Some states seek to limit health officials' powers to act in disease outbreaks.


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Since the COVID-19 pandemic began, public health measures to control the spread of the virus have provoked fierce debate. In recent months, at least 15 state legislatures have passed or are considering bills to limit the legal authority of public health agencies, according to the Network for Public Health Law, which has partnered with the National Association of County and City Health Officials to document the situation. In addition, lawmakers in at least 46 states have introduced bills to rein in the power of governors to take action in public health and other emergencies.

Figure. Dr. Anthony ... - Click to enlarge in new windowFigure. Dr. Anthony Fauci responds to accusations by Senator Rand Paul (R-KY) as he testifies before the U.S. Senate Health, Education, Labor, and Pensions Committee on Capitol Hill in Washington, DC, on July 20. Photo by J. Scott Applewhite / Pool via CNP / Alamy.

The anger fueling these actions stems from the perceived overreach by health officials, resulting in a backlash of legislative attempts to limit their authority. These include measures to prevent the closure of businesses or allow lawmakers to rescind mask mandates. In addition, some state courts have limited the emergency and regulatory powers that governors used to respond to the pandemic. Demands for "individual freedom" spurred some of these state actions, though their consequences are likely to be more far reaching.


"Many of these new laws are dangerous because they were passed without fully considering the expertise of public health leaders and health care providers, who were consumed with responding to the pandemic," said Jill Krueger, director of the Network for Public Health Law's Northern Region. "Had legislators heard directly from more infectious disease experts, including nurses, they might have been less likely to pass laws that change long-standing definitions of terms like isolation and quarantine."


Among problematic laws cited by the network in its report, Proposed Limits on Public Health Authority: Dangerous for Public Health (http://www.networkforphl.org/resources/proposed-limits-on-public-health-authorit), is one in North Dakota that would ban all mask requirements even for such contagious diseases as tuberculosis, another in Kansas that eliminates gubernatorial authority to close businesses for public health reasons, and one in Montana that limits quarantine powers of local health boards. "Prohibition of quarantine orders undermines the basis of infection control and would make it impossible to stop outbreaks of deadly diseases that are spread by individuals who are not yet symptomatic," the report states.


"Nurses know that when it comes to public health emergencies, acting quickly can save lives," said Krueger. "In states that shift authority from public health leaders and governors to state legislatures, it is nearly inevitable that responses to emergencies will be slower and less nimble, because decision-making is more dispersed."


Krueger recommended that nurses educate themselves about proposals in their states to weaken or strengthen public health authority and use their position as trusted professionals in the community to advocate for appropriate legislation.


"Whether they have cared for COVID patients, organized vaccination clinics, or served in one of the other ways by which nurses keep our communities healthier and safer, nurses should be at the table when public health authority is being discussed," she said. "I would encourage nurses interested in speaking out on this issue to seek out training in the legal issues as well as in advocacy skills. It takes practice to learn how to make your case to a legislator or legislative staffer, and how to build a longer-term relationship with them."-Roxanne Nelson