measures to reduce their exposure to infection. Limited research indicates that public officials can avoid losing their credibility in such situations by sharing the dilemmas of disease control with the public in a productive and effective way.

Current understanding about the influence and causes of panic in public crises and how to remedy its effects has been advanced through recent efforts to prepare society to deal productively with terrorism. Both the September 11, 2001, terrorist attacks and subsequent anthrax assaults in the United States demonstrated that open and informative relationships among citizens, government, and public health and safety authorities are fundamental to a population’s ability to cope with unconventional health threats. In her contribution to this chapter, Monica Schoch-Spana describes a series of findings by study and research focus groups convened by the Center for Biosecurity of the University of Pittsburgh Medical Center in collaboration with Johns Hopkins University to examine governance dilemmas in bioterrorism response. These groups characterized the unique governing dilemmas posed by a major infectious outbreak and produced guidelines by which decision makers can identify opportunities to enlist public trust and cooperation in such emergencies.

Legal authority must be brought to bear on nearly every facet of pandemic preparedness, from measures designed to reduce the risk of animal-to-human transmission of disease; to surveillance and detection procedures; to medical interventions to prevent or control the spread of infection; to the imposition of voluntary or mandatory quarantine and/or isolation measures; to travel limitations, trade restrictions, and border closures. This chapter continues with an examination of the legal and ethical questions attached to major public health interventions for preventing or ameliorating pandemic influenza; it also summarizes ethical values that can inform public health practice in an emergency.


Martin I. Meltzer, Nancy J. Cox, and Keiji Fukuda1

Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Reprinted from Emerging Infectious Diseases, CDC, 2003


Address for correspondence: Martin Meltzer, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Clifton Road, Mail Stop C12, Atlanta, GA 30333; fax: 404–639–3039; e-mail:

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