possibility of joint procurement of medical 

countermeasures, such as vaccines, which could be done through a Joint Procurement Agreement 

between the EU institutions and those EU Members who wish to participate.16 

EU Members have the right to maintain or introduce additional measures and procedures to 

tackle serious threats to health due to biological, chemical, environmental, or unknown origin 

within their borders.17 In compliance with Decision No. 1082/2013, EU Members have 

designated the appropriate competent authorities responsible for epidemiological surveillance,for 

alert notifications, and for taking the necessary measures to protect public health in times of 

crisis.18 The Commission has prepared a template for the national authorities to be used to 

provide information on preparedness and response planning regarding cross-border threats 

to health.19

III. Overview of Systems Responsible for Crises Management at the EU Level 

The various health crises that the EU has encountered thus far, such as mad cow disease, the 

SARS and flu epidemics, and the ash cloud caused by the eruption of a volcano in Iceland, have 

demonstrated the need for cross-sector preparedness, monitoring, and response in order to tackle 

such crises effectively. Therefore, beginning in 1998, the EU established the following critical 

organizations and systems with the objective of enhancing its own ability and that of its 

Members to respond to public health emergencies more efficiently. 

A. Epidemiological Surveillance Network 

Decision No. 1082/2013 extended the scope of the network for the epidemiological surveillance 

of communicable diseases that was initially established in 1998 to include all the additional 

sources of threats to public health contained in article 2 (quoted above).20 This network is 

operated and coordinated through the ECDC. The national authorities are required to send all 

authorities connected through the network certain data, including comparable and compatible 

data related to the communicable diseases and other threats to public health contained in article 

 

15 Id. art. 2, para. 4. 

16 Id. art. 5. 

17 Id. art. 2, para. 6. 

18 Id. art. 15, para. 1(a) & (b). 

19 Commission Implementing Decision 2014/504/EU of 25 July 2014 Implementing Decision No. 1082/2013/EU of 

the European Parliament and of the Council with Regard to the Template for Providing the Information on 

Preparedness and Response Planning in Relation to Serious Cross-border Threats to Health (Notified Under 

Document C(2014) 5180) Text with EEA Relevance, 2014 O.J. (L 223) 25, http://eur-lex.europa.eu/legalcontent/EN/TXT/?uri=uriserv:OJ.L_.2014.223.01.0025.01.ENG. 

20 Id. art. 6, para. 1. 
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2; updates on the development of epidemic situations; and information on unusual epidemics or 

new communicable diseases of unknown origin, including those that occur outside the EU.21

B. Early Warning and Response System 

At the EU level, an Early Warning and Response System (EWRS) was established in 1998, to be 

used to notify alerts relating to serious cross-border threats to health.22 Based on this system, the 

Commission and the national authorities are constantly communicating regarding alerts, 

assessing public health risks, and deciding on appropriate measures.23 

Alert notifications are sent either by the Commission or the national authorities to the EWRS 

when a serious cross-border threat is unusual or unexpected for the specific place where it 

originated and has the potential to lead to significant morbidity and mortality in humans (or 

grows larger), affects more than one Member State, and may require a coordinated response at 

the Union level.24

C. European Centre for Disease Prevention and Control 

The ECDC is an independent agency, located in Stockholm, Sweden, whose chief mission is to 

“identify, assess and communicate current and emerging threats to human health from 

communicable diseases.”25 Specifically, the ECDC has the following tasks: 

 Search for, collect, and disseminate scientific and technical data; 

 Provide scientific opinions and scientific and technical assistance; 

 Provide information promptly to the Commission, Member States, and Community agencies 

as well as international organizations involved in public health issues; 

 Coordinate the actions of the EU networks dealing with public health issues together with 

those networks or contact points designated by the national authorities, the so-called 

“dedicated surveillance networks;” and 

 Exchange information and expertise, and facilitate the implementation of joint actions.26

Since it began its functions in 2005, the ECDC has assumed responsibility for the operation of 

the Epidemiological Surveillance Network at the Union level and the EWRS, both of which were 

established in 1998.27 Since ECDC was established, EU Members have been required to forward 

to the ECDC any information sent through the EWRS, provide the ECDC with timely scientific 

 

21 Id. art. 6, para. 3. 

22 Id. art. 8, para. 1. 

23 Id. 

24 Id. art. 9, para. 1(a)–(c). 

25 Regulation (EC) No. 851/2004, supra note 5, art. 3, para. 1. 

26 Id. art. 3, para. 2. 

27 Decision No. 1082/2013, supra note 11, art 17, para. 1. 
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and technical data to enable it to perform its mission, and identify competent bodies and experts 

in public health who could be available to assist the EU in case of disease clusters or outbreaks.28 

D. Health Security Committee

Decision No. 1082/2013 granted formal status to the Health Security Committee (HSC), which 

was first established as an informal forum of discussion of public threats in the aftermath of the 

9/11 attacks.29 The HSC is composed of representatives of the EU Members through their 

designated person and is chaired by a person appointed by the Commission.30 The HSC is tasked 

with (a) supporting the exchange of information between the Commission and the EU Members 

on practices regarding implementation of Decision No. 1082/2013; and (b) coordinating jointly 

with the Commission preparedness and response planning, as put together by the EU Members.31 

IV. Privacy Concerns 

Since public health crises often involve the handling and processing of personal data of 

individuals, EU Members and the Commission are required to comply with EU legislation on the 

protection of privacy and personal data, as provided for in Directive 95/46/EC,32 which has been 

implemented by the EU Members, and Regulation (EC) No. 45/2001 on the Protection of 

Individuals with Regard to the Processing of Personal Data by the Community Institutions and 

Bodies and on the Free Movement of Such Data.33

In compliance with the EU legislation, which requires that personal data must be collected only 

for a specific purpose and must be eliminated afterwards, Decision No. 1082/2013 provides that 

the EWRS system must include a “selective messaging functionality” under which personal data 

of individuals must be communicated only to national competent authorities responsible for 

tracing measures.34 The national authorities will forward such data only to the other EU 

Members that are involved in the contact tracing measures.35 

 

28 Regulation (EC) No. 851/2004, supra note 5, art. 4. 

29 Decision No. 1082/2013, supra note 11, art. 17, para. 1. 

30 Id. art. 17, para. 3. 

31 Id. art. 17, para. 2. 

32 Directive 95/46/EC of the European Parliament and of the Council of 24 October 1995 on the Protection of 

Individuals with Regard to the Processing of Personal Data and on the Free Movement of Such Data, 1995 O.J. 

(L 281) 31, http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:31995L0046:en:HTML. 

33 Regulation (EC) No. 45/2001 of the European Parliament and of the Council of 18 December 2000 on the 

Protection of Individuals with Regard to the Processing of Personal Data by the Community Institutions and Bodies 

and on the Free Movement of Such Data, 2001 O.J. (L 8) 1, http://eur-lex.europa.eu/legal-content/EN/TXT/? 

uri=celex:32001R0045. 

34 Decision No. 1082/2013, supra note 11, art. 16, para. 2. 

35 Id. art. 16, para. 3. 
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Any messages that contain personal data can be kept for twelve months and after that period 

must be automatically erased from the EWRS selective messaging functionality.36 Decision No. 

1082/2013 deems the national competent authorities in charge of preparedness and monitoring 

public health care crises and the Commission as “controllers” as defined by EU legislation on 

privacy. Controllers are either natural or legal persons or public authorities that determine the 

purposes and means for processing personal data.37 Therefore, they are required to take technical 

and organizational measures to protect personal data against unauthorized access, accidental loss, 

or illegal destruction.38

V. WHO International Health Regulations and the EU 

The collaboration of the EU and the World Health Organization (WHO) is based on article 168 

of the Treaty on the Functioning of the EU, which requires the EU and Member States to foster 

cooperation with international organizations competent in the field of public health.39 The 

Commission and the WHO cooperate by exchanging information and sharing experience in 

assessing health risks, strengthening communicable disease surveillance and improving 

responses, and developing tools for health monitoring.40 The ECDC also collaborates closely 

with the WHO.41

In 2005, the WHO revised its International Health Regulations (IHR).42 The IHR, as an 

international legal instrument, is legally binding on all states parties, including the twenty-eight 

EU Members. The revised IHR introduced the concept of public health emergencies of 

international concern in order to cover existing, new, and old diseases, including health crises 

due to noninfectious diseases. It entered into force on June 15, 2007, and requires WHO 

members to implement the regulations gradually by 2016. The EU itself is not a WHO member, 

and therefore is not a party to the IHR. However, article 57(3) of the IHR recognizes the role of 

the EU as a “regional economic integration organization” and states that, “[w]ithout prejudice to 

their obligations under these Regulations, States Parties that are members of a regional economic 

integration organization shall apply in their mutual relations the common rules in force in that 

regional economic integration organization.”43

 

36 Id. art. 16, para. 4. 

37 Directive 95/46/EC, supra note 32, art. 2(d). 

38 Id. art. 16, para. 1. 

39 TFEU, supra note 1, art. 168, para. 3. 

40 In 2001, the European Commission and the WHO signed a Memorandum of Understanding to further develop and 

reinforce their mutual cooperation, and the WHO has also established an office in Brussels. Exchange of Letters 

Between the WHO and the Commission of the European Communities Concerning the Consolidation and 

Intensification of Cooperation – Memorandum Concerning the Framework and Arrangements for Cooperation 

Between the WHO and the Commission of the European Communities, 2001 O.J. (C 001) 7 (Jan. 4, 2001), 

http://eur-lex.europa.eu/smartapi/cgi/sga_doc?smartapi!celexapi!prod!CELEXnumdoc&lg=EN&numdoc=22001 

A0104(01)&model=guichett. 

41 EU in the World, Public Health, WHO, http://ec.europa.eu/health/eu_world/ international_organisations/who/ 

index_en.htm (last visited Oct. 24, 2014). 

42 WHO, International Health Regulations (2d ed. 2005), http://www.who.int/ihr/publications/97892415 96664/en/. 

43 Id. art. 57, para. 3. 
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In a 2006 Communication on the IHR, the Commission articulated the role that the ECDC and 

the EWRS can play in implementing the IHR more effectively and coherently in case of public 

health crises of international concern.44 In general, preparation and planning for health crises at 

the EU level follows the general recommendations of the WHO, adapted to particular situations 

in Europe. If a health emergency, such as pandemic influenza, erupts outside of the EU, the 

WHO is the organization that identifies the level of emergency and preparedness. The European 

Commission also has the authority to recognize a pandemic independently of the WHO, based on 

Decision No. 1082/2013, elaborated above.45 

VI. Ebola Outbreak 

The current Ebola outbreak in West Africa, like the recent polio outbreak in the EU,46 set in 

motion the agencies and networks involved in handling such crises, even though, according to 

EU estimates, the risk of Ebola for EU citizens was low.47 The European Commission is closely 

working with the EU Member States within the Health Security Committee to keep them 

informed about the latest developments and to coordinate approaches on prevention and 

preparation for Ebola. The Commission’s Health and Consumers Directorate-General has been 

closely monitoring the event in cooperation with the ECDC and the WHO since March 2014, 

when news of the outbreak first appeared. The ECDC is producing risk assessments, 

epidemiological updates, and other information. The risk of importation to the EU is considered 

very low, in particular if returning travelers and health care providers are properly informed and 

are aware of the risk.48 Only a few EU health care workers have been infected and have returned 

to the EU for medical care.49

The European Food Safety Agency played an active role in monitoring the Ebola epidemics due 

to reports of a potential link between Ebola virus found in bushmeat, coming from wild animals 

native to African forests, and possible transmission to humans. The EFSA experts concluded 

that the risk from bushmeat consumption and possible infection with Ebola virus is low. 

Meanwhile, however, the EU has prohibited the import of bushmeat into the EU.50 

 

44 Communication from the Commission to the European Parliament and to the Council, on the International Health 

Regulations, COM (2006) 552 final (Sept. 26, 2006), http://ec.europa.eu/health/ph_international/ documents / 

comm_ihr_552_2006_en.pdf. 

45 Decision No. 1082/2003, supra note 11, art. 12. 

46 See ECDC, TECHNICAL REPORT, DETECTION AND CONTROL OF POLIOVIRUS TRANSMISSION IN THE EUROPEAN 

UNION AND EUROPEAN ECONOMIC AREA (Feb. 2014), http://www.ecdc.europa.eu/en/publications/Publications/poliodetection-control-EU.pdf. 

47 Press Release, European Commission, Memo, The EU’s Response to Help Fight the Ebola Outbreak in West 

Africa (Sept. 5, 2014), http://europa.eu/rapid/press-release_MEMO-14-520_en.htm. 

48 Outbreak of Ebola Virus Disease in Western Africa, EUROPEAN COMMISSION, DIRECTORATE-GENERAL FOR 

HEALTH AND CONSUMERS (Oct. 28, 2014; updated Nov. 12, 2014), http://ec.europa.eu/health/ebola/index_en.htm. 

49 Id. 

50 EFSA Assesses the Risk of Transmission of Ebola Through Bushmeat, EUROPEAN FOOD SAFETY AUTHORITY 

(Nov. 4, 2014), http://www.efsa.europa.eu/en/press/news/141104a.htm?utm_source=feed&utm_medium= 

rss&utm_campaign=comb. 
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From the outset of the Ebola crisis, the European Commission has been active with humanitarian 

aid, expertise, and international coordination. In addition, diplomatic outreach is being done via 

the Delegations of the EU and other channels in order to facilitate the humanitarian response in 

the countries concerned and to sensitize governments not to overreact to the crisis with regard to 

travel restrictions, trade impediments, etc. 

As early as March 2014 the European Commission gave €1.9 million (about US$2.4 million) to 

help contain the Ebola epidemics and to ensure immediate health care for the affected 

populations. Since then, the Commission has boosted its humanitarian assistance on two 

occasions, bringing it to a current total of €11.9 million (about US$14.84 million).51 On 

September 5, 2014, the European Commission announced €140 million of funding (about 

US$175 million) for the countries affected by the Ebola virus in West Africa: Guinea, Sierra 

Leone, Liberia, and Nigeria.52

 

51 Press Release, European Commission, supra note 47. 

52 Id. 
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World Health Organization 

Wendy Zeldin 

Senior Legal Research Analyst*

SUMMARY A global approach to addressing health issues and emergencies is provided by the United 

Nation’s World Health Organization (WHO), which was established in 1946. The WHO 

has a Constitution and issues International Health Regulations (IHR). Its membership is 

open to all Members of the United Nations and Associate Members. The WHO’s objective 

is the attainment by all peoples of the highest level of health. 

Following a severe acute respiratory syndrome (SARS) pandemic in 2003, the WHO and 

its Member States updated the WHO mechanisms for preventing and controlling 

pandemics. In 2005, the WHO commenced a Pandemic Preparedness Program that 

requires the Member States to create national preparedness plans. Also in 2005, the World 

Health Assembly agreed on new IHR that create an international pandemic risk 

management system by requiring the Member States to report on an expanded list of 

diseases and public emergencies, to control the entry and exit of travelers and goods, and 

to take other precautionary measures in accordance with WHO recommendations. The 

system was put to the test in the A(H1N1) virus influenza that emerged in Mexico in April 

2009 and quickly reached global dimensions. Since that time, the WHO has instituted the 

Pandemic Influenza Preparedness (PIP) Framework to improve preparedness for and 

response to pandemic influenza and has replaced the 2009 guidance with the 2013 

Pandemic Influenza Risk Management WHO Interim Guidance. 

I. Structure of the World Health Organization 

The World Health Organization (WHO), established on July 22, 1946, is an agency of the United 

Nations (UN) responsible for handling global health issues.1 Any Member State of the UN may 

become a WHO member by accepting its Constitution.2

 Territories may be admitted to the 

WHO as Associate Members if an application is made on their behalf by the Member State or 

 

*

 Most of this report was originally prepared by George E. Glos, former Special Group Leader, July 2003; it was 

supplemented in 2009 by Edith Palmer, former Senior Foreign Law Specialist, and was again updated for the 

purposes of the present report. 

1

 World Health Organization (WHO), Summary Report on Proceedings Minutes and Final Acts of the International 

Health Conference Held in New York from 19 June to 22 July 22 1946, Official Records of the World Health 

Organization No. 2, 9 U.N.T.S. 3 (June 1948), http://apps.who.int/iris/bitstream/10665/85573/1/Official_record2_ 

eng.pdf?ua=1.

2

 CONSTITUTION OF THE WORLD HEALTH ORGANIZATION, http://apps.who.int/gb/bd/PDF/bd47/EN/constitutionen.pdf?ua=1 (last visited Oct. 29, 2014). The Constitution was adopted as one of the Final Acts of the 1946 

International Health Conference; the text is also available in the Summary Report cited above in note 1, supra.
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other authority responsible for the territory’s international relations.3

 At present, there are 194 

Member States of the WHO.4

 

The WHO’s governing organs are the World Health Assembly, the Executive Board, and 

the Secretariat.5

A. World Health Assembly 

The World Health Assembly (WHA), the WHO’s supreme decision-making body, is composed 

of delegates representing the Member States.6 The WHA meets in a regular annual session and 

special sessions, as necessary.7 The WHA is responsible for the WHO’s policy-making 

programs and budget. 

The WHA has the authority to adopt regulations concerning sanitary and quarantine 

requirements and other procedures designed to prevent the international spread of disease; 

nomenclatures for disease, causes of death, and public health practices; standards for 

international diagnostic procedures; standards for the safety, purity, and potency of biological, 

pharmaceutical, and similar products moving in international commerce; and the advertising and 

labeling of biological, pharmaceutical, and similar products moving in international commerce.8

 

Regulations come into force for all Members after due notice of their adoption has been given, 

except for such Members that have notified the Director-General of their rejection or 

reservations within the period stated in the notice.9

The WHA also has the authority to make recommendations to Members on any matter within the 

competence of the WHO.10

B. Executive Board 

The Executive Board is the executive organ of the WHA.11 It is composed of thirty-four health 

experts designated by, but not representing, their governments.12 The Executive Board forwards 

 

3 Countries, WHO, http://www.who.int/countries/en/ (last visited Oct. 30, 2014).

4 Id. 

5

 For additional information, see About WHO, http://www.who.int/about/en (last visited Oct. 28, 2014), and 

Governance, WHO, http:www.who.int/governance/en (last visited Oct. 28, 2014). See also World Health 

Organization Organigram (Sept. 25, 2014), http://www.who.int/about/structure/WHO_organigram_ 

25092014.pdf?ua=1.

6

 WHO CONSTITUTION art. 10.

7 Id. art. 13.

8 Id. art. 21.

9 Id. art. 22.

10 Id. art. 23.

11 Id. art. 28.

12 Id. art. 24.
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recommendations on the Director-General’s programs to the WHA,13 advises on questions 

referred to it by the WHA, and implements the WHA’s decisions and policies. It is also 

empowered to take emergency measures in case of epidemics or disasters.14

C. Secretariat 

The Secretariat comprises the Director-General and roughly eight thousand other technical and 

administrative staff.15 The Director-General appoints the staff of the Secretariat,16 and prepares 

and submits to the Executive Board the financial statements and budget estimates of 

the organization.17 

D. Regional Offices 

The WHO has six geographical regions: Africa, the Americas, Eastern Mediterranean, Europe, 

Southeast Asia, and Western Pacific.18 Each has its own organization consisting of a regional 

committee representing the Member States and Associate Members in the region concerned, and 

a regional office staffed by experts in various fields of health.19

II. WHO Departments 

The WHO departments most directly concerned with responding to health emergencies, 

including infectious disease epidemics or pandemics, are described below. 

The Health Security and Environment (HSE) Department works within the WHO and with 

partners and countries to strengthen national and global capacities necessary for detecting, being 

prepared for, preventing, and responding to health security risks and emergencies; to enhance 

national and global readiness for health security emergencies; and “to provide global leadership 

and guidance when major infectious disease outbreaks and other health security emergencies 

occur.”20 The HSE’s strategic priorities for 2014–2017 include mounting an effective response 

to any major new epidemic, pandemic, or food-related health security risk; attaining the core 

capacities set forth in the International Health Regulations (IHR) by all countries; developing “a 

global strategic plan for antimicrobial drug resistance with clearly defined roles for all major 

sectors and WHO and implementing the key roles for WHO”; implementing the Codex 

Alimentarius and the Pandemic Influenza Preparedness (PIP) Framework; and adopting “a

 

13 Id. arts. 26 & 28.

14 Id. art. 28; see also WHO, Rules of Procedure of the Executive Board of the World Health Organization as at 

April 2014, http://www.who.int/governance/EB_rules_of_procedure_rev2014-en.pdf?ua=1.

15 WHO CONSTITUTION art. 30; Governance, supra note 5.

16 WHO CONSTITUTION art. 35.

17 Id. art. 34.

18 Regional Offices, WHO, http://www.who.int/about/structure/en/ (last visited Oct. 30, 2014).

19 WHO CONSTITUTION arts. 45–47.

20 Health Security (HSE), WHO, http://www.who.int/about/structure/organigram/hse/en/ (last visited Nov. 5, 2014).
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significantly stronger and more effective approach for global surveillance for major pandemic 

and epidemic infectious disease.”21 

The HIV/AIDS, TB, Malaria and Neglected Tropical Diseases (HTM) Department “helps 

countries to prevent, reduce and mitigate the health impact of these diseases, which are a major 

factor affecting development.” 22 The department’s objectives are “to develop norms, standards 

and policies to foster new solutions” for prevention of “these high-burden diseases”; to assemble 

the requisite expertise to combat the diseases; “to develop innovative frameworks for public 

health action against these diseases” and provide support for strengthening the health system; 

and to encourage leaders and civil society to promote “increased and sustained investment in 

countering these diseases.”23

The Health Systems and Innovation (HSI) Department covers the areas of essential medicines 

and health products; health statistics and information systems (HSIS); health systems governance 

and financing; health workforce; knowledge, ethics and research; service delivery and safety; 

and the WHO Centre for Health Development, Kobe.24 One example of the activities covered by 

the essential medicines and health products section was promoting an agreement during the ninth 

African Vaccine Regulatory Forum (November 3–7, 2014) on a collaborative mechanism to fasttrack approvals for clinical trials and registration of potential Ebola therapies and vaccines.25 

The mechanism is to cover the following: 

 Clear pathways and timelines for expedited ethical and regulatory review of clinical 

trial applications and approval of products; 

 Agreement on timelines and joint safety and efficacy assessments of the new 

products to fast-track national registration; 

 Endorsement of a panel of safety experts for expedited review of safety data of new 

products with relevant communication to National Regulatory Authorities . . . ; 

 Technical assistance from the [WHO] to facilitate these processes.26

The Polio and Emergencies (PEC) Department has among its objectives the worldwide 

eradication of polio; the coordination and implementation of health responses to humanitarian 

emergencies and disasters; and the strengthening of the WHO’s work “in and with countries, 

with a special emphasis on fragile states and situations.”27 The department, which is in charge of 

the WHO’s technical assistance to countries, has “the main Organization-wide elements of the 

 

21 Id.

22 HIV/AIDS, TB, Malaria and Neglected Tropical Diseases (HTM), WHO, http://www.who.int/about/structure/ 

organigram/htm/en/ (last visited Nov. 5, 2014).

23 Id.

24 WHO Headquarters Structure, WHO, http://www.who.int/about/structure/organigram/en/ (last updated 

Sept. 25, 2014).

25 Essential Medicines and Health Products: African Regulators’ Meeting Looking to Expedite Approval of Vaccines 

and Therapies for Ebola, WHO, http://www.who.int/medicines/news/AFR_reg_meet/en/ (last visited Nov. 5, 2014). 

26 Id.

27 Polio and Emergencies (PEC), WHO, http://www.who.int/about/structure/organigram/pec/en/ (last visited 

Nov. 5, 2014).
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WHO country support function, that aim at tailoring WHO country collaboration to the needs 

and capacities of all its Member States.”28 The PEC/POL leads the Global Polio Eradication 

Initiative, a public-private partnership that has reduced the incidence of polio by 99% over the 

last two decades.29 

The PEC also handles the humanitarian aspects of emergency preparedness and response by 

coordinating activities “to reduce the health impact of emergencies by leading the development 

of global strategies, identifying best practices, providing evidence to inform global policies, 

analyzing health trends, and providing technical guidance.”30 In addition, during health 

emergencies, the PEC is responsible for coordinating the health actors and mobilizing the 

capacities of WHO and its partners “to ensure the surge to country level of expert staff, logistics, 

finances, and medicines/supplies for emergency response.”31

III. Areas of Priority 

The WHO has six main priorities for providing leadership. These include universal health 

coverage; health-related Millennium Development Goals; noncommunicable diseases, such as 

cancer, heart disease, and mental health disorders; social, economic, and environmental 

determinants; access to medical products; and the International Health Regulations (2005).32

IV. International Health Regulations (2005) 

The International Health Regulations (2005) (IHR),33 which the 194 WHO Member States have 

agreed to implement, were adopted by the WHA under the authority of the WHO Constitution, 

which gives the WHA the power to adopt regulations “designed to prevent the international 

spread of disease,” and that thereupon “enter into force for all WHO Member States that do not 

affirmatively opt out of them within a specified time period.”34

The IHR are a binding instrument of law developed in response to the exponential “growth in 

international travel and trade, and the emergence or re-emergence of international disease threats 

 

28 Id.

29 Id.

30 Id.

31 Id.

32 Leadership Priorities, WHO (undated), http://www.who.int/about/resources_planning/WHO_GPW12_ 

leadership_priorities.pdf?ua=1 (last visited Oct. 29, 2014); Danielle Renwick & Toni Johnson, The World Health 

Organization (WHO), COUNCIL ON FOREIGN RELATIONS, http://www.cfr.org/public-health-threats-andpandemics/world-health-organization-/p20003 (last updated Oct. 7, 2014). 

33 WHO, International Health Regulations of 1969, amended in 1973 and 1981, http://whqlibdoc.who.int/ 

publications/1983/9241580070.pdf?ua=1; WHO, International Health Regulations (2d ed. 2005) (in force on June 

15, 2007), http://www.who.int/ihr/publications/9789241596664/en/; see also Alert, Response, and Capacity 

Building Under the International Health Regulations (IHR), WHO, http://www.who.int/ csr/ihr/current/en/ (last 

visited Oct. 15, 2014). 

34 WHO, Foreword to International Health Regulations (2005), supra note 33, at 1; see also WHO CONSTITUTION

arts. 21(a) & 22.
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and other health risks. . . .”35 Accordingly, the IHR’s stated purpose and scope are “to prevent, 

protect against, control and provide a public health response to the international spread of disease 

in ways that are commensurate with and restricted to public health risks, and which avoid 

unnecessary interference with international traffic and trade.”36 The IHR require states to 

enhance their core surveillance of and response capacities to disease threats at all levels—

primary, intermediate, and national, and also at designated international ports, airports, and 

ground crossings. In addition, they provide for a series of health documents, such as ship 

sanitation certificates and an international certificate of vaccination or prophylaxis for travelers.37

V. Monitoring and Alert Systems 

The WHO has a monitoring and response system for influenza that, since the adoption of the PIP 

Framework in May 2011 (described in Part VI(A), below) has been called the Global Influenza 

Surveillance and Response System (GISRS). (This system was formerly known as the Global 

Influenza Surveillance Network (GISN), which dates back to 1952.)38 The system operates 

through a network of National Influenza Centres, “national institutions designated by national 

Ministries of Health and recognized by WHO.”39 The GISRS keeps track of the evolution of 

influenza viruses and offers recommendations on such matters as “laboratory diagnostics, 

vaccines, antiviral susceptibility and risk assessment,” and “also serves as a global alert 

mechanism for the emergence of influenza viruses with pandemic potential.”40

In 1997, the WHO established an Outbreak Verification System to gather information, verify 

reports of, and track infectious disease outbreaks.41 In addition, the WHO regularly distributes to 

certain public health officials and scientists an Outbreak Verification List as a means of 

following up on reports of various outbreaks of disease.42 

In 2000, the WHO established the Global Outbreak Alert and Response Network (GOARN), 

which is a network of surveillance systems that “includes a number of formal and informal 

 

35 International Health Regulations (2d ed. 2005), supra note 33.

36 Id.

37 Id.

38 Global Influenza Surveillance and Response System (GISRS), WHO, http://www.who.int/influenza/ 

gisrs_laboratory/en/ (last visited Oct. 29, 2014); THE GLOBAL INFORMATION SURVEILLANCE NETWORK, WHO 

(undated), available at http://www.paho.org/hq/images/stories/AD/HSD/CD/INFLUENZA/gisn.pdf (last visited 

Oct. 29, 2014). 

39 National Influenza Centres, WHO, http://www.who.int/influenza/gisrs_laboratory/national_ influenza_centres/en/

(last visited Oct. 29, 2014).

40 GLOBAL INFLUENZA SURVEILLANCE AND RESPONSE SYSTEM (GISRS), supra note 38.

41 Thomas W. Grein et al., Rumors of Disease in the Global Village: Outbreak Verification 6:2 EMERGING 

INFECTIOUS DISEASES 97, 97 (Mar. –Apr. 2000), http://wwwnc.cdc.gov/eid/article/6/2/pdfs/00-0201.pdf. 

42 Stephen S. Morse, Global Infectious Disease Surveillance and Early Warning Systems: ProMED and ProMEDmail, in GLOBAL INFECTIOUS DISEASE SURVEILLANCE AND DETECTION: ASSESSING THE CHALLENGES—FINDING 

SOLUTIONS, WORKSHOP SUMMARY (Stanley M. Lemon et al. eds., 2007), available at http://www.ncbi.nlm.nih.gov/ 

books/NBK52873/#ch2.s2 (scroll down page to view). 
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sources.”43 The WHO gathers this raw intelligence and converts it into “meaningful 

intelligence,” using six main criteria “to determine whether a reported disease event constitutes a 

cause for international concern.”44 Information on incoming reports and rumors, their 

epidemiological significance, and decisions on the actions needed are stored in an electronic 

event management system. The system “records key information, decisions and actions by 

WHO and its partners.”45 The Global Alert and Response Team includes “WHO Country 

Offices, WHO sub-Regional Response Teams, WHO Regional Offices, the Alert and Response 

Operations Centre team in Geneva and disease specialists.”46 The Team responds to “incoming 

reports of suspected outbreaks, reports of unknown disease, outbreaks undergoing verification 

and outbreaks at various stages of containment.”47 

The Department of Pandemic and Epidemic Diseases is responsible for developing “strategies, 

initiatives, and mechanisms to address priority emerging and re-emerging epidemic diseases, 

thereby reducing their impact on affected populations and limiting their international spread.”48

VI. Outbreaks and Responses 

A. Pandemic Influenza Preparedness Plan 

At the Fifty-sixth Annual Meeting of the World Health Assembly in Geneva on May 28, 2003, 

the WHO adopted two resolutions concerning SARS and infectious diseases control. Member 

states were urged to take action to enhance, support, and strengthen national, regional, and 

international efforts to address the SARS outbreak. The Director-General was requested to take 

measures falling within the infectious diseases group and take into account reports from sources 

other than official notification; to alert the international community to the presence of a public 

threat that may constitute a serious threat to neighboring countries or to international health; and 

to collaborate with national authorities in assessing the severity of the threat and the adequacy of 

control measures, and, when necessary, in conducting on-the-spot studies by a WHO team, with 

the purpose of ensuring that appropriate control measures were being employed. 

The first global conference on SARS, held June 18–19, 2003, in Kuala Lumpur, Malaysia, was 

convened by the WHO to provide technical guidance for the ongoing and long-term response to 

SARS. At the time, an adequate point-of-care diagnostic test was still not available for SARS 

and remained a top priority.49 Even now, although research is being done to develop laboratory 

 

43 Id. 

44 Event Verification, WHO, http://www.who.int/csr/alertresponse/verification/en/ (last visited Oct. 28, 2014). The 

criteria listed on the webpage are unknown disease, potential for spread beyond national borders, serious health 

impact or unexpectedly high rates of illness or death, potential for interference with international travel or trade, 

strength of national capacity to contain the outbreak, and suspected accidental or deliberate release.

45 Id.

46 Id.

47 Id.

48 Pandemic and Epidemic Diseases, WHO, http://www.who.int/csr/disease/en/ (last visited Oct. 28, 2014). 

49 WHO Global Conference on Severe Acute Respiratory Syndrome (SARS): Where Do We Go from Here?, Kuala 

Lumpur, Malaysia, 17–18 June 2003, http://www.who.int/csr/sars/conference/june_2003/materials/report/en/. 
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tests to improve diagnostic tests for SARS and other respiratory pathogens, “no specific clinical 

or laboratory findings can distinguish with certainty SARS-CoV disease from other respiratory 

illnesses rapidly enough to inform management decisions that must be made soon after the 

patient presents to the healthcare system,” and so early clinical recognition of the disease “still 

relies on a combination of clinical and epidemiologic features.”50

Following the pandemic outbreak of SARS in 2003, the WHO member states deliberated on how 

to prevent and control new pandemics. In 2005, the WHO commenced a Pandemic Influenza 

Preparedness Plan that required the Member States to devise a national pandemic plan and 

submit it to the WHO. This plan was last revised in 200951 and contains the WHO phases of 

pandemic alert.52 They progress from level 1, characterized by animal infections and only a few 

human infections, to levels 5 and 6, characterized by widespread human infection that, in level 6, 

reaches global proportions.53 The system was put to the test in the A(H1N1) influenza virus that 

emerged in Mexico in April 2009 and quickly reached global dimensions.54 

On May 24, 2011, the WHA adopted the Pandemic Influenza Preparedness (PIP) Framework.55 

The stated objective of the PIP Framework is 

to improve pandemic influenza preparedness and response, and strengthen the protection 

against the pandemic influenza by improving and strengthening the WHO global 

influenza surveillance and response system (“WHO GISRS”), with the objective of a fair, 

transparent, equitable, efficient, effective system for, on an equal footing: 

(i) the sharing of H5N1 and other influenza viruses with human pandemic 

potential; and 

(ii) access to vaccines and sharing of other benefits.56

 

50 Clinical Guidance on the Identification and Evaluation of Possible SARS-CoV Disease among Persons Presenting 

with Community-Acquired Illness (Version 2) (last updated July 7, 2012), http://www.cdc.gov/sars/clinical/ 

guidance.html; see also James McIntosh, What Is SARS? What Are the Symptoms of SARS?, MEDICAL NEWS TODAY

(last updated Sept. 10, 2014), http://www.medicalnewstoday.com/articles/ 7543.php. For further information on 

SARS, see Severe Acute Respiratory Syndrome (SARS), WHO, http://www.who.int/topics/sars/en/ (last visited 

Oct. 28, 2014).

51 The current version of this plan is published in WHO, PANDEMIC INFLUENZA PREPAREDNESS AND RESPONSE: A

WHO GUIDANCE DOCUMENT (Apr. 2009), http://whqlibdoc.who.int/publications/2009/9789241547680_ 

eng.pdf?ua=1. 

52 Id. For the role of the U.S. government in developing the pandemic phases, see J. Montero, Why is Pandemic 

Influenza Different?, 48 NEW HAMPSHIRE BAR JOURNAL 54 (2007), available at http://www.lexis.com

(by subscription). 

53 PANDEMIC INFLUENZA PREPAREDNESS AND RESPONSE: A WHO GUIDANCE DOCUMENT, supra note 51, at 29. 

54 E. Eduardo Castillo, As Swine Flu Spreads, Who Should Get Tamiflu?, ASSOCIATED PRESS (May 12, 2009), 

available at http://www.utsandiego.com/news/2009/may/12/med-swine-flu-051209/. 

55 WHO, PANDEMIC INFLUENZA PREPAREDNESS FRAMEWORK FOR THE SHARING OF INFLUENZA VIRUSES AND 

ACCESS TO VACCINES AND OTHER BENEFITS (May 24, 2011), http://whqlibdoc.who.int/publications/2011/ 

9789241503082_eng.pdf?ua=1. 

56 Id. at 6.
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The PIP Framework applies to influenza viruses with human pandemic potential, such as H5N1; 

it does not apply to seasonal flu viruses, noninfluenza pathogens, or other biological material that 

may be contained in clinical specimens shared under the Framework.57

In 2013, the Pandemic Influenza Risk Management WHO Interim Guidance replaced the 2009 

Pandemic Influenza Preparedness and Response guidance document.58 Key features of the new 

guidance include the following: 

 Focus upon risk assessment at national level to guide national level actions 

 Revised approach to global phases 

 Flexibility through uncoupling of national actions from global phases 

 Inclusion of principles of emergency risk management for health 

 New and updated annexes on planning assumptions, ethical considerations, whole-ofsociety approach, business continuity planning, representative parameters for core 

severity indicators, and containment measures.59

As a result of lessons learned from the influenza A(H1N1) 2009 pandemic, the 2013 Guidance 

revises WHO’s approach to global phases of pandemic events.60 The phases include the 

interpandemic phase (the period between influenza pandemics); the alert phase (when influenza 

caused by a new subtype has been identified in humans); the pandemic phase (the period of 

global spread); and the transition phase (the de-escalation phase).61 These global phases are to 

be used to describe a new influenza subtype’s spread, “taking account of the disease it causes, 

around the world,” and are “clearly uncoupled from risk management decisions and actions at 

the country level.”62 

The Guidance points out that “[t]he global phases and their application in risk management are 

distinct from (1) the determination of a PHEIC [Public Health Emergency of International 

Concern] under the IHR (2005) and (2) the declaration of a pandemic.”63 The WHO DirectorGeneral is responsible for determining a PHEIC, under article 12 of the IHR; that determination 

leads to the communication of temporary recommendations.64 The Director-General may also 

declare a pandemic “during the period of spread of human influenza caused by a new subtype, 

and appropriate to the situation.”65

 

57 Id. at 7.

58 PANDEMIC INFLUENZA RISK MANAGEMENT: WHO INTERIM GUIDANCE (June 10, 2013), http://www.who.int/ 

influenza/preparedness/pandemic/influenza_risk_management/en/.

59 Id.

60 Id. at 2.

61 Id. at 7.

62 Id. at 2.

63 Id. at 7.

64 Id.

65 Id.
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The Guidance is based on “all-hazards emergency risk management for health” (ERMH) 

principles, “thereby aligning pandemic risk management with the strategic approach adopted by 

WHO, in accordance with World Health Assembly resolution 64.10,” to strengthen national 

health emergency and disaster management capabilities.66 The Resolution, among other 

measures, urges Member States to (1) strengthen health emergency and disaster riskmanagement programs as part of their national and subnational health systems, supported by 

related legislation and its effective enforcement; (2) integrate such programs (including disaster 

risk reduction) into national or subnational health plans and “institutionalize capacities for 

coordinated health and multisectoral action to assess risks, proactively reduce risks, and prepare 

for, respond to, and recover from, emergencies, disasters and other crises; and (3) develop 

programs “on safe and prepared hospitals that ensure: that new hospitals and health facilities are 

located and built safely so as to withstand local hazards; that the safety of existing facilities is 

assessed and remedial action is taken; and that all health facilities are prepared to respond to 

internal and external emergencies.”67

B. Recent Developments and Concerns 

In 2013, humans were found for the first time to have been infected with the avian influenza 

A(H7N9) virus. Since providing the first notification of such an infection in late March 2013, 

China has been reporting to the WHO on cases of subsequent human infection with the virus.68 

The virus is a subgroup of H7 viruses, normally found among birds. Previous reports of human 

infections with other H7 subgroups (H7N2, H7N3, and H7N7) have come from Australia, 

Canada, Italy, Mexico, the Netherlands, the United Kingdom, and the United States.69 

On October 22, 2014, the WHO Emergency Committee, convened by the WHO DirectorGeneral under the IHR, held its third meeting on the Ebola virus disease outbreak in West Africa, 

in advance of the three-month date of expiration of temporary recommendations the WHO had 

issued on August 8, 2014, and their extension on September 22.70 The meeting was held because 

of the increase in the number of cases in Guinea, Liberia, and Sierra Leone, and the incidence of 

new cases in Spain and the United States.71 As of the date of the meeting, the number of total 

cases stood at 9,936, with 4,877 deaths, and “[c]ases continue to increase exponentially in 

 

66 Id. at 3. A PHEIC is defined under the IHR as “an extraordinary event which is determined, as provided in these 

Regulations: (i) to constitute a public health risk to other States through the international spread of disease and (ii) to 

potentially require a coordinated international response.” IHR art. 1(1). Article 12 of the IHR pertains to 

determining PHEICs. 

67 Strengthening National Health Emergency and Disaster Management Capacities and Resilience of Health 

Systems, WHA64.10 (May 24, 2011), at 2–3, http://apps.who.int/gb/ebwha/pdf_files/WHA64/A64_R10-en.pdf. 

68 WHO, BACKGROUND AND SUMMARY OF HUMAN INFECTION WITH AVIAN INFLUENZA A(H7N9) VIRUS – AS OF 31

JANUARY 2014, at 1, http://www.who.int/influenza/human_animal_interface/20140131_background_and_summary_ 

H7N9_v1.pdf?ua=1. 

69 Id.

70 Press Release, WHO, Statement on the 3rd Meeting of the IHR Emergency Committee Regarding the 2014 Ebola 

Outbreak in West Africa (Oct. 23, 2014), http://www.who.int/mediacentre/news/statements/2014/ebola-3rd-ihrmeeting/en/. 

71 Id.
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Guinea, Liberia, and Sierra Leone” with the situation in these countries remaining to be “of great 

concern.”72 According to the statement, “[t]he key lessons learned to control the outbreak 

include the importance of leadership, community engagement, bringing in more partners, paying 

staff on time, and accountability. WHO, UN partners, and the international community have 

scaled up their support in these three countries.”73 At the same time, the Committee noted that 

the Ebola outbreaks in Nigeria and Senegal had been declared over as of October 20 and 

17, respectively. 

On October 23, 2014, the WHO convened a meeting of high-ranking government representatives 

from countries affected by the Ebola virus along with representatives from their development 

partners, civil society, regulatory agencies, vaccine manufacturers, and funding agencies “to 

discuss and agree on how to fast-track testing and deployment of vaccines in sufficient numbers 

to impact the Ebola epidemic.”74 The government representatives included officials from the 

ministries of health and of foreign affairs from Canada, China, the European Union, France, 

Germany, Guinea, Italy, Japan, Liberia, Mali, Nigeria, Norway, the Russian Federation, Sierra 

Leone, Switzerland, the United Kingdom, and the United States.75 The meeting reached 

consensus on a number of key commitments—namely, (1) results from phase 1 clinical trials of 

most advanced vaccines are expected to be available in December 2014, and efficacy trials are to 

begin in the affected countries during this timeframe; (2) pharmaceutical companies developing 

the vaccines will increase production capacity so that millions of doses will be available in 2015, 

and regulatory authorities in the countries where the vaccines are manufactured and in Africa 

will support this goal by working under very short deadlines; and (3) community engagement 

“should be scaled up urgently in partnership between local communities, national governments, 

NGOs and international organizations.”76 

At the same time, The New York Times reported that “WHO has been badly weakened by budget 

cuts in recent years, hobbling its ability to respond in parts of the world that need it most. Its 

outbreak and emergency response units have been slashed, veterans who led previous fights 

against Ebola and other diseases have left, and scores of positions have been eliminated. . . .”77 

The unit specializing in pandemic and epidemic diseases now “has only 52 regular employees,” 

although the number can be increased during outbreaks, and the WHO’s regional emergency 

outbreak experts, who were experienced in fighting Ebola, “were cut from more than a dozen to 

three.”78 Moreover, a separate WHO section that handles emergency response “was whittled ‘to 

the bone’ during the budget cuts—to 34 staff members from about 94.”79 As a result, Dr. 

 

72 Id.

73 Id.

74 Press Release, WHO, WHO Convenes Industry Leaders and Key Partners to Discuss Trials and Production of 

Ebola Vaccine (Oct. 24, 2014), http://www.who.int/mediacentre/news/releases/2014/ebola-vaccines-production/en/. 

75 Id.

76 Id.

77 Sheri Fink, Cuts at WHO Hurt Response to Ebola Crisis, NY TIMES (Sept. 3, 2014), http://www.nytimes.com/ 

2014/09/04/world/africa/cuts-at-who-hurt-response-to-ebola-crisis.html?_r=1. 

78 Id.

79 Id.
Legal Responses to Health Emergencies: World Health Organization 

The Law Library of Congress 261

Margaret Chan, the WHO Director-General stated that “[t]he W.H.O. simply did not have the 

staffing or ability to flood the Ebola zone with help.”80

 

80 Id.
The Law Library of Congress 262

Bibliography 

Constance A. Johnson 

Senior Legal Research Analyst

This bibliography contains selected, recent English-language materials on public health law, with 

an emphasis on responses to international health crises.

* * * * * * * 

Benatar, Solomon R. Global Health, Vulnerable Populations, and Law. 41 JOURNAL OF LAW,

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Bennet, B. & T. Carney. Trade, Travel and Disease: The Role of Law in Pandemic 

Preparedness. 5 ASIAN JOURNAL OF WTO AND INTERNATIONAL HEALTH LAW AND POLICY. pp. 

201–329. 2010. Available through Hein Online: 

http://www.heinonline.org/HOL/TitleSummary?index=journals/aihlp&collection=journals

Bishop, D. Lessons from SARS: Why the WHO Must Provide Greater Economic Incentives for 

Countries to Comply with International Health Regulations. 36 GEORGETOWN JOURNAL OF 

INTERNATIONAL LAW. pp. 1173–1226. 2004–2005. K12.A92 

http://lccn.loc.gov/2004250066

Cenevska, I. Protection of the Health of Workers and the General Public under the Euratom 

Treaty and the EU Environmental Policy: The Ratio Between Human Health Protection and 

Environmental Protection. 21 EUROPEAN ENERGY AND ENVIRONMENTAL LAW REVIEW. pp. 

176–87. 2012. KJC6242.A13 E97 

http://lccn.loc.gov/93648172

Cuéllar, Mariano-Florentino. Coalitions, Autonomy, and Regulatory Bargains in Public Health 

Law. In Daniel Carpenter & David A. Moss, eds. PREVENTING REGULATORY CAPTURE: SPECIAL 

INTEREST INFLUENCE AND HOW TO LIMIT IT. pp. 326–64. New York: Cambridge University 

Press, 2014. HD3616.U63P74 2014 OVERFLOWA5S 

http://lccn.loc.gov/2013008596

Note: Includes discussion of public health surveillance, among other issues. 

 
Legal Responses to Health Emergencies: Bibliography 

The Law Library of Congress 263

de La Rosa, Stephane. The Directive on Cross-Border Healthcare of the Art of Codifying Case 

Law. 49 COMMON MARKET LAW REVIEW. pp. 15–46. 2012. K3.O3835 

http://lccn.loc.gov/97660535

deLisle, Jacques. Atypical Pneumonia and Ambivalent Law and Politics: SARS and the 

Response to SARS in China. 77 TEMPLE LAW REVIEW. pp. 193–245. Summer 2004. 

K24.E44 

http://lccn.loc.gov/88647435

Fidler, David. P. Navigating the Global Health Terrain: Mapping Global Health Diplomacy. 6 

ASIAN JOURNAL OF WTO AND INTERNATIONAL HEALTH LAW AND POLICY. pp. 1–45. 2011. 

Available through Hein Online: 

http://www.heinonline.org/HOL/TitleSummary?index=journals/aihlp&collection=journals

Fidler, David P. Constitutional Outlines of Public Health’s “New World Order.” 77 TEMPLE 

LAW REVIEW. pp. 247–89. Summer 2004. K24.E44 

http://lccn.loc.gov/88647435

Flood, Colleen M. & Anthea Williams. A Tale of Toronto: National and International Lessons 

in Public Health Governance from the SARS Crisis. 12 MICHIGAN STATE JOURNAL OF 

INTERNATIONAL LAW. pp. 229–46. 2004. K10.O86915 

http://lccn.loc.gov/2004250073

Freeman, Michael, Sarah Hawkes & Belinda Bennett, eds. LAW AND GLOBAL HEALTH:

CURRENT LEGAL ISSUES. 639 pp. Oxford, UK: Oxford University Press, 2014. 

 K3569.8.L39 2014 

http://lccn.loc.gov/2013957466

Gerwin, L. E. The Challenge of Providing the Public with Actionable Information During a 

Pandemic. 40 JOURNAL OF LAW, MEDICINE, AND ETHICS. pp. 630–54. Fall 2012. 

 KF3821.A15L38 

http://lccn.loc.gov/93657473

Jacobs, Lesley A. Rights and Quarantine During the SARS Global Health Crisis: Differentiated 

Legal Consciousness in Hong Kong, Shanghai, and Toronto. 41 LAW AND SOCIETY REVIEW. pp. 

511–47. Sept. 2007. K12.A865 

http://lccn.loc.gov/87647377

Kassim, Puteri Nemie Jahn. Medical Confidentiality Against Disclosure in the Public Interest: 

Should Such Protective Privileges End When Public Peril Begins? 1 MALAYAN LAW JOURNAL. 

pp. xxxv–xliii. 2006. KPG19.A2 M35 

http://lccn.loc.gov/34013138
Legal Responses to Health Emergencies: Bibliography 

The Law Library of Congress 264

Klein, A. Criminal Law, Public Health, and Governance of HIV Exposure and Transmission. 

13 INTERNATIONAL JOURNAL OF HUMAN RIGHTS. pp. 251–78. 2009. JC571.I593 

http://lccn.loc.gov/97652903

MORAG, NADAV. COMPARATIVE HOMELAND SECURITY: GLOBAL LESSONS. 388 pp. Hoboken: 

NJ: John Wiley & Sons, 2011. UA10.5.M67 2011 

http://lccn.loc.gov/2010050398

Note: See chapter 9, “Public Health Strategies and Institutions,” pp. 335–58. Briefly 

discusses Australia, Canada, the European Union, France, Germany, Israel, and the 

United Kingdom. 

Murray, C. Implementing the New International Health Regulations: The Role of the WTOs 

Sanitary and Phytosanitary Agreement. 40 GEORGETOWN JOURNAL OF INTERNATIONAL LAW. 

pp. 625–53. 2008–2009. K12.A92 

http://lccn.loc.gov/2004250066

Naiki, Y. Accountability and Legitimacy in Global Health and Safety Governance: The World 

Trade Organization, the SPS Committee, and International Standard-Setting Organizations. 43 

JOURNAL OF WORLD TRADE. pp. 1255–79. 2009. K10.O9 

http://lccn.loc.gov/88648171

O’Leary, N. Pieter M. Bioterrorism or Avian Influenza: California, the Model State Emergency 

Health Powers Act, and Protecting Civil Liberties During a Public Health Emergency. 42 

CALIFORNIA WESTERN LAW REVIEW. pp. 249–64. Spring 2006. K3.A438 

http://lccn.loc.gov/65009948

O’Leary, N. Pieter M. Cock-A-Doodle-Doo: Pandemic Avian Influenza and the Legal 

Preparation and Consequences of an H5N1 Influenza Outbreak. 16 HEALTH MATRIX: JOURNAL 

OF LAW-MEDICINE. pp. 511–51. 2006. K8 .E17 

 http://lccn.loc.gov/93650369

Onzivu, William. Globalism, Regionalism, or Both: Health Policy and Regional Economic 

Integration in Developing Countries, an Evolution of a Legal Regime? 15 MINNESOTA JOURNAL 

OF INTERNATIONAL LAW. pp. 111–87. Winter 2006. K13.I5475 

http://lccn.loc.gov/2006245251

Roehrs, S. Privacy, HIV/AIDS, and Public Health Interventions. 126 SOUTH AFRICAN LAW 

JOURNAL. pp. 360–97. 2009. K23.O7 

http://lccn.loc.gov/19018370

 
Legal Responses to Health Emergencies: Bibliography 

The Law Library of Congress 265

ROWITZ, LOUIS. PUBLIC HEALTH FOR THE 21ST CENTURY: THE PREPARED LEADER. 521 pp. 

Sudbury, MA: Jones & Bartlett Learning, 2006. RA445.R78 2006 

http://lccn.loc.gov/2005008298

ROWITZ, LOUIS. PUBLIC HEALTH LEADERSHIP: PUTTING PRINCIPLES INTO PRACTICE. 738 pp. 

Burlington, MA: Jones & Bartlett Learning, 2014. RA427.R69 2014 

http://lccn.loc.gov/2012033832

Schloenhardt, Andreas. From Black Death to Bird Flu: Infectious Diseases and Immigration 

Restrictions in Asia. 12 NEW ENGLAND JOURNAL OF INTERNATIONAL AND COMPARATIVE LAW. 

pp. 263–94. Spring 2006. K14.E76 

http://lccn.loc.gov/2003235348