Pandemic planning: Regional governments may be reluctant to report outbreaks

December 19, 2005

The distribution and division of power across several regional governments in federal systems can hinder national and international efforts to control infectious disease outbreaks, says a team of researchers in the open access journal PLoS Medicine (http://www.plos.org. For the full article: http://www.plos.org/press/plme-03-01-wilson.pdf)

"Canada's experience with SARS outlines the challenges of such constitutional division of powers when it comes to managing public health crises," says the team, led by Dr. Kumanan Wilson of the University of Toronto Joint Centre for Bioethics.

In Canada, the management of outbreaks falls under provincial jurisdiction and the transfer of data on outbreaks from the provinces to the federal government is voluntary. This situation hindered the federal government's ability to obtain data on SARS from the Province of Ontario and to effectively communicate the status of the outbreak to the World Health Organization (WHO).

In the aftermath of SARS, and in anticipation of avian flu, the international health community has recognized that pandemic planning and response is an inherently multi-governmental concern. This concern is reflected in the WHO's newly revised International Health Regulations, which originally date back to the 19th century when cholera epidemics overran Europe, and which are intended to ensure maximum global security against the international spread of disease.

The fragmentation of powers within federations, say Dr. Wilson and colleagues, could make it difficult for them to comply with the new regulations, which include very detailed requirements for countries to report information to the WHO. All WHO member nations are required to notify the WHO "within 24 hours of assessment of public health information, of all events which may constitute a public health emergency of international concern within its territory."

Yet, say Dr. Wilson and colleagues, federal governments may not have the authority to collect the data necessary for such reporting, while regional governments may have many reasons to keep such data to themselves--including concerns about the impact of disclosure on their economy and aversion to federal scrutiny.

The authors say it is apparent that this "federalism dilemma" will need to be addressed, both by WHO member nations and by the WHO itself, if the revised International Health Regulations are to be implemented successfully.
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University of Toronto Joint Centre for Bioethics Innovative. Interdisciplinary. International. Improving health care through bioethics.

The JCB is a partnership among the University of Toronto and 15 health care organizations. It provides leadership in bioethics research, education, and clinical activities. Its vision is to be a model of interdisciplinary collaboration in order to create new knowledge and improve practices with respect to bioethics. The JCB does not advocate positions on specific issues, although its individual members may do so.

For more information: http://www.utoronto.ca/jcb/

PLoS Medicine
All works published in PLoS Medicine are open access. Everything is immediately available--to read, download, redistribute, include in databases, and otherwise use--without cost to anyone, anywhere subject only to the condition that the original authorship is properly attributed. Copyright is retained by the authors. The Public Library of Science uses the Creative Commons Attribution License. Please mention PLoS medicine (www.plosmedicine.org) as the source of the article.

University of Toronto Joint Center for Bioethics

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