Public Health Experts Urge U.S. to Balance Safety, Civil Liberties at Ports-of-Entry

James G. Hodge Jr. and Dr. Georges Benjamin, M.D.

Public health experts at a AAAS Capitol Hill briefing urged U.S. public and private sectors to improve security at its ports-of-entry by increasing resources and procedures for disease surveillance of incoming travelers and goods, and encouraging coordination among agencies responsible for guarding against infectious disease.

By increasing resources for agencies on the front lines of U.S. biosecurity, clarifying legal and ethical responsibilities, and providing advanced technology training to help officials recognize and respond to potential threats, the speakers said that the government will be better able to secure the nation's 475 air, land, and sea ports-of-entry.

"The central question is how to rapidly detect a potentially dangerous situation, protect the public, and get the infected individual the necessary treatment," said Dr. Georges Benjamin, M.D., executive director of the American Public Health Association. "We are constantly balancing the public's right to safety with an individual's right to privacy."

At the 23 July briefing organized by the AAAS Center for Science, Technology and Security Policy (CSTSP), Benjamin, along with James G. Hodge Jr., executive director of the Center for Law and the Public's Health at Georgetown and Johns Hopkins Universities, highlighted the logistical and legal challenges the public health system faces when protecting U.S. borders.

The briefing came on the heels of an 17 June announcement by the U.S. government that it has begun implementing the World Health Organization's International Health Regulations designed to prevent the global spread of infectious disease.

By encouraging government health agencies to share information about national outbreaks in their country, many experts hope other countries will be better equipped to lessen the health and economic consequences should the disease spread.

"With an increase in international travel and shipping, it's very important for national and international officials to talk about the spread of infectious diseases," said Kavita Berger, senior program associate at CSTSP. "The consequences of inaction are costly in terms of both economics and lives."

With more than 425 million people entering the United States by airplane, boat, car, or on foot per year, the U.S. Centers for Disease Control and Prevention (CDC) has its hands full as the lead federal agency charged with blocking infectious diseases from crossing the country's borders.

Operating 20 quarantine stations with a staff of 133 officials, the CDC is constantly interviewing flight crews, passengers, and border agents looking for sick travelers and those returning from high-risk areas.

If CDC officials determine that a traveler has a reasonably high chance of being exposed to an infectious disease, the government may require them to separate themselves from the community through voluntary home curfew or mandatory supervision in an isolated federal facility.

"The quarantine system has two complementary goals," Benjamin said. "Not only do they facilitate early recognition of disease symptoms, but they also reduce the risk of transmission before the symptoms appear because the high-risk persons are, hopefully, identified and under observation."

Hodge, an attorney who also teaches at the Johns Hopkins Bloomberg School of Public Health and Georgetown University Law Center, said that because the CDC regularly consults with other local and federal agencies, including the Departments of Homeland Security and Health and Human Services.

"It's important that each agency know their authority, when they can use it, and when they cannot," said Hodge. "It is very concerning when agencies do not know if they have the authority to order quarantine in a high-risk or emergency situation."

In addition to clearly defining each agency's jurisdiction, Hodge said that any quarantine system must take into account both the public's right to safety and an individual's right to due process.

For a quarantine system to be effective, Hodge said, there must be guarantees from the government that individuals under observation will be provided information about why they are being detained, given access to an appeals process, and be provided accommodations including treatment, basic necessities, and opportunities to communicate with others.

"No one should enter into a government quarantine voluntarily unless they were guaranteed by the government to be treated fairly with due process," said Hodge. "The public health care system depends on the public's trust in government to look out for individual and communal interests."

AAAS's Center for Science Technology and Security Policy was established in 2004 with support from the Science, Technology & Security Initiative at the MacArthur Foundation. Encouraging communication among academic centers, policy institutes, and policymakers, CSTSP aims to integrate science and public policy for enhanced national and international security.

Benjamin Somers

1 August 2007