According to the Institute of Medicine, the local health department workforce is at the hub of the public health emergency preparedness system. A growing body of research has pointed to troubling attitudinal gaps among local health department workers, a vital response cohort, regarding willingness to respond to emergent infectious disease threats, ranging from naturally occurring pandemics to bioterrorism events. A summary of relevant literature on the empirical evidence, ethical norms, and legal standards applicable to the willingness of public health professionals to respond to an infectious disease emergency is presented. Recommendations are proposed for future work to be done to bring the relevant empirical, ethical, and legal considerations together to develop practical guidance for the local response to infectious disease emergencies.
Local health departments are the core of the public health emergency preparedness system. But a growing body of research has pointed to troubling attitudinal gaps among local health department workers regarding willingness to respond to emergent infectious disease threats, ranging from naturally occurring pandemics to bioterrorism events. Here the authors summarize relevant literature on the empirical evidence, ethical norms, and legal standards applicable to the willingness of public health professionals to respond to an infectious disease emergency. Recommendations are proposed for future work to develop practical guidance for the local response to such emergencies.
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References
1.
AltevogtBM, PopeAM, HillMN, ShineKI, eds. Research Priorities in Emergency Preparedness and Response for Public Health Systems: A Letter Report. Washington, DC: National Academies Press; 2008.
2.
TaylorHA, ChaffeeMW. The Navy Medicine Office of Homeland Security—a powerful organization response to the terrorist attacks on the United States. In: VeenemaTG, ed. Disaster Nursing and Emergency Preparedness for Chemical, Biological, and Radiological Terrorism and Other Hazards. New York: Springer; 2003.
3.
BalicerRD, OmerSB, BarnettDJ, EverlyGS. Local public health workers' perceptions toward responding to an influenza pandemic. BMC Public Health, 2006; 6:99.
4.
BarnettDJ, BalicerRD, ThompsonCB, et al. Assessment of local public health workers' willingness to respond to pandemic influenza through application of the extended parallel process model. PLoS One, 2009a;4:e6365.
5.
GershonRR, MagdaLA, QureshiKA, et al. Factors associated with the ability and willingness of essential workers to report to duty during a pandemic. J Occup Environ Med, 2010; 52(10):995-1003.
6.
BarnettDJ, ThompsonCB, ErrettNA, et al. Determinants of emergency response willingness in the local public health workforce by jurisdictional and scenario patterns: a cross-sectional survey. BMC Public Health, 2012; 12:164.
7.
BalicerRD, BarnettDJ, ThompsonCB, et al. Characterizing hospital workers' willingness to report to duty in an influenza pandemic through threat- and efficacy-based assessment. BMC Public Health, 2010; 10:436.
MalmH, MayT, FrancisLP, OmerSB, SalmonDA, HoodR. Ethics, pandemics, and the duty to treat. Am J Bioeth, 2008; 8(8):4-19.
10.
JacobsonPD, WassermanJ, BotoseneanuA, SilversteinA, WuHW. The role of law in public health preparedness: opportunities and challenges. J Health Polit Policy Law, 2012; 37(2):297-328.
11.
McCabeOL, BarnettDJ, TaylorHG, LinksJM. Ready, willing, and able: a framework for improving the public health emergency preparedness system. Disaster Med Public Health Prep, 2010; 4(2):161-168.
12.
AlexanderGC, WyniaMK. Ready and willing? Physicians' sense of preparedness for bioterrorism. Health Aff (Millwood), 2003; 22(5):189-197.
13.
DiMaggioC, MarkensonD, LooGT, RedlenerI. The willingness of U.S. emergency medical technicians to respond to terrorist incidents. Biosecur Bioterror, 2005; 3(4):331-337.
14.
QureshiK, GershonRR, ShermanMR, StraubT, GebbieE. Health care workers' ability and willingness to report to duty during catastrophic disasters. J Urban Health, 2005; 82(3):378-388.
15.
EhrensteinBP, HansesF, SalzbergerB. Influenza pandemic and profession duty: family or patients first? A survey of hospital employees. BMC Public Health, 2006; 6:311.
16.
IrvinCB, CindrichL, PattersonW, SouthallA. Survey of hospital healthcare personnel response during a potential avian influenza pandemic: will they come to work?. Prehosp Disaster Med, 2008; 23(4):328-335.
17.
BarnettDJ, LevineR, ThompsonCB, et al. Gauging U.S. emergency medical services workers' willingness to respond to pandemic influenza using a threat—an efficacy-based assessment framework. PLoS One, 2010; 5:e9856.
18.
ChaffeeM. Willingness of health care personnel to work in a disaster: an integrative review of the literature. Disaster Med Public Health Prep, 2009; 3(1):42-56.
19.
WitteK. Putting the fear back into fear appeals: the extended parallel process model. Communication Monographs, 1992; 59:329-349.
20.
WitteK, AllenM. A meta-analysis of fear appeals: implications for effective public health campaigns. Health Educ Behav, 2000; 27(5):591-615.
21.
BarnettDJ, ThompsonCB, SemonNL, et al. EPPM and willingness to respond: the role of risk and efficacy communication in strengthening public health emergency response systems. Health Commun, 2014; 29(6):598-609.
22.
AnanthamD, McHughW, O'NeillS, ForrowL. Clinical review: influenza pandemic—physicians and their obligations. Crit Care, 2008; 12(3):217.
23.
DwyerJ, TsaiDF. Developing the duty to treat: HIV, SARS, and the next epidemic. J Med Ethics, 2008; 34(1):7-10.
24.
SimondsAK, SokolDK. Lives on the line? Ethics and practicalities of duty of care in pandemics and disasters. Eur Respir J, 2009; 34(2):303-309.
25.
GarrettAL, ParkYS, RedlenerI. Mitigating absenteeism in hospital workers during a pandemic. Disaster Med Public Health Prep, 2009; 3(Suppl 2):S141-S147.
26.
YongeO, RosychukRJ, BaileyTM, LakeR, MarrieTJ. Willingness of university nursing students to volunteer during a pandemic. Public Health Nurs, 2010; 27(2):174-180.
KassNE. An ethics framework for public health and avian influenza pandemic preparedness. Yale J Biol Med, 2005Oct; 78(5):239-254.
29.
KaymanH, Ablorh-OdjidjaA. Revisiting public health preparedness: incorporating social justice principles into pandemic preparedness planning for influenza. J Public Health Manag Pract, 2006; 12(4):373-380.
30.
ThompsonAK, FaithK, GibsonJL, UpshurRE. Pandemic influenza preparedness: an ethical framework to guide decision-making. BMC Med Ethics, 2006; 7:E12.
31.
KassNE, OttoJ, O'BrienD, MinsonM. Ethics and severe pandemic influenza: maintaining essential functions through a fair and considered response. Biosecur Bioterror, 2008; 6(3):227-236.
32.
SwainGR, BurnsKA, EtkindP. Preparedness: medical ethics versus public health ethics. J Public Health Manag Pract, 2008; 14(4):354-357.
33.
KinlawK, BarrettDH, LevineRJ. Ethical guidelines in pandemic influenza: recommendations of the Ethics Subcommittee of the Advisory Committee of the Director, Centers for Disease Control and Prevention. Disaster Med Public Health Prep, 2009; 3(Suppl 2):S185-S192.
34.
BarnettDJ, TaylorHA, HodgeJGJr, LinksJM. Resource allocation on the frontlines of public health preparedness and response: report of a summit on legal and ethical issues. Public Health Rep, 2009; 124(2):295-303.
35.
DeBruinD, LiaschenkoJ, MarshallMF. Social justice in pandemic preparedness. Am J Public Health, 2012; 102(4):586-591.
36.
WyniaMK, GostinLO. Ethical challenges in preparing for bioterrorism: barriers within the health care system. Am J Public Health, 2004; 94(7):1096-1102.
37.
VeatchRM. Disaster preparedness and triage: justice and the common good. Mt Sinai J Med, 2005Jul; 72(4):236-241.
38.
LevinPJ, GebbieEN, QureshiK. Can the health-care system meet the challenge of pandemic flu? Planning, ethical, and workforce considerations. Public Health Rep, 2007; 122(5):573-578.
39.
TilburtJC, MuellerPS, OttenbergAL, PolandGA, KoenigBA. Facing the challenges of influenza in healthcare settings: the ethical rationale for mandatory seasonal influenza vaccination and its implications for future pandemics. Vaccine, 2008; 26(Suppl 4):D27-D30.
40.
LevinD, CadiganRO, BiddingerPD, CondonS, KohHK; Joint Massachusetts Department of Public Health-Harvard Altered Standards of Care Working Group. Altered standards of care during an influenza pandemic: identifying ethical, legal, and practical principles to guide decision making. Disaster Med Public Health Prep, 2009; 3(Suppl 2):S132-S140.
41.
BergerJT. Pandemic preparedness planning: will provisions for involuntary termination of life support invite active euthanasia?. J Clin Ethics, 2010; 21(4):308-311.
42.
SokolDK. Virulent epidemics and scope of healthcare workers' duty of care. Emerg Infect Dis, 2006; 12(8):1238-1241.
43.
TomlinsonT. Caring for risky patients: duty or virtue?. J Med Ethics, 2008; 34(6):458-462.
44.
PfrimmerD. Duty to care. J Contin Educ Nurs, 2009; 40(2):53-54.
45.
van der WeijdenCP, BredenoordAL, van DeldenJJ. The duty to treat in the context of an influenza pandemic. Vaccine, 2010; 28(32):5260-5264.
46.
MorinK, HigginsonD, GoldrichM; Council on Ethical and Judicial Affairs of the American Medical Association. Physician obligation in disaster preparedness and response. Camb Q Healthc Ethics, 2006; 15(4):417-421.
47.
RudermanC, TracyCS, BensimonCM, et al. On pandemics and the duty to care: whose duty? who cares?. BMC Med Ethics, 2006; 7:E5.
48.
AlexanderCA, LantosJD. Commentary [on Physician obligation in disaster preparedness and response]. Camb Q Healthc Ethics, 2006; 15(4):422-423.
49.
RhodesR. Commentary [on Physician obligation in disaster preparedness and response]. Camb Q Healthc Ethics, 2006; 15(4):424-428.
50.
TomczykD, AlvarezD, BorgmanP, et al. Caring for those who care: the role of the occupational health nurse in disasters. AAOHN J, 2008; 56(6):243-250.
51.
RitvoP, WilsonK, GibsonJL, et al. Canadian survey on pandemic flu preparations. BMC Public Health, 2010; 10:125.
52.
GostinLO. Public Health Law and Ethics: A Reader. Berkeley, CA: University of California Press; 2010.
53.
Jacobson v. Massachusetts, 1905; 197(11).
54.
ParmetWE, GoodmanRA, FarberA. Individual rights versus the public's health—100 years after Jacobson v. Massachusetts. N Engl J Med, 2005; 352(7):652-654.
55.
MarinerWK, AnnasGJ, GlantzLH. Jacobson v. Massachusetts: it's not your great-great-grandfather's public health law. Am J Public Health, 2005; 95(4):581-590.
56.
MoultonAD, GoodmanRA, CahillK, BakerELJr.Public health legal preparedness for the 21st century. J Law Med Ethics, 2002; 30(2):141-143.
57.
HodgeJGJr.The evolution of law in biopreparedness. Biosecur Bioterror, 2012; 10(1):38-48.
58.
42 U.S. Code. 2006a:§§ 5121-5207.
59.
42 U.S. Code. 2006b:§ 247d(a)(1)-(2).
60.
42 U.S. Code. 2006c:§§ 247d-6d; 247d-6e.
61.
BotoseneanuA, WuH, WassermanJ, JacobsonPD. Achieving public health legal preparedness: how dissonant views on public health law threaten emergency preparedness and reponse. J Public Health (Oxf), 2011; 33(3):361-368.
62.
GostinLO, SapsinJW, TeretSP, et al. The Model State Emergency Health Powers Act: planning for and response to bioterrorism and naturally occuring infectious diseases. JAMA, 2002; 288(5):622-628.
AndersonED, HodgeJGJr.Emergency legal preparedness among select US local governments. Disaster Med Public Health Prep, 2009; 3(Suppl 2):S176-S184.
68.
RosenbaumS, HartyMB, SheerJ. State laws extending comprehensive legal liability protections for professional health-care volunteers during public health emergencies. Public Health Rep, 2008; 123(2):238-241.
69.
HoffmanS. Responders' responsibility: liability and immunity in public health. Georgetown Law J, 2008; 96:1913-1969.
70.
CarpenterM, HodgeJGJr, PepeRP. Deploying and using volunteer health practitioners in response to emergencies: proposed uniform state legislation provides liability protections and workers' compensation coverage. Am J Disaster Med, 2008; 3(1):17-23.
71.
RutkowL, GableL, LinksJM. Protecting the mental health of first responders: legal and ethical considerations. J Law Med Ethics, 2011; 39(Suppl 1):56-59.
72.
RosenbaumS. When worlds collide: public health and union rights in Virginia Mason Hospital v. Washington State Nurses Association. Public Health Rep, 2008; 123(5):664-666.
SavoiaE, BiddingerPD, FoxP, LevinDE, StoneL, StotoMA. Impact of tabletop exercises on participants' knowledge of and confidence in legal authorities for infectious disease emergencies. Disaster Med Public Health Prep, 2009; 3(2):104-110.
