In past pandemic planning scenarios, we war game what would happen if the president and VP are both unable to fulfill their constitutional duties due to an infectious disease.

The Presidency, the Agencies, and Congress all have clear processes (set out below) but...
(1/5)
⏹️Presidency⏹️

Presidential Succession Act (1947) sets out order:
1⃣Vice President (M. Pence)
2⃣Speaker of the House (N. Pelosi)
3⃣Speaker pro tempore (C. Grassley)

Then Cabinet members on dept creation order starting with4⃣State (M. Pompeo)5⃣Treasury (S. Mnuchin)

(2/5)
⏹️Congress⏹️
Senate: filled by appointment
House: filled by election (rules set by states)

Quorum is necessary for many activities: in light of 9/11, in 2003, 1st Continuity of Congress Report called for a Constitutional amendment to allow for temporary elections:
(3/5)
The 2nd Continuity of Congress report noted that there is a risk of confusion in the line of succession if there is not clarity over who is able to take up the position. I disagree with its proposed revised order (removing Congress).

(4/5)
Report:
brookings.edu/wp-content/upl…
While these reports were drafted in consideration of a physical attack, the impacts of a lack of transparency over current health states may contribute to lack of clarity & confusion. The timing with an election adds extra national security vulnerability in the space between.
END

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More from @alexandraphelan

13 Aug
Today, @nytimes has examined the CDC's data for excess mortality ("deaths above normal") over the pandemic.

Since March, at least 200,000 more Americans have died than usual.

That's ~60,000 more deaths than officially directly linked to #COVID19.

1/3
nytimes.com/interactive/20…
You can see the pattern of excess deaths match the movement of the pandemic across the US.

This suggests that official death counts may be substantially underestimating overall effects of #covid19: inc. deaths from SARS-CoV-2 & other causes linked to the pandemic.

2/3
Accurate counts during epidemics are challenging: mortality from past pandemics (eg 1918 & 2009 flu) have been recalculated afterwards.

But this shows how critical accurate data reporting systems are & why Trump Admin's decisions on data are so worrying:
wsj.com/articles/covid…
Read 4 tweets
11 Jun
Last night, US District Court ruled that police in Portland, Oregon are limited in using tear gas against protestors because, inter alia, the risk of irreparable harm given the #covid19 pandemic.

1. A thread on this decision & reflection on evidence between science & law.
2. The Plaintiffs claimed use of tear gas violates:
– Fourth Amendment (as excessive force as an unreasonable search and seizure) &
– First Amendment (chilling political speech)

For a restraining order, Ps had to show that irreparable injury is likely w/o injunction.
3. The Court made this finding after asking parties to provide further evidence on "the science of tear gas" and Covid19.
kptv.com/news/suit-to-s…
Read 13 tweets
29 May
Legally, can President Trump withdraw the US from membership of the WHO?

– The WHO Constitution is a treaty.
– Membership of WHO requires signing the WHO Constitution & completing state domestic ratification processes (art 4).
– US has ratified the treaty.
(1/3)
*From WHO side*
WHO Constitution does not set out an express withdrawal process. This is not unusual and it is generally accepted that States are free to withdraw from international treaties & institutions (principle of state sovereignty, enshrined in Vienna Convention)
(2/3)
*US side*
Legally it's murky if the President can withdraw. While Exec has power to sign treaties, ratification follows advice & consent of Senate.
– Some argue Exec thus retains power to exit treaties
– Others argue it requires Congress consent:
(3/3)
yalelawjournal.org/forum/presiden…
Read 6 tweets
22 Apr
Australia has called for legal amendments to give the @WHO power to investigate outbreaks similar to UN weapons inspectors.

1. How would this be done legally? What are the implications? I haven't done a thread in a while, so here we go.

smh.com.au/politics/feder…
2. When States revised the International Health Regulations after SARS in 2005 they sought to balance sovereignty w public health but there was a "subtle but undeniable dilution of sovereign control" @Gianlucaburci, w WHO able to investigate reports from other states/ngos/media.
3. Another example of this sovereignty dilution: if a State doesn't accept WHO's offer to assist with investigating reports of an outbreak they may have, WHO may share the report with other States if it poses a public health risk (art 10).
Read 9 tweets
13 Mar
The drum beat of my doctorate & work in international law & infectious disease has been: laws & norms, laws & norms.

Over last 4 years we've seen:
- Int'l level: int'l health laws ignored & norms weakened.
- National: chronic underfunding & dismissal of evidence-base.

(1/4)
2 years ago, I gave a talk @SydneyLawSchool @SydneyHealthLaw @USSC on this issue: rise of populism and impacts on global health (link below). I looked at how Australia & the US were underprepared for the next pandemic.

In the last line I said:

soundcloud.com/sydneylawschoo…
(2/4)
Last year, we launched the International Law Impact & Infectious Disease Consortium at @georgetown_ghss out of our concerns about the weakening of international laws and its impact on global health pandemic preparedness (but we need funding). (3/4)

ghss.georgetown.edu/iliaid/
Read 4 tweets
2 Mar
CDC Rule (2017) expressly addressed this, w HHS/CDC the "payer of final resort" (despite comments that this would be unethical).

Under §70.13 @CDCDirector can authorize payment for care & treatment, although it's secondary to any state, local, or private insurance obligations.
@CDCDirector The law provides for this, and it's unethical for the US government to require individuals subjected to mandatory care & treatment to pay for it.

This also risks undermining the #Covid19 public health response: without #UHC #Medicare4All people will understandably avoid care.
The @CDCDirector’s discretion is subject to availability of appropriations. This underscores the considerations for federal emergency funding: Congress cld specifically provide add’l funds for such costs & at the same time: the #covid19 health care costs of all Americans. #M4A
Read 5 tweets

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