New in @Health_Affairs: “Public Health Emergency Reform Is Coming—These Six Principles Should Guide It.” Thread 👇
In a legislative session in which some on the far right are seeking to strip executive emergency powers, I’ve crafted a balanced approach to reforming #PublicHealth statutes in light of concerns about overreach without unduly hindering swift responses & nimble adjustments.
Even if you feel public health orders went too far in 2020, there are other infectious disease threats on the horizon that could pose different (e.g., disproportionately killing/injuring children) &/or greater risks (e.g., w/ higher transmissibility or mortality).
Stripping public health powers to spite current governors/health officers is a dangerous game. Laws enacted this year could hobble emergency responses for decades to come.
In a legislative session in which some are seeking to strip executive emergency powers, I’ve crafted a balanced approach to reforming public health statutes in light of concerns about overreach without unduly hindering swift responses and nimble adjustments.
I propose six principles aimed at clarifying, not eliminating, public health emergency powers:
1. Transparency is key. Disclosure requirements should be mandated by statute. Official orders should be required by law to include info about their specific purpose, the current scientific understanding they're based on & how it could evolve & criteria for lifting/adjusting.
2. Time limits are good, but should be renewable by officials as needed. The default should never be inaction. Waiting for the legislature to take the reins hasn't worked well in 2020. If the legislature wants to overturn, they should be able to do so *if* they have the votes.
3. A scaled response dialed up/down is key. If governors R stuck w/ all-or-nothing b/c new statutes say they can't draw distinctions b/w different settings based on different risks, public health & balance will suffer. But the legislature should decide in advance what's essential
4. Neutral orders based on risk & best available "scientific understanding" ("evidence" may be too high a bar in early days) R the gold standard. Legislatures should guide officials toward orders that apply risk & priority analysis without singling out religious places/gatherings
5. Supports are critical to #PublicHealth effectiveness & #HealthJustice. Officials ordering restrictions shld be required by law to provide supports, legal protections, & accommodations of safer alternatives to restricted activities, w/in available means. #ProgressiveRealization
6. Individual rights matter. Criminal enforcement can do more harm than good 4 #PublicHealth. Statutes shld authorize criminal penalties 4 public health violations *only* if justified as the least restrictive alternative. Business licensing/civil penalties should be tried 1st.
Feedback welcomed! And if you know an expert/organization advising state, local, federal legislators on these issues, send them my way!

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More from @ProfLWiley

11 Jan
This thread re: @ratatousical resonates with some of my thoughts about how in-person education might be even better after our year of connecting online...
I feel like I’m getting to know my students (in smaller classes, at least) *better* than in a typical F2F semester. I’d already noticed that in some of the fully online courses I teach in @AUWCL’s MLS program, but it really stood out to me when my JD courses shifted online.
I can see each of their faces more clearly when they speak. I’m making an intentional effort to create space for us to chat about things other than school & the law, plus I get to meet their pets.
Read 5 tweets
10 Jan
Unless we switch to untested 1-dose protocol, we currently have enough doses nationally to vax 40% of over 65s. 40 million doses remaining = 20 million vaccinated. And that’s only if we don’t vax any more under-65 high-exposure folks in health care, education.
If we release all doses from ultra-cold storage right now, it will take careful planning & oversight to ensure we don’t accidentally force the untested 1-dose protocol on a lot of people. I’m not saying it can’t be done, just that caution is warranted.
If more states proceed with opening up access to anyone over 65 (and no one under 65) regardless of exposure/risk, which 40% (or less) of that group *actually* gets fully vaxxed will determine how rapidly we can reduce hospitalizations & deaths.
Read 4 tweets
10 Jan
Without high engagement of well-resourced local health depts, privately run, profit-focused health care institutions/mega-pharmacies will do whatever is easiest/most aligned with their financial incentives to quietly get doses out the door. This is going to be the story all year.
Right now many are giving 1a doses to their own nonclinical, low-exposure, low-risk WFH employees (because it’s easiest & helps their bottom line) instead of doing the work to reach unaffiliated front-line clinical workers w/ smaller, more independent & less integrated employers
For phase 1b & beyond, hospitals receiving doses are quietly providing access to “enrolled” patients, leaving patients who lack a regular source of care/receive care from smaller, more independent community providers at the mercy of underfunded county programs
Read 9 tweets
10 Jan
Lots of focus on temporary residents (snowbirds) being permitted access to county-run vax sites in FL. Notably, Oklahoma seems to have adopted an address verification system that’s causing trouble & slowing down it’s vax campaign.
State residency status shouldn’t matter from a public health perspective & denying benefits on that basis might infringe on constitutional right yo interstate travel.
Note: no indication so far that these are “vaccine tourists,” but that could certainly be happening/start happening soon.
Read 4 tweets
8 Jan
Some extended thoughts re: the problems with Operation Warp Speed’s Pharmacy Partnership for Long-Term Care Program & whether WV’s success as the only state to opt out offers a model for future efforts to actively send mobile teams out for on-site vax of high-priority pops.
I can hardly express my disappointment w/ economists, MDs & others calling for elected officials to abandon prioritization. Given that we don’t have enough doses to achieve herd immunity any time in the next 6 months, prioritization is critical to achieving public health goals.
The key question is *how to implement* prioritization. An active approach with mobile teams sent to offer vax on-site at high-risk/high-priority worksites & residential locations is critical to public health success.
Read 4 tweets
8 Jan
This is the predictable result of entrusting the lion’s share of doses to private, profit-focused health care institutions & overseeing them based exclusively on how quickly they burn through doses rather than how well they reach the 1a populations they said they would.
We’ll see a similar dynamic in next phases. Major hospital systems will vax anyone among their “enrolled” patient populations who arguably meets criteria rather than doing the work of reaching folks who don’t have a reg source of care or working w/ community providers/partners.
This will further entrench market concentration, harm smaller, more independent primary care practices, erode equity, & undermine public health goals unless more doses are shifted to community providers & local health departments who partner w/ housing authorities, employers, etc
Read 4 tweets

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