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Georgetown's Gostin on Zika, Other Public Health Threats: U.S. Needs Comprehensive Plan

By Tracy Schorn

June 28, 2016

zika, mosquito

The World Health Organization estimates that between three million to four million people in the Americas will be infected with the Zika virus in the next year. Presently, there is no vaccine or treatment for Zika, a mosquito-borne disease that also can be passed along by sexual contact. The majority of those infected are asymptomatic; however, the virus can cause paralysis and blindness and has been linked to microcephaly, a serious birth defect. The risks to pregnant women have been well publicized.

In February the Obama administration requested Congress to set aside $1.9 billion to fight Zika. On June 23 the House of Representatives passed a $1.1 billion Zika funding bill that was sharply rejected by Democrats as the amount will partially be offset by cuts to other health programs. Opponents also criticized a provision to restrict government financing of Planned Parenthood. The White House has threatened to veto the Republican-backed spending package.

After passing the bill, the House went into sudden recess until July 5, and left Zika funding in the lurch just at a time when public health officials say a coordinated response to the virus is essential.

The D.C. Bar recently spoke with Georgetown University Law Center global health law professor Lawrence O. Gostin about the government response to Zika and the legal issues that arise when dealing with public health crises. Gostin is University Professor at Georgetown, the university's highest academic rank, and directs the law school's O'Neill Institute for National and Global Health Law.

D.C. Bar: What are your thoughts about the recent budget impasse in Congress over Zika funding?

Lawrence Gostin, Georgetown University Law Center global health law professorGostin: Zika is a public health emergency, spreading rapidly throughout the Americas and the Caribbean. It is only a matter of time before there is local transmission in the United States with the summer upon us.

Congress's most solemn duty is to safeguard the population from health threats. Yet Congress waited for months, leaving the Centers for Disease Control and Prevention, the National Institutes of Health, and the states with precious little funding for mosquito control, testing, and vaccine research.

Instead, Congress's Zika appropriation was far less than the president requested, stole funding from other vital public health services to fund Zika [response], and laced the bill with poisonous pills such as restricting funding for Planned Parenthood and other birth control measures. Zika is a public health crisis, but it is also a moral crisis because the virus affects newborns and the poorest women are at the greatest risk. Playing politics with an infectious disease that strikes infants and the poor is shameful.

D.C. Bar: What are the employment law issues surrounding Zika exposure? Can an employee refuse to come to work or travel for work to avoid exposure? Could working in mosquito-infested areas be a workplace hazard?

Gostin: I could foresee that working in an area of high risk would be a workplace hazard. For example, if there were a major mosquito-borne outbreak of Zika, we wouldn't expect women of child-bearing age to come to work in a factory or office that was not air conditioned or did not have proper screens and mosquito control.

D.C. Bar: Is there any overarching plan as to how the federal government, states, and local governments would react and interact during an infectious disease crisis? What are the legal challenges to responding to Zika?

Gostin: Sadly there are no coherent contingency plans. The United States seems to lurch from one disease crisis to the next, from SARS and influenza to Ebola and Zika.

The nation needs a plan that is well funded. I urge the federal government to develop a comprehensive plan for dealing with public health emergencies. This plan should have clear responsibilities for different levels of government—federal, state, and local—to avoid confusion stemming from federalism. There should also be a contingency emergency fund so that Congress doesn't have to appropriate funding in the middle of a crisis. That would avoid the politics. And politics should never get in the way of the public health.

The legal challenges are first and foremost to avoid panic and overreaction by elected officials. During Ebola, several states instituted quarantines and impeded travel by health workers to West Africa. Public health actions that are grounded not on science but on irrational fears are almost always unlawful. The other legal challenge is to ensure that state public health powers are current and up to date. At the moment they are highly antiquated.