Legal Epidemiology and Pandemic Control
Law is a structural determinant of health. Variations in how states and local jurisdictions have written, interpreted, and enforced laws can affect the health of the associated communities. The implementation of thousands of new laws and legally-enforceable orders was a central part of our federal, state, and local COVID-19 response. Legal epidemiology, “the scientific study of the health effects of laws and legal practices,” can both offer insights into the impact of variations in how state and local governments and communities responded to the pandemic, and can offer policymakers more evidence to inform their decision making when having to make decisions in future public health emergencies. Unlike the realm of biomedical research, there is no significant infrastructure supporting such research. This “lack of basic research,” state Scott Burris et al. in a new New England Journal of Medicine perspective, “produces both policy and scientific errors that could be substantially reduced by a better foundation of basic research on diverse mechanisms of legal effects.”
Me and my IUPUI colleagues recently found that one significant obstacle to conducting such research in Indiana is the accessibility of local laws and orders to the public and to researchers. We found nearly half of all counties in Indiana did not have comprehensive, up-to-date versions of their local ordinances and resolutions available online for the public, nor is there a centralized repository in Indiana cataloguing these public policies for all 92 counties. In fact, as we recently published in the American Journal of Public Health, to get access to these local laws, we had to travel to numerous county government buildings across the state with a scanner, manually scanning more than 25,000 pages worth of local law. As we conclude in our piece,
To assess the impact of law on public health, researchers must be able to obtain accurate, up-to-date, and comprehensive data on local-level laws. Indiana is not unique in the varied ways local governments publish and store laws. To improve access to and assessment of local public health laws, we recommend that (1) local laws of all kinds be online; (2) online systems be standardized across jurisdictions, organized, and searchable; and (3) online systems be freely and openly accessible. These recommendations not only would assist researchers in examining the public health impact of laws but would facilitate transparency and accountability. A concerted effort to fund and implement such an approach to local legal publication will pay dividends in public health and democratic engagement with local government.
Vaccine Mandates & Passports
A new survey finds greater public support for federal, state, and local government-imposed Covid-19 vaccine mandates than the issuance of so-called vaccine passports. Increasingly, it appears that if vaccine mandates arise, they will be put in place by institutions, like universities and businesses, rather than governments. While most businesses have been hesitant to put in place vaccine mandates, a rising number of hospitals are implementing such requirements. According to an American Hospital Association representative, more health care institutions are likely to consider vaccine mandates once the vaccines receive full FDA approval.
Vaccines and Employers
Attorneys quoted in a few recent articles caution against employers separating their vaccinated workers from those who refuse to get vaccinated (or successfully apply for exemptions). While such actions might be legal, taking such steps would raise substantial potential discrimination and enforcement concerns, and would be, as one attorney phrased it, “a stupendously bad idea…from an employee-relations perspective.” (“Employers’ top five COVID-19 vaccination questions answered,” “Segregating Unvaccinated Workers? Think Twice, Attorneys Warn“)
Drug Overdose & Suicide Deaths During Covid-19
A new JAMA study indicates that, from March-August 2020, there were fewer suicide deaths in the U.S. than expected, but over 10,000 excess overdose deaths nationwide. The authors speculate that the excess drug overdose deaths “may have been related to economic stress,” and that “[p]andemic-associated changes in access to substance use disorder treatments may have exacerbated mortality from overdoses.”
Safe Syringe Programs (SSPs) are a proven intervention helping those with substance use disorders not only reduce their risk of contracting and spreading infectious diseases such as Hepatitis and HIV, but also to connect with treatment and other social services. Through offering access to naloxone, counseling and treatment services, and training, SSPs reduce area overdose deaths without increasing illegal activity. Indiana law requires that local government leadership periodically reauthorize local SSPs. Scott County, Indiana, the epicenter of the nation’s first rural HIV epidemic in 2015, is currently deliberating whether to extend authorization for its SSP.