While it is good to see progress at the European level to deal with threats to human health that do not recognise borders, the steps that may be taken to ensure security in the name of health many lead to greater threats to civil liberties.
Integral to coordinated responses to public health threats are efforts to quarantine populations, restrict movement of individuals (infected or not), and triage. Where are the risks to civil liberties?
First, quarantining and free movement. Establishing the boundaries of quarantine zones if notably difficult. Toronto, with SARS, had great difficulty not just identifying where the boundaries should be, but in keeping people from wandering across them. Officials lacked the legal authority to restrict freedom of movement as, of course, no crimes were being committed. Indeed, in order to enforce quarantine boundaries, illiberal measures may be required.
Are quarantine zones to be identified by physical barriers with armed guards (to keep people in and others out)? And what is to be done to infected people who try to ‘escape’? What enforcement procedures are likely and when do they escalate to the use of lethal force? We know from general behaviour of armed forces that they are not so easy to control when confronted with unruly citizens, and may actually be loathe to fire on their own citizens. The challenge facing planners of quarantine zones is defining their scope: are they big enough to catch all likely infected people and then some who aren’t or are they small enough to ensure that no uninfected person is included, but risks missing some infected people? The public health planners would prefer the former, despite creating the possibility that uninfected people would then be essentially trapped with infected people — a potential death sentence. No surprise if some of these people might try to escape, to be confronted by what response from officials?
Second, is triage. This is the decision-making about who lives and who dies. Certainly in combat, soldiers understand the risks and accept that battlefield decisions are not easy to make. In peacetime, such decisions take on a completely different complexion. Public health threats such as pandemics are not combat, despite the rhetoric from governments that such threats much be met with a ‘war on disease’. How, then, are the life and death decisions to be made? Within a quarantine zone, would a large number of untreatable and infected people be left to die when numbers swamp the capacity of the health system to cope? It must be remembered that a widespread pandemic would create chaos within health systems as health professionals fall ill or become trapped in quarantine zones. Medical supplies will become scarce, and treatment facilities will be unable to cope with the demand at the rate at which it is appearing — people getting sick faster than people are being treated and getting better.
The risks are that we won’t consider these issues within the context of civil liberties and human rights, but use the excuse of a public emergency to enact essentially authoritarian measures, without reflection in the longer term of the consequences for our society. The evidence, though, is before us: terrorists threats are met with authoritarian legislation which is often found by courts to violate human rights or constitutions. Will health be the next victim?