Ethical Standards to Improve Local Response Capacity to Infectious Disease Events

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DESCRIPTION (provided by applicant): The local health department workforce sits at the hub of the public health emergency preparedness system. A growing body of research has recently identified troubling attitudinal gaps among this workforce regarding willingness to respond to infectious disease threats, ranging from naturally-occurring pandemics to bioterrorism events. Research conducted by members of our study team has determined that public health workers are more likely to respond to infectious disease events if they perceive their response as mandatory rather than voluntary, and if they believe their agency is taking extra measures to protect them and their families. These findings emphasize the need for a greater understanding among local health department leadership and line staff of the ethical and intersecting legal dimensions of infectious disease response in advance of an outbreak. Guidance is needed to help local health departments address the ethical tensions that arise when balancing the rights of individuals (i.e., their employees) and the public good. The goal of the proposed project is to develop an ethically sound guidance document for local health departments to use in planning for and executing their responses to infectious disease outbreaks. Our aims are to: 1) Describe and characterize perceptions of legal and ethical obligations relevant to willingness to fulfill professional roles during infectious disease outbreaks (manmade or natural) among local health department workers (employers/administrators; employees) and barriers to optimum policy creation, implementation, and enforcement using (a) focus groups with members of the local health department workforce, (b) key informant interviews with local health department administrators and front line staff, and (c) a national survey of the local health department workforce; 2) Develop a guidance document for local health department employers/administrators by (a) Applying appropriate ethical norms and legal considerations to our descriptive findings to identify tensions between ethical obligations and intersecting legal standards and self-reported willingness to respond, including identifying detailed examples of particular concerns; (b) Solicit directed feedback from relevant stakeholders. This project will benefit from the on-going input of an expert Advisory Committee and has the support of the National Association of County and City Health Officials. In this time of fiscal austerity and significant workforce cutbacks in public health agencies, innovative measures are necessary to ensure effective responses to infectious disease outbreaks. Therefore, the need for ethically informed guidance that balances the rights of members of the public health workforce with the public good is especially acute.