This report contains discussions of the regulations addressing health emergencies in 25 jurisdictions, including countries from six continents, the European Union, and the World Health Organization. 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.
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Legal Responses to Health Emergencies
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.
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.
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 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.
Emergency measure 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.
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. 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.
Egyptian law regulates the powers of public health authorities in Egypt in the event of an infectious disease outbreak and 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.
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. 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.
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. 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.
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. 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. 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.
India’s Central Government and state governments are empowered to regulate health-related matters. The Epidemic Diseases 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 district, thus, responsibility for directly addressing the crisis rests with the deputy commissioner at the district level.
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’s powers include the authority to order quarantine and decontamination of property. In responding to intentional contamination, the Home Front Command (HFC) of the Israeli Defense Forces is charged with making the first response.
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.
InThe Japanese government has implemented a health crisis management system in addition to Japan’s general 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. 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.
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 in to the country. However, in order for action under this authority to remain in place for an extended period of time, they need legislative approval.
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.
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.
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 1926 Quarantine Act gives the president and the country’s health authorities broad powers to deal with public health crises.
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.
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.
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.
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.
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 coordinate network of agencies and institutions to address public health crises. 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.
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 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.
World Health Organization:
A global approach to addressing health issues and emergencies is provided by the United Nation’s World Health Organization (WHO). 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. 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.
Last Updated: 06/09/2015