Will History Absolve the Policymakers? (The H1N1 Fog of War)

Western democracies have laws about when and how the government can declare emergencies to suspend civil liberties. They grant special powers to the government to act expeditiously to remedy devastation caused by natural disasters, to effectively mobilize in times of war or to protect the public in cases of serious pandemics. These decisions restrict the individual rights of citizens in order to protect the public as a whole. In countries with authoritarian and totalitarian systems of government these types of decisions are more easily made because public criticism of the government is not allowed. Furthermore, the baseline expectation of freedom and liberty by the citizens which exists in constitutional democracies either is non existent or exists at a very low threshold in totalitarian countries. In the 1980s Cuba's response to the AIDS was to test everyone and quarantine those who tested positive for HIV. This link to a New York Times editorial from 1989 begs the question, do the ends justify the means? Link Most policy decisions do not take place in this high stakes arena and in western democracies are usually the end result of a process following the rational model, the incremental model or any of their variations. Jreisat, Jamil E. (2002)

When a pandemic shows up on a country's doorstep policy decisions have to be made quickly in a framework where the facts are not fully crystallized. For guidance on how to respond effectively policymakers can look to the history of their own countries or of other countries to find out how similar pandemics were managed and what the outcome was. On the other hand, each society is unique and even within one country what may have been and effective way to respond to a pandemic ten years ago may not be applicable now because of cultural and other changes within the society. Making the right decision could potentially save millions of lives and the policy makers could be lauded by the press and the citizens. An effective response could be studied after the fact, by academics and other policymakers as an example of effective public administration . On the other hand, in democratic societies, if police powers are invoked and the pandemic turns out to be more benign than anticipated, then policymakers and their decisions will be the subject of ex post facto review. They may have to answer to commissions of inquiry, there may be lawsuits and sometimes criminal investigations.

In the case of the H1N1 virus the responses of various governments say volumes about the role of government and public administration and the cultural milieu in those societies. In the United States the Supreme Court has upheld the right of the legislature to enact reasonable regulation to protect the public health and the public safety; Jacobson v Massachusetts 197 U.S. 11 (1905). Justice Harlan wrote "a community has the right to protect itself against an epidemic of disease which threatens the safety of its members." So far the response of the US has been cautious at the federal level while at the local level there have been school closures on a case by case basis.

In contrast, the Chinese government recently quarantined tourists in Hong Kong and placed some Canadian students under preventative medical surveillance. A report in the China Daily titled Expert: China's Quarantine of virus suspects in Line with Law justifies the actions of the Chinese government.
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China has reason to be cautious given the recent SARS out break. It is too early to say conclusively but the fatality rate of the H1N1 virus appears to be lower than anticipated. The jury is still out on H1N1 even as the New York Times reports that we have our second fatality in New York City link. There is a big difference between contemplating the closure of schools as opposed to quarantining large swaths of the population. In an open society as ours, how far will public health authorities go if the death toll is higher? In countries where individual rights are not that highly regarded governments use what we may deem a much lower threshold for deciding to use measures such as quarantine. A pandemic has the potential for becoming the next post WW1 influenza outbreak or it may turn out to be very contagious but mostly non fatal. Policy makers at the outset do not know which category the current virus is in. Any decision made will have far reaching consequences, they will need to use judgment, intuition, and creativity in deciding on an effective policy. Jreisat, Jamil E. (2002).


Submitted by Tamara