Public health and civil liberties

The opinion pieces that constitute this month’s ‘Talking Point’ address the old conflict between the enforcement of public health measures and the inevitable infringements of individual rights and liberties that are the result. The task of the ‘neutral commentator’ is made difficult by the fact that the authors are not particularly at odds with each other. George Annas argues that compulsory enforcement of public health measures is both an infringement of individual rights and is ineffective or even counter-productive; Ronald Bayer believes that the inevitable conflict between public health measures and human rights must be acknowledged and dealt with according to the situation. The neutral commentator’s role is hindered further by the fact that, as a scientist and advisor to the German government, I believe that there are indeed situations when compulsory measures are the only reasonable option—but these must be the last resort when all voluntary measures fail. Annas blames politicians and public health officials for fostering a climate of fear about health threats. Certainly the extreme measures to prevent perceived—but in reality slight or even non-existent—dangers can be highly counter-productive except to the individual who gains the desired public exposure. In the USA, these ‘threats’ are primarily about terrorism, and the related fears that thrive in the post-9/11 society. Europe has had similar disproportionate reactions to perceived threats, such as mad cow disease, but more often public health officials have had to calm feelings of hysteria and fear among the public whipped up by an uninformed and often unscrupulous press. They have to walk a thin—and often uncertain— line between relieving public fear by giving fact-based advice and ensuring that steps are taken to minimize any actual threat. Annas draws a parallel between the knee-jerk reactions of the US government in the wake of the terrorist attacks of September 11—that is, hastily introduced laws allowing government agencies to circumvent standards of human rights—and the reaction to a possible pandemic, whether it originates from terrorism or nature. In many ways, this is a fair analogy: there is little doubt that the ‘one percent doctrine’ he describes is all too pervasive among both the US and European governments, and that politicians fear being held responsible for a lack of preparedness following a disaster, natural or otherwise. However, the draconian measures introduced in the wake of September 11 were directed at those suspected—no matter how slight—of terrorism. It is not clear whether innocent victims of a future pandemic would be treated in the same harsh manner. Although he rightly condemns fearmongering, Annas’s refutation of the claims about the potential deaths resulting from a deliberate release of anthrax or botulinum toxin—he points out that the few cases in which such bioweapons were used resulted in a negligible death toll—does not hold up. The failure of these amateurish attempts does not negate the potential damage from a well-planned and executed attack using these agents; most microbiologists will confirm that the potential threat is quite real.