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Brendon Gray 2006


In 2002, the New Zealand Ministry of Health published proposals for new legislation that would amend existing coercive public health powers for dealing with communicable disease outbreaks. These proposed powers included mandatory vaccination provisions, isolation and detention orders and a new regime governing contact tracing. The proposals recognised that reform of the law governing these particular powers is necessary because existing legislation is incompatible with a modern notion of human rights protection.

The need for coercion and the ideal of protecting human rights are competing claims that need to be balanced in designing future legislation to meet communicable disease threats. The aim of this dissertation is to investigate these competing claims by reviewing the medical evidence for the effectiveness of coercive public health intervention using two case studies: smallpox and pandemic influenza control.

Evidence suggests that isolation, quarantine, contact tracing and vaccination are all effective public health interventions for smallpox control. In the case of pandemic influenza, there is some evidence to support the use of isolation, quarantine and contact tracing in limited situations. Vaccination is the intervention of choice for influenza control; however, no vaccine will exist at the start of a future pandemic. Current legislation granting coercive powers is identified here and deficiencies in the legislation in terms of human rights protection are explored.

A structured analysis using four ethical principles (necessity, effective means, proportionality and fairness) is then used to determine the appropriate rationale for the use of coercive powers to control smallpox and pandemic influenza. The result of this analysis forms the basis for making recommendations about the content of future public health legislation governing the use of coercion in communicable disease control.

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