Pandemic Demonstrates Need for Coordinated National Response

Our county, state, and federal public health programs have worked valiantly during the COVID-19 pandemic. Their efforts have been directed at containing outbreaks and promoting mitigation measures, such as use of masks, social distancing, and contact tracing, while encouraging, facilitating, and implementing several vaccination protocols. Yet, the outcomes they achieved have been mixed at best. Why?

A foundational problem with our COVID-19 public health response has been the failure to achieve coordinated national action across counties and states. Pandemics recognize no borders. A unitary response by everyone is essential to successful containment and eradication.

What led to this lack of coordination? Simply stated, the federal government lacked the Constitutional authority to mandate a unitary response from counties and states, and it lacked sufficient political will to seek such a unitary response through efforts at consensus building and encouragement.

What is the underlying issue? Fundamentally, the question is: Can the rights of the community take precedence over personal rights in a pandemic? In other words, can the community mandate and enforce individuals to take health actions that benefit everyone in the community, even when those individuals object to taking such actions?

Logic would suggest that one’s personal rights are not unlimited. Specifically, personal rights do not include the right to engage in behaviors that endanger the lives of others. This is true because the personal rights of others are being violated by such actions. Clearly, limitation of personal rights is a fundamental principle of human collaborative behavior that has permitted us to construct communities and societies throughout history.

By extension, it also can be argued that counties and states should be bound by the same dictum. The rights of counties and states do not extend to actions that endanger the lives of those residing in adjacent counties or states. Like persons, counties and states have limited rights, not unlimited ones.

Our Declaration of Independence speaks of the “inalienable right to life, liberty, and the pursuit of happiness.” Please note that the first of these rights is “life.” The Preamble to our Constitution speaks of “promotion of the general welfare” as an outcome of the newly created government of the United States of America. Thus, it can be argued that a fundamental task of our federal government is to promote the general welfare by assuring the inalienable right to life.

Practical actions will need to be taken prior to the next pandemic in order to improve our capacity to implement a national coordinated response. These include:

• Review of the Constitution to examine the current requirements for states’ rights and what changes will be needed to permit the federal government to mandate and enforce unitary action in national health emergencies.
• Development of related operational federal guidelines that outline specific actions that the government of the United States can mandate in national health emergencies, with appropriate rationales, and specification of consequences for violating these mandates.
• Development and implementation of essential public health education modules for all levels of the education system so that all citizens are well versed in national health emergencies and the steps necessary to contain them.

Ron Manderscheid, PhD, is the former president and CEO of NACBHDD and NARMH, as well as an adjunct professor at the Johns Hopkins Bloomberg School of Public Health and the USC School of Social Work.

The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.